Autism Spectrum DisordersAn Introduction Shamsi Sadeghzadeh, BCBA Director of Outreach Services
What is Autism? • Autism is not a disease • Autism is not a psychiatric disorder • Autism is a neurological condition that can profoundly impact how the individual interacts with the world
History of Autism • In 1943, Leo Kanner observed a group of children, thought to have MR, had unique challenges in: • Developing speech • Social interaction • Ritualized & repetitive behaviors • Isolation • Transitioning • Routine based • Regression of skills
Causes of Autism No specific known cause for all cases
Environmental Factors & ASD • Toxins such as pollutants & pesticides • Pre-natal exposure to influenza, rubella, cytomegalo • Exposure to increased sex hormones • Family history of positive allergies • Family history of autoimmune disorder • Father’s age • Mother’s size
MMR Vaccines – Autism Connection? • MMR vaccines were first manufactured in mid-1930s • First cases of autism were identified in 1943 • Preservatives in Vaccines to prevent contamination • Preservatives contain Thimerosal (49.6% Mercury) • Mercury poisoning signs are identical with autism’s • Since 2001, no mercury in all childhood vaccines… • Rate of autism is still going up
MMR Vaccines & Autism Connection? • About 15% of autism is the regressional type. • Toddlers would loose skills about age of 18 month. • MMR vaccines are usually given at about 18 month. • An aboundance of home videos show the symptoms of before and receiving vaccines.
MMR Vaccines & Autism connection? • Influenza vaccines contain mercury • Infants & pregnant women receive Influenza vaccines • Courts have compensated parents against vaccines • An IOM report released on September 5,2011 states: “The measles, mumps, and rubella vaccine does not cause autism”. But…. • The medical debate will continue…
Core Skill Deficits in ASD • Social Interaction • Communication • Restricted and stereotypic patterns of behavior
Deficits in Social Interaction • Marked impairments in the use of multiple nonverbal behaviors such as eye-to- eye gaze, facial expression, body posture, and gestures to regulate social interaction • Failure to develop peer relationships appropriate to developmental level • A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) • A lack of social or emotional reciprocity • Lack of empathy
Joint Attention • Ability to share experience with another • Develops early in life • Early sign for autism detection • Required for learning from others
Deficits in Communication • Development of spoken language • In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others • Stereotyped and repetitive use of language or idiosyncratic language • Lack of spontaneous make-believe play or social imitative play appropriate to developmental level
Stereotyped Patterns of Behavior • Preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus • Inflexible adherence to specific, nonfunctional routines or rituals • Stereotyped and repetitive motor mannerisms (e.g. Hand or finger flapping or twisting, or complex whole-body movements) • Persistent preoccupation with parts of objects
Brain Research • In mid 80s, researchers at Harvard, lead by Margaret Bauman, compared brains of 2 deceased men one with autism and found differences in the size of amygdala. It was smaller in the brain of the man with autism. • Another study at the Mind Institute found that there was a decreased number of neurons in the amygdala, particularly in one subdivision of it called lateral nucleus which communicates with a part of brain that controls perception.
Brain Research • A study was done at the Stanford University published in September, 2011, and that found that the brain of autistic kids was unique. The part of the brain that is involved in social/communication and self awareness is different. • These researchers believe that by comparing MRIs, they can distinguish brains of kids with and without autism with 90% accuracy.
Brain Research • A study at the Weimann Institute ‘s Neurobiological Department published in July, 2011 found the following: • In sleeping autistic toddlers, the MRI scans showed lowered level of synchronization between right and left brain areas known to be involved in language and communication. The weaker the synchronization, the more severe were the symptoms of autism.” • Using these scans, “they were able to make autism diagnosis with 70% accuracy.”
Brain Research • Researchers continue to work in hopes of finding the dream biological fingerprint that one day, by using a simple blood test, autism could be diagnosed at birth or even during pregnancy.
Diagnosis of Autism There is no medical test
Early Diagnosis • The substantial increase in rate of autism has generated pressure from families and policy makers for information about the ASD and for effective intervention and services. • Several studies have used retrospective approach by interviewing parents and watching home videos to identify early signs. • As a result there are now tools that can reliably detect the presence of autism even in infants.
Importance of Early Diagnosis of ASD • Researches have found that early detection can result in early diagnosis which will necessitate early intervention that has been established to make a significant difference in outcome.
Importance of Early Intervention • Brain Plasticity- Brain has the ability to change through learning. • The age of 0-6 is considered crucial window of opportunity. • Parents shift attention from confusion to focus on education and effective future planning. • Statistics show that about 50% of children receiving intensive EI will move to general education by age 5. • Finally, without EI, the lifetime cost of autism, including care and lost productivity is estimated at $3.2 million per child.
Red Flags in Social development • Toddlers: Lack of interest in others Lack of interest in environment Lack of interest in physical contact Lack of interest in age-appropriate toys Absence 0f purposeful play Lack of turn taking Lack of symbolic play
Red Flags in Communication • Infants: No babbling Not responding to name Not imitating sounds Poor eye –contact • Toddlers: Use of scripted phrases Echolalia, immediate or delayed Not making gesture Little professors Delay in speech
Red Flags in restricted behavior • Infants: Repetitive motor movements hand flapping Difficulty with change Feeding issues • Toddlers: Lack of interest in functional play Routine based Keep self occupied with obsessive behaviors Very rigid, doors kept shut, lights off Categorizing toys rather than functional play Rule –bound, shoes placed certain area
Other Red Flags • Excessive tantrums • Sensitivity to light or sound • Feeding challenges • Sleeping issues • Transition difficulties • Poor motor coordination, clumsy • Lack of safety awareness • Hyperactivity
Other Red Flags • Lack of appropriate gaze • Lack of warm, joyful expression with gaze • Lack of attending to & from vocalization with parents • Lack of joint attention • Loss of language or social skills at any age
M-CHAT • Modified Checklist for Autism in Toddlers (M-CHAT) • www.firstsigns.org
Early Signs of Autism • Poor attention to face & voice • Tendency to be isolated • Limited social engagement & responsiveness • Less babbling & fewer words • Restricted interest • Absence of purposeful play • Lack of turn taking • Interest in parts of objects • Show repetitive movements • Lack of symbolic play
CSBS DP Infant-Toddler Checklist Sample questions: • 1.Do you know when your child is happy and when your child is upset? • 2. When your child plays with toys, does he/she look at you to see if you are watching? • 3. Does your child smile or laugh while looking at you? • 4. When you look at and point to a toy across the room, does your child look at it?
Co-Morbid Conditions • Mental Retardation • Learning Disabilities • ADHD • Obsessive-Compulsive Disorder • Tourette Syndrome • Epilepsy • Anxiety • Depression
High Functioning Autism/Asperger Syndrome • No significant delay in speech • No significant cognitive delay • Later onset • “Little Professor” • Fascination with letters and numbers • Interested in others rather than aloof or withdrawn
Additional Characteristics of Asperger Syndrome • Poor eye-contact • Unable to use or read body language • Unable to repair conversation • Flat tone of voice(lacking expression) • Formal language- advanced vocabulary • Excessive talking about desired topic • Unable to initiate, maintain, and end conversation
Impaired Social Interaction • Socially isolated • Becomes tense in social situation • Wants friends but lacks friendship skills • Difficulty understanding social cues • Obsessed with specific topics • Literal thinking • Avoids eye-contact • Lack of empathy-theory of mind
Impaired Social Interaction cont. • Active but odd-silly behaviors to get attention • Perfectionist • Unaware of code of conduct • Precision-correcting others • Insists on routine and schedule • Unique sense of humor
Theory of Mind • Refers to the ability to read other’s mind to figure out what he/she is feeling& thinking • Enables person to understand others’ perspective
Executive Functioning • Refers to the ability of the brain to handle multiple activities in order to accomplish a given task
Hidden Curriculum • The set of unwritten rules that no one has been directly taught but that everyone knows
Motor Functioning • Motor clumsiness • Acquisition of self-help skills • Play: bikes, climbing, ball/team sports • Handwriting • Gait patterns, posture, proximity
Learning Characteristics • Concrete facts • Visual • Organizational difficulties • Predictability-Routine • Need for closure • Transitioning Difficulties • Dealing with unstructured time
Effective Strategies • Communication • Sensory Diet • Social/Behavioral
Communication vs. Speech & Language • Speech & Language: Articulation, using words and sentences • Communication: Where do I go?, What do I do?, What comes next?, How do I do it?, What is for lunch?, When do we leave?, What are my choices?
Communication Involves: • Establishing Attention • Shifting Attention • Taking in Information • Sorting Information • Retrieving Information • Sending Information (responding)
Forms of Communication • Speech Vocalization • Sign Language • Pointing • Gestures • Body Language • Icons • Pictures • Written Language • BEHAVIORS
Communication Partner • The person is only ½ of the communication interaction • How effective are you as the communication partner?
The Most Common Assessment of Errors • Overestimating the individual’s level of functioning from performance of Splinter skills • Assume understanding because person can perform familiar routine • Appearance of higher level of linguistic ability due to echolalia
The Communication Message • Transient Message- It is there and then it is gone. Easily missed speech and Sign Language (Visual but transient) • Non-Transient message is present long enough to take in and process information printed picture object