Chapter 21 Autism Spectrum Disorders Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Introduction ASDs Class of neurodevelopmental disorders Impairments in Social reciprocity Communication Repetitive behaviors Neurologically based Have genetic predisposition Gene–environment interaction plays a role Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Diagnostic Categories within the Autism Spectrum Autistic Disorder Defined by a pattern of at least six symptoms distributed across three domains At least two symptoms must be in social reciprocity Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) Child without prerequisite number/distribution of symptoms for another diagnosis within the ASDs or atypical presentation with functional impairments in the relevant areas Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Diagnostic Categories within the Autism Spectrum (continued) Asperger’s Disorder Diagnosed if three symptoms (two related to social reciprocity and one to habitual behaviors) are present Early language development typical, but pragmatic language impairments common Adaptive behaviors may be delayed Overlap between diagnosis of high-functioning autism and Asperger’s Disorder Often not diagnosed until school age Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Diagnostic Features of Autism Spectrum Disorders Qualitative impairments in social reciprocity Inability to read and comprehend feelings, experiences, and motives of others Difficulties interacting with peers Diminished use of eye contact and facial expression No Theory of Mind Atypical communication development Atypical development in receptive and expressive language Early language often characterized by imperative labeling, echolalia, atypical prosody, and improper use of pronouns May have a basic impairment in nonverbal communication behaviors Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Diagnostic Features of Autism Spectrum Disorders (continued) Atypical behavior Repetitive, perseverative, and stereotyped behaviors Strict adherence to routines Young children may have attachments to unusual things Stereotyped movements (e.g., pacing, spinning, running in circles, drumming, rocking, arm flapping, toe walking) Unusual responses to sensory input (e.g., overreaction to environmental noises, touch, or odors) Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Causes of Autism Spectrum Disorders The genetics of autism Family studies Candidate gene studies Association with genetic disorders of known etiology Brain structure and function in ASDs Obstetric complications An increased risk for ASD has been reported among premature infants Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Causes and Epidemiology of Autism Spectrum Disorders Environmental exposures Teratogens Vaccinations (no scientific evidence of connection) Infections Gender and ASDs More boys than girls, gender ratios range from 2:1 to 5:1 Epidemiology of ASDs Prevalence approximately 1 in 110 children Reported rate in 2011 is tenfold that of a generation before Advanced maternal and paternal ages have been associated with increased risk for ASD diagnosis Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Early Identification of Autism Spectrum Disorders Early diagnosis Atypical development of pretend play, pointing, use of eye gaze, and social interest distinguish toddlers at high risk Screening tools Evaluation of the child with an ASD Multidisciplinary assessment Diagnostic measures Laboratory testing and neuroimaging Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Associated Conditions Intellectual disability Learning disabilities Especially specific impairments in executive function Epilepsy Reported in about 25% of people with ASDs Tic disorders Up to 9% of children with ASDs have motor tics Sleep disorders 50%–70% of children with ASDs Gastrointestinal symptoms Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Associated Conditions (continued) Psychiatric conditions Greater risk for depression, mood disorders, attention-deficit/hyperactivity disorder, and anxiety Associated genetic disorders Tuberous sclerosis Fragile X syndrome Chromosome 15 deletion Other syndromes: Moebius syndrome, Joubert syndrome, Down syndrome, phosphatase and tensin homolog mutation, CHARGE syndrome, and Smith-Lemli-Opitz syndrome Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment Approaches Early educational programs focus on teaching social language and enhancing appropriate behaviors Educational approaches Preschool programs vary Generally include structured teaching periods, reinforcement of spontaneous communication, instruction of specific skills using principles of reinforcement, and incidental learning K–12 involves individualized education program Specific academic goals should relate to cognitive and functional level Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment Approaches (continued) Behavioral approaches Applied behavior analysis (ABA) Developmental, Individual-Difference, Relationship-Based (DIR) Model Relationship Development Intervention (RDI) Management of maladaptive behaviors Pragmatic language and social skills training Medication Stimulant medications Selective serotonin reuptake inhibitors Atypical neuroleptics Mood stabilizers and other medications Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment Approaches (continued) Complementary and alternative therapies Dietary manipulation, vitamin supplements, and non–FDA-approved use of prescription medication most common Family support Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Outcome IQ scores that fall in the average range and presence of language that can be used in conversation predict best outcomes More than half of children diagnosed with autism acquire language that can be used for communication In some cases, intervention leads to child no longer meeting diagnostic criteria by school age Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Summary ASDs are neurodevelopmental disorders with a genetic basis, potentially affected by environmental factors Characterized by impairments in communication, social interaction, and repetitive interests and behaviors Advances in early recognition and intervention have had a positive impact Chapter 21 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.