Pervasive Developmental Disorder PS 572 Language & Social Skills For Individuals with Autism Sharon A. Reeve, PhD, BCBA

Today… Review syllabus Pick #s for webpage grade sheet Pick Topic Discuss PDD diagnostic criteria Discuss Evidence-Based Practice

Overview of Presentation History of Autism Diagnostic Characteristics and Prevalence Causes

Evolution of Term Autism First used by Swiss psychiatrist Eugen Bleuler in early 1900s to describe persons with schizophrenia Derived from the Greek autos (self) and ismos (condition) Describes idea of “turning inward on one’s self” In 1943 Psychiatrist Leo Kanner used term “infantile autism” to describe a group of children who were socially isolated, behaviorally inflexible, and had impaired communication 1944 Psychiatrist Hans Asperger describes “little professor” syndrome

Evolution of Term Autism 1967, Bruno Bettelheim’s The Empty Fortress published 1968 DSM-II (Diagnostic and Statistical Manual of Mental Disorders) lists autism as type of childhood schizophrenia 1980 DSM-III places autism within Pervasive Developmental Disorders 2000 DSM-IV-TR is current classification system we will be talking about

What Are Pervasive Developmental Disorders (PDD)? Pervasive developmental disorders are characterized by severe impairment in several areas of development: Social interaction skills Communication skills Presence of stereotyped behavior, interests, and activities

These disorders are usually evident in the first few years of life (before age 3) and are often associated with some degree of mental retardation They may be observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system) What Are Pervasive Developmental Disorders (PDD)?

Specific Pervasive Developmental Disorders Autistic Disorder Rett’s Disorder Childhood Disintegrative Disorder Asperger’s Disorder Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

Popular Name for Pervasive Developmental Disorders

What are ASDs Technically Speaking? Continuum comprised of autism, Asperger’s, and PDD-NOS (Volkmar & Klin, 2005) “the concept of autism is evolving from the singular autistic disorder into the plural autistic spectrum disorders (ASDs)” (Filipek, 2005, p.535) In the 1970s, researchers collected data on children in the UK who had any features of autism Found that impairments were manifested in many different ways and called it the autistic continuum Currently, some researchers prefer the term spectrum to continuum because it does not imply a smooth transition from one end to the other (Wing, 2005)

Asperger’s Disorder Severe and sustained impairment in social interaction combined with restricted, repetitive, and stereotyped patterns of behavior, interests, and activities No clinically significant delays in language acquisition, cognitive development, or self-help skills in first 3 years of life It has not been determined if Asperger’s is qualitatively different from Autism Some researchers believe it is For now, they are distinct diagnoses

DSM Criteria for PDD-NOS Severe and pervasive impairment in the development of reciprocal social interaction along with Communication skills OR Presence of stereotyped behavior, interests, and activities But criteria are not met for any other PDD

Rett’s Disorder Occurs only among females and involves a pattern of head growth deceleration, MR, a loss of fine motor skill, and the presence of awkward gait and trunk movement.

Childhood Disintegrative Disorder Rare pattern of regression following at least two years of normal development producing stereotyped behaviors, loss of play, social, and communication skills

Differential Diagnostic Features of PDDS From Volkmar and Klin (2005)

Feature AutismAsperger’sRett’sCDDPDD- NOS Age0-36Usually >365-30>24Variable Sex ratioM>F F(?M)M>F Loss ofskillsVariableUsually notMarked Usually not Social skillsVery poorPoorVariesVery poorVariable Comm skillsPoorFairVery poor Fair to good Stereotype d interests Variable (mechanica) Marked (facts) NA Variable FamilySometimesFrequentRarelyNoUnknown SeizureCommonUncommonFrequentCommonUncommon ↓ head grwthNo YesNo IQ rangeSevere MR to normal Mild MR to normal Severe MR OutcomePoor - goodFair to goodVery poor Fair -good

Diagnostic Criteria for Autistic Disorder A total of six or more total characteristics from the following three categories (DETAILED ON SUBSEQUENT SLIDES) Onset must be before age 3: 1.Qualitative impairment in social interaction (must have at least two characteristics) 2.Qualitative impairment in communication (must have at least one characteristic) 3.Restricted repetitive and stereotyped patterns of behavior, interests and activities (must have at least one characteristic) Adapted from: Diagnostic and Statistical Manual, 4th Ed., APA, 1994

I. Qualitative Impairment in Social Interaction Must meet 2 of the following: Marked impairment in the use of non-verbal behaviors such as eye contact, facial expression or gestures to regulate social interaction Failure to develop appropriate peer relationships Lack of spontaneous seeking to share enjoyment or interests (joint attention) Lack of social/emotional reciprocity

II. Qualitative Impairments in Communication Must meet 1 of the following: Delayed development or total lack of spoken language In individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation Stereotypic and repetitive use of language Lack of varied, spontaneous pretend or social play

III. III.Restrictive Repetitive and Stereotyped Patterns of Behavior or Interests Must meet 1 of the following: Preoccupation with one or more stereotyped and restricted pattern of interest that is either abnormal in intensity or focus Inflexible adherence to non-functional routines Stereotyped and repetitive motor mannerisms Persistent preoccupation with parts of objects

Learning Characteristics of Children with Autism Stimulus overselectivity Difficulty responding to natural contingencies and social cues Difficulty generalizing skills May rely on rote memory May memorize information rather than comprehend it May demonstrate proficient performance on tasks demanding visual spatial judgment and pattern recognition Splinter skills Difficulty in all dimensions of language including expressive/receptive language

Behavioral Characteristics of Children with Autism Little or no eye contact Does not respond to name Tantrums easily Odd hand and finger mannerisms Lines up toys or objects Does not play with toys Prefers to be alone Likes to spin self or objects Displays self-injurious behaviors Lacks normal fear Displays hand flapping and/or toe walking Rocks or bangs head Arches back Video

Physiological Characteristics of Children with Autism Large head circumference Low muscle tone Frequent ear infections Difficulty sleeping or unusual sleep patterns Frequent gastrointestinal issues (reflux, stomach pains, diarrhea, constipation) Rigid preference for certain foods Other co-morbid disorders (mental retardation, seizures, hyperactivity, immune dysfunction, anxiety, depression, OCD, etc.)

Prevalence The Individuals with Disabilities Education Act (IDEA) requires each state’s Department of Education and the U.S. Department of Education to record specific childhood disabilities, including autism, for each school year Current Centers for Disease Control statistics peg the prevalence of all ASDs as 1/150 nationwide but 1/94 in NJ Since 1992, autism prevalence has increased at an average of 22% each year in NJ

Prevalence Increase in prevalence may be due to Increases in requests for service Changes in diagnostic criteria Increased assessment opportunities Better awareness by pediatricians, teachers, parents An actual increase in cases?

Etiology Possibilities Genetic (strongest evidence) Genes controlling development of brain “circuitry” have been implicated; some are inherited genes while others are gene mutations Prenatal/Perinatal complications Maternal rubella increases likelihood of autism Environmental Psychogenic “Refrigerator Mother” Although this has been shown to be false quite some time ago, unfortunately, it is still mentioned.

Etiology Possibilities Immunizations? Although controversial, current scientific data do not support any causal relationship between vaccinations and autism Incidence rates of autism have continued to rise unabated even with the removal of thimerosal (mercury-based compound) from vaccines in a number of countries worldwide

Why Does Autism Need Specialized Treatment? Pervasive Developmental Disorder (PDD) implies that a child with autism is affected along multiple dimensions (Unlike certain other single dimension problems: learning disability, communication disorder, emotional and behavioral disorders)

Why Does Autism Need Specialized Treatment? Learning deficits Affects every aspect of child’s education and academics Language disabilities Articulation, expressive, receptive, spontaneous, conversation, non-contextual vocalizations Behavioral disorders Stereotypic behavior: motor, visual, tactile, Compulsive behaviors rigidity of routine, intolerant of change

Why Does Autism Need Specialized Treatment? Attention deficits Lack of eye contact, unaware of danger Emotional impairments Non-contextual emotions, lack of self-concept Social impairments Eye contact, gestures, facial expression, greetings, awareness of other children, friendships, Play skills deficits Imaginative, pre-occupations with objects/activities, general content knowledge

Why Does Autism Need Specialized Treatment? Sleep disturbances Going to sleep late, getting up early, getting up during the night Toileting impairments Lack of awareness of accidents Eating disabilities Texture, appearance, gustatory

References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Filipeck, P.A. (2005). Medical aspects of autism. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp ). Hoboken, NJ: John Wiley & Sons. Volkmar, F.R., & Klin, A. (2005). Issues in the classification of autism and related conditions. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 5-41). Hoboken, NJ: John Wiley & Sons. Wing, L. (2005). Problems of categorical classification systems. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp ). Hoboken, NJ: John Wiley & Sons.