AUTISM SPECTRUM DISORDER - NEURODEVELOPMENTAL DISORDER

1. Presented By:
Anvesh Chauhan
M.Sc Clinical Psychology
(I Sem)
Department of Psychology
Dev Sanskriti Vishwavidyalaya

2. Autism Spectrum Disorder
•Autism spectrum disorder (ASD) refers to a group of complex
neurodevelopment disorders characterized by repetitive and
characteristic patterns of behavior and difficulties with social
communication and interaction
•The term “spectrum” refers to the wide range of
symptoms, skills, and levels of disability in functioning
that can occur in people with ASD
•Infantile autism was described for the first time by
Leo Kanner in 1943 as ‘autistic disturbance of affective
contact’. This syndrome has variously been described
as autistic disorder, pervasive developmental
disorder, childhood autism, childhood psychosis and
pseudodefective psychosis.

3. •The onset occurs before the age of 2½ years
though in some cases, the onset may occur later
in childhood. Such cases are called as childhood
onset autism or childhood onset pervasive
developmental disorder.
• Autism spectrum disorder is characterized by
persistent deficits in social communication and social
interaction across multiple contexts, including deficits
in social reciprocity, nonverbal communicative
behaviors used for social interaction, and skills in
developing, maintaining, and understanding
relationships. (DSM V p.31)
Category of ASD:
•Asperger syndrome
•Childhood disintegrative disorder
•Pervasive developmental disorders not otherwise
specified

4. According To The American Autism Association,
Doctors typically diagnose autism spectrum disorder
(ASD) in childhood when symptoms can occur before
3 years of age,
•According to the Centers for Disease Control,
Autism affects an estimated 1 in 59 children in the
United States today.
•Autism spectrum disorder is diagnosed four
times more often in males than in females.
(DSM V)
CDC report that there is no known connectionTrusted
Source between vaccines and autism.

5. Clinical Features
The characteristic features are:
1. Autism (marked impairment in reciprocal social
and interpersonal interaction):
i. Absent social smile.
ii. Lack of eye-to-eye-contact.
iii. Lack of awareness of others’ existence or feelings;
treats people as furniture.
iv. Lack of attachment to parents and absence of
separation anxiety.
v. No or abnormal social play; prefers solitary
games.
vi. Marked impairment in making friends.
vii. Lack of imitative behaviour.
viii. Absence of fear in presence of danger.

6. 2. Marked impairment in language and non-verbal
communication :
i. Lack of verbal or facial response to sounds or
voices; might be thought as deaf initially.
ii. In infancy, absence of communicative sounds like
babbling.
iii. Absent or delayed speech (about half of autistic
children never develop useful speech)
iv. Abnormal speech patterns and content. Presence
of echolalia, perseveration, poor articulation
and pronominal reversal (I-You) is common.
v. Rote memory is usually good.
vi. Abstract thinking is impaired.

7. 3. Abnormal behavioural characteristics:
i. Mannerisms.
ii. Stereotyped behaviours such as head-banging,
body-spinning, hand-flicking, lining-up objects,
rocking, clapping, twirling, etc.
iii. Ritualistic and compulsive behaviour.
iv. Resistance to even the slightest change in the
environment.
v. Attachment may develop to inanimate objects.
vi. Hyperkinesis is commonly associated.
4. Mental retardation Only about 25% of all children with
autism have an IQ of more than 70. A large majority (more
than 50%) of these children have moderate to
profound mental retardation. There appears to be a
correlation between severity of mental retardation, absence
of speech and epilepsy in autism.

8. 5. Other features
i. Many children with autism particularly enjoy
music.
ii. In spite of the pervasive impairment of
functions, certain islets of precocity or splinter
functions may remain (called as Idiot savant
syndrome). Examples of such splinter func
tions are prodigious rote memory or cal cula
ting ability, and musical abilities.
iii. Epilepsy is common in children with an IQ of
less than 50.
The course of infantile autism is usually
chronic and only 1-2% become near normal
in marital, social and occupational
functioning.

9.  Genetic factors -More in monozygotic twins
than dizygotic twins .
Siblings of autistic children shows a prevalence of
autistic disorder of 2 %
Biochemical factors - 1/3 of clients with
autistic disorder have elevated plasma serotonin
Medical factors -Postnatal neurological
infections Fragile X chromosome syndrome
 Perinatal factors -Maternal bleeding after 1st
trimester and maconium in amniotic fluid
Parenting influence and social
environmental factors -
Parental rejection ,Family break up ,Family stress ,
Faulty communication patterns
Various Factors

10. • A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by the following, currently or by
history (examples are illustrative, not exhaustive; see text):
• 1. Deficits in social-emotional reciprocity, ranging, for example, from
abnormal social approach and failure of normal back-and-forth conversation;
to reduced sharing of interests, emotions, or affect; to failure to initiate or
respond to social interactions.
• 2. Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in eye contact and body language
or deficits in understanding and use of gestures: to a total lack of facial
expressions and nonverbal communication.
• 3. Deficits in developing, maintaining, and understanding
relationships, ranging, for example, from difficulties adjusting behavior to
suit various social contexts; to difficulties in sharing imaginative play or in
making friends; to absence of interest in peers.
• Specify current severity: Severity is based on social communication
impairments and restricted, repetitive patterns of behavior

11. B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following, currently
or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or
speech (e.g., simple motor stereotypies, lining up toys or flipping
objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or
ritualized patterns of verbal or nonverbal behavior (e.g., extreme
distress at small changes, difficulties with transitions, rigid thinking
patterns, greeting rituals, need to take same route or eat same food
every day).
3. Highly restricted, fixated interests that are abnormal in intensity or
focus (e.g., strong attachment to or preoccupation with unusual
objects, excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in
sensory aspects of the environment (e.g., apparent indifference to
pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with
lights or movement).
Specify current severity:
Severity is based on social communication impairments and
restricted, repetitive patterns of behavior

12. C. Symptoms must be present in the early
developmental period (but may not become fully
manifest until social demands exceed limited capacities,
or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in
social, occupational, or other important areas of current
functioning.
E. These disturbances are not better explained by
intellectual disability (intellectual developmental
disorder) or global developmental delay. Intellectual
disability and autism spectrum disorder frequently co-
occur; to make comorbid diagnoses of autism spectrum
disorder and intellectual disability, social
communication should be below that expected for
general developmental level.

13. Risk and Prognostic Factors (DSM V)
Environmental:
Advanced Parental Age
Low Birth Weight
 Fetal Exposure To Valproate
Genetic and physiological:
Heritability estimates for autism spectrum disorder
have ranged from 37% to higher than 90%, based on
twin concordance rates.
 15% of cases of autism spectrum disorder appear
to be associated with a known genetic mutation.

14. Treatment
Parental counselling and supportive psychotherapy can be very
useful in allaying parental anxiety and guilt, and helping their
active involve ment in therapy. However, overstimulation of child
should be avoided during treatment.
This helps a person with autism develop the skills
for everyday living and learn independence.
3. Occupational therapy (OT):
i. Development of a regular routine with as few changes as
possible.
ii. Structured class room training, aiming at learning
material and maintenance of acquired learning.
iii. Positive reinforcements to teach self-care skills.
iv. Speech therapy and/or sign language teaching.
v. Behavioural techniques to encourage interpersonal interactions.
1. Behaviour Therapy
2. Psychotherapy

15. 4. Pivotal response treatment (PRT):
This therapy aims to support motivation and the
ability to respond to motivational cues in children
with ASD. It is a play-based therapy that focuses on
natural reinforcement.
5.Verbal behavior therapy (VBT):
This helps a child with ASD connect language and
meaning. Practitioners of VBT focus not on words,
but the reasons for using them.
6. Pharmacotherapy- haloperidol and risperidone
Other drugs such as SSRIs, chlorpromazine,
amphetamines, methysergide, imipramine, multi-
vitamins and triiodothyronine

16. There is no cure for autism.
However, researchers are studying nearly
every aspect of the condition, from its causes to
potential treatments.
In some people with ASD, medications and
behavioral health interventions can improve
the effects of the condition to enable a person
to function independently in adulthood.
Summary

17. • The ICD-10 Classification of Mental and Behavioural Disorders
• A Short Textbook of Psychiatry
• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5,2013)
• www.autismspeaks.org
• www.autism-society.org
• www.cdc.gov
• Interactive Autism Network