AUTISM
Overview • What is Autism? • Is there more than one type of Autism? • What causes Autism? • How is Autism diagnosed? • What are the characteristics of Autism? • What are the most effective approaches to treating Autism? Is there a cure?
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
WHAT IS AUTISM? • 3 categories for autism in IDEA? • Today, autism is a severe form of a broader group of disorders • These are referred to as pervasive developmental disorders(later) • Typically appears during the first 3 years of life
WHAT IS AUTISM? • Very likely neurological in origin – not emotional, not the refrigerator mom • Prevalence is 2-6/1000 individuals (1/2 to 1 ½ million affected) • 4 times more prevalent in boys • No known racial, ethnic, or social boundaries • No relation to family income, lifestyle
WHAT IS AUTISM? • Autism impacts normal development of the brain in areas of social interaction and communication skills. • Difficult to communicate with others and relate to the outside world. • Occasionally, aggressive and/or self-injurious behavior may be present.
WHAT IS AUTISM? • May exhibit repeated body movements (hand flapping, rocking). • Unusual responses to people • Attachment to objects • Resistance to change in routine • Sensory sensitivities
WHAT ARE THE TYPES? • Actually, the “umbrella” heading is Pervasive Developmental Disorder (PDD). • Autism is one of the 5 PDDs. • All have commonalities in communication and social deficits • Differ in terms of severity
1. Autistic Disorder • Impairments in social interaction, communication, and imaginative play. • Apparent before age 3. • Also includes stereotyped behaviors, interests, and activities
2. Asperger’s Disorder • Impairments in social interactions, and presence of restricted interests and activities • No clinically significant general delay in language • Average to above average intelligence
3. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) • Often referred to as atypical autism • Used when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors
4. Rett’s Disorder • Progressive disorder which, to date, has only occurred in girls. • Period of normal development and then the loss of previously acquired skills • Also loss of purposeful use of hands, which is replaced by repetitive hand movements • Beginning at age of 1-4 years
5. Childhood Disintegrative Disorder • Normal development for at least the first 2 years • Then significant loss of previously acquired skills
Conclusions on Types • Autism is a spectrum disorder • This means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severe • Autistic individuals can be very different from each other • “Autism” is still commonly used to refer to any of the 5 PDDs
What causes (and doesn’t cause) autism? • Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry, and genetic factors • Bettleheim’s theory of psychogenesis?
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
CHARACTERISTICS • 1. Communication/Language • 2. Social Interaction • 3. Behaviors • 4. Sensory and movement disorders • 5. Resistance to change (predictability) • 6. Intellectual functioning
1. Communication/language • Broad range of abilities, from no verbal communication to quite complex skills • Two common impairments: • A. Delayed language • B. Echolalia
A. Delayed language • 50% of autistic individuals will eventually have useful speech (?) • Pronoun reversal: “You want white icing on chocolate cake.” • Difficulty in conversing easily with others • Difficulty in shifting topics • Look away; poor eye contact • Facilitated communication??????
Elements of Facilitated Communication • 1. Physical Support • 2. Initial training/introduction • 3. Maintaining focus • 4. Avoiding competence testing • 5. Generalization • 6. Fading
B. Echolalia • Common in very young children (Age 3) • Immediate or delayed (even years) • Is there communicative intent with echolalia?
2. Social Interaction • One of hallmarks of autism is lack of social interaction • 1. Impaired use of nonverbal behavior • 2. Lack of peer relationships • 3. Failure to spontaneously share enjoyment, interests, etc. with others • 4. Lack of reciprocity • Theory of mind?
3. Behaviors • Repetitive behaviors, including obsessions, tics, and perseveration • Impeding behaviors (impede their learning or the learning of others) • Will need positive behavior supports • A. Self-injurious behavior • B. Aggression
4. Sensory and movement disorders • Very common • Over- or under-sensitive to sensory stimuli • Abnormal posture and movements of the face, head, trunk, and limbs • Abnormal eye movements • Repeated gestures and mannerisms • Movement disorders can be detected very early – perhaps at birth
5. Predictability • Change in routine is very stressful • May insist on particular furniture arrangement, food at meals, TV shows • Symmetry is often important • Interventions need to focus on preparing students for change if possible
6. Intellectual functioning • Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardation • In general, majority of individuals with autism are also identified as having mental retardation – 75% below 70 • Verbal and reasoning skills are difficult • Savant syndrome
Interventions • 1. Individualization and early intervention are the keys • 2. Include life skills, functional academics, and vocational preparation • 3. Positive behavior support • 4. Social stories (music therapy?) • 5. Lovaas model
