The New Face of Autism

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The New Face of Autism
(Il volto nuovo di autismo)

• Re-conceptualizing the Social and Behaviorial
  Presentation of Autistic Individuals

Sam Goldstein Ph.D. Assistant Clinical Professor
of Psychiatry University of Utah
Affiliate Research Professor of Psychology
George Mason University
www.samgoldstein.com
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Goals

• Briefly discuss the historical theories of Autism
  Spectrum Disorders (ASD).
• Define ASD.
• Briefly discuss syptoms of ASD by age.
• Briefly discuss a core theory of ASD.
• Briefly review hypothesized causes.
• Introduce data from the largest
  epidemiological/standardization sample collected
  of normal children and those with ASD.

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Kanners Description (1943)

• Inability to relate in ordinary ways to people.
• Disinterest in parents and people.
• Excellent rote memory skills.
• Language difficulties including but not limited
  to mutism, echolalia, pronoun reversal,
  literalness, poor social language.
• Lack of spontaneous activity.
• A wide range of cognitive skills.

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Kanners Description (1943)

• Self absorbed facination with the inanimate
  environment.
• Pronounced resistance to change in routine.
• Purposeless repetitive movements.
• Isolated interest and proficiency in meaningless
  tasks with endless repetition.

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Gillbergs Description

• Impaired social interaction.
• Self absorbed behavior.
• Odd interests and routines.
• Speech and language problems inspite of seemingly
  competent superficial language skills.
• Non-verbal communication problems.
• Motor clumsiness.

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Autism is increasingly referred to as a spectrum
disorder in which individuals can present
problems ranging from total impairment to near
reasonable functioning.
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In the DSM model Autism Spectrum Disorder (ASD)
is referred to as the Pervasive Developmental
Disorders (PDDs).
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The Pervasive Developmental Disorders (PDDs) are
a group of conditions that share certain clinical
features but appear to have diverse etiologies
and natural courses.
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The term PDD emphasizes the pervasiveness of
disturbances over a wide range of different
domains affecting the normal unfolding and
development of multiple competencies.
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PDDs

• Onset in infancy or early childhood.
• Typical patterns of delays and deviance in
  social, affective and communicative development.
• Expanding recognition and interest in the
  clinical and educational realms.
• Spectrum, continuum or syndrome?

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Core DSM and ICD Autistic Symptoms

• Impaired social relations.
• Impaired communication skills.
• Impaired behavior.

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The social development of autistic children is
qualitatively different from other children.
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In normal children perceptual, affective and
neuroregulatory mechanisms predispose young
infants to engage in social interaction from very
early on in their lives.
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Young autistic children

• Have little interest in the human face.
• Lack differential preference for speech sounds.
• Lack imitative capacity.
• Lack interest in physical comfort.
• Dont attach to caretakers well.

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Symptoms Present Before 24 Months Failure To

• Orient to name
• Attend to human voice
• Look at face and eyes of others
• Imitate
• Show objects
• Point
• Demonstrate interest in other children

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Symptoms Present Before 36 Months

• Use of others body to communicate or as a tool
• Stereotyped hand/finger/body mannerisms
• Ritualistic behavior
• Failure to demonstrate pretend play
• Failure to demonstrate joint attention

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Joint Attention

• Behaviors that focus the attention of the self
  and others on the same object (e.g.
  pointing,sharing emotion, etc.)
• Develops between 6 and 9 months
• Precursor of more advanced social and
  communication skills

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Joint Attention

• This abnormality thought to be one of the
  earliest signs of autism
• Present in children with developmental delays
  absent autism
• This ability when present in preschoolers with
  autism predicts better prognosis for language
  development

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Pretend Play in Autism

• Limited, often absent
• When present usually characterized by repetitive
  themes, rigidity, isolated acts, one-sided play,
  limited imagination.

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Theory of Mind

• A line of research has proposed that the social
  deficits in autism represent a specific, innate
  cognitive capacity to attribute mental states to
  others and oneself and use these to explain and
  predict another persons behavior.

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One in four autistic children experience physical
problems including epilepsy.
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Up to eighty percent of autistic children
experience intellectual deficits.
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Level of cognitive functioning and useful
language by five years of age are the best
predictors of outcome.
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Percentage of Increase in School Based Diagnoses
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Autism occurs at a greater than chance rate with

• Fragile X
• Tuberous sclerosis
• Neurofibromatosis
• Williams syndrome
• Phenylketonuria
• Congenital rubella

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Idiopathic Autism

• 90 of cases.
• Genetics plays an important role.
• Autism occurs more frequently in monozygotic than
  dizygotic twins.
• The rate of autism among siblings is
  significantly higher than the general population.
• No single causative gene has been identified.
• At least five or more genes interact.
• Genes on chromosomes 7 and 15 look promising.

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The Autism Spectrum Rating Scale Project
(Goldstein and Naglieri, 2009)

• A normative look at autistic symptoms, behaviors
  and impairments,

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ASRS Data Collection Procedure

• Site coordinators from across the U.S. collected
  data between October 2006 and February 2008.
• Over 5,000 children were sampled at home and at
  school.
• Normative data was stratified to best match the
  U.S. Census on race/ethnicity, parental education
  level, and geographic location.
• Standard procedures were followed
• informed consent obtained
• specific instructions given to raters
• raters debriefed upon completion

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ASRS Standardization Samples
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ASRS Structure
DSM-IV-TR Algorithm
Treatment Scales Peer Socialization Adult
Socialization Social/Emotional Reciprocity Atypica
l Language Stereotypy Behavioral Rigidity Sensory
Sensitivity Attention
Validity Scales Positive Impression Negative
Impression Inconsistency Index
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Sample Items ASRS Scales
Principal Axis Factoring with Direct Oblimin
rotation.
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Classification Accuracy
Classification accuracy (predicting ASD vs.
General Population group membership) of responses
on the ASRS Parent (6-18).
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Important Conclusions

• Autism Spectrum Disorder represents a unique,
  measurable condition distinct from normal
  behavior and development.
• DSM-IV and ICD 10 require revision.
• ASD is best represented by a 3 factor model with
  associated symptoms and behaviors.

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www.samgoldstein.com