Download social interaction and communication

Signs, Symptoms and
Diagnosis of Autism in
Children
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
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
Causes of Autism??
 Probably multiple causes
 Genetic
 Environmental
 A definition : A genetic predisposition with something
in the environment that triggers it.
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
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 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
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.