1. Chapter 7 Autism Spectrum Disorders

2. DSM-IV Definitions
Autistic Disorder - marked by three defining features, with onset before age: 1) impaired social interaction, 2) impaired communication, and 3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities
Asperger Syndrome - impairments in all social areas, particularly an inability to understand how to interact socially
Rhett’s Syndrome - a distinct neurological condition that begins between 5 and 30 months of age, marked by a slowing of head growth, stereotypic hand movements, and severe impairments in language and coognitive abilities
Childhood disintegrative disorder - shares characteristics with autistic disorder, but doesn’t begin until after the age of 2 and sometimes not until age 10
Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) - diagnosis given to children who meet some, but not all, of the criteria for autistic disorder.

3. IDEA Definition
Autism is a developmental disability affecting verbal and nonverbal communication and social interaction, generally before age 3, that adversely affects a child’s performance.

4. Characteristics Impaired social relationships
Many children with autism do not speak. Echolalia is common among those who do talk
Varying levels of intellectual functioning, uneven skill development
Unusual responsiveness to sensory stimuli
Insistence on sameness
Ritualistic and stereotypic behavior
Aggressive or self-injurious behavior

5. Screening
Early diagnosis is highly correlated with dramatically better outcomes
Autism can be reliably diagnosed at 18 months of age
Checklist for Autism in Toddlers (CHAT)
Modified Checklist for Autism in Toddlers (M-CHAT)

6. It is largely based on clinical judgment
Diagnosis
Childhood Autism Rating Scale (CARS)
Autism Diagnostic Interview—Revised
Gilliam Autism Rating Scale (GARS)
Asperger Syndrome Diagnostic Scale (ASDS)
It is largely based on clinical judgment

7. Prevalence and Causes Prevalence
Recent estimates - Autism occurs in as many as 1 in children (CDC, 2007)
Boys are affected about 4 times more often than girls
Autism is the fastest-growing category in special education (autism epidemic)

8. Prevalence and Causes Causes The cause of autism is unknown
Controversial theories
MMR vaccine
Mercury (thimerosal)
No evidence of childhood vaccinations causing autism
There is a clear biological origin of autism in the form of abnormal brain development, structure, and/or neurochemistry
Genes may be responsible for the abnormality
Environmental factors may trigger the disorder

9. What is a science-based approach?
and how is it different from pseudo-science?

10. Science reliable and valid measurements replication
pre- post measures
control/comparison group(s)
“blind” or independent evaluators
replication
published in peer reviewed journals

11. Pseudoscience No scientifically valid evidence
(no) controlled studies
(in)consistent findings
(not) published in peer reviewed journals
Use “numbers” and graphs
Ph.D.’s and M.D.s “Institutes”

12. What does body of scientific research conclude about interventions with children with ASD?

13. Current unproven or disproven medical interventions
Secretin
peptide hormone that stimulates the secretion of digestive fluids, no benefits in 3 controlled studies
Gluten Free/Casein Free Diet
food allergies cause or contribute to autism has no sound scientific evidence supporting
Hyperbaric oxygen
The logic for using hyperbaric oxygen treatment for developmental disorders relates to the auto-immune and/or viral theory of these conditions. Encephalitis, in this theory, is thought to be part of developmental disorders. No data on the use of hyperbaric oxygen for developmental disorders

14. Current unproven or disproven medical interventions
Vitamin B6 and magnesium
Dimethylglycine (DMG) (Vitamin B 15)
AZT (Terovir)
Steroids
Antibiotics
Antifungal medications
Behavioral Optometry
Craniosacral therapy
“The emphasis in Biodynamic Craniosacral Therapy is to help resolve the trapped forces that underlie and govern patterns of disease and fragmentation in both body and mind. This involves the practitioner "listening through the hands" to the body's subtle rhythms and any patterns of inertia or congestion. “

15. Current not yet validated or disproven nonmedical interventions
DIR (Greenspan’s Floortime)
“Floortime is your child’s practice time. Each time you get down on the floor and interact—spontaneously, joyfully, following your child’s interests and motivations—you help him build that link between emotion and behavior, and eventually words, and in doing so move forward on his journey up the developmental ladder”
Sensory Integration
is a complex disorder of the brain that affects developing children. Children with SPD misinterpret everyday sensory information, such as touch, sound, and movement.
RDI (Guttstein)
Higashi Method
Music Therapy
AIT (Auditory Integration Training)
Hippotherapy/Dolphin therapy
Occupational Therapy

16. Found harmful in scientific studies
Facilitated Communication
Auditory integration training
Intravenous immune globulin
withholding vaccinations

17. Evidence-Based Treatment
Applied Behavior Analysis is the only treatment approach that has been documented to produce significant gains (comprehensive and long-lasting) for children with ASD
U.S. Surgeon General’s Report
New York State Department of Early Intervention Task Force
12+ well-designed, peer-reviewed comparison studies (with over 342 subjects)
Hundreds of peer-reviewed studies documenting specific ABA procedures

18. Why Science? Wasted money, time, energy
Basing decisions about interventions mainly on preconceptions, opinions, speculations, subjective impressions, and badly done studies has many risks:
Wasted money, time, energy
Exploitation of vulnerable people
Physical and emotional injuries
Lost opportunities to make real advances
Reinforcement and perpetuation of practices that impede progress
The most tried-and-true way to reduce those risks is to rely on careful scientific evaluation to separate opinions and beliefs from verifiable facts.

19. Educational Approaches
Applied Behavior Analysis (ABA)
Discrete Trial Training
Picture Exchange Communication System (PECS)
Peer-mediated interventions
Errorless discrimination learning
Generalization
Functional assessment of challenging behavior
Pivotal response intervention
Naturalistic language strategies

20. Educational Approaches (continued)
Social stories
Picture activity schedules
Educational Placement Alternatives
Regular Classroom
Resource Room

21. Where do we start? Imitation Attending to environment Eye contact
Visual & auditory
Eye contact
Joint Referencing
Exploratory behavior
Shared attention
Imitation: learning from peers
Attending to environment- includes safety features and greeting opportunities
Eye contact- learning about facial expression “missed opportunities”
Exploratory behavior: reaching out- manipulating objects - easier to program for child who is exploring
Environment than child who doesn’t reach (reinforcer assessments) - we say need 12 “good reinforcers”
For child on DAILY basis
Shared attention:
Turn taking:

22. Howard, Sparkman, Cohen, Green, & Stanislaw (2005)
Generic Early Intervention
Autism Programs
Intensive ABA
parental preference most significant factor in placement

23. Children in the study <48 months of ageDx
Autism or PDDNOS
qualified, independent examiners
Intervention
No secondary medical condition
English primary language
No IQ “cut off”

24. Generic Early Intervention Programs
1:6 staffing ratio
 hours per week
>50% individual or group Speech Tx
Curriculum
developmentally appropriate
language “rich” environments
typical preschool activities

25. Autism Preschool Programs
•1:1 or 1:2 staffing ratio
• hours per week
•Behavioral consultant
•50% individual or group Speech Tx
•Curriculum
•Discrete trial component
•PECs
•TEACCH
•typical preschool activities

26. Intensive ABA 1:1 staffing 35 hours per week errorless learning
>800 trials/structured opportunities per day
Joint attention, imitation, and initiation*
Speech Pathologist consultant

27. Re-contacted 1 year after baseline Independent follow-up testers
Procedure
Re-contacted 1 year after baseline
Independent follow-up testers
IEP and file review
educational placement
hours and services

28. Participants at Baseline
Generic EI (16)
Autism (16)
Intensive ABA (29)
Age (mos) 35 39 31
IQ (SS) 60 54 59
Language (mos) 17 15 14
Autism Dx 72 81 82
Mother Ed (yrs) 13 28

29. Cognitive Functioning
Standard Scores

30. Receptive Language
Standard Scores