Introduction to Autism Session One What is Autism Presented by Marc Tardif Social Skills Program Co-ordinator Learning Objectives: After the workshop participants will be able to: Label the disorders which fall under the PDD umbrella Label the three Autism Spectrum Disorders Describe impairments in social interaction, communication, & behaviour The Latest Statistics… 1 in 165 Canadians are affected with ASD Ratio of males to females 4:1 Possible Causes of Autism Genetic: Current research links ASD to biological or neurological differences in the brain Organic: Some research suggests that environmental factors play a part in the expression of ASD DSM IV Diagnostic Criteria At least two impairments in social interaction At least one impairment in communication At least one impairment in restricted or repetitive behaviour A diagnosis requires a total of 6 or more impairments present in total Impairment in Social Interaction Impairment in the use of nonverbal behaviours Failure to develop peer relationships appropriate to age level Lack of spontaneous seeking and sharing Lack of social or emotional reciprocity *requires at least two impairments from this category Impairments in Communication Delay or total lack of the development of spoken language In individuals with adequate speech, marked impairment in ability to initiate or sustain conversation Stereotyped, repetitive use of language or idiosyncratic language Lack of make-believe play or social imitative play *requires at least one impairment from this category Restricted, Repetitive and Stereotyped Patterns of Behaviour Preoccupation with one or more stereotyped and restricted patterns of interest Apparently inflexible adherence to specific, nonfunctional routines or rituals Stereotyped and repetitive motor mannerisms Persistent preoccupation with parts of objects *requires at least one impairment from this category Diagnosis A diagnosis is reached after an assessment is completed by a pediatrician or a psychologist Diagnosis can take place as early as 18 months There is no proven cause or cure for autism (Scientific American Journal, 2000) Pervasive Developmental Disorder CDD Rett’s Syndrome Autism Asperger Syndrome PDDNOS Autism Spectrum Disorders (ASDs) Childhood Disintegrative Disorder Extremely rare: Prevalence rate 1.7/100 000 Typical development until age two Onset usually between 36 – 46 months Significant loss of skills More common in boys than girls 4:1 (Canadian Journal of Psychiatry- In Review) Rett’s Syndrome 1 in 10,000-23,000 Have normal head size at birth and normal development Between 5 – 48 months head growth slows Develop stereotypic hand movements Poor coordination and social withdrawal occurs (Source: Canadian Journal if Psychiatry- In Review) Pervasive Developmental Disorder –Not Otherwise Specified (PDD-NOS) Referred to as “Atypical” autism Do not meet criteria for full autism diagnosis Traditionally seen as a “milder” form of autism Is a diagnosis by exclusion of other disorders in autistic spectrum Screening and assessment is the same as for autism Asperger Syndrome Must have both: 1. Qualitative impairment in social interaction 2. Restricted and repetitive patterns of behaviour, interests and activities No delay in language development, though language development may be peculiar Fail to make connection between thoughts/feelings and behaviour/actions Symptoms may be subtle or even undetected until child is over 3 years of age Facts about Asperger’s Syndrome (AS) First identified by Dr. Hans Asperger in 1944 Approximately 5 out of every 10,000 people 15,000 Canadians More common in boys than girls (4:1) (Autism Society, 2005) Autism Usually manifests itself during the first three years of life Problems with social interactions is the hallmark symptom as people with ASD have problems relating to others The range and intensity of disability varies widely Associated with developmental disability High-functioning Autism (HFA) vs. Asperger’s Syndrome (AS) DSM-IV-TR criteria: History of language delay in HFA but not in AS Intact cognitive functioning in AS but not in HFA (Tsai, 2005) Differences Autism Asperger’s Onset 1-3 years After 3 years Early Language Impaired proficient Motor Skills Developmental level Below developmental level Cognitive Level Often below chronological age At or above chronological age Visual Spatial Skills Strength weakness Verbal Skills Weakness strength Social Pragmatic Aspects of Language Weakness weakness Repetitive Behaviour Actions, objects/physical mannerisms Verbal cognitive mannerisms (Condillac, 2003) Triad of Impairments Social Interaction Language and Communication Restricted, Repetitive Behaviour Social Deficits Lack of reciprocal social interactions Unusual reaction to other’s emotions Lack of joint attention May not seek out the company of peer Avoidance of eye contact Social Interaction Communication Deficits Idiosyncratic use of language Literal interpretation of language Echolalia or delayed echolalia Use of unusual expressions Tend to use third person Difficulty initiating/sustaining a conversation Communication Deficits Thank you MGM. Rain Man Best Picture 1988 Communication Deficits Literal Interpretation http://www.boreme.com/boreme/funny2007/police-helps-kid-p1.php Temple Grandin “During the last couple of years I have become more aware of a kind of electricity that goes on between people. I have observed that when several people are together and having a good time, their speech and language follow a rhythm. They will all laugh together and then talk quietly until the next laughing cycle…” “I have always had a hard time fitting in with this rhythm, and I usually interrupt conversations without realizing my mistake. The problem is that I can’t follow the rhythm.” (Grandin, 1995) Behavioural Deficits Insistence on sameness No real fear of dangers Hand or arm flapping Spins objects Tantrums Inappropriate attachment to objects Uneven gross or fine motor skills Triad + 2 Restricted and Repetitive Behaviours Social Interactions Language and Communication Sensory Anxiety Anxiety and PDD Neurological differences responsible for anxiety coping Anxiety is a subjective response to stimuli Difficulty using “buffers” Behaviours quickly become an anxiety reduction tool Kevin Baskerville (2005) Sensory Issues Children with Autism tend to overreact or under react to sensory input Under react (hyposensitive): don’t respond to small or even moderate amounts of stimulation in the area of their sensitivity (i.e., fail to respond to ordinary speech) Over react (hypersensitive): find small or moderate amount of stimulation overloading or irritating (i.e., speech or television) Sensory Issues Auditory- hearing appears to be selective Visual- attraction or aversion to particular visual stimuli Tactile- attachment to objects may be related to tactile qualities Taste- non-food items are sometimes tasted Smell- sometimes become fixated on the smell of something Sensory Overload Activity Risk Markers ("Red Flags") Social Little or no eye contact Difficulty mixing with other children No functional play but uses objects in a repetitive manner (lining up, stacking) Prefers to be alone May not want to be held or cuddled Risk Markers ("Red Flags") Communication Inappropriate laughing or giggling Echolalia Not responsive to verbal cues Difficulty in expressing needs, failure to use gestures or pointing in place of words Risk Markers ("Red Flags") Behavioural Insistence on sameness, resists change in routine No real fear of danger Toe walking Hand or arm flapping Apparent insensitivity to pain Spins objects Noticeable physical over/under activitiy Tantrums Uneven gross/fine motor skills Autism Speaks Video From : www.autismspeaks.org Please fill out your evaluation forms References Autism Society (2005). 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Jackson, Luke (2002). Freaks, geeks and asperger syndrome. Jessica Kingsley Publishers. London & Philadeplhia Leaf & McEachin (1999). A Work In Progress: Behavior management strategies and a curriculum for intensive behavioural treatment of autism. New York, NY: DRL Books, L.L.C. Metro-Goldwyn-Mayer Studios Inc (1998). Rainman. Best Picture, MGM Studios Inc. Michaels, Alex (2005). Executive functioning. Educational Consultants of New England, Inc. Waltham, MA. Retrieved May 5, 2006 from http://www.stopthatbehaviour.com/i_executive_functioning.html References Ministry of Education Ontario. Special Education Monographs No.4: Students with Autism. April 1990. Retrieved October 19, 2005. http://www.edu.gov.on.ca/eng/general/elemsec/monog4.html Newport, Jerry (2005). The person is more important than the label. Progress Through Partnership. National Autism Conference. State College, Pennsylvania. Notbohm, Ellen. (2005). Ten things Every Child With Autism Wishes You Knew. Arlington, Texas: References Future Horizons Perry A, Condillac R.L (2003). Evidence-based practices for children and adolescents with autism specturm disorders: review of the literature and practice guide. Children’s Mental Health of Ontario. Toronto, Ontario, Retrieved September 15th 2005. Pennsylvania, State College (2005). Progress through partnership, national autism conference. Penn State. Robledo, S.J & Ham-Kucharski, D (2005). The autism book, answers to your most pressing questions. Group Inc. New York. Penguin References Stokes, S. (2001). Structured teaching: Strategies for supporting students with autism? Written under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. http://www.cesa7.k12.wi.us/sped Tidmarsh, Lee & Volkmar, Fred (2003). The canadian journal of psychiatry-in review. Vol 48, No 8, September 2003. Pg. 518, 519 Tsai, Luke. M.D. (2005). Autism spectrum disorder and co-morbid neuorpsychiartric disorders. Progress Through Partnership. National Autism Conference. State College, Pennsylvania. Training & Inservice- Autism Module Complied by Gateway Society World Class Communication Technologies(2004). Souls, beneath and beyond autism. Books That Touch. Winter, Matt (2003). Asperger syndrome, what teachers need to know. Jessica Kingsley Publishers, London & Philadelphia.