Autism Spectrum Disorder

What is Autism Spectrum Disorder (ASD)?

Neurodevelopmental disability Not a mental
illness People first language Child or individual
with autism NOT autistic child �Hidden� disability
� no identifying physical characteristics

Why do there seem to be so many more children with ASD?

Increased awareness More uniform criteria for
diagnosis Broader range of diagnosis
Misdiagnosis Actual increase in the number of children
with ASD


Definition ASD: DSM-5


Qualitative
impairments in
social communication and interaction Persistent
pervasive deficits not accounted for by general developmental
delays, manifested by all 3 of the following:
social-emotional reciprocity nonverbal communicative
behaviors relationships appropriate to the developmental
level


Defining ASD: DSM-5


Restricted/repetitive
behaviors/interests Restricted, repetitive
activities as manifested by at least 2 of the
following: stereotyped or repetitive speech, motor movements,
or use of objects Excessive adherence to routines
Highly restricted, fixated interests that are abnormal in
intensity or focus Hyper- or hypo-reactivity to sensory
input or unusual sensory interests


Defining
ASD: DSM
-5


DSM-5
also requires clinicians to
specify: Other diagnoses that may be present such
as cognitive or language impairment, known medical or genetic
conditions, other neurodevelopmental or behavior disorders
Clinician rates the severity of the ASD: level 1 requires
support; level 2, substantial support; or level 3, very substantial
support


ASD: Changes in the DSM-5

DSM-5 revisions
Autism Spectrum Disorder Formerly Autism, Asperger
Syndrome, and PDD-NOS Consolidated required features
Social/communication deficits Restricted, repetitive
patterns of behavior, interests, activities Addition of
sensory criteria Increases specificity while maintaining
sensitivity Important to distinguish spectrum from
non-spectrum developmental disabilities Improves stability
of diagnosis Addition of new diagnostic category - SCD

Social Communication Disorder (SCD)

Diagnosed when an individual has deficits in the social use of
language but do not demonstrate the restricted interests or
repetitive behavior typically observed in ASD

Previously Established Diagnosis

The DSM-V text states �Individuals with a well-established
DSM-IV diagnoses of autistic disorder, Asperger�s disorder, or
pervasive developmental disorder not otherwise specified should be
given the diagnosis of autism spectrum disorder�


Absolute Indications for Referral

No babbling by 12 months No gesturing (pointing,
waving bye-bye, etc.) by 12 months No single words by 16
months No 2 word spontaneous phrases by 24 months (not
echolalic) ANY loss of ANY language or social skills at ANY
age


Signs of Autism: Social communication & interaction

Expressive and/or receptive language delay Limited use
of communicative gestures, ie. Pointing, waving Use of
atypical ways to communicate, ie. Leading by the hand May
have history of regression of language skills at average age of 21
months Atypical social interaction Poor eye
contact


Signs of
Autism:
Restricted/repetitive behaviors & interests

Repetitive behaviors Repetitive physical movements,
ie. hand flapping, spinning, finger flicking Sensory
difficulties, ie. sound or tactile sensitivities
Behavioral concerns, ie. tantrums, hyperactivity, poor
compliance


Screening for ASD

American Academy of Pediatrics (AAP) Policy Statement, 2006
& 2007 Developmental surveillance at all well
visits Administer standardized developmental screening tool
at 9, 18, and 24 or 30 month visits Specific ASD screen at
18 and 24 months


Routine Screening?

What are some of the common screening tools?
MCHAT R/F� modified checklist for autism in toddlers
Ages and Stages Questionnaire: Social Emotional (ASQ-SE)
Social Communication questionnaire (SCQ)


AAP
Policy
Statement 2006/2007

For those at-risk/positive screening results�
PCP to refer developmental concerns to early intervention or
early childhood programs

AND
Recommend developmental evaluations

Difficulties with Diagnosis

No blood test or brain scan No �medical� tests
Most reliable diagnosis - Multi-Disciplinary Team
Evaluation Developmental Pediatrician
Psychologist Speech Pathologist Occupational
Therapist

Possible Causes

No one cause of autism No one type of autism
Early onset Regression
Both genetics and the environment play a role in
early brain development leading to autism Much research is
being done to learn more


Care Teams for Children with ASD

Developmental and Behavioral Pediatrics Neurology
Psychiatry Psychology Gastroenterology
Genetics Occupational Therapy Physical
Therapy Speech Therapy


Genetics

Risk of any ASD for sibling of child with autism is 2 - 18%
(2011) Relatives may be affected by difficulties that are
conceptually related to autistic behaviors (broader autistic
phenotype)


Genetic syndromes

Some known genetic syndromes can be associated with
autism: Tuberous Sclerosis Syndrome Fragile X
Syndrome Klinefelter Syndrome Rett Syndrome
Down Syndrome


Vaccine Controversy

No evidence-based studies have supported a relationship between
vaccines and autism Retraction of Lancet article reporting
link between MMR vaccine and autism Ongoing family concerns
fueled by reports in the media that contradict research

Strengths Associated with ASD

Attention to detail Lots of energy
Honesty Methodical habits Nonjudgmental
attitude Passionate about their interests Strong
mechanical skills Visual learning Memory

Challenges Associated with ASD

Language and communication difficulties Thinking
differences Social deficits Difficulty waiting
Sensory challenges Motor skills challenges (more
noticable in older children)

Variability in ASD

Every individual on the Autism Spectrum is unique What
works for one individual may not work for another individual
The saying goes� �If you have seen one person with autism, you
have seen one person with autism�

Communication Difficulties: Speaking

May: Be non-verbal or have limited verbal skills
Be very verbal but still struggle communicating Have
difficulty expressing basic wants, needs, or feelings Have
difficulty asking for help, for a break, for attention Have
difficulty asking and answering questions Have difficulty
making choices (yes, no, last option) Repeat your words and
phrases Confuse pronouns (Mine and yours, I and you)

Communication Difficulties: Listening and Understanding

May: Seem like they can not hear Not respond
to name, instructions, or questions Seem to understand more
than they actually do Seem like they don�t understand when
they do Have difficulty with abstract concepts
Time concepts (�wait�, �later�, �in a minute�, �after
while�) General terms (�share�, �be nice�, �be a good
boy�) Idioms (�shake a leg� for hurry up)

Possible Thinking Differences

Extreme focus on narrow topics Attachment to certain
objects Rigid or literal thinking patterns Desire
for sameness/order/repetition Need for preparation
Slow to process information and respond Difficulty with
complex instructions

Visual Supports

Assist in understanding Provide clear
expectations Reduce anxiety Establish trust

Possible Social Deficits

Difficulty with social interaction Difficulty
understanding perspective of others Preference for objects
or interests over people Difficulty reading & using
nonverbal social cues Difficulty understanding �unwritten�
social rules Poor eye contact

Sensory Processing

Extreme reactions or lack of reaction to certain sensory
input Auditory Visual Tactile
Olfactory Gustatory Vestibular
Proprioception

Possible Attention Problems

Attention difficulties Off-task behavior due to
distractions in their surroundings Hyperactivity
Impulsivity Lack of inhibition

Safety

Many children with autism lack the ability to understand
danger Data suggests that children with autism are at
increased risk for serious injury and even death due to
accidents Many children with autism will require safety
supervision much longer than other children Top safety
risk: Wandering/Bolting

Possible Emotional Difficulties

May laugh or giggle for no apparent reason May cry
�out of the blue� Excessive fear of harmless objects or
situations Lack of fear in response to actual dangers
High anxiety & stress level in �normal situations�
May become upset if others interrupt what they are doing

Common Challenging Behaviors

Non-compliance Tantrums Disruption
Property Destruction Aggression Self-Injurious
Behavior (SIB) Bolting Spitting

How We Contribute to Challenging Situations

We are inconsistent and unpredictable� even when we
don�t mean to be We place the individual in confusing,
disorganized environments We misunderstand the difficulties
of people with ASD We are sometimes stressed/anxious around
individuals with ASD and they pick up on it

Occupational Therapist Role in Treatment

Enhancing participation and performance activities of
daily living, instrumental activities of daily living, education,
work, play, leisure and social participation Evaluation to
assess individual skills strengths and challenges
Intervention individualized techniques and procedures
directed at the individual, environment or activity

Therapist Role cont�d

Use of Self-Management skills to encourage, empower and equip
patients and families Measuring outcomes
occupational performance client satisfaction
role competence health and wellness prevention
of further difficulties quality of life