What is Autism?

1. Neurodevelopmental disorder with a spectrum of clinical conditions 3 areas of dysfunction: Social interaction/social relatedness difficulty Communication impairment Restrictive/repetitive behaviors and interests Early intervention before the age of three is vital. What is Autism?

2. Undiagnosed prior to early intervention efforts Patients with verbal abilities Patients older than 3 years How about that patient who has always seemed peculiar? Patients report significant relief even when diagnosis is made later. What about the patients we missed?

3. The Verbal Individual With Autism: Have You Seen This Patient? Adam: 8 year-old Ethan: 13 year-old Ryan: 23 year-old Jeff: 35 year-old Richard: 54 year-old

4. Listen to Parents The Verbal Individual With Autism: Have You Seen This Patient? • Are aware of the possibility of autism • Do have concerns when something is wrong • Do give accurate and reliable information about their children • Need your questions to generate discussion about their child’s development

5. By school age: Usually talking well and can enter school May have stopped avoiding social contact and is at least tolerant of it May be socially awkward and socially immature The Verbal Individual With Autism: Have You Seen This Patient? Get History from Parents

6. Over the next few years: "Eccentricities" dominate his social interactions A "little professor" on topics of special interest to him When not talking about his interests, his social interactions are immature or stilted The child may interact with peers, although others may perceive him as different The Verbal Individual With Autism: Have You Seen This Patient? One sided conversations

7. As time passes and social demands increase: May become anxious in social situations Peers may reject him and he may become depressed In school, he may be placed in learning support classes because of social, behavioral or language comprehension problems He may be considered to have an attention problem or obsessive compulsive behaviors The Verbal Individual With Autism: Have You Seen This Patient? Poor social understanding

8. ASD Facts: Epidemiology • Conservative prevalence: 1 in 500; recent estimates: 1 in 150 • ASD more prevalent in pediatric population than: • Cancer • Diabetes • Downs Syndrome • Male to female ratio: 4 to 1

9. Autism Myths

10. Causation unknown Strong genetic influence Evidence supports polygenic inheritance Recurrence risk is 5-8% in siblings Autism does NOT result from: Poor parenting MMR vaccine Thimerosal preservative in vaccines ASD Causes:

11. ASD Facts • Present at birth, with onset of symptoms before 36 months • Accurate diagnosis possible at 18-24 months • Parents first voice concerns around 18 months, but diagnosis is typically not until 3 years or older

12. Autism Spectrum Basics • Autism is a neurodevelopmental disorder with a broad spectrum of behavioral manifestations • Autism is not rare! At 1 in 500, each pediatrician should have up to 3 or 4 affected children in their practice

13. Again, 3 Problem Areas Delays or abnormalities in: • Social Interaction • Language Delay • Restricted or Repetitive Behavior

14. Social Symptoms Lack of: • Use of eye contact to regulate social interaction • Orienting to name • Joint attention behaviors: pointing & showing • Pretend play • Imitation • Nonverbal communication • Language development

15. Language Delay – Need for immediate referral 9 months: No babbling 12 months: No pointing or other gestures 16 months: No single words 24 months: No functional 2-word phrases (not echolalic) Any age: Any loss of language or social skills

16. Behavioral Red Flags Investigate further and consider autism if the child: • Doesn’t know how to play with toys in a typical fashion • Restricted patterns of interest • “Toe walks” • Has unusual attachments • Lines things up • Presents with sensory symptoms • Has odd movement patterns and/or very repetitive behaviors • Demonstrates echolalia • Throws prolonged or frequent tantrums • Is hyperactive

17. 0 – 3: Early Intervention Different in each state • Babies Can’t Wait Programs • Autism Centers of Excellence • University Based Developmental Disorders • Check with State Office Call 1-800-323-GROW for nearest CFC

18. Special Education • Mandated by federal IDEA legislation • Programs managed and vary by school district • Make referrals in writing! • Individualized Education Plan (IEP) for each child • Services for children with autism may include: • Speech therapy • Occupational therapy • Communication assistance (PECS) • Teacher education on classroom management

19. The Verbal Individual With Autism: Have You Seen This Patient? Long Term Planning Later Years • Vocational and Occupation Training • Transition to adult healthcare providers • Long term care vs. Residential Placement • Estate planning