Autism Spectrum Disorder

Autism

includes a wide range, “a spectrum” of symptoms, skills and level of disability

reflects multifactorial influences, including genetic and environmental factors

Risk factors: Genetic predisposition

many genes and pathways may contribute

fragile X syndrome, tuberous sclerosis; rett syndrome

Risk Factors: Prenatal factors

parental age and some prenatal factors can influence likelihood

Risk factors: Myth busting

parenting style and vaccines do not cause autism

Prevalence for Autism

1 in 31 children aged 8 years has been identified with ASD

ASD occurs across racial, ethnic, and socioeconomic groups

ASD is over 3 times more common among boys than among girls

Definitions of Autism

a neurodevelopment condition characterized by persistent differences in social communication and interaction, alongside restricted or repetitive patterns of behaviors, interests, or activities

social communication and restricted/repetitive patterns

Diagnosis (DSM 5)

a. persistent deficits in social communication and interaction across context

b. restrictive and repetitive patterns of behavior, interests, or activities

c. symptoms present in early childhood

d. symptoms limit and impair everyday functioning

Social Communication and Interaction: A1

Useful emotional reciprocity (may include differences in back and forth conversation, sharing interest in affect, and initiating or responding to interaction

Context matters (communication can vary with familiarity, sensory load, language, and the supports available)

Social Communication and Interaction: A2

nonverbal communication (differences in eye gaze, gesture, facial expression, body language, or integrating verbal and nonverbal cues

Social Communication and Interaction: A3

Relationships (differences in developing, maintaining, and understanding relationships across contexts

Restricted, Repetitive Patterns of Behaviors, Interests or Activities: B1

movement, objects, or speech (repetitive movements, echolia, lining up objects, or distinctive use of language may be present)

natural interests (interest may be highly specific, restricted and fixated

Restricted, Repetitive Patterns of Behaviors, Interests or Activities: B2

sameness and routines (transitions or unexpected change may require preparation and additional support

Sensory processing (hyper or hypo reactivity to sound, light, tough, movement, taste, pain, or temperature may occur

Symptoms and occupational challenges: Communication

differences in reciprocity, language, and social understanding

Symptoms and occupational challenges: Patterns and routines

restricted or repetitive behaviors, interests, or routines

Symptoms and occupational challenges: Occupations

effects may appear in participation, daily living, and play

Occupational performance skills: Communication and social

expressing needs and navigating interaction

Occupational performance skills: Motor and praxis

planning, sequencing, and carrying out action

Occupational performance skills: Sensory processing

registering and responding to sensory input

Occupational performance skills: Executive functioning

starting, shifting, organizing, and completing

Occupational performance areas: Self-care and daily living

routines, dressing, eating, sleep, and community mobility

Occupational performance areas: Education and work

access, participation, productivity, and accommodations

Occupational performance areas: Play and leisure

choice, exploration, and restoration

Occupational performance areas: Social participation

belonging with family, peers, and community

Level 1

needs support, patient’s social and communication skills and repetitive behaviors are only noticable without support

Level 2

needs substantial support, patient’s social and communication skills and repetitive behaviors are still obvious to the casual observer, even with support in place

Level 3

needs very substantial support, patient’s social and communication skills and repetitve behaviors severly impair daily life

Evaluation of Autism

observation and interview

standardized or non-standardization assessment

Screening tools of Autism: Developmental screening

questions indicate whether further evaluation is needed

Screening tools of Autism: Modified Checklist of Autism in Toddlers (MCHAT)

toddler autism screener with a structured follow up interview

care giver completes checklist

Screening tools of Autism: Ages and Stages Questionnaires

caregiver completed questionnaires across developmental domains

Screening tools for Autism in Toddlers and Young Children

a 20 minute interactive screening measure using play-based activities

observe play and communication

Diagnostic tools for Autism

no single tool stands alone; results are integrated with history, observation, clinical judgement, and context

Autism Diagnostic Interview Revised

caregiver interview (a semi-structured interview that gathers developmental history and patterns of social communication and behavior)

ADOS

standardized, direct observation of social communication and behavior across structured activities

GARS-3

rating scale describing autism-related behaviors, typically informed by people who know the individual well

Common Co-occuring conditions

anxiety, mood disorders, ADHD, sleep disorders, and epilepsy