Signs, Symptoms and Diagnosis of Autism in Children

1. Signs, Symptoms and Diagnosis of Autism in Children

2. Self-Absorbed Quirky Social Aggressive, Destructive Odd Behavior Non-Verbal Highly Verbal Communication Awkward Agile Motor Hyposensitive Hypersensitive Sensory Profound Intellectual Disabilities Gifted Measured I.Q. Spectrum of Autism Created by Dr. Tina Dyches

3. Myths about Autism • Caused by “cold” refrigerator mothers • Children with eye contact do not have Autism • Children who are “social” do not have Autism • All people with Autism have extraordinary skills

4. Myths about Autism (con.) • People with Autism just need love to get better • People with Autism just need more discipline to get better • Autism can be outgrown • There is a cure for Autism

5. What is Autism? The essential features of Autistic Disorder are the presence of markedly abnormal or impaired development in: • social interaction and communication • and a markedly restricted repertoire of activity and interests —DSM-IV

6. Causes of Autism?? • Probably multiple causes • Genetic • Environmental • A definition : A genetic predisposition with something in the environment that triggers it.

7. Red Flags in Young Children • No big smiles or other warm, joyful expressions by six months or thereafter • No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter • No babbling by 12 months • No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months

8. More Red Flags • No words by 16 months • No two-word meaningful phrases (without imitating or repeating) by 24 months • Any loss of speech or babbling or social skills at any age

9. Thoughts on Diagnosis • Reasons to get a diagnosis • Understanding • Services and Intervention • When? • ADOS now at 18 Months • Identification and Intervention most important • Concerns about getting a “label”

10. Typical Behavior Characteristics of High-Functioning Individuals with Autism Adapted from C. Bees (1998). The GOLD Program: a program for gifted learning disabled adolescents. Roeper Review, 21, p. 160.

11. Early Screening • Modified Checklist for Autism in Toddlers (M-CHAT™)—available readily and free online • Many false positives; follow up with interview • Scientifically validated for children ages 16-30 months old • American Academy of Pediatrics recommends that all children be screened for Autism at 18 and 24 months old. The M-CHAT is one of their recommended tools.

12. Diagnostic Tools • Current Tools • Observation—Autism Diagnostic Observation (ADOS) • Developmental History (Parent Report)—Autism Diagnostic Interview-Revised (ADI-R) • Childhood Autism Rating Scale (CARS) • Future • Brain Imaging—Pinpoint subgroups and treatment • Genetic Testing

13. Current Prevalence Rates • Prevalence • 1 out of 88 nationally • 1 out of 47 in Utah County

14. Changes in DSM-5 • Name changed from Pervasive Developmental Disorder to Autism Spectrum Disorder • Single Diagnosis rather than a category containing five individual diagnoses (PDD-NOS and Asperger’s eliminated) • Three symptom domains become two Domains • Severity Criteria added to better capture the idea of a spectrum (3 levels) • New diagnostic category (not on the autism spectrum) of Social Communication Disorder --Sally Ozonoff, Editorial: DSM-5 and autism spectrum disorders—two decades of perspectives from the JCPP, Journal of Child Psychology and Psychiatry, 53:9 (2012), ppe4-e6

15. Social Communication & Interaction –proposed • Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: • Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.

16. Social Communication & Interaction –proposed (continued) • Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures • Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

17. Behaviors, Interests, Activities —proposed • Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: • Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). • Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

18. Behaviors, Interests, Activities —proposed (continued) • Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). • Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). NEW

19. Additional Diagnostic Criteria—proposed • Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities). NEW • Symptoms together limit and impair everyday functioning.