Autism Spectrum Disorders

Transcription

1 Autism Spectrum Disorders Diagnosis, Intervention, and Implications Laura L. Bailet, Ph.D. Executive Director, Nemours BrightStart! 1

2 Goals for Today Review diagnostic features of autism spectrum disorder (ASD) Discuss an evidence-based approach to diagnosis Discuss key components of intervention Describe ASD patterns and issues across the lifespan 2

3 Autism Spectrum Disorder Wide continuum of associated cognitive/neurobehavioral disorders Incidence of 1 in 88 (1 in 54 boys) Diagnosis typically during preschool years, although often a year or more after parents see symptoms 3

4 General Features for Autism Spectrum Disorder (ASD) Impaired Social Relatedness Repetitive Behaviors Impaired Communication 4

5 DSM 5 Diagnostic Criteria for ASD (299.00) Persistent deficits in social communication and interaction Restricted, repetitive patterns of behavior, interests, or activities Symptoms must be present early in developmental period Symptoms must cause clinically significant impairment Severity level must be specified: Level 3, 2, or 1, with 3 being the most severely impaired 5

6 Autism: Why Is Early Identification Important? Early, intensive intervention results in better outcomes Early identification facilitates: educational planning provision of family support and education management of family stress delivery of appropriate medical care 6

7 Why Is Early Identification Important? From a University of Michigan study: Only 14% are nonverbal by age 9 years; 5% have NO AUTISM SYMPTOMS Another 20% have mild residual features but are functioning predominantly in mainstream education and activities Better Language Early Intervention Better Outcomes Better Behavior 7

8 Range of ASD Severity and Prognosis About 40% of individuals with ASD also have Intellectual Disability (IQ < 70) About 25% of individuals with ASD are essentially nonverbal These are the strongest predictors of inability to function independently as adults Adult outcomes and needs are highly variable and not easily predicted during early childhood 8

9 Autism: A TREATABLE Disorder Nearly ALL children with autism make substantial functional gains with early, intensive intervention This often prevents the more severe aggressive and selfinjurious behavior that emerges when the child cannot communicate effectively 9

10 Features of Autism 12 to 24 Months The most potent predictors of autism in very young children reflect NEGATIVE (absence of normal) behaviors POSITIVE (abnormal) behaviors associated with autism may occur later (restricted interests, repetitive behaviors) 10

11 Features of Autism 12 to 24 Months May NOT be aloof May NOT show odd behaviors DO fail to respond when spoken to in neutral fashion DO fail to try and direct others attention in ordinary situations 11

12 Developmental Red Flags (?) 12 Months No Pointing No Showing No Looking at Others** No Orienting to Name** **Best discriminators of autism vs. developmental delays 12

13 Developmental Red Flags For 18 to 24 Months No or limited babbling No pointing, waving bye-bye No single words by 16 months No spontaneous 2-word phrases by 24 months 13

14 Developmental Red Flags For 18 to 24 Months Poor eye contact Limited social reciprocity Failure to respond to name or social comments Poor comprehension of words out of context 14

15 Developmental Red Flags For 18 to 24 Months Parental concern about in own world Repetitive behaviors or unusual use of objects, especially with language or social delay Loss of any language or social skills at any age 15

16 Features of Autism 24 Months Problems with JOINT ATTENTION: Protodeclarative pointing Following a point Bringing objects to show parent 16

17 Features of Autism 24 Months Problems with Social Relatedness Interest in other children Imitation Problems with Communication: Responding to name 17

18 Modified Checklist for Autism in Toddlers (M-CHAT) FREE online and in paper form or For toddlers ages months Parent completes it; health care professional reviews responses and asks clarifying questions or uses structured follow-up interview from website Strong sensitivity and specificity 18

19 Sibling Risk Siblings of children with autism are at INCREASED risk and must be followed closely. (Incidence of 3-7% in siblings) 19

20 Components of Comprehensive Assessment General medical and neurologic evaluation Speech, language, and communication evaluation Cognitive and adaptive behavior evaluations Behavioral and academic evaluations Psychiatric consultation as needed 20

21 Components of Comprehensive Assessment Occupational and physical therapy evaluation as needed Assessment of family stress, resources, and supports Reevaluation within 1 year to assess child s progress and family resources, supports, and coping skills 21

22 Autism: Key Components for Intervention Intervene early and often! 22

23 Autism: Key Components of Intervention Parental education and support Books, websites, support groups Intensive, multi-modal, individualized intervention Communication, socialization, behavior, developmental skills Medical treatment when needed Get young children with ASD into school programs as early as possible 23

24 Autism: Key Components of Intervention Individualize program according to needs/preferences of child and family Obtain high intensity of engagement (25 or more hours/week), much of which is 1-to-1 teaching sessions Involve families in intervention planning and implementation 24

25 Important Caregiver Attributes for Children with ASD Unconditional love and compassion Patience, resilience, and flexibility Strong problem-solving skills Strong family and/or social support network High (but flexible) structure and routine Willingness and ability to seek professional help and follow through Aspirational realism Financial means 25

26 Caregiver Attributes Favorable to Children with ASD Organized, predictable living space(s) and routine Continuity of school and therapeutic relationships Safe, stable neighborhood Reliable adult supervision most or all the time Safety features appropriate to child s needs (door and window locks; alarms; high fences; tracking devices; monitoring of Internet access) Consistent collaborative communication with other caregivers 26

27 Caregiver Attributes Unfavorable to Children with ASD Unwillingness or inability to understand and accept the condition Unwillingness or inability to seek out and follow through with various therapies Unwillingness or inability to work with child s school personnel to develop an appropriate educational plan Unwillingness to meet the child halfway, e.g., provide favorite toys, activities; acknowledge talents and interests; adhere to critical routines Overreliance on inappropriate corporal punishment 27

28 Autism: Key Components of Intervention Functional, spontaneous communication should be the PRIMARY intervention focus Assume that most children with autism will learn to speak Vigorously apply effective teaching strategies for verbal and nonverbal communication 28

29 Autism: Key Components of Intervention Use different approaches if communication progress is not occurring within 2-3 months of intensive intervention Teach social behaviors across all settings with parents, teachers, siblings, classmates, and normal children 29

30 Autism: Key Components of Intervention BEHAVIOR IS A FORM OF COMMUNICATION Teaching communication will usually reduce some problem behaviors Replace problem behaviors with an alternative that accomplishes the same purpose 30

31 Autism: Key Components of Intervention Address sensory integration problems if they are a barrier to the child s learning and behavior (both cravings and aversions) Monitor progress closely Recommend increased intensity or change in focus/method if clear progress is not evident 31

32 Autism: Key Components of Intervention Reassure parents that poor parenting did not cause autism Praise them for taking initiative and recognizing the problem Encourage them to actively engage in problem solving and assessing intervention options 32

33 Autism: Key Components of Intervention Acknowledge that the child s program may need adjustments over time, and that THIS IS OK! Most reasonable interventions will not cause irreparable harm Caution against unproven therapies Locate respite options for families 33

34 Most Important Intervention Strategies Visual supports pictures, computers, visual schedules Social stories Chill out location with favorite soothing items and ambience (e.g., lighting, music, etc.) Awareness of sensory integration issues 34

35 Example of Visual Schedule Read Snack Swing 35

36 Example of A Visual Schedule FIRST THEN 36

37 Social Stories Social stories are a strategy for helping the child understand an event, skill or concept Originally developed by Carol Gray, Examples of free, printable social stories available at 37

38 What Is Asperger s Disorder? Characterized By: Difficulty with social understanding and interaction Difficulty with both verbal and nonverbal social communication Intense, obsessive interest in a few topics Inflexible adherence to specific, nonfunctional routines 38

39 Problems Often Seen in Asperger s Disorder Social withdrawal Inappropriate social interaction Difficulty completing work Perfectionism low frustration tolerance poor handwriting poor time management and organization 39

40 Problems Often Seen in Asperger s Disorder Difficulty with transitions Difficulty with change in routine Difficulty waiting for one s turn poor impulse control obsessive-compulsive tendencies lack of perspective regarding others needs 40

41 Problems Often Seen in Asperger s Disorder Emotional meltdowns sensory overload low frustration tolerance difficulty gradually diffusing negative emotions tendency to see everything in black and white difficulty modulating emotional intensity to match the precipitating event 41

42 Communication Problems in Asperger s Disorder Nonverbal: diminished eye contact odd body language odd or diminished facial expression and gesturing poor grasp of unspoken social customs 42

43 Communication Problems in Asperger s Disorder Verbal: formal, pedantic language overly precise language odd prosody or intonation patterns literal interpretation of language difficulty maintaining conversation difficulty using language to indicate needs or desires 43

44 Social Interaction Problems in Asperger s Disorder Lack of normal peer relationships Tendency to be more comfortable with adults than children Poor understanding of social interaction Difficulty taking the perspective of others Lack of empathy typical for age 44

45 Problems with Obsessive Interests and Routines Common topics are transportation issues and vehicles, science, dinosaurs, and electronics Interests often are different than those of typical peers Interests lead to the exclusion of other activities 45

46 Problems with Obsessive Interests and Routines Interests often are more rote than meaningful For repetitive routines: tend to be nonfunctional may be imposed on self and/or others May display repetitive motor habits 46

47 Sensory Sensitivity in Asperger s Disorder Examples of Sensory Processing Abnormalities: hypersensitive to sounds hypersensitive to light touch and textures hypersensitive to taste and/or smell hypersensitive to bright light under-responsive to pain May seek and benefit from deep muscle compression May like squeezing into tight spaces or being under furniture 47

48 Intervention for Asperger s Disorder: Overview Possible Components of Intervention: Social skills training Emotional competence training Life skills training Individual counseling Family counseling Classroom accommodations Medication 48

49 Community Resources for ASD Center for Autism and Related Disabilities (CARD), Hope Haven Children s Clinic and Family Center, (904) Nemours Children s Clinic Jax; Neurology, Neuropsychology, Psychology, Psychiatry, etc. (904) Wolfson Children s Rehab., (904)

50 Websites for ASD e.autismnavigator 50

51 Websites for ASD