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Autism and Other Pervasive
Developmental Disorders
Pervasive Developmental Disorders (PDDs)
Serious conditions characterized by “severe and pervasive impairment” in at
least one of three areas of functioning:
(1) reciprocal social interaction,
(2) communication, or
(3) the presence of stereotyped behaviors, interests, or activities
Autistic Disorder
Asperger’s Disorder
A persistent and pervasive
A persistent and pervasive
deficit in three general areas:
deficit in two general areas:
(1) social interaction,
(1) social interaction, and
(2) communication, and
(3) flexible, adaptive behavior
(2) preoccupation with
idiosyncratic topics
Note:
No marked delays in
language
No marked deficits in
intellectual or adaptive
functioning
Language Characteristics of Children with Asperger’s Disorder
Language and communication
Not aware of social situation when talking
Talks in monologues, comments on own actions, or talks to self
Shows deviant modulation (e.g., monotonous)
or articulation (e.g., over-exact)
Gets off-topic or derailed when talking
Pedantic or long-winded speech
Verbosity or “endless talking”
Obsessive questioning, frequently debates with others, argumentative
Precocious, “know-it-all”
Neologisms (i.e., makes up or uses unusual words or phrases)
Common speech problems (e.g., stutters, lisps)
Echolalia (i.e., repeating words of phrases)
Percentage
68%
56%
54%
33%
30%
28%
26%
21%
21%
21%
19%
Speech characteristics of 43 children and adolescents initially seen by Hans Asperger
and colleagues. Based on Hippler and Klicpera (2003).
Pervasive Developmental DisordersNot Otherwise Specified (PDD-NOS)
Used when children display severe and pervasive impairment in social
interactions, communication skills, or stereotyped interests and behaviors, but
do not meet full diagnostic criteria for any other pervasive developmental
disorder
Examples:
Childhood-onset autism
Residual autism
Children with features of autism, but not enough to meet diagnostic criteria
Autism Spectrum:
• Autistic Disorder
• Asperger’s Disorder
• PDD-NOS
Associated Features
Mental Retardation
Anxiety & Depression
ADHD
Tics & Tourette’s Disorder
Tics:
sudden, rapid, and recurrent motor movements or
vocalizations that that are beyond the individual’s control
Tourette’s Disorder:
a psychological condition characterized by the presence of multiple
motor tics and at least one vocal tic
Prevalence (per 10,000)
25
20
15
10
5
0
Autism
Asperger
Rett's
CDD
PDD-NOS
Pervasive Developmental Disorder
Prevalence of pervasive developmental disorders in the general
population. Most data indicate that autism spectrum disorders affect
3.6 per 1000 youth. However, recent data indicate that the prevalence
of autism spectrum disorders may be as high as 6.6 per 1000 youth.
Based on Centers for Disease Control (2007) and Fombonne (2005).
35%
30%
Percent (%)
25%
20%
15%
10%
5%
0%
Lives
Independently
Has Friends
Married
Attended
College
Employed
Adult Outcome
Adult outcomes of people with autism. Most individuals with
autism have problems in social functioning throughout life. Based on
Howlin (2005).
Etiology
Genetics:
MZ concordance 31%-91%
DZ concordance 5% or less
The Autism Genome Project has identified 19 different genes that likely play
roles in the development of autism spectrum disorders
Etiology
Biological causes:
• Enlarged brain volume
• Atypical brain density
• Hypoactivity of amygdala
• Hypoactivity of right fusiform gyrus
• Deficits in executive functioning (esp. orbital & medial prefrontal cortex)
Baron-Cohen (2005) suggests that children with autism spectrum disorders
show “social brain” deficits
Etiology
Deficits in social cognition:
Children later diagnosed with autism show early social deficits
• Problems with joint attention might affect social and language development.
• Problems with social orientation might affect children’s understanding of
social situations and processing others’ emotions
• Delays in symbolic (pretend) play might underlie children’s problems
understanding others and responding empathically
Problems with social orientation. Researchers tracked the gaze
of individuals without autism (black) and people with autism
(white) as they watched films of social interactions. People without
autism attended to actors’ eyes and the objects of joint attention.
People with autism attended primarily to inanimate objects in the
room and often missed important aspects of the social interaction.
Percent (%) Who Passed False Belief Task
100%
75%
50%
25%
0%
No diagnosis
Down syndrome
Autism
Child's Diagnosis
Children with autism often fail the false-belief task, but healthy children and
children with Down syndrome usually pass this task. These results indicate that
children with autism have problems with theory of mind, that is, understanding the
intentions and motives of others. Based on Baron-Cohen and colleagues (1985).
A developmental model for autism. In this general model, individuals show genetic risk for
the disorder which can lead to structural and/or functional differences in the developing brain.
Brain abnormalities, in turn, can lead to problems in the development of social cognition
during infancy. Social cognitive abnormalities also affect developing brain structure. By early
childhood, deficits are severe enough to merit the diagnosis of autism.
Treatment: Early Intensive Behavioral Intervention (EIBI)
• Focuses on children’s overt behavior
• Practitioners use learning theory to guide treatment
• Therapists structure the environment to maximize learning
• The main technique is discrete trial training
A behavior is selected by the therapist
The behavior is broken down into component parts
Each part is introduced, modeled, and practiced
Therapist liberally reinforces successful execution of behavior
Therapist initially provide prompts; later, prompts are faded
Later skills build upon early skills
Treatment: Pivotal response Training
• A home-based behavioral intervention designed to increase the motivation
and self-regulation skills of children with autism
• Learning is directed by the child and occurs in naturalistic settings
• Parents act as primary therapists for their children
• Child is taught to ask questions to increase his/her motivation to learn
• Therapy specifically targets children’s self-management skills
• Parents reinforce children for attempts at executing behaviors, not only on
successful behavioral completion
Treatment: Treatment and Education of Autistic and related
Communication-handicapped Children (TEACCH)
• A classroom-based intervention program that relies heavily on observational
learning, prompts, and operant conditioning to improve children’s behavioral
and communicative skills
• The primary technique is structured teaching; tasks are broken down and
scaffolded by teachers/therapists so that children can successfully complete
them
• Therapy techniques used in the classroom are also taught to parents; one
therapist works with the child and one therapist serves as a parent consultant
Treatment: Academic Inclusion
• Children with autism spectrum disorders are entitled to a free appropriate
public education and academic accommodations according to IDEA (2004)
• Academic inclusion is based on the notion that children with developmental
disabilities can benefit from interactions with other typically developing
children
• For academic inclusion to be beneficial, typically-developing classmates
need to be systematically taught how to interact with a classmate with autism
• The main criticism of academic inclusions is that it is technically not a
treatment approach; it simply refers to the setting in which treatment takes
place
Treatment: Interventions with limited empirical support
Why might parents select a treatment with limited empirical support?
1.
Many parents are not aware of the empirical data regarding the
treatment for autism. Consequently, most parents might rely on
advice from therapists, paraprofessionals, or well-meaning friends—
advice that might not be empirically based.
2.
Many parents have tried one of the more traditional approaches to
treatment and have meet with limited success.
3.
High-quality and empirically supported treatments for autism are
unavailable to many families