+High Incidence
Condition Presentation:
Autism Spectrum
Disorders
Presented by
Benjamin J. Springer
University of Utah
April 08, 2009
Training School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with
Serious Emotional Disturbance/Behavior Disorders
US Office of Education 84.325K
H325K080308
+
Autism Spectrum Disorders
Diagnostic Criteria

Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision (DSM-IV-TR)

299.00 Autistic Disorder falls under the category of Pervasive
Developmental Disorders.

Diagnostic criteria are met for this disorder when a total of
six (or more) items from:
(1) Qualitative Impairment in Social Interaction,
(2) Qualitative Impairments in Communication,
(3) Restricted Repetitive and Stereotyped Patterns of Behavior

The disturbance is not better accounted for by Rett’s Disorder
or Childhood Disintegrative Disorder
+
Autism Spectrum Disorders
Diagnostic Criteria (cont’d)

DSM-IV-TR 299.80 Asperger’s Disorder

Qualitative impairment in social interaction.

Restricted repetitive and stereotyped patterns of behavior.

The disturbance causes clinically significant impairment in
social, occupational, or other important areas of functioning.

There is no clinically significant delay in language.

There is no significant delay in cognitive development.

Criteria are not met for another specific Pervasive
Developmental Disorder or Schizophrenia.
+
Asperger’s & High Functioning Autism:
Is there a difference?

Miller & Ozonoff, (1997) found that the four cases Hans Asperger originally
described would be diagnosed, according to DSM criteria, as having autism,
not Asperger’s syndrome.

Research suggests that the use of early language delay as a differential
criterion between autism and Asperger’s is insufficient, (Eisenmajer, Prior,
Leekam, Wing, Ong, Gould, and Welham, 1998).

Any differences in language ability that are apparent in the pre-school years
between children with autism and Asperger’s has largely disappeared by
early adolescence, (Eisenmajer, Prior, Leekam, Wing, Ong, Gould, and
Welham, 1998; Ozonoff, South and Miller, 2000).

Some general agreement exiists that children with Asperger’s syndrome do
not show conspicuous cognitive delays in early childhood, (Howlin and
Asgharian, 1999).
+
Autism Spectrum Disorders
Special Education Eligibility

The Individuals with Disabilities Education Improvement Act of
2004, (IDEA-04) Regulatory Definitions of Disability Classifcations:
34 C. F. R. § 300.7(c)(2004).





Autism means a developmental disability significantly affecting
verbal and nonverbal communication and social interaction,
generally evident before age 3, that adversely affects a child’s
educational performance.
A child who manifests the characteristics of “autism” after age 3
could be diagnosed as having “autism” if the criteria stated above
are satisfied.
An IDEA evaluation must use a variety of technically sound tools and
strategies that assess the relative contribution of cognitive,
behavioral, physical, and developmental factors.
No single measure is sufficient.
The data generated must include relevant functional, academic, and
developmental information, including information provided by the
parent.
+
The History of Autism, in brief:

Scattered reports of children who apparently had some type of ASD
in the 19th century (Maudsley, 1867)

“Wild Boy of Aveyron”, a feral child discovered by a young
physician named Jean-Marc-Gaspard Itard (Itard, 1801/1962;
Shattuck, 1994).

Formally identified by psychiatrist Leo Kanner in 1943, called it
“early infantile autism.”

Asperger’s Syndrome named after the Austrian pediatrician Hans
Asperger (1944). He called his patients, “little professors.”

In 1967, Bruno Bettleheim theorized that autism resulted from “a
child’s defensive withdrawal from an intellectual, cold-hearted, and
hostile parent.”

Zero support for Bettleheim’s theory (Rutter, 1999).
+
Autism Now: Prevalence

There is not a full population count of all individuals with an
ASD in the United States, however:

The Center for Disease Control and Prevention (CDC)
and the Department of Health and Human Services
provide data indicating approximately 1 in 150
children with an ASD in the U.S.

1 in 500 for autistic disorder (Baird et al. 2001; Bertrand
et al. 2001; Chakbrabarti & Fombonne, 2001).

(Utah Autism Developmental Disabilities Monitoring
(ADDM) Network Project in 2002 reported a total
prevalence of ASDs as 7.5 per 1,000 children)
+
Syndromal vs. Idiopathic Autism


Autism co-occurs with several syndromes at a high rate, thus
the syndromes are considered “causally” related to autism:

Chromosomal Disorders, e.g., Fragile X, 15q duplication, Rett
disorder, del22q11, Ring 20

Tuberous sclerosis; cytomegalovirus; in-utero thalidomide or
valproic acid exposure; inherited metabolic disorders, and
others.
When no such syndrome is present, the autism is considered
idiopathic.
+
Current Genetic Studies

Search for possible genetic markers




Language impairments
Psychiatric Comorbidity
Broader Autism Phenotype (Sub-clinical ASD characteristics
that may run in families).
Utah Autism Research Program


Hillary Coon, Ph. D., William McMahon, M.D., and Mark
Leppert, Ph. D.
Utilizes Utah’s genealogy resources to create extended
pedigrees.
+
Brain Studies

No clear pathology at a gross level

A possible pattern: Rapid early head growth, with abnormally
slowed growth later on (Courchesne, 2001, 2003).

Location of more subtle pathology may be important

Temporal lobe, limbic system (tubers or other neuron
abnormalities in these regions associated with autism, in
other regions not associated, (Weidenheim et al., 2001; Bolton
et al., 2002).
+
Psychiatric Comorbidity

Core ASD symptoms may be exacerbated by comorbid
disorders.

ADHD, Affective Disorders, are the most common.

Ghaziuddin et al., 1998 found that 23 of 35 individuals with
ASD (65%) had symptoms of another psychiatric disorder.

Adolescents with mild ASD are particularly at-risk for anxiety
and /or depression.
+
Evidence Based Assessment

“Gold Standard” Measures

Autism Diagnostic Interview-Revised, (ADI-R), Western
Psychological Services: Provides standardized
developmental history.
-Excellent Diagnostic Validity

Autism Diagnostic Observation Schedule (ADOS),
Western Psychological Services: Catherine Lord, Ph.D.
(1)Instrument used for direct child observation
(2)Assesses same areas as ADI-R
(3)Corresponds to DSM-IV
(4)Presses for behaviors critical to diagnosis
-Excellent Diagnostic Validity
+
Evidence Based Assessment (cont’d)

Autism Checklists/Rating Scales

Make sure the measure is appropriate for the child’s cognitive level.

Autism Behavior Checklist (ABC) Krug et al., 1980

Childhood Autism Rating Scale (CARS)

Gilliam Autism Rating Scale, second edition (GARS-2)

Gilliam Asperger’s Disorder Scale(GADS)

Asperger Syndrome Diagnostic Scale (ASDS)

Australian Scale for Asperger’s Syndrome (Garnett & Attwood, 1994)

Social Communication Questionnaire (Western Psychological Services)
+
Evidence Based Treatment of ASD

Sally J. Rogers & Laurie A. Vismara of the M.I.N.D. Institute,
University of California Davis, 2008:
EVIDENCE-BASED COMPREHENSIVE TREATMENTS
FOR EARLY AUTISM:


Treatment of unwanted or challenging behaviors should
follow the principles and practices of POSITIVE
BEHAVIOR SUPPORTS (Carr et al., 2002; Horner, Carr,
Strain, Todd, & Reed, 2002, for review):
-Functional Analysis
-Functional Behavioral Assessments
-Instruction of Replacement Behaviors
-Applied Behavioral Analysis (ABA)
Build spontaneous functional communication skills
+
Evidence Based Treatment of
ASD(cont’d)

Children with autism need to be engaged in meaningful (to the
child as well as others), age-appropriate learning activities that
are functional in multiple settings. “Naturalistic Teaching”
approaches that begin with child choice and use intrinsic
reinforcers.

Effective early intervention = Well defined and coherent set of
teaching plans for developing functional skills, fitted to the
child’s current developmental level. MUST BE DELIVERED AT A
HIGH FREQUENCY THROUGHOUT THE DAY.

Peer Interactions are a crucial part of the intervention programs
for children with autism. National reviews recommend that
children with autism have frequent access to typical peers
(NRC, 2001).
+
Evidence Based Treatment of
ASD(cont’d)

Assuring generalization of new skills and behaviors IS
CRITICAL. Generalization is fostered when the skills that are
taught are functional and ecologically valide in natural
settings and daily routines.

Parents and family members need to be included in the
intervention in a variety of ways, (e.g., setting goals, locating
supports for themselves, and receiving training in effective
ways, etc.)
+
Overview of Intervention &
Treatment Approaches for ASD

Discrete Trial (Lovaas, 1973/1980, 1987)







Consists of Antecedent, Response, and Consequence
Includes Detailed task analysis
Is teacher directed
Uses prompting, shaping, and chaining strategies
Teaches verbalization through imitaiton of sounds, words, sentences,
questions, etc.
Criticized for dependence on antecedents and consequences
Naturalistic Behavioral Interventions


Pivitol Response Training (Koegel et al. 1998; Pierce & Schreibman,
1997).
Motivate the child to communicate by providing an enticing
environment.
+
Overview of Intervention &
Treatment Approaches for ASD(cont’d)

University of Utah Meta-Analysis: Interventions Targeting
Reciprocal Social Interaction in Children and Young Adults
with Autism (Miller et al., 2006).



Peer-mediated interventions significantly more effective than
child-specific interventions.
Collateral skills interventions are at least equally effective (if
not somewhat better) than child-specific interventions.
Picture Exchange Communication System PECS (Bondy &
Frost, 1994).

Teaches the child to initiate a picture request and persist until
the communicative partner responds.
+
Overview of Intervention &
Treatment Approaches for ASD(cont’d)

Social Games



Teach specific dramatic play scripts (young children).
(Goldstein et al., 1988).
Teach social game to group geared toward the child with
ASD’s special interest (Baker et al., 1998).
Video Modeling



Brief role-plays of social (or other) behavior
Individual with ASD role-plays the behavior
Several studies show it teaches a variety of skills, and may be
better than traditional role-play (Dorwick & Jesdale, 1991;
Charlop-Christy et al., 2000).
+
Fads and Non-Evidence Based
Interventions

Scott O. Lilienfeld, Ph. D. “Scientifically Unsupported and
Supported Interventions for Childhood Psychopathology: A
Summary”, (2005).

Scientifically Questionable Treatments (SQT’s)are usually
Somatic and/or Psychosocal:

Secretin Hormone Therapy

Elimination Diets, (e.g., Gluten-Casein Free Diets,etc.)

Vitamin B6 Therapy

Facilitated Communication (FC)

Sensory-Motor Integration (SMI)
+ Promising Developments:
Increasing Social Engagement in Young Children with Autism
Spectrum Disorders Using Video Self-Modeling.
(Bellini S., J. Akullian, A. Hopf, (2007) School Psychology Review, Vol. 36, No. 1, pp. 80-90).

Assessment
 2 preschool-aged students with ASD diagnosed by prior psychological reports.

Design

Multiple baseline design across participants.

Dependent Measures
 Unprompted social engagement with peers.

Steps to Intervention
 Video footage collected 2 weeks before collecting baseline data.
 Videos were edited to remove teacher prompting of pro-social behavior
 Children viewed one edited video clip per day.
 After watching the video, children participate in “free-play”

Data Analysis
 Calculation of non-overlapping data points and computation of effect sizes (ES)

Results


Student 1 yielded an ES of 8.38
Student 2 yielded an ES of 4.24
+
Conclusions…

ASD’s present intriguing yet challenging sets of behaviors for
school psychologists, teachers, and parents.

Evidence Based Treatments for Autism exist!

Increased public awareness of Autism presents unique
challenges to school psychologists. Awareness of current
research in the area is ESSENTIAL!

Advocacy for children and families struggling to find
adequate treatment & resources is an important role for
school psychologists.

Bridging the gap between research and practice has never
been more salient, especially for school psychologists.