Autism Notes

Week 2: Autism Spectrum Disorder

Define ASD (DSM-5): impairment in social interaction and social communication

• Presence of restricted and repetitive behaviors

• Unusual responses to sensory information

• High sensitivity to changes in environment

• Dependent on routines

ASD Level 1: Those on this level will require some support to help with issues like inhibited social interaction and lack of organization and planning skills.

ASD Level 2: In this level, individuals require substantial support and have problems that are more readily obvious to others. These issues may be trouble with verbal communication, having very restricted interests, and exhibiting frequent, repetitive behaviors.

ASD Level 3: On the most severe end of the spectrum is Level 3 which requires very substantial support. Signs associated with both Level 1 and Level 2 are still present but are far more severe and accompanied by other complications as well. Individuals at this level will have limited ability to communicate and interact socially with others.

Restricted and repetitive behaviors (RRB): abnormal or intense preoccupation with routines or patterns

Sensory processing disorder: hypo or hyper reactivity to sensory information, or unusual preoccupation with the sensory aspects of the environment.

Theory of mind: Difficulty with theory of mind or perceiving another’s thoughts

Echolalia: echoing back of another’s behavior/scripting

Stimming: seeking repetitive stimulation to calm/organize

Diagnostic Process

• Referral for screening through provider

• Individual assessment through experienced clinician, covering:

• History (family, developmental milestones, other issues)

• Physical, neurological examination

• Parent interview

• Testing language, cognitive, development, sensory

• Observation: formal, informal

• Audiological testing

Signs and symptoms

• Difficulty with social communication and interaction

• Restricted and repetitive behaviors (RRBs): abnormal or intense preoccupation with routines or patterns

• Motor abnormalities

• Sensory processing disorder (auditory, oral, tactile, vestibular): hypo or hyper reactivity to sensory information, or unusual preoccupation with the sensory aspects of the environment.

• Feeding disorders

• Co-occurring medical disorders (seizures, GI problems)

• Strong need for routines

• Difficulty with theory of mind or perceiving another’s thoughts

• Auditory Processing

• Echolalia: echoing back of another’s behavior/scripting

• Stimming: seeking repetitive stimulation to calm/organize

• Motor issues related to use of sensation to plan, guide, and execute movement

• Sleep disturbances

Etiology

• No clear etiologic factor

• Likely originates in utero with abnormalities in brain development

• Increased evidence for genetic etiology

• Growing research suggests complex combination of biology, genetics and environmental factors

Etiology & Brain Development

• Abnormalities in brain volume

• Differences in eye contact (around 2 mos.)

• Increased evidence for genetic etiology

• Loss of brain connectivity (brain white matter, especially corpus callosum)

Etiology & the environment

• Age of parents

• Exposure to toxins prenatally, during pregnancy

• Nutrition

• Fevers during pregnancy (3rd trimester)

• Prenatal vitamins/folic acid can reduce risk

Incidence and Prevalence

• 1% of world’s population

• 3.5 million Americans

• Increase in diagnosis to 1 in 68 (2014)

• Boys 5 x more likely

Prognosis

• Many children improve

• Some individuals have residual issues throughout lifetime

• IQ, language strong predictors of lifespan functional issues

Medical management

• Early identification is key: 0-3 years most effective

• Interventions primarily behavior based with focus on language, sensory, motor, cognitive skills

• Limited pharmacological interventions for hyperactivity, irritability, anxiety, perseveration

• ◦ Pharmacology- stimulant medications (Ritalin, Adderall, Concerta, Dexedrine)

• ◦ Behavioral: counseling, specific skill training, coping skills, sensory motor

• ◦ Education: parent, teacher, child

Occupational Therapy Intervention

• Highly individualised - Sensory integration

• ADL/IADL retraining - Behavioral intervention

• Family education