Elizabeth Akey, PhD, HSPP
Patsy Hoyer, CFNP
Lafayette Medical Education Foundation CME
May 23, 2012

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Elizabeth Akey, PhD, HSPP 5/23/12

 Estimates are rising rapidly
 1 in 89 children (CDC; 2012)
 2002: 1:150
 2011: 1:110
 1 in 100 adults (Brugha et al., 2011)
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Elizabeth Akey, PhD, HSPP 5/23/12

 Autism
 Asperger’s Disorder
 Pervasive Developmental Disorder NOS
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Elizabeth Akey, PhD, HSPP 5/23/12

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Elizabeth Akey, PhD, HSPP 5/23/12

 Qualitative impairment in social behavior and communication
 Qualitative impairment in interests and activities
 Present since very early childhood
 Causing significant impairment in daily functioning
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Elizabeth Akey, PhD, HSPP 5/23/12

Autism
• Limited functional language
• Severely restricted interests
• Little social reciprocity
• IQ<70
PDD NOS
• Adequate language; weak pragmatics
• Restricted interests
• Limited social reciprocity
• IQ variable
Asperger’s
• Adequate language; weak pragmatics
• Restricted interests
• Limited social reciprocity
• IQ average or high
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Elizabeth Akey, PhD, HSPP 5/23/12

Autism Spectrum Disorders defy generalization
Measured IQ
Social Interaction
Severe
Aloof
Communication
Motor Skills
Fine Motor
Gross Motor
Nonverbal
Uncoordinated
Awkward
Sensory Hyposensitive
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S. Andrews, GLASS. Used with permission
Elizabeth Akey, PhD, HSPP 5/23/12
Passive
Gifted
Active but odd
Verbal
Coordinated
Agile
Hypersensitive

Billstedt, Gillberg, & Gillberg (2005), follow up of 120 individuals with autism and atypical autism, childhood diagnosis in early 80’s, to adulthood 13- 22 yrs later
◦
Older, restrictive definition of autism
OUTCOME
Good
Fair
Restricted but acceptable
Poor
Very poor
%
0
8
13
57
22
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Elizabeth Akey, PhD, HSPP 5/23/12

 Students with disabilities more likely to pursue 2-year degrees than 4-year degrees and more likely to drop out without completing
 National Center on Educational Statistics, 1999
Students leaving college within 1 st two years
National average
Students identifying with disabilities
Students identifying with learning disabilities
1/3
1/2
2/3
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Elizabeth Akey, PhD, HSPP 5/23/12

 Limited give-and-take
 Awkward pauses or breaks in conversation
 Little emotional response
 Unusual gestures or posture
 Fixation on details
 Rigid adherence to routines or instructions
 May not come for treatment until symptoms are quite serious or painful
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Elizabeth Akey, PhD, HSPP 5/23/12

 Challenging, critical, or unusually blunt responses
 Not hostile
 Unusual sensory reactions
 Unexpected inflexibility
 Inability to keep a job despite high intelligence
 Few friends or social activities
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Elizabeth Akey, PhD, HSPP 5/23/12

Behavioral health concerns
 Mood disorders
 Depression
 Bipolar I or II
 NOS
 Anxiety
 Inattention
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Elizabeth Akey, PhD, HSPP 5/23/12
Comorbidity estimates
 50% by adolescence
 85%
 60%

A: Dealing with the question of diagnosis
B: Managing in the office
C. Treating comorbid disorders and symptoms
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Elizabeth Akey, PhD, HSPP 5/23/12

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Elizabeth Akey, PhD, HSPP 5/23/12

 Transfer of care from pediatricians may occur at later ages than typical
 Gather all available information
 Cognitive functioning, verbal ability, medical history
 Caregiver report on behavior and any sensory issues
 Agencies or organizations involved in person’s care
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Elizabeth Akey, PhD, HSPP 5/23/12

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• Understand the context
Birth to 17y11m
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

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Parents hold legal responsibility
Free and appropriate education through public schools
GLASS (Tippecanoe
County)
Schools must identify students in need
Parents responsible for financial support
18 +
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Young adult is emancipated
Continuing education is responsibility of student/parents
Vocational Rehabilitation
Services
Students must selfidentify
Possible Social Security or employment
ADA protections
Elizabeth Akey, PhD, HSPP 5/23/12

Context: College
 Young adults must self-identify to college administrators and establish eligibility for supportive services
 Schools are required to provide certain academic accommodations but not social supports
 Young adults must self-identify to each instructor
 Young adults must choose to participate in available programs
Elizabeth Akey, PhD, HSPP 5/23/12

 Notice possible symptoms
 Adapt your interactions to person’s needs and abilities
 Assess severity of impact on functioning
 Decide on level of disclosure
 Refer for ancillary services
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Elizabeth Akey, PhD, HSPP 5/23/12

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Elizabeth Akey, PhD, HSPP 5/23/12

 Structure visit to person’s needs and abilities
 Communicate in short and direct statements
 Tell person what is coming next, and why
 Use visual aids
 Go slowly
 Go gently
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Elizabeth Akey, PhD, HSPP 5/23/12

 Be predictable; keep routines
 Supply information
 Respect patient’s privacy
 Act as consultant, not decision-maker
 Negotiate
 Ignore some behaviors
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Elizabeth Akey, PhD, HSPP 5/23/12

C.
Treating comorbid disorders and symptoms
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Elizabeth Akey, PhD, HSPP 5/23/12

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
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Christian Sarkine Autism Treatment Center, IU School of
Medicine, Dept. of Psychiatry
 HANDS in Autism website http://handsinautism.org/aboutus.html
 Toolkit for Medical Professionals http://www.handsinautism.org/toolkit.html
Allison Morton-Cooper (2004). Health Care and the Autism
Spectrum: A Guide for Health Professionals, Parents and Carers.
Jessica Kingsley Publishers.
IN*SOURCE: Indiana Resource Center for Families with
Special Needs
 www.insource.org
Elizabeth Akey, PhD, HSPP 5/23/12

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Indiana Resource Center for Autism
 http://www.iidc.indiana.edu/index.php?pageId=32/
Autism Speaks
 http://www.autismspeaks.org/family-services/resourcelibrary/adults-autism
Indiana Bureau of Developmental Disability Services,
 District 4, Terre Haute IN Phone 812-232-3603
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Elizabeth Akey, PhD, HSPP 5/23/12