Clinical and Research Program in Pediatric Psychopharmacology Features of AUTISM CORE Features Impaired Social-Emotional Competence Restricted/Repetitive Behaviors (RRBs) Non-verbal communication - Eye contact (joint-attention) Cognitive Rigidity - Routines / rituals (rule-bound/transitional difficulties/lack spontaneity) Social-emotional reciprocity - Empathy - Sharing (activities, affect, conversations) - Social flexibility - Contextual understanding Repetitive patterns - Speech (Delayed echolalia, Scripting) - Motor mannerisms (Flapping, Clapping, Rocking, Swaying) - Interests Social-emotional Salience - Relevant social-emotional stimulus Atypical Salience - Idiosyncratic (odd) Interests Abstracting ability - Black & white/concrete/literal thinking - Tolerance for unstructured time, ambiguity Sensory Dysregulation - Atypical sensory perceptions/responses - Introsceptive ability Introspective/Introceptive ability (self awareness of cognitions, emotions, & physiological state) - Psychological mindedness Executive Functions (Control/moderation of emotions, motivations, interests) - All or none approach - Abnormal intensity of interests Convictions Passions Opinionated Difficulty moderating (all or none) - Mood/Emotions - Cognitions (black and white) - Motivation - Interests - Relationships - Social boundaries - Rate of speech Lack contextual adaptability x Developmental transitions (rigidity) ASSOCIATED Features Poor motor coordination Novelty averse behaviors Atypical fear response Self-injurious behaviors Clinical and Research Program in Pediatric Psychopharmacology

DSM Criteria for Autism Schizophrenic reaction - Childhood Type Schizophrenia - Childhood Type Infantile Autism DSM-I (1952) DSM-II (1968) DSM-III (1980) Pervasive Developmental Disorders Pervasive Developmental Disorders Autism Spectrum Disorder DSM I (1952) Schizophrenic reaction, childhood type (Psychotic reaction in children with Autism) DSM II (1968) Schizophrenia, childhood type (This category is for cases in which schizophrenic symptoms appear before puberty. The condition may be manifested by autistic, atypical and withdrawn behavior) DSM III (1980) Infantile Autism Criteria for Infantile Autism A. Onset before 30 months of age 

B. Pervasive lack of responsiveness to other people (autism) 

C. Gross deficits in language development

D. If speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal.

E. Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interest in or attachments to animate or inanimate objects.

F. Absence of delusions, hallucinations, loosening of associations, and incoherence as in Schizophrenia. DSM-III-R (1987) DSM-IV-R (1994/2000) DSM-5 (2013) Clinical and Research Program in Pediatric Psychopharmacology

Autism Spectrum Disorder (299.00) DSM-5 Diagnostic Criteria for Autism Autism Spectrum Disorder (299.00) ______ ________ Clinical and Research Program in Pediatric Psychopharmacology

Autism Spectrum Disorder Prevalence of Autism Spectrum Disorder Children with ASD ADDM Network Children 8 years old Medical records reviewed by trained clinicians SURVEYS ASSESSING PREVALENCE OF ASD IN GENERAL POPULATION ADDM 2008 Survey - Individuals with an ASD had average medical expenditures that exceeded those without an ASD by $4,110–$6,200 per year. Medical expenditures for individuals with an ASD were 4.1–6.2 times greater than for those without an ASD. Differences in median expenditures ranged from $2,240 to $3,360 per year with median expenditures 8.4–9.5 times greater. Children with ASD have higher annual mean number of psychiatric (2.2 vs 0.3) outpatient visits and are nearly 9 times more likely to use psychotherapeutic medications than children without ASD (43% vs. 5.0%) (Croen et al., 2006). The financial burden of health care (average annual cost) is reported to be 3 times higher for those ASD individuals with psychiatric comorbidities than those without ($4849 vs $1682). 7/1000 15/1000 Prevalence of ASD has more than DOUBLED between 2002 & 2010 and is increasing at the rate of 10 - 17% / year Centers for Disease Control & Prevention (CDC) Surveys: ADDM Network Surveys 2000, 2002, 2004, 2006, 2008, & 2010

Prevalence of ASD Substantial rise in the prevalence of AUTISM Intellectually Capable Intellectually Impaired ADDM 2008 Survey - Individuals with an ASD had average medical expenditures that exceeded those without an ASD by $4,110–$6,200 per year. Medical expenditures for individuals with an ASD were 4.1–6.2 times greater than for those without an ASD. Differences in median expenditures ranged from $2,240 to $3,360 per year with median expenditures 8.4–9.5 times greater. Children with ASD have higher annual mean number of psychiatric (2.2 vs 0.3) outpatient visits and are nearly 9 times more likely to use psychotherapeutic medications than children without ASD (43% vs. 5.0%) (Croen et al., 2006). The financial burden of health care (average annual cost) is reported to be 3 times higher for those ASD individuals with psychiatric comorbidities than those without ($4849 vs $1682). Substantial rise in the prevalence of AUTISM in intellectually capable populations Centers for Disease Control & Prevention (CDC) Surveys: ADDM Network Surveys 2000, 2002, 2004, 2006, 2008, & 2010

Intelligence Profile in AUTISM Intellectual Disability [ID] Autism Spectrum Disorder With ID [Low-Functioning] High-Functioning IMPAIRED IQ Intelligence Quotient (IQ) Domains of Autism Non-verbal Communication Emotional Processing (awareness/perception, motivation, response) Empathy (ToM; perspective taking [relating with others]) Social Processing (awareness, motivation, response) Restricted-Repetitive Behaviors (interests, routines) Cognitive Flexibility (rigid routine, poor social adaptability, rigid thinking, transitional difficulties, novelty averse, inability to share) Sensory Dysregulation (hypersensitive, hyposensitive) Abstract Thinking (Concrete/literal, black & white example; tolerate ambiguity, tolerate unstructured time) Salience (emotions, physiological, cognitive, social) Executive Control (emotions, motivations, interests) Introspective ability (self awareness, self reflection, psychological mindedness) Affective speech Reading emotions (non-verbally in others and within self) Cognitive domains of development – Intellectual, social, and emotional Social – emotional relatedness Emotional Capacity – Empathy, OTHER FEATURES Social & emotional salience (forest for the trees, registering socially and emotionally relavent stiulii) Sensory Dysregulation Concrete/literal Restricted-Repetitive Behaviors Emotional Processing Empathy (ToM) Social Processing Cognitive Flexibility Abstract Thinking (Concrete/literal) Introspective ability Social-emotional immaturity, understanding, competence, capicity, Non-verbal Asocial Verbal Socially curious Clinical and Research Program in Pediatric Psychopharmacology

The Alan & Lorraine Bressler Program for Autism Spectrum Disorder Social-emotion Competence Across the Lifespan Preschool Latency Teenage Young Adult Adult (0–5 years) (6–12 years) (13–18 years) (19–35 years) (≥36 years) Minimal social- emotion demands ± Superior intellectual capacity Socially isolated Bullied Impaired intellectual functioning Social difficulties (friends, prom, dating) Impaired intellectual performance ± Intellectual success Challenges: -Social & relationship -transition to adulthood Delayed social milestones (marriage, children) Social-emotional isolation Sensory Dysregulation Present with ADHD At risk for depression, anxiety, psychosis At risk for drug abuse Suffer from anxiety & mood dysregulation Social phase Professional Phase Areas of Social-emotional Development - Non-verbal communication skills - Social skills - Empathy - Abstracting ability - Cognitive Flexibility - Executive Control - Introspective ability Typical Development AUTISM Capacity Competence Demands: Peers develop these skill set; Developmental expectations (less flexible environment) Disability Social-emotional maturity curve The Alan & Lorraine Bressler Program for Autism Spectrum Disorder