1. Autism Spectrum Disorders
Chapter 6

2. Outline: Autism Spectrum Disorder
Defining features
Associated characteristics
Prevalence & Course
Causes
Treatment

3. Defining Features of ASD
Difficulties in the following areas, with onset in early life (< age 3)
Social interaction & communication
Restricted, repetitive patterns of behavior, interests, or activities
Autism Spectrum Disorder
Neurodevelopmental disorder
Differences in those with ASD contributing to the “spectrum”
Level of intellectual ability
From profound disability to above-average intelligence
Severity of language problems
Some with ASD are mute; others are able to speak well
Behavior changes with age
Some make little progress; others develop speech, become more outgoing
Those who make progress are typically those with higher intelligence and earlier speech

4. Social Interaction Impairments
Impairment in understanding & expressing non verbal behaviors (e.g., eye contact, facial expressions, body postures, gestures)
Failure to develop peer relationships appropriately
Lack of spontaneously sharing with others (joint attention) – lack of showing, pointing out objects of interest
Early sign of language impairment
Protoimperative gestures = gestures or vocalizations used to express needs
Protodeclarative gestures = gestures or vocalizations directing someone’s attention to something of mutual interest
Children with ASD use protoimperative gestures (e.g., pointing to a toy child wants), but NOT protodeclarative gestures (methods to engage other people in the interaction)
However, children with ASD are more responsive to parents than unfamiliar adults

5. Communication Impairments
Delay in spoken language (50% do not develop language) OR
Impairment in ability to initiate / sustain conversation
Atypical early vocalizations = early indicator of ASD in infants
Unusual rhythm & intonation of speech
Lack of make-believe play

6. Communication Impairments cont.
Lack of social chatter – fail to use language for social communication
Language is silly, nonsensical, incoherent, & irrelevant
Pronoun reversal = child repeats personal pronoun exactly as heard, without changing pronoun to suit the situation
Parent: “What’s your name?”
Child (Tim): “Your name is Tim”
Echolalia – parrot-like repetition of words or word combinations
Parent: “Do you want a cookie?”
Child: “Do you want a cookie?”
Common element = failure to understand that language can be used to inform & influence other people

7. Restricted & Repetitive Behaviors & Interests
Stereotyped, repetitive body movements or movements of objects (e.g., hand flapping, rocking, spinning) = self-stimulatory behaviors
Children crave stimulation; self-stimulation serves to excites the nervous system
OR Environment is too stimulating & these behaviors block out, control unwanted stimulation
Inflexible adherence to routines / rituals, insistence on sameness
Restricted, fixated interests that are abnormal in intensity or focus (e.g., preoccupation with objects)
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of environment (e.g., indifference to pain/temp, adverse response to sounds or textures)

8. Theory of Mind
ToM = ability to attribute mental states to oneself & others, understanding that others have beliefs, desires, & intentions different from one’s own
Typically developing 4-year-olds have developed ToM
They understand that someone can have a false belief about a situation
Children with ASD get this puzzle wrong

9. Prevalence & Course 1-2% worldwide
Dramatic increase in diagnosed cases
Unsubstantiated proposed causes (e.g., vaccines, diet, allergies)
Rise in prevalence likely due to:
Greater awareness
Greater recognition of milder forms of ASD
Broadening of concept and definition
Changes in diagnostic criteria & categories
Diagnostic substitutions
Is there a rise in prevalence rate due to some unidentified cause?

10. Prevalence & Course 4-5x more common in boys
Sex difference most apparent among children average/above intelligence
Among children with ASD & profound intellectual disability, numbers similar across sex
Rates of ASD similar across racial & ethnic groups
Higher prevalence among Caucasian children than African American & Hispanic children
Cultures vary in view of ASD

11. Prevalence & Course Age of Onset
Diagnosis usually made in preschool or later
Most parents become concerned 1+ yrs before diagnosis
Usually < 2nd birthday
First concerns: Lack of progress in language, imaginative play, social relations
Early indicators:
Using few gestures to express social interest
Not responding when name is called
Lack of eye contact
Limited babbling
Odd or repetitive ways of moving hands/fingers
AAP recommends all children be screened for ASD at mo

12. Course
70% with ASD show poor outcomes long term and are unable to live independently
Those with higher intellectual functioning have better prognosis

13. Causes Genetic Influences: Family & Twin Studies
15-20% of siblings of those with ASD also have the disorder
Family members of children with ASD display higher rates of social & language deficits, unusual personality features
Concordance rates for ASD
Identical twins = 70-90%
Fraternal twins = nearly 0%
Heritability of an underlying liability may be as high as 90%
However, greater role for environmental factors than previously thought

14. Causes Problems in Early Development
Health problems during pregnancy, at birth, or immediately following birth
Prenatal & neonatal complications
preterm birth
bleeding during pregnancy
Toxemia
viral infection
Very preterm birth (<26 wks)
Other risk factors affecting prenatal environment
Parental age
IVF
Maternal use of drugs
Toxic chemicals in the environment during pregnancy
Maternal illness during pregnancy
SSRI exposure during first trimester

15. Associated Characteristics
Intellectual Deficits & Strengths
70% have intellectual impairment
40% severe to profound impairments, IQs < 50
30% mild to moderate impairments, IQ = 50-70
30% average to above-average intelligence
Average or above average intelligence predicts independent living status as adults
25% develop splinter skills or islets of ability – special talent in spelling, drawing, memorization, music
Above average for general population & well above own level of intellect
5% of children with ASD develop an isolated & remarkable talent = autistic savants

16. Treatment: Overview Best treatments
developmentally oriented
early behavioral interventions involving parents
used along with special education
These treatments associated with gains in
Language
Communication
Measured IQ
Modest reduction in severity of core symptoms
Antipsychotic meds can help in decreasing interfering & challenging symptoms
Meds have side effects; pros vs. cons should be weighed

17. Key Components of Behavioral Treatments for ASD (e.g., ABA)
Early: Interventions should begin as soon a ASD diagnosis is seriously considered
Intensive: Active engagement of child at least 25 hrs/week, 12 mo a year
Low Student-Teacher Ratio: One-on-one time is important to meet individualized goals
High Structure: Predictable routines, visual activity schedules, clear physical boundaries
Family Inclusion: Include family component with parent training
Peer Interactions: Promote opportunities for interactions with typically developing peers