Autism Basics

1. Autism Basics Bev Long Diagnostic Center, Central California

2. 559-228-2221 blong@dcc-cde.ca.gov

3. Autism research and publishing is at an all time high

5. Overview

6. Autism is a life-long developmental disorder that seriously affects the way individuals communicate and interact with those around them. • It usually manifests itself during the first three years of life. • Autism is a “spectrum disorder,” meaning that its symptoms and characteristics can present themselves in a variety of combinations, ranging from mild to quite severe.

7. Impaired communication and social interaction are the most fundamental symptoms of autism. • As many as 50% of individuals with autism are non-verbal and up to 80% are intellectually challenged. • A small percentage is gifted with extreme artistic, intellectual or technical ability. • Common behaviors include: • seemingly purposeless repetitive behavior • unusual responses to people • attachments to objects • resistance to change • extreme sensory sensitivity.

8. Currently 1 in every 250 children are diagnosed with autism. • 1.5 million people with autism in the US. • Autism is the fastest growing developmental disability. In the US, autism increased by 172% during the 1990’s. • 33% of children also have a seizure disorder. • Autism spectrum disorders are now more common than Down Syndrome, childhood cancer, cystic fibrosis, multiple sclerosis, blindness and deafness.

9. Only mental retardation and cerebral palsy rank ahead of autism as a developmental disability. • Families with one autistic child have a 2-8 percent chance of having another autistic child. • Boys are 3-4 times more likely to be diagnosed with an ASD.

10. There is no definitive cause or cure for autism, but current research suggests a genetic base to the disorder and links it to neurological differences in the brain.

12. Controversy over incidence:Labeling or Epidemic??? • As the numbers of students classified as autistic increases, the number of students classified as mentally retarded and learning disabled has decreased. • Institutions such as the Mind Institute at Davis believe that reclassifying and/or broadening the definition of autism cannot in any way account for the increase in the number of children being diagnosed.

13. PDD Rett Syndrome Childhood Disintegrative Disorder

14. Real Kids…The range • The child with no eye contact, no means of communication, no awareness or others around him. Absent. Classic Autism. • The child who is aware of others in the environment, may or may not have some words, watches, but does not interact.

15. The Range… • The child who approaches others in odd, non-productive ways. Unexpected touching, standing too close, uncomfortable eye contact. High functioning autism. • The child who desires social contact, can even talk about feeling sad that he doesn’t have friends . . .seems “clueless,” talks too much, doesn’t consider the listener’s desires, doesn’t read other’s body language. Asperger Syndrome.

16. Internal Causes Genetic – recent genome Project shows that as many as 20-30 genes may be involved. Congenital – condition that just occurs as the nervous system of the unborn or young child develops External Causes Environmental – child is exposed to a specific environmental element (toxin) before birth or during infancy that causes pervasive changes or damage to the nervous system. Two Categories of Causes of Autism

18. Congenital factors Genetic Predisposition Autistic Spectrum Environmental factors

19. Misconceptions • Autistic children never have eye contact • Autistic children don’t have feelings or emotions • Autistic children don’t smile or seek physical comfort • Autism is a mental disorder • Autism is caused by bad parenting • Autistic children choose to be difficult to annoy parents and teachers

20. We are talking about students who are: • Somebody’s child • Somebody’s grandchild • Somebody’s sister or brother • Somebody who is loved and for whom many tears have been shed

21. Early Signs

22. Signs that may be seen in infancy as early as 8 months • Two kinds of autistic babies: • Placid, undemanding baby who rarely cries • Screaming baby who is difficult to pacify • Peculiarities in gaze: • Avoidance of eye contact • Gaze may be brief and out of the corner of the eye • Fails to shift gaze from object to person

23. Peculiarities of hearing: • May appear deaf but have normal hearing • Unaffected by audible changes in the environment • May be fascinated by particular sounds • Common sounds may cause distress

24. Peculiarities in social development and play: • Lack interest in early social interaction with parents • Lack of shared interest • Do not take an active part in baby games

25. Rocking • Head banging • Scratching or tapping blanket • Fascination for shiny or twinkling objects • Fixated on an object such as a piece of string

26. Red Flag Biggies • Does not babble or coo by 12 months of age • Does not gesture (point, wave, grasp) by 12 months of age • Does not say single words by 16 months of age • Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age • Has ANY loss of ANY language or social skill at ANY age

27. History

28. 1911 • Eugen Bleuler, a Swiss psychiatrist first coined the term “autism.” He applied the term to adult schizophrenia.

29. 1943 • Dr. Leo Kanner of Johns Hopkins University described autism for the first time. He based his discovery from 11 children he observed between 1938 and 1943. He grouped these children because they “withdrew from human contact” as early as age 1.

30. 1944 • Austrian psychiatrist Dr. Hans Asperger describes a disorder that later becomes known as Asperger disorder. Viennese physician. • Published “Autistic Psychopathology in Childhood” in 1944, one year after Kanner. • Because of war, he probably didn’t know of Kanner’s work. • He believed in a biological, rather than a psychological cause. • He described verbal youngsters with milder symptoms

31. 1940’s – 1960’s • The medical community felt that children who had autism were schizophrenic. This lack of understanding of the disorder led many parents to believe that they were at fault.

32. Bruno Bettelheim • During the 1950s and 1960s, the medical establishment, thanks to Bruno Bettleheim, blamed autism on the child's mother for failing to bond with her child. These mothers were called a "refrigerator mother." Thousands of autistic children received gloomy therapies based on this theory. Many children were taken away from their parents. Their mothers endured a difficult period of blame, guilt and self-doubt. "the precipitating factor in infantile autism is the parent's wish that his child should not exist."

33. 1964 • Dr. Bernard Rimland further delineates the clinical features of autism. Specifically, he provided a definitive review of the empirical evidence which established that autism was a biological disorder.

34. 1966 • Dr. Andreas Rett first describes Rett disorder as a distinct clinical condition.

35. 1977 • Sir Michael Rutter and Dr. Susan Folstein published the first autism twin study, revealing evidence for a genetic basis for autism. Both Sir Rutter and Dr. Folstein have made major contributions to further refining the clinical phenotype associated with Autistic Disorder and Pervasive Developmental Disorders.

36. 1978 • Drs. Michael Rutter and Eric Schopler continue to publish and redefine the signs and symptoms of autism.

37. 1981 • Asperger's syndrome was named by Lorna Wing in a 1981 medical paper, after Dr. Hans Asperger, an Austrian psychiatrist and pediatrician who would not be recognized internationally until 1990.

38. 1988-1991 • Multiple research studies published showing evidence for a genetic basis for autism.

39. 1991 • Autism Diagnostic Interview published by Drs. Catherine Lord, Sir Michael Rutter, and Ann Le Couteur.

40. 1992 • American Psychiatric Association refines the diagnostic criteria for Autistic disorder.

41. 1991-1997 • Multiple case reports of individuals with chromosome 15 anomalies observed in children with autistic disorder.

42. 1998 • First report of genetic linkage on chromosome 7q for Autistic disorder and first genomic screen -- IMGSAC.

43. Theory of Mind Thinking About Thinking

44. Theory of Mind • So commonplace that until recently we haven’t investigated it at all. • The ability to think about other people’s thinking…and, further, to think about what they think about our thinking…and, even further, to think about what they think we think about their thinking, and so on….

45. Theory of Mind..say it another way… • The ability to appreciate that other people have mental states: • Intentions • Needs • Desires • Beliefs • And these may be different than MINE!!

46. The Sally / Anne Test • Designed by Simon Baron-Cohen in 1985 • Experiment carried out with: • Normal 4 year olds • Children with Autism, older than 4 • Children with Down Syndrome with mental ages of 4

47. Sally / Anne Test

48. Sally / Anne Test

49. Sally / Anne Test

50. What Did We Learn? • By 4 years, normally developing children know that Sally will guess that the marble is in the basket. • Developmentally delayed, non-autistic children know when their mental age is 4. • Autistic children do not understand until much later (rarely younger than 11). They will say that Sally will guess that it is in the box.