Autism Spectrum
Disorders (ASD)
Cara Kimberg, M.S.
What is Autism?
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Four ways to “define” autism
DSM-IV
 Parents with a child with autism
 Individuals with autism
 What we know (i.e. stereotypes of autism)
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Let’s take a look at each one to get a more
comprehensive idea of this disorder
DSM-IV criteria
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First, important to note that autism is a spectrum
disorder characterized by:
Impairments in social interaction
 Impairments in communication
 Presence of restricted, repetitive behaviors (RRBs)
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Spectrum = variability within and across these
areas
1 in 150 children diagnosed with autism includes
the entire spectrum
DSM-IV criteria (continued)
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Umbrella term is really Pervasive Developmental
Disorders (PDD)
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5 different subtypes of PDD
Autistic Disorder
 Asperger’s Disorder
 PDD-NOS
 Rhett’s Disorder
 Childhood Disintegrative Disorder
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Autism
Spectrum
Disorders
Rhett’s Disorder (299.80)
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(A) All of the following:
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apparently normal prenatal and perinatal development
apparently normal psychomotor development through the first 5
months after birth
normal head circumference at birth
(B) Onset of all of the following after the period of normal
development:
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deceleration of head growth between ages 5 and 48 months
loss of previously acquired purposeful hand skills between ages 5 and 30
months with the subsequent development of stereotyped hand
movements (e.g., hand-wringing or hand washing)
loss of social engagement early in the course (although often social
interaction develops later)
appearance of poorly coordinated gait or trunk movements
severely impaired expressive and receptive language development with
severe psychomotor retardation
Facts about Rhett’s Disorder
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Complex neurological disorder
Genetic in origin
Primarily in girls
Present at birth but more apparent during second year
Second most common cause of severe learning
disability in girls
1:10,000 to 1:23, 000 diagnosed
Period of temporary regression including loss of
communication skills, and purposeful hand movements
Childhood Disintegrative Disorder (299.10)
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(A) Apparently normal development for at least the first 2 years after
birth as manifested by the presence of age-appropriate verbal and
nonverbal communication, social relationships, play, and adaptive
behavior.
(B) Clinically significant loss of previously acquired skills (before age 10
years) in at least two of the following areas:
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(C) Abnormalities of functioning in at least two of the following areas:
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expressive or receptive language
social skills or adaptive behavior
bowel or bladder control
play
motor skills
qualitative impairment in social interaction (e.g., impairment in
nonverbal behaviors, failure to develop peer relationships, lack of social
or emotional reciprocity)
qualitative impairments in communication (e.g., delay or lack of spoken
language, inability to initiate or sustain a conversation, stereotyped and
repetitive use of language, lack of varied make-believe play)
restricted, repetitive, and stereotyped patterns of behavior, interests, and
activities, including motor stereotypies and mannerisms
(D) The disturbance is not better accounted for by another specific
Pervasive Developmental Disorder or by Schizophrenia.
Facts about Childhood
Disintegrative Disorder
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Child regresses from age 2-10 (debated) in terms
of language skills, social behavior, and all
developmental motor skills
Can occur abruptly or over a longer period of
time
Sometimes child is aware of their loss of skills
No cure
Autistic Disorder (299.0)
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(A) total of six (or more) items from (1), (2), and (3), with at
least two from (1), and one each from (2) and (3):
1)qualitative impairment in social interaction, as manifested by
at least two of the following:
 (a) marked impairment in the use of multiple nonverbal
behaviors such as eye-to-eye gaze, facial expression, body
postures, and gestures to regulate social interaction
 (b) failure to develop peer relationships appropriate to
developmental level
 (c) a lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people (e.g., by a lack of
showing, bringing, or pointing out objects of interest)
 (d) lack of social or emotional reciprocity
Autistic Disorder
(2) qualitative impairments in communication as manifested by at
least one of the following:
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(a) delay in, or total lack of, the development of spoken language
(not accompanied by an attempt to compensate through
alternative modes of communication such as gestures or mime)
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(b) in individuals with adequate speech, marked impairment in
the ability to initiate or sustain a conversation with others
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(c) stereotyped and repetitive use of language or idiosyncratic
language
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(d) lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level
Autistic Disorder
(3)restricted repetitive and stereotyped patterns of behavior,
interests, and activities, as manifested by at least one of the
following:
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(a) encompassing preoccupation with one or more stereotyped
patterns of interest that is abnormal either in intensity or focus
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(b) apparently inflexible adherence to specific, nonfunctional
routines or rituals
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(c) stereotyped and repetitive motor mannerisms (e.g., hand or
finger flapping or twisting, or complex whole-body movements)
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(d) persistent preoccupation with parts of objects
Autistic Disorder
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(B) Delays or abnormal functioning in at least
one of the following areas, with onset prior to
age 3 years: (1) social interaction, (2) language as
used in social communication, or (3) symbolic or
imaginative play.
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(C) The disturbance is not better accounted for
by Rett's Disorder or Childhood Disintegrative
Disorder.
Asperger’s Disorder (299.80)
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(A) Qualitative impairment in social interaction, as
manifested by at least two of the following:
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marked impairment in the use of multiple nonverbal behaviors such as
eye-to-eye gaze, facial expression, body postures, and gestures to
regulate social interaction
failure to develop peer relationships appropriate to developmental level
a lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing, or
pointing out objects of interest to other people)
lack of social or emotional reciprocity.
(B) Restricted repetitive and stereotyped patterns of behavior,
interests, and activities, as manifested by at least one of the
following:
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encompassing preoccupation with one or more stereotyped and
restricted patterns of interest that is abnormal either in intensity or
focus
apparently inflexible adherence to specific, non-functional routines or
rituals
stereotyped and repetitive motor mannerisms (e.g., hand or finger
flapping or twisting, or complex whole-body movements)
persistent preoccupation with parts of objects
Asperger’s Disorder
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(C) The disturbance causes clinically significant impairment
in social, occupational, or other important areas of
functioning.
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(D) There is no clinically significant general delay in language
(e.g., single words used by age 2 years, communicative phrases
used by age 3 years)
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(E) There is no clinically significant delay in cognitive
development or in the development of age-appropriate selfhelp skills, adaptive behavior (other than in social interaction),
and curiosity about the environment in childhood.
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(F) Criteria are not met for another specific Pervasive
Developmental Disorder or Schizophrenia.
Pervasive Developmental Disorder-NOS
(299.80)
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This category should be used when there is a severe
and pervasive impairment in the development of
reciprocal social interaction or verbal and nonverbal
communication skills, or when stereotyped behavior,
interests, and activities are present, but the criteria are
not met for a specific Pervasive Developmental
Disorder, Schizophrenia, Schizotypal Personality
Disorder, or Avoidant Personality Disorder. For
example, this category includes atypical autism --presentations that do not meet the criteria for Autistic
Disorder because of late age of onset, atypical
symptomatology, or subthreshold symptomatology, or
all of these.
Parents of children with ASD
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http://www.autismspeaks.org/sponsoredevents
/autism_every_day.php
Impact on the family
Social
 Financial
 Everyday routines
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Variable experiences based on an individual child
and his/her strengths and weaknesses
Anecdotal Stories
(www.Autismspeaks. org)
Individuals with Autism
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http://www.autismspeaks.org/video/index.php
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How people with autism see the world
Life of Adults with Autism
Temple Grandin “Autism the way I see it”
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Different types of thinking in autism
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1.Visual thinking - Thinking in Pictures, like mine
2. Music and Math thinking
3. Verbal logic thinking
Play to strengths to be most effective
http://autisticsavant.blogspot.com/2007_05_27_archiv
e.html
Story from a Teenager with ASD
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“The characteristics of people with Asperger's are the perfect ones to make
obtaining friends difficult. Asperger's Syndrome is part of a spectrum of
autistic disorders, all linked by a level of non-communication. At the lowest
level, we have cases like my brother Eric, a person trapped in a void where
communication is only at the most rudimentary level, about the level of a nonexpressive two or three year old. Then among several forms at the highest level,
we have Asperger's syndrome. Those with Asperger's often suffer from a
plethora of symptoms. The most prominent ones are difficulty with reading
people's body language, a singular interest in a subject or several subjects (from
my own life, I have one major interest in rock music, compulsively looking for
new reviews and obsessing over the best quality of sound to listen to them), a
slight monotone voice, struggling with proper body distance, and a tendency to
use a vocabulary that is of a slightly higher sophistication than most people
would use such as when I employ words like vitriolic, inundate, smorgasbord,
plethora, paraphernalia, and others of that variety. While obviously every
person with the syndrome may not experience each and every single trait, I
have experienced all of these symptoms to some degree. Couple that with a
fairly shy personality, a shyness that may or may not have anything to do with
Asperger's Syndrome, and I am often left feeling like everyone sees me as being
quiet and not worth talking to.”
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(Autismspeaks.org)
Stereotypes about ASD
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Head banging
Hand flapping
Non-communicative
Non-verbal
“own world”
How is Autism Diagnosed?
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Autism Diagnostic Observation Schedule (ADOS; Lord
et al)
Autism Diagnostic Interview-Revised (ADI-R; Rutter et
al)
Social Communication Questionnaire (SCQ; Rutter et
al)
Childhood Autism Rating Scale (CARS; Schopler et al)
Clinical judgment plays a HUGE role
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What are the dangers of this?
Potential differential diagnoses (type of
language/communication disorder, OCD, anxiety disorder)
Benefits of Early Diagnosis
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Treatment and intervention effectiveness
Skill acquisition
exposure
Types of Treatments/Interventions
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Interpersonal Relationship Intervnetions and
Treatments
Skill-Based Interventions and Treatment
Cognitive Interventions and Treatment
Physiological/Biological/Neurological
Interventions and Treatment
Other Interventions, Treatments and Related
Agents
Interpersonal Relationship
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Social-affective interpretation of ASD
Need for people with ASD to express
attachments to others appropriately
Seek to facilitate affect, attachment, bonding,
sense of relatedness
Holding Therapy (not recommended)
 Developmental, Individual-Difference Relationship
Based Model (Floortime; www.icdl.com)
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Skill-Based
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Most common methods used by schools
Intent is to develop and support functional
demonstration of specific skills rather than to facilitate
bonding
Target specific skills to teach to improve functioning in
specific areas
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Picture Exchange Communication System (PECS)
Facilitated Communication (not recommended)
Assistive Technology
Applied Behavior Analysis (Scientifically Based Practice)
TEACCH
Cognitive
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Teaching individuals with ASD to monitor their
own behavior and performance
Shift control from others to the individuals
Connection between thoughts, feelings and
behavior
Social Stories
 Social Decision Making Strategies
 LEAP (Scientifically Based Practice)
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Physiological/Biological/Neurological
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Address the neurological dysfunctions or problems
thought to exist at the core of ASD
Alter way in which neurological system processes
information, the manner in which information is
received, chemistry and processes associated with
sensations, perceptions and emotions
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Irlen Lenses (limited support)
Sensory integration (promising practice)
Auditory Integration Training (limited support)
Pharmacology (promising practice)
Others
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Mercury: Vaccinations and Autism (limited
support)
Gluten-Casein Intolerance (limited support)
Music therapy (limited support)
Controversies with Treatments
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Limited scientific support
Treatments as a “cure”
Decisions regarding financial resources
Where does research money go?
Autism is all over the news
Community Resources
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Center for Autism and Related Disabilities