AAA Section 03 Autism Spectrum Disorder Ver 03 2013

Autism Spectrum
Disorder

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Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 1
Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33

Introduction to the Section.

• What is Autism & DSM-V change?
• Symptoms of autism.

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• Prevalence of autism.
• How Autism was first recognised.
• Assessment.
• Diagnosis.
• Questions.


Learning Outcomes of this Section.

On completion of the Section and with independent
study you should be able to:

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1. Understand the main symptoms, variations and
diagnostic criteria relating to autistic disorder.

2. Be able to describe autistic disorder in detail.


Autism Spectrum Disorder.
A continuum that…
“…ranges from the most profoundly

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physically and mentally retarded
person ... to the most able, highly
intelligent person with social
impairment in its subtlest form as
his only disability. It overlaps with
learning disabilities and shades into
eccentric normality.”
The Autistic Spectrum (2003) Lorna Wing


Autism
No single cause; no
single cure.

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Hence: A spectrum, a
continuum, a syndrome.


What Is Autism?

• Autism is a developmental disability that significantly
affects a person’s verbal and nonverbal

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communication, social interactions, and education
performance. It is generally evident before age 3.

• Characteristics include engagement in repetitive
activities & stereotyped movements, resistance to
environmental change or changes in daily routines, &
unusual responses to sensory experiences.


What Is Autism?

• Considered a continuum whereby it can be

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found with various degrees of impairment
and functioning (Wing & Gould, 1979).

• The probability of a second child being
diagnosed with ASD is 1 in 20.

• A life-long pervasive developmental disorder
with genetic susceptibility.


What Is Autism?
• A syndrome – cluster of symptoms appearing in a
particular combination (Boucher & Pennington,
1991).

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• A spectrum of disorders. Ranges from low
functioning – high functioning / Asperger's Disorder
(Asperger's Syndrome).

• Presence of markedly abnormal or impaired
development in social interaction and
communication and a markedly restricted repertoire
of activity and interests.


What Is Autism (under DSM-IV)?

The DSM-IV includes five types of disorder under
the term ‘Pervasive Developmental Disorder’

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PDD.
1) Autistic Disorder*.
2) Rett’s Disorder.
3) Childhood Disintegrative Disorder.
4) Asperger’s Disorder*.
5) Pervasive Development Disorder Not
Otherwise Specified*.
* Mainly these form the Autistic spectrum ASD.


What Is Autism (under DSM-V)?
The major change to the diagnosis of autism is the
use of the umbrella term of ‘Autism Spectrum
Disorder’. [from May 2013]

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The DSM-V will combine the currently separate
diagnoses of Autistic Disorder, Asperger's Disorder,
Pervasive Developmental Disorder-not otherwise
specified (PDD-NOS) and Childhood Disintegrative
Disorder.
The age of onset will be more
flexible, allowing for older children
to be diagnosed.

What Is Autism?
“There are no clearly established guidelines for measuring
the severity of a person's symptoms. Therefore, the
line between Autism and PDDNOS is blurry.”
(Boyle, 1995).

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Other features often present:
• An insistence on sameness.
• Attentional and perceptual abnormalities – notice fine
details and very small changes in their environment.
• Difficulties generalising learning to new situations.
• Can have exceptional talents and abilities (savant
abilities).


What Is Autism?

Impairment
in social interaction.

Impairment in verbal Restricted, repetitive and
and non verbal stereotyped patterns of
communication. behaviour.

• The so-called ‘triad of impairment’ summarises the
difficulties of the autistic child but the actual
manifestation of these can vary.

The Triad Of Impairment.

1. Impairment in social interaction.

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• Difficulties in making sense of the world
can lead to behaviour that appears bizarre
and antisocial.
• May withdraw totally or may attempt to
interact but may upset, bore or irritate
others.
• Problems in forming relationships.



2. Impairment in verbal and non verbal
communication.

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• Difficulties in receptive language – may
take everything literally.
• Difficulties with metaphor.
• Difficulties with pragmatics - don’t easily
understand facial expressions, tone of
voice, gesture (Happè, 1993; Tager-Flusberg, 2001).



3. Restricted, repetitive and stereotyped
patterns of behaviour.

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• Find change very difficult.
• Often develop obsessive interests.
• Rigid and restricted behavioural patterns –
very set in their routines (Happè, 1993).
• Restricted repertoire of interests.


What Does Autism Look Like?

• Poor eye contact.
• Doesn't seem to know how to play with

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toys.
• Excessively lines up toys or other
objects.
• Is attached to one particular toy or
object.
• Doesn't smile.
• At times seems to be hearing impaired.

What Does Autism Sound Like?
• The child doesn’t point, make baby babble or
gestures by one year of age.

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• Usually the child doesn’t speak one word by 16
months of age (however, some have language
and lose it around 2 years of age.).
• Does not combine two words by 2 years of age.
• Does not respond to name when called.
• Loses language or social skills.


What Does Autism Feel Like?
• Hypersensitive to sounds:
– Imagine chairs sliding on the floor, keys on a keyboard
clicking, someone chewing, a fly buzzing outside the

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window all coming at you at one time.
• Has a routine and feels lost if the routine is changed.
• Hypersensitive to touch.
• Hypersensitive to light.
• Takes language literally:
– If a police officer says “freeze” the person with
autism thinks: that’s silly…it’s not freezing.
• Thinks in pictures.


Prevalence Of Autism.
• Went from 1 in 2500, to 1 in 1000, to 1 in 166 over
the past decade.
• Autism is now more common than childhood

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cancer, Down’s syndrome, spina bifida or cystic
fibrosis.
• Boys are affected 4 times as often as girls but
unknown as to why.
• 1 out of 68 families will have a child with autism.
• Growing at a rate of 10-17 percent per year (it is
thought).


Prevalence Of Autism.
Prevalence of Autism
.

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Number of cases per 10,000

80
p
l
o
60 n
j
m
40
i k
h
20
a c d g
e f
0 b
1965 1970 1975 1980 1985 1990 1995 2000 2005


Increasing Incidence Of Autism?
"Autism is not a modern problem, even
though it has only been recognised in
modern times. In view of the short

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history of psychiatry, and the even
shorter history of child psychiatry, we
know that a disorder recently described
is not necessarily a recent disorder. An
increase in diagnosed cases does not
necessarily mean an increase in cases."

Autism: Explaining the Enigma (1989) by Uta Frith.


Increasing Incidence Of Autism?
• Science still baffled over its aetiology
(genetic origin).

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• Diagnosis has been purely behaviourally
bases.
• New criteria for diagnosis may account for
the apparent increase in its prevalence.
• Currently estimates vary wildly.


How Autism was First Recognised.

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• Leo Kanner and Hans Asperger who, independently
of each other, published accounts of this disorder.
• These publications, Kanner's in 1943 and Asperger’s
in 1944, contained detailed case descriptions and
also offered the first theoretical attempts to
explain the disorder.

• Both authorities (Leo Kanner and Hans Asperger)
believed that there was present from birth a
fundamental disturbance which gave rise to highly

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characteristic problems.
• Kanner, working in Baltimore, and
Asperger, working in Vienna, saw cases of strange
children who has in common some fascinating
features.
• Above all the children seemed to be unable to
entertain normal affective relationships with
people.

• Kanner’s paper has become the most quoted in
the whole literature on autism.
• Asperger’s paper, written in German, and
published during the second world war, was

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largely ignored.
• Asperger’s definition of autism or, as he called
it, ‘autistic psychopathy’ is far wider than
Kanner's.
• Having this special category has proved clinically
useful.
• The belief has grown that Asperger described
quite a different type of child, not to be confused
with the one Kanner described. This is not the
case.


• Both Kanner and Asperger choose the
word ‘autistic' in order to characterise

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the nature of the underlying
disturbance.
• In fact, it is not really a
coincidence, since the label had already
been introduced by the eminent
psychiatrist Eugen Bleuler in 1911.


• In the 70s, knowledge of Autism begun to spread to
Sweden. The first autistic classes within special

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education were started in the middle of the 70s.
• The work of Asperger did not become known until
the end of the 1980s when his book was translated
into English.
• Kanner's work and Bettelheim's ‘refrigerator
mother’ theory of autism were quite often
confused and it was generally accepted that
autistic children had frigid mothers.


Assessment & Diagnosis.
• Assessed on a behavioural basis.
• ICD-10 (11th edition, due in 2015) and DSM-IV
(shortly DSM-V); tick-list medical approach.

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• Missed diagnosis and misdiagnosis.
– Multiple referral routes.
– Pressures on LEA resources.
– Multiple assessment protocols.
• There’s also pressure NOT to
diagnose (limited resources at
Local Authority level).


The NICHD lists these five behaviours that signal
further evaluation is warranted:

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– Does not babble or ‘coo’ by 12 months.
– Does not gesture (point, wave, grasp) by 12
months.
– Does not say single words by 16 months.
– Does not say two-word phrases on his or her own
by 24 months.
– Has any loss of any language or social skill at any
age.



• Assessment for the purpose of diagnosis typically
occurs in clinics or private practices and is led by

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psychiatrists, psychologists, or physicians.
– CARS rating system (Childhood Autism Rating
Scale).
– The Checklist for Autism in Toddlers (CHAT).
– The Autism Screening Questionnaire.
– The Screening Test for Autism in Two-year Olds.


• Thorough assessment depends on information
gathered through a variety of methods.
– Professionals.

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– Family members.
– Educators.
• There is not a single test that when used alone
can provide a definitive diagnosis of an autism
spectrum disorder.


• It’s easier to ‘spot’ autism at the low functioning
end of the spectrum.

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• High functioning children do adapt .
• Early intervention is critical.
– Younger children have a greater degree of brain
plasticity (Edelman, 1992).
• Late screening:
– Very few tools sensitive to adolescent/adult
diagnosis.
– Self-diagnosis common (AQ published on web).


Is There A Cure For Autism?
• No – it is a lifelong disorder.
– Some suggest otherwise but there’s a lack
of evidence.

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• But people with Autism often make good
progress and develop coping strategies.
• Range of therapies and treatments but no
real consensus on what is most effective.
• Because there is a wide variability in people
with Autism there is a need to develop an
individual treatment and management plan.


AAA Section 03 Autism Spectrum Disorder Ver 03 2013

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AAA Section 03 Autism Spectrum Disorder Ver 03 2013