Autism Spectrum Disorder Megan Kunze, MA, BCBA Special Education and Clinical sciences Doctoral Student, University of Oregon

Thank you! Dr. Wendy Machalicek, BCBA-D Dr. Berenice de la Cruz, BCBA-D Tracy Jane Raulston, Doctoral Candidate, BCBA

Overview Part 1: Part II: Part III: What is autism? What are the signs of autism? Part II: How is autism diagnosed? How prevalent is autism? Part III: How is autism treated? Interventions: Evidence-Based and Non-Evidence Based Practices

Part I: What is Autism?

Autism Spectrum Disorder & Asperger’s Syndrome Autism spectrum disorder (ASD) is a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and restrictive/repetitive behaviors. Usually includes some level of intellectual disability. Asperger’s Syndrome, while can appear similar to autism, it is characterized by difficulties in social interaction, verbal and nonverbal communication, but does not include repetitive behaviors or intellectual disability.

History Asperger’s Syndrome Some relate this to “high functioning autism” Includes social and communication difficulties , usually high intelligence and large vocabulary Does not include instance on sameness (i.e. Repetitive, restrictive, and stereotyped behavior) Hans Asperger 1906-1980 Published the first definition of Asperger’s Syndrome in 1944. In four boys, he identified a pattern of behavior and abilities that he called “autistic psychopathy,” meaning autism (self) and psychopathy (personality). The pattern included “a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest, and clumsy movements.” Asperger called them “little professors,” because of their ability to talk about their favorite subject in great detail. Kanner’s Type: Issues in communication and social relatedness Usually includes intellectual disability Repetitive, restrictive, and stereotyped behavior Insistence of sameness Changes in routine may cause extreme agitation Travel routes, clothing, arrangement of activities or items. Leo Kanner 1896-1981 Dr. Kanner, who founded the Johns Hopkins Children's Psychiatric Clinic in 1930, was the first to describe ''infantile autism,'' which also became known as ''Kanner syndrome.'' He described the disability as the ''innate inability of certain children to relate to other people.''

Diagnostic and Statistics Manual of Mental Disorders- IV TR (DSM iV, 2000): BIG 3 Deficits in social skills 2. Deficits in communication 3. Might engage in restrictive & repetitive behaviors Pervasive Developmental Disorders (PDD) Autistic Disorder/ Autism (Kanner’s Type) Asperger's Disorder Pervasive Developmental Disorder Not Otherwise Specific (PDD-NOS) Childhood Disintegrative Disorder Rett Disorder

Diagnostic and Statistics Manual of Mental Disorders- V TR (DSM V, 2013) Children with genetic disorders with ASD features will receive “ASD diagnosis with associated features”. The genetic disorder will be considered “associated features” (e.g. Fragile X and Rett’s Disorder). Autism Spectrum Disorder (ASD) Level 1: Requiring Support Level 2: Requiring Substantial Support Level 3: Requiring Very Substantial Support Social Communication Disorder (SCD) BIG 2 Social communication difficulties 2. Restrictive and repetitive behaviors Loss of Diagnostic Title of Asperger’s: Effects on Identity?

Levels 1,2, and 3: Social and Communication Interaction Diagnosis of Autism Spectrum Disorder: Social and Communication Level 1: Impairments are obvious without supports. Difficulty with initiations and responding to others, may seem uninterested in others. Level 2: Impairments obvious even with supports. Limited attempts to initiate interaction with others and limited or unusual responses to others social attempts. Level 3: Very limited or undeveloped social communication skills that seriously impair the person’s ability to initiate or maintain interaction with others

Levels 1,2, and 3: Restrictive Interests and Repetitive Behaviors Concern from the field! What if the child only presents Level 1? With limited intervention will they grow to be a 2? Would more intense intervention keep them at 1 or even assist child in overcoming difference? Levels 1,2, and 3: Restrictive Interests and Repetitive Behaviors Restrictive Interests and Repetitive Behaviors Diagnosis of Autism Spectrum Disorder: Level 1: Interfere with functioning in a limited number of settings. Person resists efforts to interrupt these repetitive behaviors or rituals. Level 2: Interfere with functioning across settings and are frequent enough to be noticed by others. Person vigorously resists efforts to interrupt these repetitive behaviors or rituals. Level 3: Interfere with functioning is serious across all settings. Person is in distress when interrupted and will struggle to get back to ritual.

Autism Spectrum Disorders (ASD) Impairments in: Communication Social Relatedness Some range of repetitive, restrictive, and stereotyped behavior

A peek at Asperger’s and Autism “Asperger's, not what you think it is” Krister Palo TEDxYouth@ISH Ted Talk: Asperger's Dylan shares about Autism

What are signs of ASD?

1. Difficulties with social skills (CDC, 2016) Does not respond to name by 12 months of age Prefers to play alone Only interacts to achieve desired goal Has flat or inappropriate facial expression Does not understand personal space Avoids or resists physical contact Not easily comforted by others when in distress Difficulty understanding other’s feelings, labeling or sharing about own feelings Avoids eye contact or minimally uses it to communicate Lack or difference in joint attention: rarely seeks to share interests, enjoyment, or achievement

Lack/delay in Joint Attention The ability to coordinate one’s own attention between object and another person Creates a triangular attention (also called triadic attention) Involves the ability to gain, maintain, and shift gaze and/or gestures for communication and socialization Building block for developing functional communication, social skills, meaningful relationships, and theory of mind Full joint attention around 18 months

2. Communication Problems (CDC 2016) Delayed speech and language skills Repeats words or phrases over and over (echolalia) Reverses pronouns (e.g., says "you" instead of "I") Gives unrelated answers to questions Does not point or respond to pointing Uses few or no gestures (e.g., does not wave goodbye) Talks in a flat, robot-like, or sing-song voice Does not pretend in play (e.g., does not pretend to "feed" a doll) Does not understand jokes, sarcasm, or teasing

3. Unusual Interests or Behaviors (CDC 2016) Lines up toys or other objects Plays with toys the same way every time Likes parts of objects (e.g., wheels) Is very organized Gets upset by minor changes Has obsessive interests Has to follow certain routines Flaps hands, rocks body, or spins self in circles

4. Other Symptoms (CDC, 2016) Hyperactivity (very active) Impulsivity (acting without thinking) Short attention span Aggression Causing self injury Temper tantrums Unusual eating (pica, white or crunchy foods) and sleeping habits Unusual mood or emotional reactions Lack of fear or more fear than expected Unusual reactions to the way things sound, smell, taste, look, or feel

5. Developmentally Different (CDC, 2016) Follow different and un-even development May be able to read long words before recognizing letter “b” Motor function may follow typical pattern, but are delay in social/communication domains May be able to work a smart phone but can not request a cookie

Range of Symptoms (CDC 2016)

Summary: Autism Spectrum Disorder = Differences in communication Differences in social interaction Some range of rigid, restrictive or stereotypic behavior

Remember: “If you’ve met one person with autism… People diagnosed with ASD are unique in more ways than not. We treat the child, not the diagnosis QUESTIONS?