Week 12 - Asking “What If?” - Autism Spectrum Disorder: Core Features, Diagnosis, and Treatment

Common autism myths

• Children with autism are incapable of friendship or love

• All people with autism have a special ability

• Autism is caused by bad parenting

• Autism is new

• There is an autism epidemic

• People with autism are cold and unempathetic

Autism spectrum disorder (ASD)

a complex developmental disorder caused by differences in the brain

• Deficits in social communication and interaction

• Restricted, repetitive, stereotyped behaviors, interests and activities

• 1 in 36 children

ASD

• 1 in 37 boys, 1 in 151 girls

• No medical test or cure

• Costs a family $60,000 a year

• Occurs in all racial and ethnic groups

• More common than childhood cancer, juvenile diabetes, and pediatric AIDS combined

Autism according to Kanner in 1943

• A profound autistic withdrawal

• An obsessive desire for the preservation of sameness

• A good rote memory

• An intelligent and pensive expression

• Mutism or language without real communicative intent

• Oversensitivity to stimuli

• A skillful relationship to objects

DSM-5 Social/Communication Domain

Social interaction and communication domains condensed into one domain: social/communication deficits: all three of the following must be met:

1. Deficits in social-emotional reciprocity

• Abnormal social approach, difficulties with back and forth conversations, reduced sharing of interests, emotions and affect

2. Deficits in nonverbal communicative behaviors

• Facial expressions, gestures, eye contact, body language

3. Deficits in developing and maintaining relationships

• Adjust behaviors to suit social context, difficulties in imaginative play, making friends, interest in others

DSM-5 restricted, repetitive patterns of behavior, interests or activities

1. Stereotypes or repetitive speech, motor movements or use of objects

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior or excessive resistance to change

3. Highly restricted, fixated interests that are abnormal in intensity or focus

4. Hyper or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment

Variations in ASD presentation

• Core symptoms manifest differently across age groups

• Presentation may differ in females

• ASD symptoms may be missed more frequently in children from some cultural and socioeconomic groups

• Individuals with lower IQ/language abilities present differently

• “If you’ve met one person with autism, you’ve met one person with autism.” - Dr. Stephen Shore

Social (Pragmatic) Communication Disorder

• Must have ALL of these social verbal and nonverbal communication deficits

  • Deficits in using communication for social purposes

  • Impairment in ability to adjust communication to context

  • Difficulties following conversation rules and telling stories

  • Difficulty making inferences or with ambiguous language (too literal)

• Functional limitations in communication, social participation, school and work

• Onset in early development

• Not due to neurological or medical condition, ASD, intellectual disabilities, global developmental delay

Pragmatics

involves 3 major communication skills

1. Using language for different purposes

• Greeting (ex: hello, goodbye)

• Informing (ex: I’m going to get a cookie)

• Demanding (ex: give me a cookie)

• Promising (ex: I’m going to get you a cookie)

• Requesting (ex: I would like a cookie, please)

2. Changing language according to the needs of a listener or situation

• Talking differently to a baby than to an adult

• Giving background info to an unfamiliar listener

• Speaking differently in a classroom than on a playground

3. Following rules for conversations and storytelling

• Taking turns in convo

• Introducing topics of convo

• Rephrasing when misunderstood

• How to use verbal and nonverbal signals

• How close to stand to someone when speaking

• How to use facial expressions and eye contact

Diagnosing ASD

• Comprehensive psychiatric evaluation

• Autism Diagnostic Interview-Revised (ADI-R)

• Language and Cognitive testing

• Autism Diagnostic Observation Schedule (ADOS)

PEERS Lessons

• Introduction and trading information

• Two-way conversations

• Electronic communication

• Choosing appropriate friends

• Appropriate use of humor

• Starting and joining conversations

• Exiting conversations

• Good sportsmanship

• Get-togethers

• Handling arguments

• Changing reputations

• Handling teasing and embarrassing feedback

• Handling physical bullying

• Handling cyber bullying

• Minimizing rumors and gossip

Does The Curious Incident of the Dog in the Night-Time accurately represent autism?

Christopher’s traits:

• Significant difficulty communicating and interacting with people (ex: overly literal)

• Difficulty interpreting gestures and facial expressions

• Difficulty taking others’ perspectives

• Formal speech, no social spontaneity/reciprocity

• Restricted interests

• Rocks or groans when overwhelmed 

• Hypersensitives to sound, smell and touch

Stereotypical representation

Christopher’s unique way of experiencing things

• Focus on orderliness

• Derives comfort from highly detailed information

  • “It was 1:12 a.m. when Father arrived at the police station. I did not see him until 1:28 a.m. but I knew he was there because I could hear him.”

• emotional limitation: trouble reading faces and the emotions of others

Contrast with Milo of The Phantom Tollbooth

Theory of mind and need for order

• Smarties task

• “...when I was little I didn’t understand about other people having minds. And Julie said to Mother and Father that I would always find this very difficult. But I don’t find this difficult now.”

• Need for Order

  • Regularity and predictability in his sentences

  • “I do this, then I do that…”