Test

When you can see the two

animals in this picture, please
raise your hand .

WHAT IS AUTISM?
Very complex, often baffling
developmental disability
First described by Leo Kanner
in 1943 as early infantile
autism
Auto children are locked
within themselves.
For next 30 years, considered
to be an emotional disturbance

Autism

A spectrum of neuropsychiatric disorders

characterized by deficits in social interaction and
communication, and unusual and repetitive behavior.

Hot of the press

(March 27, 2014) Today, the Centers for
Disease Control and Prevention (CDC)
released new data on the prevalence of
autism in the United States. This surveillance
study identified 1 in 68 children (1 in 42
boys and 1 in 189 girls) as having autism
spectrum disorder (ASD).

Defining:
Autism Spectrum Disorder
1943 Leo Kanner Infantile autism
1944 Hans Asperger
1960s Separation from schizophrenia
1970s Biology / genetic underpinnings
1980 DSM-III Pervasive Developmental Disorders
1987 DSM-III-R - Autistic Disorder / PDD-NOS
1994 DSM-IV Aspergers Disorder
2013- DSM-5- Autism Spectrum Disorder

Autism is a Spectrum
Disorder
Autistic Disorder
Aspergers
Disorder
Childhood
Disintegrative
Disorder
Rhetts Disorder
PDD:NOS

DSM-IV Definition of Autism

(MI definition)

Impairment in
Socialization

Restricted &
Repetitive
Behavior

Impairment in
Communication
START 2011

Phenotype: Social Interaction

Younger children may have little or no interest in establishing
friendships
Older individuals may have an interest in friendship but lack an
understanding of social conventions and how to interact
Often an individuals awareness of others is markedly impaired,
demonstrating no concept of the needs & interests of others (e.g.,
happiness, distress, etc.), appearing oblivious to other children
(including siblings)

Phenotype: Communication
When speech does develop, pitch, intonation, rate, rhythm, or
stress may be abnormal (e.g., monotonous, inappropriate to
context, or with question-like rises at the end of sentences)
Grammatical structure is often immature, stereotyped (e.g.,
repeating jingles), or idiosyncratic
Comprehension is often delayed
Disturbance in pragmatic/social use of language is evidenced
by an inability to integrate words with gestures or understand
humor and non-literal speech/irony/implied meanings
Imaginative play is often absent or markedly impaired

Phenotype: Stereotyped
Behaviors and Activities
Insistence on sameness
Insistence on nonfunctional routines or rituals
demonstrating resistance and/or distress over trivial changes (e.g., a
new driving route to school)

A markedly restricted range of interests

Stereotyped body movements & postural abnormalities
Preoccupation with parts of objects
Fascination with movement
Highly attached to inanimate objects

Triad of ASD

Core Symptom Domains

PLUS Associated Medical Features

EpilepsyEEG abnormalities

Gastro-intestinal
Aggression
Dysfunction
Social
Impairment
Sleep
Disturbance
Motor problems:
Apraxia

AUTISM
SPECTRUM
Speech/DISORDERS
Communication

ADHD

Deficits

Language Disorders

Social
Anxiety

& Restricted
Interests

Intellectual
Disabilities

Obsessive
Compulsive
Disorder

OCD

Immune
Dysfunction

American Academy of Neurology

Warning Signs
Any child with any of the following five symptoms should be
evaluated for autism:
1. No babbling by 12 months.
2. No gesturing, pointing, or waving goodbye by 12 months.
3. No single words by 16 months.
4. No two words spoken together spontaneously by 24
months (not echolalic)
5. Any loss of previously acquired language or social
skills at any time.

DSM-IV Diagnosis of Autistic Disorder (1)

Must have six symptoms from the following three
domains
Three Domains:
1.

Social Interaction
Impairment in non-verbal behaviors
B. Poor peer relations
C. Lack of spontaneous sharing
D. Lack of social or emotional reciprocity
A.

DSM-IV Diagnosis of Autistic Disorder (2)

2.

Communication
A.

Delay or lack of language development

Impairment in ability to initiate or sustain a

conversation
C. Stereotyped, repetitive or idiosyncratic use of language
D. Lack of spontaneous make-believe or socially imitative
play
B.

DSM-IV Diagnosis of Autistic Disorder (3)

3.

Behaviors, Interests & Activities

Preoccupation with stereotyped and restricted patterns
of interest
B. Inflexible adherence to specific and nonfunctional rules,
routines, or rituals
C. Stereotyped and repetitive motor mannerisms
D. Persistent preoccupation with parts of objects
A.

How is Autism
Diagnosed?
No definitive medical test
Team uses interviews, observation, and
specific checklists developed for this
purpose.
Team might include neurologist, psychologist,
developmental pediatrician, speech/language
therapist, learning consultant, etc.
Must rule out MR, hearing impairment,
behavior disorders, or eccentric habits

Implications for treatment

No medication for majority
Atypical neuroleptics, antiepileptics, SSRIs,
stimulants, lithium (and other drugs) for some
Diets??
Gillberg & Coleman 2000

Implications for treatment

Physical exercise!!
Sensory awareness environment (reduce
noise, certain sounds, smell etc.)
Concrete, visual (not always), straightforward
Minimize ambiguities and symbolic
interpretation
Gillberg & Peeters 2004

Treatment: Medical

Regular follow-up recommended

Monitoring, screening of common medical
issues
Sleep issues, GI issues, nutritional concerns

Medication management

Medications
Alternative medical treatments

Medications

Target symptoms
Anxiety
Aggression
Obsessive/compulsive features
ADHD features
Sleep problems
Seizures
Mood lability
Repetitive behaviors

Medications

Stimulants
SSRIs
Atypical antipsychotics
Risperdal
Melatonin
Seizure medication

Alternative Treatments
Diet
Gluten and casein free diet
Vitamins
B6, Mg, B12
Super Nu Thera
Yeast treatments
Manipulation
Secretin, intravenous immune globulin (IVIG), steroids,

antivirals, chelation

Classroom strategies
Behavioral: use seating charts; classwide and
school wide behavioral plan; develop each
personalized behavioral plan; teach self monitoring
(5 point scale); review schedule often; model
positive behavior; be generous with specific praise;
provide direct feedback
Environmental: post daily activities; use
preferential seating; allow dedicated space for
student; avoid sudden changes in routine; label
desks; maintain consistent routine; provide
movement breaks; use study carrols; keep
unnecessary material away

Classroom strategies
Communication: pictures and picture schedule;
simple sign language; assigment notebook;
teach the meaning of idioms; use short verbal
phrases; allow wait time (just how long is a
minute?); alert students to key phrases (This is
important!)
Social: use mixed grouping; use social stories
or social scripts; use pictures with words to
present choices; allow students to work in
pairs; integrate team building; teach
awareness early

Classroom strategies
Visual: write information on board or desk;
provide notes; give written information for
assignments/projects; use pictures in
support of verbal and written directions;
make artifacts so child can copy
Sensory: assess students sensitivity ; allow
stress balls or fidget items; use inflatable
seat cushions; provide regular breaks;
make chewies available; have a relaxation
room

Prognosis

Previous studies summarized:

1015% with good outcomes
1525% with fair outcomes
1525% with poor outcomes
3050% with very poor outcomes
Few current longitudinal studies exist
Issues of diagnostic shift, diagnostic

stability

Test

When you can see the two

animals in this picture, please
raise your hand .