Karen L. Weigle, Ph.D.
M. Alyce Besnon, LCSW

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4.4 per 10,000 from 1966 to 1991
12.7 per 10,000 from 1992 to 2001
(Fombonne, 2003)
7.1 per 10,000 individuals under 18 years of age (Williams et al., 2006)
Currently estimated 1 in 68 individuals
5 times more common among boys (1 in 54) than among girls (1 in 252).

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Autism Spectrum Disorders represent a continuum of complex developmental disabilities that are present at an early age.
• Asperger’s Disorder
• Pervasive Developmental Disorder
• Autistic Disorder
• Childhood Disintegrative Disorder
• Rett’s Disorder

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Research has shown that a diagnosis of autism at age 2 can be reliable, valid, and stable.
More children are being diagnosed at earlier ages—a growing number (18%) of them by age 3.
Studies have shown that parents of children with ASDs notice a developmental problem before their child's first birthday.

I. A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and
(C)
(A) Qualitative impairment in social interactions
(B) Qualitative impairments in communication
(C) Restricted repetitive and stereotyped patterns of behavior, interests, and activities
II. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play

Must meet criteria A, B, C, and D:
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.
2.
Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated verbal 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.
3.
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.

B.
Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1.
Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2.
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (such as extreme distress at small changes, difficulties with transitions, rigid thinking patterns).
3.
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).
4.
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).

C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

Severity Level for
ASD
Level 3
‘Requiring very substantial support’
Level 2
‘Requiring substantial support’
Level 1
‘Requiring support’
Social
Communication
Restricted interests & repetitive behaviors
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others.
Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.
RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest.
Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.
Rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.

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Studies have generally failed to demonstrate a clear distinction between Asperger’s and autism
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Genetic studies have indicated that it is better to consider autism as a spectrum ranging from persons with severe autism, at its extreme, to very non-autistic persons at its opposite, than a group of autistic subtypes
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It is more advantageous to employ a single category of ASD than to employ individual autistic subtypes in treatments

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Developmental milestones, especially language
Sometimes regression
Medical illnesses
Sensory differences
Typical social interactions
Family history
Intellectual functioning

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Eye contact:
◦ Is there any?
◦ Is it integrated with other communicative attempts?
◦ Does the person attend and respond to yours?

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“Mind-blindness” and lack of “thinking about thinking”
---------- Confusion around social interactions
---------- Lack of “Theory of Mind”
---------- Emotional dysregulation
---------- Need For Sameness
----------- Anxiety
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Sensory dysregulation
---------- Difficulties with attention
---------- Anxiety

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Establishing a Predictable Environment
◦ Schedules and Other Visual Supports
◦ Consistent Routines
◦ Advanced preparation for changes
◦ Greater predictability and preparation leads to less anxiety
◦ Greater ambiguity leads to more impulsive behavior

AFTERNOON ROUTINE
Picked up by Granny
Eat Snack
Activity of choice (video game, watch cousins play)
Homework
Activity of choice (video game, watch cousins play)
Dinner with mom
Go home
Bath (if needed as determined by mom)
Put on deodorant
Pajamas
Brush teeth
Activity of choice
Go to bed
COMPLETED

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Visual Prompts
◦ Verbal comprehension delays complicate communication
◦ Many people with developmental disabilities learn better visually
◦ Visual reminders are still present after the verbal reminder is forgotten
◦ Examples: Post It notes, pictures, charts, schedules, and calendars.

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Social skill apps on iPads and Androids www.autismspeaks.org/autism-app for ideas of good apps
Role play
Video self modeling
◦ Easy to record with iPads and phones
Social skills groups
Autism Talk TV at www.wrongplanet.net

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About 4 times more likely to develop a
“clinically significant disturbance”.
Bradley et al. (2004)

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75% children with autism functioning in mentally impaired range; now felt to be 50%
Epilepsy: Children 7-14%; Adults 20-35%
Less than 10% have tuberous sclerosis, fragile X syndrome, PKU, congenital rubella syndrome
Developmental regression 25-30% children age
15-21 months
Unspecified increase in constipation
Sleep Disturbance

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74% prevalence of comorbid and often multiple comorbid psychiatric diagnoses in 9- to 16-yearold subjects
44% Behavioral disorders
42% Anxiety disorders
26% Tic disorders
Matilla et. al.

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These diagnoses are determined by behavioral departures from the person’s typical behavior and profile of skills
These disorders often occur at elevated rates in relatives
Differential diagnosis should always include a thorough medical evaluation to rule out any physiological or physical basis for alternations in behavior patterns in persons who cannot reliably self-report internal states

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Depression can be observed by changes in affect
Increased irritability, agitation, destructive or aggressive behavior
Increased rate of stereotypies or ritualistic/ repetitive behaviors
Diminished interest in preferred activities
Changes in weight
Changes in sleep
Psychomotor agitation or retardation

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Fatigue
Negative self-statements (for persons with mild/moderate impairments)
Diminished ability to concentrate
Recurrent thoughts of death or suicidal ideation (in persons with mild to moderate impairments)

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Mood during manic episode may alternate between elated and irritable
Number of symptoms of mania required for diagnosis are fewer, depending on level of expressive language and ID: for those with mild to moderate impairments, 3 or more symptoms; for those with more limited expressive language skills, 2 or more symptoms
◦ Inflated self esteem, grandiosity
◦ Decreased need for sleep

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Symptoms of mania continued
◦ More talkative or pressured speech
◦ Flight of ideas or subjective experience of racing thoughts
◦ Distractibility
◦ Increase in goal-directed activity, physical activity
◦ Excessive involvement in pleasurable activities that have a high potential for painful consequences
(often sexual in nature)

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There are no differences in descriptions for persons with mild to moderate ASD/ID who can express internal states and experiences; however, this is almost always difficult for most persons with ASD
Observable “signs” of Anxiety include:
◦ Palpitations, pounding heart, accelerated heart rate
◦ Sweating, chills, hot flushes
◦ Trembling or shaking
◦ Increased breathing rate

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Panic is a discrete period of observed intense fear or discomfort
Panic symptoms develop abruptly and reach peak within 10 minutes
Panic may result in the following:
◦ Irritability
◦ Aggression
◦ Destructive behavior
◦ Lashing limbs or head banging

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The differences in diagnostic information regarding Tic Disorders for people with ASD,
ID, and difficulty with expressive language, are outlined in the next slides
Information is from the DM-ID: A Clinical
Guide for Diagnosis of Mental Disorders in
Persons with Intellectual Disabilities (2007)

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In Persons with Mild to Moderate ID/ASD may be described as a tingle, cramp, “funny feeling” and are associated with an urge to move that is relieved with the behavior
In Persons with Severe to Profound ID/ASD can be mannerisms and other repetitive behaviors associated with simple motor tics

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In Persons with Mild to Moderate ASD/ID
◦ complex tics overlap stereotypies, compulsions, and other repetitive movements.
◦ Obsessions are usually lacking.
◦ SIB is high frequency, low intensity
◦ When SIB is more severe, commonly associated with more severe tics

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In Persons with Severe to Profound ASD/ID
◦ often explosive aggressive behaviors or SIB in the presence of motor tics
◦ Waxing/waning course of target behaviors

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In Persons with Mild to Moderate ASD/ID
◦ Abrupt or explosive vocalizations
◦ Exacerbation with distress
◦ Repetitive words or phrases: echolalia or pallilalia
(repeating end of ones sentences)
◦ Coprolalia (intrusive words without intensive affective response)
◦ Continuous complex tics (humming)

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In Persons with Severe to Profound ASD/ID
◦ Explosive vocalizations, exacerbated by stress
◦ Imitative behaviors, like echolalia
◦ Waxing/waning of behaviors often parallel flare up in motor tics

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In Persons with Mild to Moderate ASD/ID
◦ Reports of discomfort preceding tics
◦ Improvement with motor action
◦ Precede self-injurious behavior
◦ Complex tics or compulsive behavior
◦ Do not meet criteria for OCD

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In Persons with Severe to Profound ASD/ID
◦ Difficult to distinguish from stereotypies without subjective reports
◦ Rule out akathisia and restless legs syndrome

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Behavioral and Cognitive-Behavioral
Intervention for persons who are verbal and have anxiety, mood disorder, panic (e.g., cognitive restructuring, graduated exposure)
Habit reversal for tics

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Applied Behavior Analysis (ABA)-Lovaas 1977
Autism/Pervasive Developmental Disorders
Clinical Guideline Development Panel: http://www.health.state.ny.us/community/infa nts_children/early_intervention/autism
National Research Council (2001)

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Social Skills Training
--Social stories: promotes social skill development by story telling with a focus upon social situations and appropriate responses
--Social skills groups: practice in safe environment
--Circle of friends: focuses upon inclusion in groups, maps of friends, mentors to teach basic skills. See O.A.S.I.S. website.
Adapted from Sicile-Kira (2004)

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Picture Exchange Communication System
(PECS)
Progressively uses pictures and sequences of pictures to communicate needs and desires without prompting. Can be used to teach basic concepts (numbers, colors, making choices, following instructions, etc.) www.pecs.com
Adapted from Sicile-Kira (2004)

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Rapid Prompting Method (RPM)
A teaching method using various forms of prompts (verbal, visual, tactile) to solicit a response and keep person focused. Most helpful with people who are non-verbal or lacking in conversational skills. (Soma
Mukhopadhyay) www.halo-soma.org
Adapted from Sicile-Kira (2004)

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Sensory Integration (SI)
Typically implemented by Occupational
Therapists who focus upon processing and the use of sensory information. Certification available.
www.home.earthlink.net/-sensoryint/
Adapted from Sicile-Kira (2004)

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Atypical Antipsychotics (Abilify, Risperidone,
Olanzapine, Clozapine) for temper, aggression, SIB
SSRIs (Sertraline, Citalopram, Fluoxetine) for anxiety and repetitive behaviors
Psychostimulants (Methylphenidate, Vyvanse,
Adderall) for hyperactivity

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Gluten Free/Casein Free (GFCF) Diet-gluten allergies
Anti-Yeast (or Antifungal) Diet-overgrowth of yeast
The Feingold Diet-focuses upon removing artificial colorings and preservatives
The Ketogenic Diet-used to treat seizures
Taken from Sicile-Kira (2004)

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Vitamin B6 & Magnesium (not harmful)-some studies show benefits with improved eye contact, improved language, reduced selfstimulatory behavior, reduced aggression, and reduced self-injurious behavior.
www.autismresearchinstitute.com
Adapted from Sicile-Kira (2004)

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Fatty Acids-increase Omega fats, cod-liver oil.
Sulphate Ions- People with ASD thought to have abnormally low sulphate levels. Add magnesium sulfate (Epsom salts) to bathwater to improve absorption.
Enzymes-People with ASD thought to have trouble with low levels of stomach (peptidase) enzymes
Adapted from Sicile-Kira (2004)

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Aquatic Therapy can focus on:
--Therapeutic play-based functional movement
--Improving range of motion
--helping to facilitate neurodevelopment growth
--Improved body awareness
--Increased balance
--Sensory integration
--Mobility skills
--Cardiovascular fitness
--Fun

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Daily Life Therapy-focus upon physical education as a bridge to social development
Speech Therapy-focus on expressive and receptive language delays and pragmatic language
Occupational Therapy-focus on everyday goals and sensory problems
Adapted from Sicile-Kira (2004
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Music Therapy-can be used to increase interaction with people who are nonverbal, explore and express feelings, be creative and spontaneous
Assistive Technology & Computer Programsimprove functional capabilities
Adapted from Sicile-Kira (2004
)

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Treatment and Education of Autistic and
Related Communication handicapped
CHildren (TEACCH)-available in North
Carolina
Provides “Structured Teaching” using visual processing (due to difficulties with verbal processing) to help autistic children understand expectations

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Assesses social characteristics in pre-arranged environment: proximity, object/body use, social imitation, social response, interfering behavior, adaptation to change
Assessed in five social contexts: structured time, leisure time, travel, meal time, meeting others
Treatment: Arranging the environment to increase the best possible chance of realizing their full potential
Aaron & Gittens (1992); Olley (1986); Greenway
(2000)

“Eighty percent of adults with Asperger’s
Syndrome do not have full-time work. This (is) not because they can’t do the work.
It’s that they can’t manage to be socially acceptable while they get the work done.” http://blog.penelopetrunk.com/2009/10/2 ... -meetings/

“ Research in 2001 by the U.K.’s National
Autistic Society indicated that only 12% of those of with high-functioning autism or
Asperger’s Syndrome had full-time jobs.
In contrast, 49% of people with other disabilities, and 81% of people who are not disabled were in employment.
”
-Daniel Tammet in “Born on a Blue Day”

The lifetime cost of caring for just one individual with autism can be as high as $2.4 million

-John Elder Robison in “Jerry Seinfeld and Autism”

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Asperger’s Syndrome: An Owner’s Manual 2 for Older
Adolescents and Adults. Ellen S. Heller Korin, M.Ed.
Autism Asperger Publishing Co., 2007.
The Procrastination Workbook. William Knaus, Ed.D.
New Harbinger Publications, Inc., 2002.
Thinking Connections: Learning to Think & Thinking to Learn. David N. Perkins, Heidi Goodrich, Shari
Tishman, & Jull Mirman Owen. Addison-Wesley
Publishing Co., 1994.
The Way I See It: A Personal Look at Autism and
Asperger’s. Temple Grandin. Future Horizons, Inc.

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 http://store.fhautism.com
Movie: Temple Grandin. HBO Films.
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Syndrome. http://www.tonyattwood.com.au
American Psychiatric Association (2000).
Diagnostic and Statistical Manual of Mental th ed., Text Revision). Washington, DC:
Author.
www.aspergerfoundation.org.uk/infosheets/ta_girl s.pdf
Fletcher, R., Loschen, E., Stavrakaki, C., & First, M.

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Asperger’s Syndrome Education Network
(ASPEN)-www.aspennj.org
Tony Attwood-www.tonyattwood.com.au
Autism-Europe-www.autismeurope.org
Autism Network International (ANI)http://ani.autistics.rog/
Autism Research Institute (ARI)www.autismresearchinstitute.com
Autism Society of America (ASA)www.autismsociety.org

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Center for the Study of Autism (CSA)www.autism.org
Cure Autism Now Foundation (CAN)www.canfoundation.org
Families for Early Autism Treatment (FEAT)www.feat.org
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Interactive Autism Network www.iancommunity.org
National Alliance for Autism Research (NAAR)www.naar.org

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National Autism Organization (NAO)www.naionalautismassociaion.org
National Autism Society (NAS)www.nas.org.uk/
O.A.S.I.S. (Online Asperger Syndrome
Information and Support)www.udel.edu/bkirby/asperger/
Organization for Autism Research (OAR)www.researchautism.org/
Safe Minds-www.safeminds.org

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Schafer Autism Report-www.sarnet.org
Talk About Curing Autism (TACA)www.tacanow.com
University Students with Autism and
Asperger’s Syndromewww.users.dircon.co.uk/-cns
World Autism Organization (WAO)www.worldautism.org
The Complete Guide to Asperger’s Syndrome by Tony Attwood (2007)

1400 McCallie, Suite 100
Chattanooga, TN 37404
423-531-6961 chattanoogaautismcenter.org

Karen L. Weigle, PhD
Licensed Clinical Psychologist, HSP kweigle@gmail.com
M. Alyce Benson, MSSW
Licensed Clinical Social Worker
423-531-6961 abensonsocialworker@gmail.com