INTRODUCTION TO AUTISM

SPECTRUM DISORDERS

Created by:
Staff of Society for Treatment of Autism
OVERVIEW OF PRESENTATION

z PART ONE: WHAT IS ASD?

– HISTORY
– DIAGNOSIS/ THE SPECTRUM OF DISORDERS
z PART TWO: TREATMENT/RESEARCH
– CLASSIFYING TREATMENT PROGRAMS
– WHAT WORKS
z PART THREE: PARENTING AND TEACHING A
CHILD WITH ASD
– UNIQUE CHALLENGES
– STRATEGIES
z PART FOUR: MATERIALS AND QUESTIONS
PART ONE
ONE: WHAT ARE AUTISM
SPECTUM DISORDERS?
POPULATION CHARACTERISTICS

z APPROXIMATELY 1 IN 150 CHILDREN

z 3 TO 4 TIMES MORE MALES THAN
FEMALES
z 2-5/100 SIBLINGS DEVELOP AUTISM
z 25% DEVELOP SEIZURES
z APPROX. 50% HAVE IQs BELOW 50
PERVASIVE DEVELOPMENTAL
DISORDERS

z FIRST IDENTIFIED BY KANNER

z CHARACTERIZED BY SEVERE AND WIDESPREAD
IMPAIRMENTS IN SEVERAL AREAS OF
DEVELOPMENT:
– RECIPROCAL SOCIAL INTERACTION SKILLS,
– COMMUNICATION SKILLS, AND
– THE PRESENCE OF STEREOTYPED BEHAVIOR,,
INTERESTS AND ACTIVITIES (TRIAD OF IMPAIRMENTS)
HISTORY OF AUTISM
THE BIOLOGY TODAY
MOTHER DID IT
DID IT
•MYSTERIOUS •SPECIFIC DISEASE •MANY CLUES BUT NO
DISORDER ENTITY SPECIFICS
•RESPONSE TO •COMPLEX RESPONSE •AUTISTIC CULTURE
“EXTREME SITUATIONS” TO GENETIC AND/ OR •A DIFFERENT WAY OF
IN INFANCY BIOLOGICAL EVENTS BEING
•MOTHER’S WITHHOLD •MOTHERS HAVE •APPROPRIATE
AFFECTION FROM NOTHING WHATSOEVER EDUCATIONAL
THERE CHILDREN TO DO WITH CAUSING INTERVENTION
CAUSING MORTAL FEAR AUTISM •BIOLOGICAL
(REFRIGERATOR •SYNDROME OF COMPONENT
MOTHER) BIOLOGY AND
•PSYCHOLOGICAL GENETICS
PROBLEM •AUTISM IS A LIFELONG
•RECOVERY IN A DISORDER
THERAPEUTIC MILIEU
 PERVASIVE DEVELOPMENTAL
DISORDER

R
E H
T F
A N A
T O
U
S S
T
I
C A
S
D S
M
D
INCREASED VARIABILITY OF PRESENTATION
DIAGNOSING ASD

z THERE IS NO DEFINATIVE “TEST” FOR

AUTISM (NEVER KNOW FOR SURE)
z DIAGNOSIS IS BASED ON SPECIFIC
OBSERVABLE CRITERIA
DIAGNOSTIC PROCESS

z PARENT/CAREGIVER BECOMES CONCERNED ABOUT

DEVELOPMENT
z PARENT BRINGS CONCERNS TO PRIMARY CARE
PHYSICIAN
z REFERRAL TO DEVELOPMENTAL PEDIATRICIAN
z REFERRAL FOR MULTIDISCIPLINARY ASSESSMENT
z DIAGNOSIS SHARED WITH PARENTS
z REFERRAL FOR TREATMENT ((PUF PROGRAM,
SPECIALIZED SERVICES PROGRAM)
ELEMENTS OF A DIAGNOSIS

z DEVELOPMENTAL HISTORY
z MEDICAL INVESTIGATIONS (GENETIC TESTING,
TESTING
AUDITORY TESTING)
z OBSERVATION ACROSS MULTIPLE
ENVIRONMENTS
z FORMAL TESTING (TO DETERMINE
DEVELOPMENTAL LEVEL)
z SPECIFIC TOOLS (CARS,
(CARS ADOS
ADOS, MCHAT)

* ULTIMATELY THE CHILD MUST SATISFY DSM-IV

CRITERIA
DSM-IV

z DIAGNOSTIC AND STATISTICAL MANUAL

OF MENTAL DISORDERS – FOURTH
EDITION (AMERICAN PSYCHIATRIC
ASSOCIATION))
z CRITERIA ORGANIZED INTO THREE
AREAS:
– SOCIAL IMPAIRMENT
– COMMUNICATION IMPAIRMENT
– RESTRICTED/REPETITIVE BEHAVIOR
AUTISTIC DISORDER - SOCIAL
IMPAIRMENT

z NONVERBAL SOCIAL BEHAVIOURS (EYE

CONTACT FACIAL EXPRESSIONS)
CONTACT,
z DIFFICULTY DEVELOPING FRIENDSHIPS
z JOINT ATTENTION (SHOWING, POINTING
OUT THINGS OF INTEREST)
z ONE SIDED INTERACTIONS
AUTISTIC DISORDER -
COMMUNICATION IMPAIRMENT

z NONVERBAL OR VERBAL SKILLS

DELAYED
z DIFFICULTY INITIATING AND/OR
MAINTAINING CONVERSATIONS
z REPETITIVE OR ODD LANGUAGE
z LIMITED IMAGINATION AND/OR SOCIAL
PLAY SKILLS
AUTISTIC DISORDER -
BEHAVIORAL DIFFICULTIES

z PREOCCUPATIONS/PERSEVERATIONS
z ROUTINES/RITUALS
z REPETITIVE MOTOR MANNERISM
(STIMS)
z ATTENDING TO SPECIFIC PARTS AND
MISSING BIG PICTURE OR MOST
SALIENT ASPECT
AUTISTIC DISORDER -
ASSOCIATED CHARACTERISTICS

z SHORT ATTENTION SPAN

z SELF INJURIOUS BEHAVIOUR
z ODD RESPONSES TO SENSORY INPUT
z ABNORMALITIES OF MOOD
z UNEVEN SKILL DEVELOPMENT
z ABNORMALITIES IN EATING, DRINKING OR
SLEEPING
z UNUSUAL FEARS/ANXIETY
z SPECIAL ABILITIES
ASPERGER’S SYNDROME

z IMPAIRED SOCIAL SKILLS

z COMMUNICATION SKILLS TEND TO BE LESS
IMPAIRED
z COGNITIVE SKILLS TEND TO BE LESS IMPAIRED
z OFTEN CLUMSY AND POORLY COORDINATED
z COMMON FACT BASED SPECIAL INTEREST
z USUALLY DIAGNOSED AFTER AGE THREE

* WHAT IS THE DIFFERENCE BETWEEN HIGH

FUNCTIONING AUTISM AND ASPERGERS?
 DIFFERENTIAL DIAGNOSIS
AUTISM VS ASPERGER’S

z MOTOR SKILLS
z LANGUAGE ABILITIES
z COGNITIVE LEVEL
z INTERESTS
z SOCIAL ABILITIES
z PROGNOSIS
ASPERGER’S SYNDROME
ASSOCIATED FEATURES

z DEMANDING NATURE
z OPPOSITIONAL BEHAVIOUR
z DEPRESSION
z PERFORMANCE ANXIETY
z PERFECTIONISM
z ATTENTION SEEKING
z LEARNED HELPLESSNESS
RETTS DISORDER

z ALMOST EXCLUSIVELY IN FEMALES

z PERIOD OF “NORMAL” DEVELOPMENT
z DEVELOPS BEFORE AGE 4
z MOTOR SKILLS SIGNIFICANTLY IMPAIRED (GAIT
AND PURPOSEFUL HAND MOVEMENTS)
z ASSOCIATED WITH DECELERATED HEAD
GROWTH AFTER FIVE MONTHS OF AGE
 CHILDHOOD DISINTEGRATIVE
DISORDER

z ASSOCIATED WITH AT LEAST TWO YEARS OF

NORMAL DEVELOPMENT
z CLINICALLY SIGNIFICANT LOSS OF AT LEAST
TWO SKILLS
– LANGUAGE
– SOCIAL SKILLS
– SELF HELP SKIILLS
– BLADDER/BOWEL CONTROL,
– PLAY SKILLS
– MOTOR SKILLS
PERVASIVE DEVELOPMENTAL DISORDER
NOT OTHERWISE SPECIFIED

z DIAGNOSIS OF EXCLUSION (RULING OUT

OTHER DISORDERS)
z SIGNIFICANT SOCIAL DEFICIT AND
– COMMUNICATION DEFICIT OR
– STEREOTYPED INTERESTS/BEHAVIOURS
z ALSO KNOWN AS ATYPICAL AUTISM

** “in the autism ballpark, but not quite on the team”

 CO MORBID CONDITIONS
CO-

z HAVING AUTISM MAKES z SEIZURES/ EPILEPSY

THE CHILD MORE z MENTAL RETARDATION
VULNERABLE TO OTHER z ADD OR ADHD
TROUBLES

** AT WHAT AGE ARE CHILDREN WITH AUTISM MOST LIKELY TO DEVELOP

SEIZURES?
FRAGILE X

z DATA VARIES SAYING 4 TO 10% OF CHILDREN WITH

AUTISM HAVE FRAGILE X
z NOT ALL CHILDREN WITH FRAGILE X HAVE AUTISM
z MOTOR, ATTENTION AND LEARNING PROBLEMS ARE
COMMON
z VARYING DEGREES OF SOCIAL DIFFICULTY
RANGING FROM SHYNESS TO SOCIAL WITHDRAWAL
z PHYSICAL FEATURES INCLUDE LARGE EARS, LONG
NOSE AND HIGH FOREHEAD
RED FLAGS (EARLY WARNING
SIGNS)

z NO REACTION TO SOUND OR NAME

z PARENTS DESCRIBE BABY AS VERY “GOOD” OR
VERY DIFFICULT (EXTREMES)
z DELAYED OR ABSENT SPEECH
z REPETITIVE PLAY OR BEHAVIOURS
z ODD RESPONSES TO SENSORY INPUT
z LOSS OF SKILLS
FACTORS INFLUENCING
DIAGNOSTIC PROCESS

z OTHER CHILDREN PRESENT IN HOME OR PARTICIPATION

IN COMMUNITY GROUPS ((FOR COMPARISON))
z GEOGRAPHY (ISOLATED VS URBAN AREA)
z AVAILABILITY OF EXPERIENCED PROFESSIONALS
z PARENT EDUCATION AND LANGUAGE
z PARENT PERSISTENCE
z PRESENCE OF OTHER CONDITIONS (E.G., DOWN
SYNDROME))
z AWARENESS AND OBSERVATIONS OF EARLY
CHILDHOOD PROFESSIONALS
ETIOLOGY

z CONSIDERED A “FINAL COMMON

PATHWAY” BECAUSE SEVERAL
FACTORS/CONDITIONS MAY LEAD ASD
– GENETIC
– NEUROANATOMICAL DIFFERENCES
– NEUROCHEMICAL DIFFERENCES
– PRENATAL EVENTS (EXPSOURE TO
RUBELLA)
AUTISM MYTHS

z AUTISM IS CAUSED BY REFRIGERATOR

PARENTING (COLD & DISTANT)
z INDIVIDUALS WITH AUTISM POSSES SPECIAL
SKILLS OR TALENTS
z INDIVIDUALS WITH AUTISM AVOID ALL FORMS
OF SOCIAL CONTACT
z AUTISM CAN BE CURED
z AUTISM CAN BE DEFINITIVELY DIAGNOSED
WITH A “TEST”
TEST
PROGNOSIS

z 10% OF INDIVIDUALS WITH AUTISM LIVE AND

WORK INDEPENDENTLY AS ADULTS
z 33% HAVE PARTIAL INDEPENDENCE
z 50% REQUIRE SUBSTANTIAL ASSISTANCE
z APPROXIMATELY 75% OF AUTISTIC
INDIVIDUALS REQUIRE NEUROLEPTIC
MEDICATIONS TO MANAGE
BEHAVIOUR/ANXIETY
PART TWO
TWO: TREATMENT &
RESEARCH
CLASSIFYING TREATMENT
PROGRAMS

THREE BROAD CATEGORIES:

z BEHAVIORAL MODELS
– LOVAAS/ABA
z RELATIONSHIP-BASED DEVELOPMENTAL MODELS
– FLOORTIME/RDI
z COMBINED MODELS
– LEAP/MIND INSTITUTE/ TEACCH

**SOCIETY FOR TREATMENT OF AUTISM’S TREATMENT

PHILOSOPHY BEST CHARACTERIZED AS “COMBINED” OR
INTEGRATED IN NATURE
BEHAVIORAL-DEVELOPMENTAL
BEHAVIORAL DEVELOPMENTAL
DEBATE

PROGRAMS TEND TO DIFFER ACCORDING TO:

- WHO “CONTROLS”
CONTROLS THE FLOW OF EVENTS
DURING THERAPY (CHOICE OF MATERIALS,
ACTIVITIES)
- THERAPEUTIC CONTEXT (ARTIFICIALLY
DESIGNED VS NATURALLY OCCURRING)
- REINFORCEMENTS UTILIZED
- REPETITION (EXACT/PREDETERMINED VS
DETERMINED BY CHILD’S INTERESTS)
ALTERNATIVE TREATMENTS

z AUDITORY INTEGRATION
z FACILITATED COMMUNICATION
z CHELATION THERAPY
z DIET THERAPIES
z VITAMIN THERAPIES
z ANTI-YEAST, ENZYMES
WHAT WORKS?

zA COMBINATION OF VARIOUS
METHODS (COMBINED) SEEM
TO BE MOST EFFECTIVE
CRITICAL TREATMENT FACTORS

z AGE AT WHICH TREATMENT INITIATED

z INTENSITY OF TREATMENT
z PARENTAL INVOLVEMENT
z INTEGRATION WITH TYPICAL PEERS
z SPECIALIZED PROGRAMMING
z MULTIDISCIPLINARY INVOLVEMENT
z FUNCTIONAL APPROACH TO BEHAVIOUR
MANAGEMENT
z EMPHASIS ON DEVELOPMENT OF SOCIAL-
COMMUNICATION SKILLS
NEW YORK STATE PRACTICE
GUIDELINES

z RECOMMENDED z NOT RECOMMENDED

– AUDITORY INTEGRATION
– INTENSIVE BEHAVIORAL – FACILITATED
INTERVENTION COMMUNICATION
– THE USE OF PRESCRIBED – MUSIC
US C THERAPY
MEDICATIONS TO – ANTI-YEAST TREATMENTS
ADDRESS SEVERE – VITAMIN THERAPY
BEHAVIOURS (UNDER – DIET THERAPY (UNLESS
CARE OF PHYSICIAN) SPECIFIC ALLERGIES
IDENTIFIED)
FINAL THOUGHTS (FROM THE
NATIONAL RESEARCH COUNCIL)

THE COMMITTEE RECOMMENDS THAT

EDUCATIONAL SERVICES BEGIN AS SOON AS A
CHILD IS SUSPECTED OF HAVING AN AUTISM
SPECTRUM DISORDER. THOSE SERVICES
SHOULD INCLUDE
– A MINIMUM OF 25 HOURS A WEEK
– 12 MONTHS A YEAR
– SYSTEMATICALLY PLANNED, AND
DEVELOPMENTALLY APPROPRIATE EDUCATIONAL
ACTIVITIES.
FINAL THOUGHTS (FROM THE NATIONAL
RESEARCH COUNCIL) – CON’D

THE PRIORITIES OF FOCUS SHOULD INCLUDE:

- FUNCTIONAL SPONTANEOUS
COMMUNICATION
- SOCIAL INSTRUCTION
- COGNITIVE DEVELOPMENT
- PROACTIVE APPROACHES TO PROBLEM
BEHAVIORS
- SPECIALIZED INSTRUCTION IN A
SETTING IN WHICH ONGOING
INTERACTIONS OCCUR WITH
TYPICALLY DEVELOPING CHILDREN.
 ASSISTING PARENTS TO BE
CRITICAL CONSUMERS

z BE CAUTIOUS OF TREATMENTS THAT CLAIM TO

“CURE”
CURE
z CONSIDER WHETHER THERE IS AN ASSESSMENT
COMPONENT (TO INDIVIDUALIZE TREATMENT)
z CONSIDER THE THEORY BEHIND THE
TREATMENT
z CONSULT LOCAL PROFESSIONALS
z CONSIDER IF THERE IS RESEARCH TO SUPPORT
z DETERMINE IF ANY NEGATIVE SIDE EFFECTS
SOCIETY FOR TREATMENT OF
AUTISM - PHILOSOPHY

SPECIALIZED SERVICES FOR THOSE WITH AUTISM

SPECTRUM DISORDER WHO MEET THE CRITERIA AS
OUTLINED IN THE FSCD ACT

z INDIVIDUALIZED
z INTENSIVE
z ACTIVITY-BASED INSTRUCTION
z LEAST RESTRICTIVE TREATMENT CONTINUUM (PROMPT
HIERARCHY)
z COMMUNITY INCLUSION/INTEGRATION
z PARENTAL INVOLVEMENT/PARTICIPATION
z INTERDISCIPLINARY TEAM
PART THREE
THREE: PARENTING AND
TEACHING A CHILD WITH ASD
A CHILD WITH ASD – UNIQUE
CHALLENGES

z DISORDER IS NOT VISUALLY OBVIOUS

z CRITICAL SKILLS (TOILET TRAINING,
TRAINING
DRESSING, EATING) ARE OFTEN SLOW
TO DEVELOP
z FORCED TO READ CHILD’S MIND DUE TO
LIMITED COMMUNICATION SKILLS
z CHALLENGING BEHAVIOURS IMPACT
FAMILY ACTIVITIES AND FUNCTIONING
A CHILD WITH ASD – UNIQUE
CHALLENGES

z LACK OF SOCIAL CONNECTION

z FAMILIES REQUIRED TO MEET AND DEAL WITH
A VARIETY OF PROFESSIONALS
z PARENTS BOMBARDED WITH INFORMATION OR
UNABLE TO FIND INFORMATION
z FORCED TO EVALUATE A WIDE VARIETY OF
TREATMENTS (SOME OR WHICH OFFER THE
PROMISE OF A CURE)
TEACHING STRATEGIES FOR A CHILD
WITH ASD

z TASK VARIATION
z PUSH BOUNDRIES
z GENERALIZED SKILL DEVELOPMENT
z REINFORCE APPROPROPRIATE BEHAVIOR
z SENSORY BREAKS
z PROACTIVE PLANNING
z VISUALS
z CONSISTENTCY
z TASK ANALYSIS
z SABATOGING THE ENVIRONMENT
SCHEDULE STRIPS
IF…THEN CONTINGENCIES
SENSORY BREAKS
TASK ANALYSIS
INCORPORATING STRATEGIES INTO
TYPICAL SETTINGS

z EDUCATE OTHER CHILDREN ABOUT

DIFFERENCES AND SIMILARTIES
z AVOID USING LABELS
z USING CLASSROOM VISUALS
z INCORPORATING SENSORY BREAKS
z FACILITATE INTERACTIONS
HANDS ON AND QUESTIONS?
 RESOURCES

z SOCIETY FOR TREATMENT OF AUTISM

– www.calgaryautismtreatment.com
l ti t t t
z CANADIAN AUTISM INTERVENTION RESEARCH
NETWORK (CAIRN)
( )
– www.cairn-site.com
z AUTISM TREATMENT SERVICES OF CANADA
– www.autism.ca
ti
z GENEVA CENTRE FOR AUTISM
– www.autism.net