Autism Spectrum Disorder

• ASD = Autism Spectrum Disorder ○ Neurodevelopmental disorder ○ Deficits (ALL 3) ▪ in social communication ▪ RRB’s (Restrictive & Repetitive Behaviors) ▪ Across settings • Prevalence ○ 1 in 56 children (2019); 1:34 (2020) 1:56 (2023) ○ NJ has 3rd highest incidence reported in 2020 2.9% of children 8 years of age ○ More common in males than females ○ Males are 4 times more likely to have a diagnosis ○ Genetic and environmental causes • Quick Facts ○ 1: 34 children ○ Males 4:1 ○ More diagnosis in Blacks and Hispanics ○ Approximately 39% have intellectual disabilities (ID) ○ Approximately 41% have been diagnosed before the age of four ○ Adults with ASD have higher rates of all major psychiatric disorders ○ Adults have higher incidence of chronic medical issues • History/Background ○ Leo Kanner 1943 ▪ Childhood schizophrenia • extreme autistic aloneness,” • “delayed echolalia” • “anxiously obsessive desire for the maintenance of sameness.” • children were often intelligent and some had extraordinary memory ○ Adolf Meyers ▪ Adolf Meyer (1866–1950) was an early supporter of occupational therapy as a connection between an individual’s activities and mental health. Meyer, a psychiatrist, incorporated community-based activities and services to develop skills of everyday life into treatment with his patients. He developed an approach he called “psychobiology” and based treatment on the combined life experience and physiological and biological data of patients. He recommended taking detailed life histories of patients, revolutionizing case records. Meyer viewed individuals holistically as organisms that interact with and adapt to their environment. Meyer hired Eleanor Clarke Slagle as Director of Occupational Therapy at Johns Hopkins Hospital and served as a major influence on her work. ○ Hans Asperger 1944 (Asperger's disorder) ○ Psychological disorder ○ Diagnostic and Statistical Manual of Mental Disorders (DSM) ○ Early 1800’s ▪ Provides taxonomy and diagnostic criteria for MH disorders ▪ Multiple revisions ○ DSM II- 1952 classified as a psychological disorder ○ DSM III (1980) Autism was separate disorder ○ DSM III-R (1987) Recognized as a spectrum disorder ▪ PPD, Asperger’s disorder ▪ Emerging concepts as a developmental disorder ○ DSM IV- 1997 ▪ Human Genome Project 2003 ▪ May be genetic ○ DSM IV-R (2000) provided spectrum of disorders ▪ Diagnostic axis ○ DSM 5 (2013) controversial ▪ Classified as a ‘Neurodevelopmental Disorder’ ○ ICD 10-CM 299.00 B- 4 DSM 5 (pg.50) ▪ Sensory issues!!! Thank you Dr. Miller ▪ Reactions to sensory input- behaviors and patterns associated with all areas ○ DSM-5 changes ▪ Merged four prior dx into 1 diagnosis • No Asperger's • New category for Social Communication Disorder (315.39) ▪ Changed name to ASD- most important change • Diagnosis ○ In Children ○ Diagnosing an ASD takes two steps: ▪ Developmental Screening ▪ Comprehensive Diagnostic Evaluation ▪ Most prevalent medical condition • Seizures • Sleep disorders • Weight problems/GI issues: Lower BMI • Incidence/Etiology/Areas of Dysfunction ○ In Adolescence ▪ ASD dx commonly occurs around age 8 ▪ Students are identified by parents and teachers ▪ Evaluated by the school ▪ Present with issues with socialization, communication (humor, sarcasm) ▪ Medical issues are higher in ASD than typical peers ▪ Psychological issues are higher than peers or in younger children ▪ Similar as when younger, but change in severity • More allergy related disorders ▪ Sleep disorders, Seizures and Obesity ○ Adults ▪ Difficult to diagnosis due to overlapping conditions. ▪ ASD in adults is increasing ▪ The issue is signs would have had to occur during childhood ▪ Therefore a developmental history would be part of the evaluation process. ▪ The diagnostic criteria is the same ▪ Medical issues are higher in adults with ASD then without ▪ Higher prevalence of psychiatric disorders (depression, anxiety, OCD) ▪ Very high rate of Suicide attempts ▪ High rate of obesity leading to increase rate of disorder of age- DM, HTN, high cholesterol • Treatment ○ Children- treatment focuses on developmental, behavioral and medical supports ▪ Schools systems ○ Adolescents- focuses on social, vocational and medical supports ▪ School systems ▪ Transitional support ○ Adults – emerging - more on medical supports for symptoms ▪ Emerging • Facts & Myths ○ Only children can be diagnosed with Autism? ▪ False ○ Autism can be diagnosed as early 2 years of age. ▪ True – but should not be diagnosed that early ○ Symptoms of autism may appear a early as 6 months ▪ True ○ People with Autism are also intellectually impaired. ▪ False – Only 30% are ○ New Jersey has the highest rate of ASD in the US. ▪ True – Unsure why ○ ASD is curable ▪ False