AutismAutism Spectrum Spectrum DisordersDisorders

Autism and Asperger’s Autism and Asperger’s SyndromeSyndrome

Julie K. IveyJulie K. IveyBaylor UniversityBaylor University

Presentation at the 1st Annual Texas Wide Underwriting Conference

Autism Spectrum DisorderAutism Spectrum Disorder

A condition affecting the processing, A condition affecting the processing, integrating, and organization of integrating, and organization of

information that significantly impacts information that significantly impacts communication, social interaction, communication, social interaction, functional skills, and educational functional skills, and educational

performance. performance.

There are many manifestations and degrees There are many manifestations and degrees of severity within the autism spectrum.of severity within the autism spectrum.

What characteristics do What characteristics do you think of when you you think of when you hear the word AUTISM?hear the word AUTISM?

Discussion Video:Discussion Video:

http://www.youtube.com/http://www.youtube.com/watch?watch?

v=FDMMwG7RrFQ&feature=rv=FDMMwG7RrFQ&feature=relatedelated

Fragile – Handle with CareFragile – Handle with Care

Even though there are many things about me that are Even though there are many things about me that are unique, in the ways that really matter I am just like unique, in the ways that really matter I am just like other children. I learn best from people I trust, and I other children. I learn best from people I trust, and I learn to trust when I sense that people like me. learn to trust when I sense that people like me. Please try to see the world through my eyes, for I Please try to see the world through my eyes, for I can’t see it through yours. And please know that can’t see it through yours. And please know that even though it may not seem so, I really am trying to even though it may not seem so, I really am trying to adapt to a world that my neurological challenges adapt to a world that my neurological challenges prevent me from understanding without your help. If prevent me from understanding without your help. If you keep these things clearly in mind, you will more you keep these things clearly in mind, you will more likely be able to likely be able to teach meteach me the things I need to know the things I need to know so that I can function with greater understanding and so that I can function with greater understanding and competence in a world that is often inhospitable to competence in a world that is often inhospitable to my needs. (pg. xv)my needs. (pg. xv)

Leo Kanner’s description Leo Kanner’s description (1943)(1943)

Inability to relate to others

Extreme aloneness; isolated from outside world

Resistance to being picked up or held

Deficits in language, often mutism

Some cases had excellent rote memory

Early specific food preferences

Extreme fear reaction to loud noises

Obsessive desire for repetition and sameness

Few spontaneous activities (such as typical play)

Bizarre and repetitive physical movements (such as spinning and rocking)

Normal physical appearance

What Do We Know?What Do We Know?

Autism is a spectrum disorderAutism is a spectrum disorder Children have varied but similar characteristicsChildren have varied but similar characteristics Children with autism may or may not have mental Children with autism may or may not have mental

retardationretardation ASD is a neurological disorder not psychological ASD is a neurological disorder not psychological

or environmentalor environmental No known cureNo known cure Diagnosis is based on Behavioral CriteriaDiagnosis is based on Behavioral Criteria Life long disabilityLife long disability

Autism affects…Autism affects…

StatisticsStatistics

Autism Spectrum Disorder 1:91 Autism Spectrum Disorder 1:91 (CDC, Feb. 2010)(CDC, Feb. 2010)

Not respective of classNot respective of class 3-5:1 boy/girl – females tend to have lower 3-5:1 boy/girl – females tend to have lower

cognitive abilitiescognitive abilities ~75% MR~75% MR Age 5 – general predictor of verbal languageAge 5 – general predictor of verbal language Seizures may develop in adolescence – Seizures may develop in adolescence –

usually lower IQusually lower IQ

Epidemic?Epidemic?

Broader definition including PDD-NOS, Broader definition including PDD-NOS, Asperger’s SyndromeAsperger’s Syndrome

Closure of institutionsClosure of institutions Children left the institutions and entered schools Children left the institutions and entered schools

and doctor’s officesand doctor’s offices Autism became categorical label for special Autism became categorical label for special

education services (1991, IDEA)education services (1991, IDEA) Increased recognitionIncreased recognition

ProfessionalsProfessionals Public - mediaPublic - media

Clinical FeaturesClinical Features

Early onset – usually before age 3Early onset – usually before age 3 Social dysfunction to include Social dysfunction to include

imaginative playimaginative play Communication deficitsCommunication deficits Odd or unusual behaviorsOdd or unusual behaviors

Social DysfunctionSocial Dysfunction

Theory of Mind – Inability to put self “in someone Theory of Mind – Inability to put self “in someone else’s shoes”else’s shoes”

Reduced joint attention – pointing, sharingReduced joint attention – pointing, sharing Early predictor of ASDEarly predictor of ASD

Lack of age appropriate peer relationsLack of age appropriate peer relations Must be taught social skillsMust be taught social skills May be indifferent to typical interest of peersMay be indifferent to typical interest of peers

Lack of social-emotional reciprocityLack of social-emotional reciprocity Unaware of unwritten rules of social conductUnaware of unwritten rules of social conduct

Communication DeficitsCommunication Deficits

~50% nonverbal – no attempt to ~50% nonverbal – no attempt to compensate with gesturescompensate with gestures

~50% verbal-marked impairment in ~50% verbal-marked impairment in sustaining conversationsustaining conversation Echolalia (immediate & delayed)Echolalia (immediate & delayed) Fails to attend to social cues or contextual cuesFails to attend to social cues or contextual cues Switches topics to those of interest to Switches topics to those of interest to

him/herselfhim/herself Continues topic of interest after other person has Continues topic of interest after other person has

lost interestlost interest Interrupts conversationsInterrupts conversations

Odd/Unusual BehaviorsOdd/Unusual Behaviors

Restricted interests – favorite toy/object Restricted interests – favorite toy/object (odd), lines up objects(odd), lines up objects

Interest is not usually the item but the Interest is not usually the item but the category of itemcategory of item

Stereotypic Behaviors - flapping, twirling, Stereotypic Behaviors - flapping, twirling, rocking, sniffing, toe walking, self-bitingrocking, sniffing, toe walking, self-biting

Adherence to routines – need for Adherence to routines – need for sameness – need to impose external order sameness – need to impose external order on an ever changing complex worldon an ever changing complex world

Restricted InterestsRestricted Interests

Children with autism do not have control over Children with autism do not have control over their interests just as neurotypical children can’t their interests just as neurotypical children can’t control their interestscontrol their interests Typically developing kids can be “hooked” by Typically developing kids can be “hooked” by

socially mediated strategiessocially mediated strategies Find “hooks” for kids with autism in their Find “hooks” for kids with autism in their

interests interests Restricted interests are a symptom of the Restricted interests are a symptom of the

disabilitydisability

Abnormal Sensory ResponseAbnormal Sensory Response

Sound – covers ears, melt downSound – covers ears, melt down Vision – fascinated with lights, Vision – fascinated with lights,

movements, gaze peculiaritiesmovements, gaze peculiarities Touch – differs; some love touch, others Touch – differs; some love touch, others

pull away; hypersensitivity to painpull away; hypersensitivity to pain Taste – refusal generally due to texture, Taste – refusal generally due to texture,

pica, some very restricted dietpica, some very restricted diet

SensationSensation

All information is taken in through the sensesAll information is taken in through the senses Distorted sensory input among the 5 sensesDistorted sensory input among the 5 senses

Touch: tactile defensivenessTouch: tactile defensiveness Light touchLight touch Sticky/gooey substancesSticky/gooey substances Often crave deep touch (pressure)Often crave deep touch (pressure)

Visual PerceptionsVisual Perceptions Trouble judging distances – PE a problemTrouble judging distances – PE a problem

Auditory impairmentsAuditory impairments Frequency (pitch) and intensity (loudness)Frequency (pitch) and intensity (loudness)

Asperger’s Asperger’s SyndromeSyndrome

Clinical FeaturesClinical Features

Later DiagnosisLater Diagnosis Social DysfunctionSocial Dysfunction Communication DeficitsCommunication Deficits Odd or Unusual BehaviorsOdd or Unusual Behaviors

Later DiagnosisLater Diagnosis

Language develops, or seems to Language develops, or seems to develop normallydevelop normally

IQ is normal or nearly normalIQ is normal or nearly normal Self help skills intact except social Self help skills intact except social

skillsskills Curiosity about the environmentCuriosity about the environment

Social DysfunctionSocial Dysfunction

Difficulty forming friendshipsDifficulty forming friendships The child truly wants to have friends The child truly wants to have friends

and desires interaction with others and desires interaction with others but does not know howbut does not know how Often ridiculedOften ridiculed ConfusionConfusion

Social Dysfunction, cont.Social Dysfunction, cont.

Socially isolatedSocially isolated Inappropriate or one sided Inappropriate or one sided

conversationsconversations Expansive knowledge of odd topic Expansive knowledge of odd topic

i.e.: washing machines, trains, i.e.: washing machines, trains, dinosaurs, statisticsdinosaurs, statistics

Knowledge dominates conversation and Knowledge dominates conversation and timetime

PragmaticsPragmatics

Appropriate topic but inappropriate Appropriate topic but inappropriate commentcomment

Primary interest is to exchange Primary interest is to exchange factual informationfactual information

Literal interpretationLiteral interpretation

ProsodyProsody

““Professor like”Professor like” InconsistentInconsistent Emotion expressed in volume or Emotion expressed in volume or

pitchpitch

Odd or Unusual BehaviorsOdd or Unusual Behaviors

Inflexible adherence to routine – becomes Inflexible adherence to routine – becomes stressed or anxiousstressed or anxious

Anxiety leads to pacing, withdrawal & possibly Anxiety leads to pacing, withdrawal & possibly meltdownsmeltdowns

Interests interfere with functioningInterests interfere with functioning

Motor IssuesMotor Issues

ClumsyClumsy Poor balance, penmanship, difficulty Poor balance, penmanship, difficulty

with sportswith sports

High Functioning Autism vs. Asperger’s High Functioning Autism vs. Asperger’s SyndromeSyndrome

HFAHFA AS ASserious social difficultiesserious social difficulties serious social serious social

difficulties difficulties

onset <3 onset/diagnosis >3onset <3 onset/diagnosis >3

language deficit language “normal”language deficit language “normal”

insistence on sameness specific interestsinsistence on sameness specific interests

motor skills early OK motor skills clumsymotor skills early OK motor skills clumsy

variable family history + family history variable family history + family history (dad)(dad)

Health Related Quality of Health Related Quality of LifeLife

Health in the United States Health in the United States has traditionally been has traditionally been measured narrowly and from measured narrowly and from a deficit perspective, often a deficit perspective, often using measures of morbidity using measures of morbidity or mortality. But, health is or mortality. But, health is seen by the public health seen by the public health community as a community as a multidimensionalmultidimensional construct construct11 that includes physical, that includes physical, mental, and social domains.mental, and social domains.

Health Related Quality of Health Related Quality of LifeLife

*Personal Level: Health risks and *Personal Level: Health risks and conditions, functional status, social conditions, functional status, social support, and socioeconomic status. support, and socioeconomic status.

*Community level: resources, *Community level: resources, conditions, policies, and practices conditions, policies, and practices that influence a population’s health that influence a population’s health perceptions and functional status. perceptions and functional status.

Quality of Life- DefinitionQuality of Life- Definition

Quality of life (QOL) is a broad Quality of life (QOL) is a broad multidimensional concept that multidimensional concept that usually includes subjective usually includes subjective evaluations of both positive and evaluations of both positive and negative aspects of life. What negative aspects of life. What makes it challenging to measure makes it challenging to measure is that, although the term “quality is that, although the term “quality of life” has meaning for nearly of life” has meaning for nearly everyone and every academic everyone and every academic discipline, individuals and groups discipline, individuals and groups can define it differentlycan define it differently

Other Domains for QOL:Other Domains for QOL:*jobs*jobs

*housing *housing

*schools*schools

*neighborhood*neighborhood

*culture*culture

*values*values

*spirituality*spirituality

What we know about What we know about Persons with ASD:Persons with ASD:

Greater QOL=Greater QOL=

*Support (formal & informal) *Support (formal & informal)

*Higher Intelligence (above *Higher Intelligence (above 70) 70)

*Better communication skills*Better communication skills

*Live independently*Live independently

*Have job*Have job

*Have relationships*Have relationships

AssessmentAssessment

*Team approach*Team approach

*Deficits in:*Deficits in: Social interactionSocial interaction Language as used in social Language as used in social

communicationcommunication Symbolic or imaginative playSymbolic or imaginative play

TreatmentsTreatmentsABA- Applied Behavioral ABA- Applied Behavioral

AnalysisAnalysisTEACCH MethodTEACCH MethodPlay TherapyPlay TherapyFloor TimeFloor TimeEducational/Collaborative Educational/Collaborative

ServicesServicesDietDietMedicationMedicationOthers?Others?

Co-Morbidity:Co-Morbidity:

1.1. ADHD ADHD

2.2. Mental Retardation Mental Retardation

3.3. AnxietyAnxiety

4.4. Obsessive Compulsive Obsessive Compulsive DisorderDisorder

5.5. Motor ClumsinessMotor Clumsiness

6.6. Sensory IssuesSensory Issues

7.7. SeizuresSeizures

Families:Families:

Family issues; parents tend to Family issues; parents tend to experience:experience:

GuiltGuilt DepressionDepression Shame Shame

Consider normal physical Consider normal physical appearanceappearance

Unrealistic expectationsUnrealistic expectations Consider splinter skillsConsider splinter skills

Video Examples:Video Examples: http://www.youtube.com/watc

h?v=p3n7Pm9UkJg&mode=related&search

http://www.youtube.com/watch?v=yqcICjgp7oE&feature=related

http://www.youtube.com/watch?v=R07LZwdQOPU&feature=related

The Autism ParadoxThe Autism Paradox It’s easy to recite an entire book but It’s easy to recite an entire book but

difficult to make up a storydifficult to make up a story It’s easy to line up toys but difficult It’s easy to line up toys but difficult

to stay in lineto stay in line It makes perfect sense to climb on It makes perfect sense to climb on

the sofa but little sense to sit on itthe sofa but little sense to sit on it Memorizing the presidents in order – Memorizing the presidents in order –

10 minutes…Packing a school bag – 10 minutes…Packing a school bag – 10 hours10 hours

Family pictures on the wall ore Family pictures on the wall ore boring but that speck of dust next to boring but that speck of dust next to it, now that’s fascinating?it, now that’s fascinating?

Talking about weather patterns – piece of Talking about weather patterns – piece of cake. Talking about my day…impossible!cake. Talking about my day…impossible!

Ability to focus on spinning objects – Ability to focus on spinning objects – timeless. Ability to focus on homework – 3 timeless. Ability to focus on homework – 3 secondsseconds

Being called by name, can’t hear it. Some Being called by name, can’t hear it. Some owl hooting in the distance – clear as a bellowl hooting in the distance – clear as a bell

How to operate the remote control – zero How to operate the remote control – zero instruction. How to button up pants – instruction. How to button up pants – intensive instructionintensive instruction

Navigating social rules – poorly skilled. Navigating social rules – poorly skilled. Navigating from the back seat of the car – Navigating from the back seat of the car – highly skilledhighly skilled

Author unknownAuthor unknown

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Galore Making Groups Meaningful. Galore Making Groups Meaningful. Goldstein, Sam & Reynolds, Cecil R. (Eds.). (1999). Goldstein, Sam & Reynolds, Cecil R. (Eds.). (1999).

Handbook of Neurodevelopmental and Genetic Disorders Handbook of Neurodevelopmental and Genetic Disorders in Children. in Children. New York, NY: The Guilford Press.New York, NY: The Guilford Press.

National Education Association. (2006). The puzzle of National Education Association. (2006). The puzzle of autism.autism.

Simmons, K. L. (2006). The official autism 101 manual. Simmons, K. L. (2006). The official autism 101 manual. Alberta, Canada: Autism Today.Alberta, Canada: Autism Today.

Tilton, Adelle Jameson. (2004). Tilton, Adelle Jameson. (2004). The Everything Parent’s The Everything Parent’s Guide to Children with Autism. Guide to Children with Autism. Avon, MA: Adams Media Avon, MA: Adams Media Corporation.Corporation.

Twachtman-Cullen, D. (2006). Twachtman-Cullen, D. (2006). How to be a Para ProHow to be a Para Pro. . Higganum, CT: Starfish Specialty Press, LLC.Higganum, CT: Starfish Specialty Press, LLC.

Volkmar, F. (2006, May). Asperger’s Disorder and Autism: Volkmar, F. (2006, May). Asperger’s Disorder and Autism: An update on understanding and intervention. Presented An update on understanding and intervention. Presented by New England Educational Institute.by New England Educational Institute.