3.23.10 - Spring 2010 Dr Christine Hughes University of...

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Unformatted text preview: Spring 2010 Dr. Christine Hughes University of Miami mm vim. History of Autism & related disorders . Kanner (1943) and Asperger (1944) - DSM—IV field trials indicates reliability for diagnostic criteria 0 Diagnostic categories are not mutually exclusive . Different symptom presentations Dill-NJ"! (i994) Triad of Impairment 3/23/2010 .. ., .v .._. ~ 3.13311: Pervasive Developmental Disorders . “pervasive” — people exhibit difficulties across all daily activities & situations - “developmental disorder” ~ individuals’ development is delayed and/or atypical 0 Severe problems that affect many aspects of a young child’s psychological growth causing evident delay of speech, movement, and/ or social skills before 6 years of age “The Autism Spectrum” - 5 possible diagnoses, according to DSMJVJIR (1994) u Autistic Disorder (Autism) u Asperger’s Disorder 7 .. PDD-NOS D Childhood Disintegrative Disorder ° Rhett’s Disorder ’ ‘ “ “gm" 1, i". Impairments in Social Interaction 1. Marked impairment in use of multiple nonverbal behaviors to regulate social interactions Failure to develop peer relationships appropriate to developmental level Lack of spontaneous seeking to share enjoyment, interests, achievements with other people (i.e. joint attention) Lack of social or emotional reciprocity 1. Nonverbal Behaviors . Have difliculty with nonverbal behaviors to regulate interactions . NOT an absolute absence of these behaviors a focus on qualitative nature of deficits u emphasis is on difficulty coordinating different forms of nonverbal communication 3. Joint Attention - Refers to child’s desire to share afi'ective states and interest with others - Deficits in autism: a Do not initiate JA with others a Do not respond to JA bids of others 0 If they do engage in JA, often fail to combine positive affect with JA Measuring JA Early Social Communication Scales (ESCS) Peter Mundy, University of Miami 3/23/2010 2. Peer Relationships . Limited or lack of friendships = can and do make friends a but when a friendship exists, there often are difficulties . Quality of Friendships - Maintenance of Friendships Types of JA . Initiating Joint Attention - Responding to Joint Attention - Behavioral Requests w» ' nmwmuwmwm. mmammm nnléiin mnmnaumhmm-ummmunum-mm mmms‘mdw-mwmi‘nw 'enanwmmm s MIWMmMnshomMmmmqau-n nmmwimmmmmmhmw mmnumimmlm flammabcflmimmmmhmhmk mmmoawsemnum Midis mmm‘fluw 3/23/2010 , . . , , . - u . m . 7‘. 4,: In,‘ Associated Areas of Impairment Impairments in Communication . Social Referencing . Delays in or failure to develop spoken language . In individuals with adequate speech, marked - Empathy impairment in the ability to initiate or sustain a conversation ' Theory Of Mind . Stereotyped & repetitive use of language or idiosyncratic (expressive) language . Lack of spontaneous make—believe play or social imitative play 1. Language Development - All individuals with Pervasive Development Disorders have some difficulty in the way they communicate with others - A wide range of communication abilities n Some fail to develop meaningful spoken language a Others have very well-developed language but cannot use it to communicate efiectively Children with autism often have diniculty with the pragmatic use of language. ' r 2. initiating/ Sustaining Conversation 3. Stereotyped/ Repetitive Language - Interrupt others - Make off—topic comments - Change or introduce new topics without providing sufficient background info . May not respond to others’ comments and questions - End conversations abruptly and/ or keep talking when others attempt to end the conversation - Repeat phrases they‘ve heard = echolalia - Difficulty using pronouns - Difficulty answering “yes/ no” questions - “Scripted” language 3/23/2010 .- , .. ,V‘. ”xiii 3. Idiosyncratic Language - Odd or unique ways of describing things . Pedantic language = formal sounding language or vocabulary well above child’s age level . Difficulty following lengthy discussions and explanations . Difficulty understanding figurative expressions and sarcasm Figure 6.1 ‘Ihg Callpldmml rat {MSG} 4. Play Restricted Behaviors . play with “non-my” items . Stereotyped and repetitive motor mannerisms - Use toys in unusual ways - Persistent preoccupation with parts of objects ' Play With a toy in same way every time - Encompassing preoccupation with 1+ - May not imitate simple household routines in stereotyped &.restricted patterns of interest that play are abnormal in either mtensrty or focus . May not engage in more complex imitative o Inflexible adherence to specific, nonfunctional pretend play routines or rituals . . ‘_ V i , 2,3451“: m , » w i . . . .' .. , i “Show Associated Characteristics Motor Characteristics 1. Cognitive: _ . . Muscle tone . Usually, IQ is in range of Intellectual Disability 0 ~ 25% show a special cognitive skill that is above . Muscle strength average for the general opulation, and well ab0ve their own gene level of intellect - < 5% develop isolated and remarkable talent that is in far excess of that found even in normally developing children of the same age = savant - Gross motor skills - Fine motor skills 2. Sensory and perceptual impairments 3/23/2010 - a. , .. . ,W GU”. Dx before age 2 Other Features - Symptoms must occur before age 3 CKAT . Adaptive behavior always impaired, regardless $5?“ of IQ mam“ Public Awareness - Overall gender ratio . mug“, - 3-4 vs. 1 “ ’ am MW I M MI"? 3" ‘ Autism (Autistic Disorder) Asperger’s Disorder . Total of 6 (or more) symptoms ' Total 0f3 (01' more) symptoms a at least 2 in social interaction =- 2 in social interaction u at least 2 in communication =- 1 in restricted patterns of behavior n at least 1 in restricted patterns of behavior, interests, and activities - No clinically significant delay in cognitive development . Onset prior to 36 months = abnormal functioning in 1 or more areas social - No clinically significant delay in language interaction, language as used in social interaction, development symbolic or imaginative play Autism vs. Asperger’s PDD-NOS - Validity as a diagnostic concept distinct from - Should be used when: autism is still questioned n Individual exhibits “severe and persistent a Different research groups have different criteria for impairment in the development oi” diagnosis - Reciprocal social interaction AND " Many individuals With Asperger’s Will also meet - Verbal and nonverbal communication 0R cutena for autism-.- stereotyped behavior, interests, activities ' What does this mean? a The criteria are not met for another specific Our diagnostic criteria still needs improvement! Pervasive Developmental Disorder ‘ r 'm,‘ ,,. _‘;-'!n‘-'r_ Differential Diagnoses - Children with mental retardation (but not autism) do not display deficxts in joint attention or theory of mmd,_and can dlsplay social behaviors appropriate for mental age ~ Compared to children with developmental language disorders, children with autism use more deviant forms of language, less spontaneous social conversation and have greater impairment in nonverba communlcation Changing Prevalence Rates - May be due to: a Way in which we define or diagnose autism u Increased public awareness a Earlier referrals a Better training of professionals - People who were ofien misdiagnosed in the past . are being accurately diagnosed with an Autism spectrum disorder H V . . i a . .,u">-_‘(-'1 Early Signs of Autism (& ASDs) Most of what we know about early development in children with ASD comes from retrospective studies (i.e., parents’ reports and home videos) = Behavioralextremes - Decreasedsocial responses = Atypical communication and play behaviors = Not looking at faces Prevalence . Once thought to be about 1/2,5oo... now research suggests maybe 1/500 ~— 1/200 CDC(2004) & Pombmne (2003) . 450,000+ individuals in U.S. with some type of PDD . Occurs in all social classes, ethnic groups, cultures - Gender difference Cause? - Currently unknown... 9 Evidence provides support that PDDs are neurobiological disorders = Likely are several causes o Genetic influence? - Brain abnormalities? Treatment of Autism . Early intervention is beneficial . One—on-one behavioral training - Encouraging social connections . Video: Autism treatment 3/23/2010...
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