Download Signs, Symptoms and Diagnosis of Autism in Children

Signs, Symptoms and
Diagnosis of Autism in
Children
Karen S. Fairchild, LCSW
Social Work Month Lecture Series at BYU
March 7, 2013
Spectrum of Autism
Social
Behavior
Self-Absorbed
Quirky
Aggressive,
Destructive
Odd
Non-Verbal
Highly Verbal
Communication
Awkward
Agile
Motor
Hyposensitive
Hypersensitive
Sensory
Measured
I.Q.
Profound Intellectual
Disabilities
Gifted
Created by Dr. Tina Dyches
2
Myths about Autism
 Caused by “cold” refrigerator mothers
 Children with eye contact do not have Autism
 Children who are “social” do not have Autism
 All people with Autism have extraordinary skills
Myths about Autism (con.)
 People with Autism just need love to get better
 People with Autism just need more discipline to get
better
 Autism can be outgrown
 There is a cure for Autism
Red Flags in Young Children
 No big smiles or other warm, joyful expressions by six
months or thereafter
 No back-and-forth sharing of sounds, smiles, or other
facial expressions by nine months or thereafter
 No babbling by 12 months
 No back-and-forth gestures, such as pointing,
showing, reaching, or waving by 12 months
More Red Flags
 No words by 16 months
 No two-word meaningful phrases (without imitating
or repeating) by 24 months
 Any loss of speech or babbling or social skills at any
age
*This information provided by First Signs, Inc. ©2001-2005.
Thoughts on Diagnosis
 Reasons to get a diagnosis
 Understanding
 Services and Intervention
 When?
 ADOS now at 18 Months
 Identification and Intervention most important
 Concerns about getting a “label”
Typical
Behavior
Characteristics
of HighFunctioning
Individuals with
Autism
Adapted from C. Bees (1998). The
GOLD Program: a program for gifted
learning disabled adolescents. Roeper
Review, 21, p. 160.
Early Intervention
 Kids on the Move (Alpine School District)
 Kids Who Count (Nebo School District)
 Provo Early Intervention Program (Easter Seals)
 Federally Mandated
If there are concerns about development, do not hesitate
to have a child assessed through early intervention.
Early Screening
 Modified Checklist for Autism in Toddlers (M-
CHAT™)—available readily and free online
 Many false positives; follow up with interview
 Scientifically validated for children ages 16-30 months
old
 American Academy of Pediatrics recommends that all
children be screened for Autism at 18 and 24 months
old. The M-CHAT is one of their recommended tools.
Diagnostic Tools
 Current Tools
 Observation—Autism Diagnostic Observation (ADOS)
 Developmental History (Parent Report)—Autism
Diagnostic Interview-Revised (ADI-R)
 Childhood Autism Rating Scale (CARS)
 Future
 Brain Imaging—Pinpoint subgroups and treatment
 Genetic Testing
Causes of Autism??
 Probably multiple causes
 Genetic
 Environmental
 The definition I hold onto: A genetic predisposition
with something in the environment that triggers it.
What is Autism?
The essential features of Autistic Disorder are the
presence of markedly abnormal or impaired
development in:
 social interaction and communication
 and a markedly restricted repertoire of activity
and interests
—DSM-IV
Current Prevalence Rates
 Prevalence
 1 out of 88 nationally
 1 out of 47 in Utah County
Changes in DSM-5
 Name changed from Pervasive Developmental
Disorder to Autism Spectrum Disorder
 Single Diagnosis rather than a category containing five
individual diagnoses (PDD-NOS and Asperger’s
eliminated)
 Three symptom domains become two Domains
 Severity Criteria added to better capture the idea of a
spectrum (3 levels)
 New diagnostic category (not on the autism spectrum)
of Social Communication Disorder
--Sally Ozonoff, Editorial: DSM-5 and autism spectrum disorders—two decades of perspectives from
the JCPP, Journal of Child Psychology and Psychiatry, 53:9 (2012), ppe4-e6
Social Communication & Interaction
–proposed
A. Persistent deficits in social communication and
social interaction across contexts, not accounted for
by general developmental delays, and manifest by
all 3 of the following:
1.
Deficits in social-emotional reciprocity; ranging
from abnormal social approach and failure of normal
back and forth conversation through reduced sharing
of interests, emotions, and affect and response to total
lack of initiation of social interaction.
Social Communication & Interaction
–proposed (continued)
2.
3.
Deficits in nonverbal communicative behaviors used
for social interaction; ranging from poorly integratedverbal and nonverbal communication, through
abnormalities in eye contact and body-language, or deficits
in understanding and use of nonverbal communication, to
total lack of facial expression or gestures
Deficits in developing and maintaining relationships,
appropriate to developmental level (beyond those
with caregivers); ranging from difficulties adjusting
behavior to suit different social contexts through difficulties
in sharing imaginative play and in making friends to an
apparent absence of interest in people.
Behaviors, Interests, Activities —
proposed
B. Restricted, repetitive patterns of behavior, interests,
or activities as manifested by at least two of the
following:
1.
2.
Stereotyped or repetitive speech, motor movements,
or use of objects; (such as simple motor stereotypies,
echolalia, repetitive use of objects, or idiosyncratic
phrases).
Excessive adherence to routines, ritualized patterns of
verbal or nonverbal behavior, or excessive resistance to
change; (such as motoric rituals, insistence on same route
or food, repetitive questioning or extreme distress at small
changes).
Behaviors, Interests, Activities —
proposed (continued)
3.
4.
Highly restricted, fixated interests that are abnormal
in intensity or focus; (such as strong attachment to or
preoccupation with unusual objects, excessively
circumscribed or perseverative interests).
Hyper-or hypo-reactivity to sensory input or unusual
interest in sensory aspects of environment; (such as
apparent indifference to pain/heat/cold, adverse response
to specific sounds or textures, excessive smelling or
touching of objects, fascination with lights or spinning
objects). NEW
Additional Diagnostic Criteria—
proposed
C. Symptoms must be present in early childhood (but
may not become fully manifest until social demands
exceed limited capacities). NEW
D. Symptoms together limit and impair everyday
functioning.
Severity Levels-proposed
DSM–V Workgroup
Severity Level for ASD
Social
Communication
Restricted Interests
and Repetitive
Behaviors
Level 1
Requiring support
Without supports in place,
deficits in social
communication cause
noticeable impairments.
Has difficulty initiating
social interactions and
demonstrates clear
examples of atypical or
unsuccessful responses to
social overtures of others.
May appear to have
decreased interest in social
interactions.
Rituals and repetitive
behaviors (RRB’s) cause
significant interference
with functioning in one or
more contexts. Resists
attempts by others to
interrupt RRB’s or to be
redirected from fixated
interest.
Jerri Maroney, Andrea Kliss, Edward Toyer, AmeriHealth Mercy Family of Companies
Severity Levels-proposed
DSM–V Workgroup
Severity Level for ASD
Social
Communication
Restricted Interests
and Repetitive
Behaviors
Level 2
Requiring substantial
support
Marked deficits in verbal
and nonverbal social
communication skills;
social impairments
apparent even with
supports in place; limited
initiation of social
interactions and reduced or
abnormal response to social
overtures from others.
Marked deficits in verbal
and nonverbal social
communication skills;
social impairments
apparent even with
supports in place; limited
initiation of social
interactions and reduced or
abnormal response to social
overtures from others.
Jerri Maroney, Andrea Kliss, Edward Toyer, AmeriHealth Mercy Family of Companies
Severity Levels-proposed
Severity Level for ASD
Social
Communication
Restricted Interests
and Repetitive
Behaviors
Level 3
Requiring very substantial
support
Severe deficits in verbal and
nonverbal social
communication skills cause
severe impairments in
functioning; very limited
initiation of social
interactions and minimal
response to social overtures
from others.
Preoccupations, fixated
rituals and/or repetitive
behaviors markedly
interfere with functioning
in all spheres. Marked
distress when rituals or
routines are interrupted;
very difficult to redirect
from fixated interest or
returns to it quickly.
Jerri Maroney, Andrea Kliss, Edward Toyer, AmeriHealth Mercy Family of Companies
Resources in Utah County
Autism Resources of Utah County
http://www.autismresourcesuc.org/ (local
conferences, autism awareness events, local resource
lists)
Bridges Autism Program at Kids on the Move
http://www.kotm.org/programs/bridges/ 801-616-5800
(preschool, social groups, Kindermusik with autism
focus, individualized service plans, Floortime, parent
support group, toy lending library, home visits, ABA
home-based programs, assessment, and diagnosis)
Resources in Utah County (con.)
 Timpanogos Assessment and Psychological Services
(TAPS) Dr. Mikle South, 801-810-8378 (diagnostic
assessments, social skills groups, IQ testing, etc.)
 Kids on the Move Library—Many great books are
available and requests for book purchases are
considered – 801-221-9930
 Wasatch Mental Health’s GIANT Steps Autism
Program http://www.wasatch.org/autism.html
801-226-5437 (preschool, parent training)
Resources in Utah County (con.)
 Clear Horizons Academy
http://www.clearhorizonsacademy.org 801-437-0490
(preschool, elementary grade classes)
 BYU Comprehensive Clinic 801-422-7759 (speech
therapy, autism treatment)
 Wasatch Mental Health 801-373-4765
(Medicaid Provider—diagnosis, therapy, groups)
Resources in Utah County (con.)
 Orem Pediatric Rehabilitation 801-714-3505 (speech
therapy, occupational therapy [sensory processing
disorders], physical therapy)
 Autism Council of Utah www.autismcouncilofutah.org
(Website with compilation of community autism
resources and information)
Autismspeaks.org
 Video Glossary
 First Signs
 Tips for Families
 Treatment Recommendations
 Research Updates
 Legislative Updates
 Much more