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Autism 101: An Introduction for Families Lindsey Miller, ARNP Rachel Montague, Ph.D. June 5, 2012 Autism Center Overview of Presentation • • • • • What are Autism Spectrum Disorders? Prevalence & causes Characteristics & related issues Treatments Resources Autism Center Overview of Presentation What Are Autism Spectrum Disorders? • ASDs are brain-based developmental disorders that are present from birth and includes presence of • Social, • communicative, • and behavioral abnormalities (Diagnostic and Statistical Manual, IV (DSM-IV)) Autism Center What is meant by “spectrum disorders”? • Symptoms can occur in a variety of combinations • Symptoms present with varying degrees of severity • Two children with a diagnosis of autism can have very different strengths and challenges and can act completely differently from one another • Intellectual abilities vary Autism Center Autism Triad – Current Model Autism Center What are Autism Spectrum Disorders (ASD)? Autism Spectrum Disorders Autistic Disorder Asperger's Disorder PDD-NOS Autism Center Autism – Proposed Model Autism Center Proposed model of ASD Autism Spectrum Disorder Autistic Disorder Asperger's Disorder PDD-NOS Autism Center Prevalence of ASD • CDC estimates that 1 in 88 children have ASD • This is up to a 10-fold increase since 1950s • Similar rates across different cultures, ethnicities, or income level • Current averages indicate that boys are 4.4 times more likely to be diagnosed with ASD as compared to girls Autism Center Why the increase in ASDs? • Several reasons: • Wider public awareness • Better assessment tools • We are now diagnosing kids with autism now who present with average or above average intellectual capabilities and more subtle social and language delays. • Is there a true increase? • ASDs may have been unrecognized or misidentified in the past Autism Center What causes it? • Genetics • Identical twin studies: 60-90% of the time that 1 twin has ASD, the other does too. • For sibling studies: 8-18% of the time that 1 sibling has ASD, another sibling does too. • Even if the other siblings don’t meet criteria for ASD, they may have social difficulties, language impairment or developmental delay Autism Center What causes it? • Environment • There is also likely an environmental component • research is trying to identify specific environmental factors • What do we mean by “environment”? • It’s likely a combination of genetics & environment • The theory is that the genetic component can be turned on by an environmental trigger. Autism Center What causes it? • We know some things do NOT cause ASD – such as vaccines or parenting • In 2010, journal Lancet officially retracted the 1998 article that originally suggested a connection between autism and the MMR vaccine. • Many years ago, people believed autism was caused by “bad parenting.” Research has shown that is not the case. Autism Center When is ASD diagnosed? • ASD can sometimes be diagnosed as early as age 2 by experienced clinicians • Some children with ASD are diagnosed during school-age years. Autism Center How is ASD diagnosed? • No medical test (e.g. blood test, brain scan) • Diagnosis made using specific criteria • Based on developmental history, direct observation and interaction with child, clinical judgment by qualified professionals • Tools: • Autism Diagnostic Observation Schedule (ADOS) often used, but not required • Autism Diagnostic Interview (ADI) – semi structured parent interview about development Autism Center Characteristics of ASDs Social Interaction Impairments Communication Impairments Restricted, Repetitive Behaviors Autism Center Social Interaction Impairment • Difficulty using eye gaze, gestures, etc. • Gestures include pointing, nodding, waving goodbye • Few friendships • Difficulty sharing enjoyment & interests with others. • Difficulty relating to others, taking another’s perspective, and empathy Autism Center Communication Impairment • Language delays • Difficulty with back-and-forth conversations. • Repetitive and/or odd use of language. Autism Center Patterns of Behavior • Abnormally obsessive interests • Rigid adherence to routines • “Stereotyped” motor movements • Hand flapping, rocking, spinning, pacing • Focus on the details, miss the big pictures • Odd play skills Autism Center Related Issues in ASD • • • • • Inattention and/or Hyperactivity (ADHD) Anxiety Depression/ irritability Disruptive/ oppositional behaviors Sensory Processing Issues • Motor Planning Issues • Executive Functioning • Tic disorders Autism Center Common Strengths for Children with ASD • • • • • • Visual learning Concrete skills Memory Consistency Following rules Attention to detail Autism Center Interventions for children with ASDs • There is no cure for ASD, but intervention lead to improvement and development of skills. • Intervention is recommended as soon as diagnosis is made. • With intervention, progress can be made in many areas. • What therapy is right for your child? Autism Center School Services • Children with ASD may qualify for special education services from birth to age 21 • Birth-to-Three Services for children under 3 • Individual Education Program (IEP) for children 3 to 21 • Depending on child’s needs, extra services may include: • speech language therapy, occupational therapy, social skills groups, and/or academic support • Inclusion and self-contained placements • Behavior support or positive behavior planning Autism Center Special Education Resources • WAC codes (Washington Administrative Code) http://www.k12.wa.us/specialed/ • Wrightslaw http://www.wrightslaw.com/ • Special Educational Ombudsman Office http://www.governor.wa.gov/oeo/ • Autism Speaks IEP Guide: http://www.autismspeaks.org/family-services/ community-connections/back-to-school Autism Center Private Therapies • • • • • • • • Speech & Language Therapy Occupational Therapy (sensory, fine motor) Physical Therapy (gross motor, coordination) Individual Therapy / Counseling Social Skills Groups Biomedical Treatments Family Education & Therapy / Counseling Parent Training & Information Autism Center Speech & Language Therapy • Communication Development • Talking and understanding what others are saying • Production of speech sounds (articulation) • Social Communication – “how and why we communicate” • Nonverbal Communication • School-based and private speech language pathologists Autism Center Occupational (OT) & Physical Therapy (PT) • Gross Motor Development – “large” motor movements -- PT • E.g., running/jumping • Fine Motor Development – “small” motor movements -- OT • E.g., using utensils/tools • Sensory Processing • School-based and private OT/PT Autism Center Individual Therapy • Common types of individual therapy: • Cognitive Behavior Therapy (CBT) • Child learns how thoughts, feelings and behaviors are connected • Child learns coping skills for anxiety, anger, teasing, etc. • Behavior Management • Parents learn why child has certain behaviors and learns strategies to improve the child’s behaviors • Applied Behavior Analysis (ABA) • Can be provided by Masters level therapist or Ph.D. (psychologist) Autism Center Social Skills Groups • Group of approximately 4-8 children with social skills difficulties, led by a therapist / teacher • Focus on development of social skills • making friends, starting and ending conversations, etc. • School-based and private groups • Excellent opportunity to practice skills learned in individual therapy! Autism Center Common Medical Issues in ASD • Picky Eating • GI (stomach, poop, etc.) Problems • Seizures • Sleep Disturbances Autism Center Biomedical • Medications can be used to treat some behaviors associated with ASD • Inattention, hyperactivity, aggression, irritability, anxiety • Complementary & Alternative Medicine (CAM) • Be careful to evaluate treatments prior to beginning, and talk to your doctor Autism Center Parent Support • Parent groups • FEAT of Washington • http://www.featwa.org/ • Autism Society of Washington • http://www.autismsocietyofwa.org/ • ALLY support group at Seattle Children’s Autism Clinic • Email [email protected] for information • TACA of Washington • http://www.tacanow.org/local-chapters/washington/ Autism Center Seattle Children’s Autism Center • How to get in: • Talk to your Primary Care Provider for referral • Services offered: • Diagnosis • Medical treatment (psychiatry, neurology, neurodevelopmental, speech) • Individual therapy (cognitive behavioral, behavior management) • Treatment planning Autism Center General Resources – Local • SCH Autism Center • Autism Blog: www.theautismblog.org • Information and Resources: http://www.seattlechildrens.org/clinicsprograms/autism-center/ • Autism Outreach Project • http://www.nwesd.org/autism • Autism Society of Washington • http://www.autismsocietyofwa.org Autism Center General Resources – National and International • Autism Speaks • www.autismspeaks.org • Autism Society of America: • www.autism-society.org • Global Autism Collaboration (Center for the Study of Autism): • www.autism.org Autism Center Government Resources • Division of Developmental Disabilities (DDD) • Apply for eligibility/services • May receive services (although limited at this time) • Important to apply now so children may receive services in future • http://www.dshs.wa.gov/ddd/ • Tuesdays at 11am – free DDD application help at SCAC • Supplemental Security Income (SSI) • May be eligible for disability income • http://www.ssa.gov/ssi/ Autism Center Video Recommendations • Autism Resource DVD, produced by University of Washington’s Autism Clinic • Watch or download at • http://depts.washington. edu/uwautism/resource s/autism-resourcedvd.html Autism Center Book Recommendations • Educating Children with Autism • National Research Council • My Social Stories Book • Carol Gray • More than Words • Fern Sussman • A Parents’ Guide to Asperger and High Functioning Autism • Sally Ozonoff, Geraldine Dawson, and James McPartland Autism Center THANK YOU! Please complete your Course Evaluations… QUESTIONS? Autism Center