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The Study of Special Needs in Infancy and Early Childhhod Pervasive Developmental Disorders and Autism Spectrum Disorders: Rosa C. Martinez, Ph.D., BCBA www.RCMAutismNotebook.com (c) 2007 1 INTRODUCTION: This mini presentation will focus on “AUTISM” www.RCMAutismNotebook.com (c) 2007 2 Part 1 •Definitions •Etiology of autism •Symptoms •Prevalence •Diagnosis •Treatment approaches www.RCMAutismNotebook.com (c) 2007 3 Frequently Used Acronyms in Relation to Autism: •ABA: Applied Behavior Analysis •ABC: Applied Behavior Consultants •ABC: Autism Behavior Checklist •ABC: Antecedent, Behavior, Consequence •ADA: American w/ Disabilities Act •ADD: Attention Deficit Disorder •ADHD: Attn Deficit Hyperactivity Dis •ADI: Autism Diagnostic Interview •ADOS: Autism Diagnostic Observation Scale •AIA: Autism, Intolerance www.RCMAutismNotebook.com (c) 2007 4 More Acronyms: •AIT: Auditory Integration Training •ANC: Autism National Committee •ANDI: Autism Network for Dietary Intervention •ARI: Autism Research Institute •ARRI: Autism Research Review International •AS: Asperger’s Syndrome •ASA: Autism Society of America •ASD: Autism Spectrum Disorders www.RCMAutismNotebook.com (c) 2007 5 More Acronyms: •ASL: American Sign Language •AUTCOM: Autism National Committee •CAN: Cure Autism Now •CARS: Childhood Autism Rating Scale •CBCL: Achenbach Childhood Beh Checklist •CF: Casein free •CHAT: Checklist for Autism in Toddlers •DAN: Defeat Autism Now •DAS: Developmental Apraxia of Speech •FC: Facilitated Communication www.RCMAutismNotebook.com (c) 2007 6 More Acronyms: •FEAT: Families for Early Autism Treatment •GARS: Gilliam Autism Rating Scale •GF: Gluten Free •HFA: High Functioning Autistic •LFA: Low Functioning Autistic •NAS: National Autistic Society •NLP: Natural Language Paradigm •NOS: Not Otherwise Specified •OCD: Obsessive Compulsive Disorder •ODD: Oppositional Defiant Disorder www.RCMAutismNotebook.com (c) 2007 7 More Acronyms: •PDD: Pervasive Developmental Disorder •PDD-NOS: PDD Not Otherwise Specified •PECS: Picture Exchange Comm System •PEP: Psycho-Educational Profile •POAC: Parents of Autistic Children •PRT: Pivotal Response Training •RCMPHD: ME •SI: Sensory Integration •SIB: Self Injurious Behavior www.RCMAutismNotebook.com (c) 2007 8 More Acronyms: •TEACCH: Treatment & Education of Autistic & Related Communication Handicapped Children •TOM: Theory of Mind •TS: Tourette’s Syndrome www.RCMAutismNotebook.com (c) 2007 9 NO NEED TO REMEMBER THESE! www.RCMAutismNotebook.com (c) 2007 10 THE MOST IMPORTANT ACRONYMS: •ASD: Autistic Spectrum Disorder •PDD: Pervasive Developmental Disorder • RCMPHD: Rosa C. Martinez, PhD., BCBA www.RCMAutismNotebook.com (c) 2007 11 Part I DEFINITIONS: www.RCMAutismNotebook.com (c) 2007 12 Pervasive Developmental Disorders •PDD is a category designated by the American Psychiatric Association •PDD is NOT a disorder •PDD is a behavioral diagnoses www.RCMAutismNotebook.com (c) 2007 13 Pervasive Developmental Disorders 1.Autism Disorder 2.Asperger’s Disorder 3.Rett’s Disorder 4.Childhood Disintegrative Disorder 5.PDD-NOS www.RCMAutismNotebook.com (c) 2007 14 PDD/ ASD Autism Asperger's www.RCMAutismNotebook.com (c) 2007 PDD-NOS 15 What Is ASD? ASD and PDD are synonymous Autism is often referred to as a spectrum disorder, meaning that the symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. (Two children both with a diagnosis of autism, can act very differently from one another.) www.RCMAutismNotebook.com (c) 2007 16 What is Autism? A developmental disability …affects the processing, integrating, and organizing of information …significantly impacts communication, social interaction, functional skills, and educational performance A neurological disorder (abnormalities in the CNS) …affects functioning of the brain www.RCMAutismNotebook.com (c) 2007 17 AUTISM is on the rise! www.RCMAutismNotebook.com (c) 2007 18 www.RCMAutismNotebook.com (c) 2007 19 What Is the Difference Between PDD-NOS and Autism? PDD-NOS: Behavioral diagnoses No medical test No brain scan Same educational approach Very mild autistic symptoms Some autistic symptoms w/ other severe neurological problems AUTISM: Behavioral diagnoses No medical test No brain scan Same educational approach Severe autistic symptoms Neurological problems www.RCMAutismNotebook.com (c) 2007 20 PDD is synonymous with ASD. PDD is not synonymous with Autism. Why not? www.RCMAutismNotebook.com (c) 2007 21 PDD: •Category of various disorders •Not itself a diagnoses PDD-NOS: •Features that resemble autism but may not be as severe or extensive •PDD-NOS is a diagnosis (NOS: Not Otherwise Specified) AUTISM: •The most severe of the pervasive developmental disorders •Autism is a diagnosis www.RCMAutismNotebook.com (c) 2007 22 AUTISM: • A developmental disability (affect’s a person’s ability to communicate, understand language, play, and interact.) • Autism is a behavioral syndrome (which means that the definition is based on patterns or behaviors emitted.) • Autism is a neurological disability (presumed to be present at birth and is usually apparent before the age of 3. • Specific cause is unknown. (It is widely assumed that there are multiple causes, each of which manifests subtypes.) www.RCMAutismNotebook.com (c) 2007 23 Asperger’s: • Deficits in social interaction • Unusual responses to the environment (similar to those in autism) however: • cognitive and communicative development are within the normal or near normal range in the first years of life and •verbal skills are usually an area of strength. www.RCMAutismNotebook.com (c) 2007 24 DISORDER AUTISM ASPERGER’S DIAGNOSES 15-18 months Onset 0-3 Diagnosed over age 15-18 months 3 Atypical autism after 3 years old DSM – IV A)Social B)Communication C) Behavior At least 1 sign Does not include from A, B, and communication re: C, plus 6 verbal speech skills overall. Fewer criteria are diagnosable as PDD-NOS Spectrum of severity determines diagnoses Severely disordered verbal and non-verbal language, unusual behaviors Severe impairments but strict criteria for other PDD disorders not met. Relatively good language, mild nonverbal language deficits, restricted range of interests and relatedness www.RCMAutismNotebook.com (c) 2007 PDD-NOS 25 ETIOLOGY OF AUTISM No specific cause has yet been identified. Theories: •Biological •Neurological •MRI (Magnetic Resonance Imaging) •PET (Positron Emission Tomography) •Genetic •Environmental www.RCMAutismNotebook.com (c) 2007 26 SYMPTOMS OF AUTISM •Problems using and understanding language •Difficulty relating to people, objects, and events •Unusual play with toys and other objects •Difficulty with change in routines •Repetitive body movements www.RCMAutismNotebook.com (c) 2007 27 SYMPTOMS www.RCMAutismNotebook.com (c) 2007 28 SYMPTOMS www.RCMAutismNotebook.com (c) 2007 29 EARLY DETECTION AND EARLY INTERVENTION www.RCMAutismNotebook.com (c) 2007 30 Red Flag Criteria for diagnosis prior to 3 years old At 6 months • not making eye contact with parent during interaction • Not cooing or babbling • Not smiling when parents smile • Not participating in vocal turn-taking • Not responding to peek-a-boo game www.RCMAutismNotebook.com (c) 2007 31 At 14 months • • • • • • • • No attempts to speak Not pointing, waving or grasping No response when name is called Indifferent to others Repetitive body motions Fixation on a single object Oversensitivity to textures, smells, sounds Strong resistance to change in routine www.RCMAutismNotebook.com (c) 2007 32 At 24 months • Does not initiate 2-word phrases (doesn’t just echo words) • Any loss of words or developmental skill www.RCMAutismNotebook.com (c) 2007 33 Persons with AUTISM may possess the following characteristics in various combinations and in varying degrees of severity: www.RCMAutismNotebook.com (c) 2007 34 Inappropriate laughing or giggling No real fear of dangers! www.RCMAutismNotebook.com (c) 2007 35 Apparent insensitivity to pain May not want cuddling www.RCMAutismNotebook.com (c) 2007 36 Sustained unusual or repetitive play; Uneven physical or verbal skills May avoid eye contact www.RCMAutismNotebook.com (c) 2007 37 May prefer to be alone Difficulty in expressing needs; May use gestures www.RCMAutismNotebook.com (c) 2007 38 Inappropriate attachments to objects www.RCMAutismNotebook.com (c) 2007 Insistence on sameness 39 Inappropriate response or no Echoes words or phrases response to sound www.RCMAutismNotebook.com (c) 2007 40 Spins objects or self Difficulty in interacting with others www.RCMAutismNotebook.com (c) 2007 41 www.RCMAutismNotebook.com (c) 2007 42 www.RCMAutismNotebook.com (c) 2007 43 www.RCMAutismNotebook.com (c) 2007 44 www.RCMAutismNotebook.com (c) 2007 45 PREVALENCE www.RCMAutismNotebook.com (c) 2007 46 PREVALENCE / 166 / 150 www.RCMAutismNotebook.com (c) 2007 47 PREVALENCE Over one half million people in the U.S. have some form of ASD www.RCMAutismNotebook.com (c) 2007 48 PREVALENCE Autism is the 3rd most common Developmental disability www.RCMAutismNotebook.com (c) 2007 49 PREVALENCE Autism has no racial, ethnic, or social boundaries www.RCMAutismNotebook.com (c) 2007 50 PREVALENCE www.RCMAutismNotebook.com (c) 2007 51 DIAGNOSES OF AUTISM •No medical tests for diagnosing autism •Behavioral diagnoses •ABC •ADI •CARS •ADOS www.RCMAutismNotebook.com (c) 2007 52 DIAGNOSIS: DSM-IV SOCIAL COMMUNICATION BEHAVIOR NONVERBAL BEHAVIOR SPOKEN LANGUAGE RESTRICTED PATTERNS OF INTEREST PEER RELATIONSHIPS INITIATING CONVERSATION COMPULSIVE ROUTINES SPONTANEOUS SHARING IDIOSYNCRATIC LANGUAGE STEREOTYPIES SOCIAL RECIPROCITY MAKE BELIEVE IMITATIVE PLAY OBJECT PREOCCUPATION www.RCMAutismNotebook.com (c) 2007 53 TREATMENT APPROACHES Clinical Practice Guideline Report of the Recommendations: Autism/Pervasive Developmental Disorders Assessment and Intervention For Young Children (Age 0-3 Years) Sponsored by New York State Department of Health Early Intervention Program www.RCMAutismNotebook.com (c) 2007 54 TREATMENT www.RCMAutismNotebook.com (c) 2007 55 DO: • Refer the parent to their pediatrician! • Give them a brochure to take to their pediatrician… “Identifying Children with Autism Spectrum Disorder” Information for Physicians and Primary Health Care Providers • Provide Resources www.RCMAutismNotebook.com (c) 2007 56 Communication: • Does not respond to own name • Cannot tell me what he/she wants • Language is delayed • Doesn’t follow directions • Appears deaf at times • Seems to hear sometimes but not others • Doesn’t point or wave bye-bye www.RCMAutismNotebook.com (c) 2007 57 Social: • Doesn’t smile socially • Seems to prefer to play alone • Has poor eye contact • In his own world • Tunes others out • Not interested in peers www.RCMAutismNotebook.com (c) 2007 58 Behavioral: • “Tantrums” • “Hyperactive”, “uncooperative” or “oppositional” • Doesn;’t know how to play with toys • Repeats things over and over • Toe walks • Has unusual attachments to toys • Lines things up • Appears oversensitive to certain textures or sounds • Has odd movement patterns www.RCMAutismNotebook.com (c) 2007 59 INDICATIONS FOR IMMEDIATE FURTHER EVALUATION • No babbling by 12 months • No gesturing by 12 months • No single words by 16 months • No 2-word spontaneous phrases by 24 months (not echolalic vocalizations) • ANY loss of ANY language or SOCIAL SKILLS at any age www.RCMAutismNotebook.com (c) 2007 60 TREATMENT www.RCMAutismNotebook.com (c) 2007 61 For more resources on Autism visit.... Thank you for your participation! www.RCMAutismNotebook.com www.RCMAutismNotebook.com (c) 2007 62