What is Autism?

1
What is Autism?

• Neurodevelopmental disorder with a spectrum of
  clinical conditions
• 3 areas of dysfunction
• Social interaction/social relatedness difficulty
• Communication impairment
• Restrictive/repetitive behaviors and interests
• Early intervention before the age of three is
  vital.

2
What about the patients we missed?

• Undiagnosed prior to early intervention efforts
• Patients with verbal abilities
• Patients older than 3 years
• How about that patient who has always seemed
  peculiar?
• Patients report significant relief even when
  diagnosis is made later.

3
The Verbal Individual With Autism Have You Seen
This Patient?
Adam 8 year-old
Ethan 13 year-old
Jeff 35 year-old
Ryan 23 year-old
Richard 54 year-old
4
Listen to Parents
The Verbal Individual With Autism Have You Seen
This Patient?

• Are aware of the possibility of autism
• Do have concerns when something is wrong
• Do give accurate and reliable information about
  their children
• Need your questions to generate discussion about
  their childs development

5
The Verbal Individual With Autism Have You Seen
This Patient?
Get History from Parents

• By school age
• Usually talking well and can enter school
• May have stopped avoiding social contact and is
  at least tolerant of it
• May be socially awkward and socially immature

6
The Verbal Individual With Autism Have You Seen
This Patient?
One sided conversations

• Over the next few years
• "Eccentricities" dominate his social interactions
  
• A "little professor" on topics of special
  interest to him
• When not talking about his interests, his social
  interactions are immature or stilted
• The child may interact with peers, although
  others may perceive him as different

7
The Verbal Individual With Autism Have You Seen
This Patient?
Poor social understanding

• As time passes and social demands increase
• May become anxious in social situations
• Peers may reject him and he may become depressed
• In school, he may be placed in learning support
  classes because of social, behavioral or language
  comprehension problems
• He may be considered to have an attention problem
  or obsessive compulsive behaviors

8
ASD Facts Epidemiology

• Conservative prevalence 1 in 500 recent
  estimates 1 in 150
• ASD more prevalent in pediatric population than
• Cancer
• Diabetes
• Downs Syndrome
• Male to female ratio 4 to 1

9
Autism Myths
Myth Truth

Make no eye contact. Look at or through you, but eye contact has no social purpose.
Are not affectionate. Are affectionate on their own terms.
Do not talk. Can use advanced words, but they have no function.
Do not point. Usually develop the pointing skill later.
Are geniuses. Can have intellectual functioning that ranges from severe mental retardation to normal intelligence.
Have no hope for improvement. Can experience positive outcomes with early and intensive intervention.
10
ASD Causes

• Autism does NOT result from
• Poor parenting
• MMR vaccine
• Thimerosal preservative in vaccines

• Causation unknown
• Strong genetic influence
• Evidence supports polygenic inheritance
• Recurrence risk is 5-8 in siblings

11
ASD Facts

• Present at birth, with onset of symptoms before
  36 months
• Accurate diagnosis possible at 18-24 months
• Parents first voice concerns around 18 months,
  but diagnosis is typically not until 3 years or
  older

12
Autism Spectrum Basics

• Autism is a neurodevelopmental disorder with a
  broad spectrum of behavioral manifestations
• Autism is not rare! At 1 in 500, each
  pediatrician should have up to 3 or 4 affected
  children in their practice

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Again, 3 Problem Areas

• Delays or abnormalities in
• Social Interaction
• Language Delay
• Restricted or Repetitive Behavior

14
Social Symptoms

• Lack of
• Use of eye contact to regulate social interaction
• Orienting to name
• Joint attention behaviors pointing showing
• Pretend play
• Imitation
• Nonverbal communication
• Language development

15
Language Delay Need for immediate referral

• 9 months No babbling
• 12 months No pointing or other gestures
• 16 months No single words
• 24 months No functional 2-word phrases
• (not echolalic)
• Any age Any loss of language or social
  skills

16
Behavioral Red Flags

• Investigate further and consider autism if the
  child
• Doesnt know how to play with toys in a typical
  fashion
• Restricted patterns of interest
• Toe walks
• Has unusual attachments
• Lines things up
• Presents with sensory symptoms
• Has odd movement patterns and/or very repetitive
  behaviors
• Demonstrates echolalia
• Throws prolonged or frequent tantrums
• Is hyperactive

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0 3 Early Intervention

• Different in each state
• Babies Cant Wait Programs
• Autism Centers of Excellence
• University Based Developmental Disorders
• Check with State Office

Call 1-800-323-GROW for nearest CFC
18
Special Education

• Mandated by federal IDEA legislation
• Programs managed and vary by school district
• Make referrals in writing!
• Individualized Education Plan (IEP) for each
  child
• Services for children with autism may include
• Speech therapy
• Occupational therapy
• Communication assistance (PECS)
• Teacher education on classroom management

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Long Term Planning
The Verbal Individual With Autism Have You Seen
This Patient?

• Later Years
• Vocational and Occupation Training
• Transition to adult healthcare providers
• Long term care vs. Residential Placement
• Estate planning