1. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS LECTURE OUTLINE History and background Diagnostic features Other pervasive developmental disorders Etiology Treatment

2. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS History and background Originally called Kanner’s (1943) syndrome Very low prevalence rates – Szatmari & Mahoney (1993) estimate <.1% in Canada But highly dysfunctional and disabling condition More common in boys than girls (4:1)

3. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Diagnostic features Social development extreme autistic aloneness, avoid eye contact, lack of social interaction non-responsive to social envirnoment, more interested in mechanical objects odd behaviours – rhythmic rocking, preservation of sameness, non-compliance

4. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Diagnostic features Language acquisition 50% mute lack of meaningful communication echolailia pronoun reversal

5. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Diagnostic features Attention, perception, cognition stimulus overselectivity low IQ savants lack of independent functioning

6. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Related disorders Asperger disorder Rett syndrome Child disintegrative disorder

7. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Etiology Psychogenic – Bruno Bettelheim (1967), The empty fortress – “refrigerator mother” Biological neurobiological factors – high rates of seizures, prenatal infections and birth complications brain impairment – several areas implicated, not just a single area

8. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Etiology genetics – Folstein & Rutter twin study (1978) – for cognitive impairment, 36% concordance rate for DZ twins, 82% concordance rate for MZ twins; for autism, 0% concordance rate for DZ twins, 36% concordance rate for MZ twins

9. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Treatment biomedical psychodynamic intensive behavioural treatment

10. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Treatment – Lovaas program original work in the 1960s at UCLA with children who had been institutionalized used shaping, positive reinforcement, and punishment many gains in social and language skills but once returned to hospital, children regressed

11. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Treatment – Lovaas program 1979-84 – work with very young autistic children; treatment more intensive for longer periods of time; parent training component More enduring positive outcomes than in original study

12. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Treatment – Lovaas program 3 groups Intensive treatment (n=19) - > 40 hours per week of 1:1 treatment Minimal treatment (n=19) - < 10 hours per week of 1:1 treatment Control group (n=21) – referred to other services available to autistic children in the community

13. Outcomes of Lovaas (1987) program Group IQ at ages 6-7 Intensive treatment 83 Minimal treatment 52 Control57

14. Outcomes of Lovaas (1987) program Group Normal Grade 1 Language class Autism or DD class Intensive treatment 47%42%11% Minimal treatment 0%42%58% Control2%49%49%

15. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS Limitations of Lovaas research small sample sizes no external evaluations, need for replication (these are in progress) variability in response to treatment

16. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS SUMMARY Autism is a very rare, but a very disabling disorder of childhood Biological factors are involved, but no one single factor appears to be the causal agent

17. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS SUMMARY In spite of biological basis, there are encouraging findings from studies of intensive behavioural intervention for children with this disorder Unfortunately, these treatments are not widely available