Autism Spectrum Disorders By: Dr. Ritta Baena RETT’S DISORDER ASPERGER’S DISORDER CHILDHOOD DISINTEGRATIVE DISORDER PERVASIVE DEVELOPMENT NOT OTHERWISE SPECIFIED AUTISTIC DISORDER Low Functioning High Functioning

What is Autism Spectrum Disorder What is Autism Spectrum Disorder? (Also know as Pervasive Development Disorder) Autism Spectrum Disorder is characterized by widespread abnormalities of: 1)Social interactions 2)Communications 3)Repetitive behavior and restricted interests This disorder causes severe and pervasive (to spread throughout all parts) impairment in Thinking Feeling Language Ability to relate to others

ASD is detected by 3 years but as early as 18 months or earlier What is Autism Spectrum Disorder? These unusual behaviors are usually noticed first by the parents and range from The severe form called autistic disorder (low-functioning Autism) To pervasive development disorder not otherwise specified (PDD- NOS) To the milder form called Aspergers Syndrome. (high- functioning Autism) The Autism Spectrum Disorder (ASD) also include two rare disorders called Rett Syndrome and Childhood Disintegrative Disorder ASD is detected by 3 years but as early as 18 months or earlier

History In 1943 Dr. Leo Kanner of John Hopkins Hospital studied 11 children with disrupted behavior in the family and introduced early infantile autism In Germany Dr. Hans Asperger described what is now know as the milder form of the Autism Spectrum Disorder.

First Signs of Autism Spectrum Disorder Can be noticed when the parents of the child comes to the physician complaining that their normal engaging, babbling child has regressed and suddenly or gradually become silent, withdrawn, self abusive, or indifferent to social communication. Childs behavior does not follow the typical normal pattern of development Observable signs vary. In some the problem is apparent from birth and others there is a noticeable lag behind from the other children of the same peer/age group. But most often ASD is first noticed between 12 and 36 months. NOTE: The CHAT Screening Checklist is used to determine Autism in Toddlers

Is Autism more common in a certain groups? Answer: YES Autism appears to be more common in: Boys Siblings of those with Autism Fragile X Syndrome People with Mitochondrial Diseases

Accompanying Problems Hypersensitive to sensory input like certain sound (vacuum cleaner, telephone ringing), touch, taste, and smell. Mental Retardation Seizures occurs in 1 in 4 ASD Fragile X Syndrome occurs in 2-5 % of ASD Tuberous Sclerosis a benign tumor that occurs in the brain and rare genetic disorder Mitochondrial Diseases

Treatments Behavioral therapy There is no known cure, nor is there one single treatment, but there are ways to help minimize the symptoms of autism and maximize learning. Behavioral therapy Behavior management therapy - based on Applied Behavior Analysis (ABA) - therapy that helps to reinforce desired behavior and eliminate unwanted behavior. Speech and language therapy – helps improve ability to communicate and interact with others. Occupational therapy – tailor task to match their needs and abilities. Physical therapy - activities are design to build motor control and improve posture and balance.

Treatments Medication No cure for autism currently exists… but there are treatments to treat the symptoms Behavioral problems – Antipsychotic Treatments Seizures – Anticonvulsive Treatments Inattention and hyperactive - Stimulation medication Anxiety and depression – serotonin selective reuptake inhibitors (SSR’I) Dietary Gluten free -Gluten is a casein like substance found in wheat, rye, oat and barley. Casein-free - Casein is the principal protein found in cow’s milk. Supplementary vitamin B6 and magnesium

Autism Programs Educational and School options Public schools provide free public education from the age of 3 to 21 or up to high school, which ever comes first. A team of people that includes the parents, teacher, school psychologists and other development specialist working together to design an Individualized Education Plan (IEP) to help guide the child at school.

Is there a link between vaccine and Autism? NOTE: Vaccines have greatly benefitted people and are generally recommended by most healthcare professionals.. HOWEVER, Vaccines containing thimerosal as a preservative, a mercury based compound, have been suspected to cause Autism and other neural development problems and are curently being investigated by the CDC. So consult your doctor about the safety of a vaccine before taking it. Make sure it does not contain thimerosal.

Living Arrangement Options for Adults with ASD Independent living- Some ASD are capable of living entirely on their own and other with some assistance provided by their families, professional agencies or governments agencies Living at home - Government provides help for ASD living with their families through the Supplemental Security Income (SSI), Social Security Disability Social Security Administration (SSA). One has to make an appointment with the local SSA office to find out about eligibility. Foster homes -Some families open their homes and provide long term care and skill-development homes-the home teaches self care and housekeeping skills. Supervised group living-People with disabilities live in a group with staffed with professional help. Institutions - For those who require intensive constant supervision.

Understanding The Spectrum RETT’S DISORDER ASPERGER’S DISORDER CHILDHOOD DISINTEGRATIVE DISORDER PERVASIVE DEVELOPMENT NOT OTHERWISE SPECIFIED AUTISTIC DISORDER Low Functioning High Functioning

Autistic Disorder This varies from high functional (capable to mix in society with help and training) to low functional ( unable to cope in society) Abnormal or delay functioning in one or more of the following areas before the age of 3years: 1) Social interaction 2) Social Communication 3) Symbolic or imaginative play

Autistic Disorder 1) Impairments in social interaction a) nonverbal behaviors – e.g. body posture eye-to eye contact gesture to social interaction facial expression b) unable to develop age appropriate peer relationships. c) lack to share interests, achievements and enjoyments with others. d) no social or emotional interaction.

Autistic Disorder 2) Impairments in communication a) delay or total lack of spoken language b) individuals with adequate speech are unable to initiate or sustain a conversation c) repetitive use of language or idiosyncratic language d) lack of age appropriate make-believe play or social imitative play 3) Repetitive and Stereotype patterns of behavior, interests and activities a) preoccupied with stereotype and restricted patterns of interests that is abnormal either in intensity of focus b) unable to break from routine c) extremely preoccupied with parts of objects.

Pervasive Developmental Disorder N.O.S This category is used when severe and pervasive impairment in the development of verbal and nonverbal communication skill, or reciprocal social interaction, or when stereotyped behavior, interest and activities are present, that are no met for specific Pervasive development disorder ,schizophrenia , schizotypical personality disorder, or Avoidant personality disorder

Childhood Disintegrative Disorder A) Normal first 2 years after birth. B) Loss of acquired skill before the age of 10 years in 2 of the following: 1) social or adaptive play 2) receptive or expressive language 3) play 4) bladder or bowel control 5) motor skills C Two of the following functions are abnormal: 1) Impairment of social interaction 2) Impairment of communication 3) Repetitive, restricted and stereotype behavior patterns D The disorder is not accounted in other specific pervasive development disorder or schizophrenia.

Rett’s Disorder A Has all of the following: 1) Normal prenatal development 2) Normal psychomotor development the first 5 months after birth 3) Normal head circumference B The following appear after 5 months: 1) Decrease head circumference between 5 to 48 months 2) Loss of previously acquired purposeful hand skill between 5- 30 months and development of stereotyped hand movement (eg hand –wringing ) 3) Loss of social skill 4) Poor coordinated movements 5) Severely impaired receptive and expressive language development with sever psychomotor retardation.

Aspergers A) Social interaction by at least two of the following: Impairment in the us of eye to eye gaze ,facial expression, gesture to social interaction and body posture. Failure to develop age appropriate peer relationship. Lack social or emotional reciprocity. Unable to share enjoyment, interests or achievements with other people. B) Repetitive and stereotype patterns of behavior at least of the following: Adherence to routine and rituals. Persistent preoccupied with parts of objects. Repetitive finger flapping or twisting. Preoccupied and restricted patterns of interest in intensity or focus

Aspergers C) Impairment in social, occupational or important areas of functioning D) No delay in language E) No delay in cognitive or age appropriate self-help skills, adaptive behavior and curiosity about the environment in childhood F) Criteria are not met by another specific Pervasive Developmental Disorder or schizophrenia.