Autism Spectrum Disorder (ASD)

1
Autism Spectrum Disorder (ASD)

• This disorder includes Autism (299.0), and the
  Pervasive Developmental Disorders NOS, and
  Aspergers (299.80). It does not include Retts
  Syndrome or Childhood Disintegrative Disorder.

2
Objectives

• To describe the definitions for and epidemiology
  of ASD
• To review the current methods for screening,
  diagnosing, care and case managing, and treating
  ASD
• To review the key features of how ASD presents in
  the children enrolled New Jerseys Behavioral
  Health system of care

3
Definition

• ASD is a biologically based disorder of
  neurodevelopment. The deficits are as follows
• Reciprocal social interaction
• Communication impairments
• Stereotyped and compulsive behavior patterns,
  activity patterns, or interest patterns
• ASD is a lifelong developmental, neurological
  disability that affects
• Speech and language
• Social relationships
• Psychological functioning
• Development of cognition, emotions and behaviors
• Co-occurring disorders are frequently present
  with ASD.

4
Epidemiology

• ASD occurs in approximately 6 out of 1000
  children in the United States.
• Aspergers occurs in approximately 3 out of 1000
  children in the United States.
• The incidence of ASD appears to be increasing
  because of the following reasons
• There are more and more viable births. Therefore,
  always get a pregnancy, birth, and developmental
  history. This history is hardest to accomplish
  with adoption, especially with foreign adoption.
• Definitions have become much broader in scope
  than Kanners original description.
• Effective early screening increases the number of
  children diagnosed.
• The frequency of ASD diagnosis appears to be
  increasing as more dollars become available for
  treating this diagnosis.

5
Early Screening

• The American Academy of Pediatrics stresses the
  use of an ALARM in-office approach
• Autism is prevalent
• Listen to parents about developmental concerns
• Act early with the use of screening
• Refer to appropriate professionals,
  organizations, and programs
• Monitor incoming information and the child and
  family
• Children who are cared for in Neonatal Intensive
  Care Units (NICU) are screened and placed in
  Infant and Toddler programs, Early Intervention
  Programs, or Fetal Alcohol and Drug Syndrome
  (FADS) Centers.
• Child Evaluation Centers (CEC) often screen and
  diagnose children who are referred after the
  first year of life.

6
Early Screening (continued)

• The following are examples of short form
  screening that can be done in 15-30 minutes with
  some pediatric office help if necessary. These
  tests concentrate on areas such as emotion and
  eye-gaze, communication, gestures, sounds, words,
  understanding and object use.
• The Communication and Symbolic Behavioral Scales
  Developmental Profile (CSBS DP) are 24 screening
  tools used for ages 6-24 months.
• Modified Checklist for Autism in Toddlers
  (M-CHAT) is a list of 23 questions for ages 18
  months - 3 and one half years. This test is often
  given at an 18 month Pediatric checkup.
• Gilliam Autism Rating Scale GARS is a 10 minute
  classroom test for children ages 3-22 given by
  school staff to determine if there are
  stereotyped behaviors, communication lags, social
  interaction lags, and/or developmental
  disturbances.
• Childhood Autism Rating Scale (CARS) is a 15 item
  20 minute screening for children ages 2 and up.
  It is given by clinician while doing the guardian
  and child interview.
• ADOS (Autism Diagnostic Observation Scale) is a
  40 minute toddler to adult screening test. The
  clinician can picks up qualitative impairments in
  social interactions and communication. The test
  also finds restrictive, repetitive and
  stereotyped patterns of behavior, interest and
  activity.

7
Diagnostic Assessment

• General Information is gathered from multiple
  sources.
• History includes pregnancy, birth, and,
  developmental history and the childs medical
  history.
• Family medical and psychiatric history are
  important.
• Screening data including a parent checklist is
  gathered.
• Physical and neurological exams are completed
  usually by a multidisciplinary team with
  professionals with specialized training in early
  childhood development and ASD.
• The diagnosis is likely confirmed by a
  Developmental Pediatrician, Pediatric
  Neurologist, or Child Psychiatrist.
• Evaluation data is gathered from the educational
  system. This includes a speech, hearing, and
  language therapist, occupational and/or physical
  therapist where indicated, and developmental, and
  accurate testing psychologist.
• The educational data is added to the medical
  evaluations.
• Ear, Nose, and Throat and geneticist evaluations
  are completed if warranted.
• Examination for co-occurring conditions are
  always part of the process.
• Chromosomal studies, metabolic testing for inborn
  errors of metabolism, EEG, and Neuro-imaging
  studies are tests commonly used.

8
Psychological Assessment

• Other skills are tested such as Academic testing
  by the WAIT, Language development by the Reynell,
  and socio-emotional development by the Achenbach.
• Adaptive tests are used where verbal skills are
  quite poor. Examples are
• Vineland Adaptive Behavior Scales (VABS)
• Scales of Independent Behavior-Revised (SIB-R)
• Cognitive evaluations can start before age 3. A
  list of commonly used test include
• Bayley
• Differential Ability Scales (DAS)
• Stanford-Binet Intelligence Scales (SBS)
• Wechsler Scales-(WPPSI) Preschool and Primary
  Scale and (WISC) Scale for Children
• Varying short form or non-verbal measures
  (TONI)-Test of Non-Verbal Intelligence) that have
  to be adjusted down in scoring

9
Medical Alternative Diagnosis and or
Co-Occurring Disorders with ASD

• Hearing Loss or Congenital Deafness
• Lead or Heavy Metal Toxicity or Toxin Poisoning
  like (FADS) Fetal Alcohol and Drug Syndrome
  influence
• Epilepsy including special syndromes such as
  Tuberous Sclerosis or Landau Kleffner Syndrome
• Chromosomal Abnormalities such as Fragile X or
  Chromosome 15 abnormalities
• Central Nervous System (CNS) Physical Abuse
  Damage
• Other Intra-uterine or neonatal CNS Damage

10
Psychiatric Alternative Disorders or
Co-Occurring Disorders with ASD

• Mental retardation occurs up to 75 of the time
  with Autism (299). This percentage does not
  include Aspergers or PDD NOS (299.80) diagnosis.
• Obsessive-Compulsive Disorder (OCD) In ASD the
  symptoms is not bothersome to the children
  themselves, it may bother the parent, sibling,
  peer, aide, or teacher.
• Tourettes or Tic Disorder
• Elimination Disorders wetting or soiling
• Mood Disorders
• Anxiety Disorder other than Social Anxiety
• Schizophrenia This diagnosis is included when
  hallucinations and or delusions are prominent for
  over one month
• PTSD

11
Psychiatric Disorders Not Co-Occurring with ASD

• ADHD - This is seen as very controversial in the
  medical, neurological, and psychiatric
  communities.
• Personality Disorder Avoidant, Schizoid and
  Schizotypal Type - ASD has an earlier onset with
  more severity of symptoms
• Communications Disorders on Axis II - The social
  features of ASD arent present
• Reactive Attachment Disorder (RAD) - This
  diagnosis occurs with early and severe abuse and
  neglect. RAD improves with consistent care giving
  and ASD may not.
• Selective Mutism
• Stereotypic Movement Disorder
• Intermittent Explosive Disorder - Other forms of
  aggression associated with ASD must be looked at
  first. This is seen as very controversial in the
  medical, neurological, and psychiatric
  communities.

12
The Possible Strengths of an ASD Child

• Understanding of concrete concepts
• Memorization of rote material quickly and easily
• Recall of visual images and memories easily
• Visual Thinking
• Learning discrete chunks of information rapidly
• Hyperlexic decoding written language at an early
  age
• Long term memorization capability
• Understanding and using concrete rules and
  sequences
• Approaching tasks perfectionistically
• Being precise and detail oriented
• Maintaining a schedule
• Being honest even to a fault
• Extreme focusing on a task others may not
  perceive as pleasurable
• Being charming with innocence and without
  deviousness
• Having an excellent sense of direction
• Being compliant to poorly understood instructions

13
Care and Case Management

• Care and case management are extremely important
  because they can provide movement to the correct
  care venues as soon as possible. This can
  prevent secondary effects of delayed language
  development, delayed social development,
  co-occurring pediatric, neurological, and child
  psychiatric conditions.
• The first possible step usually occurs in NICU,
  where the child and family are often directed to
  Early Intervention Services.
• The next likely step occurs in a Pediatric Office
  (well baby visit, or crisis visit). Initial care
  and case management is initiated in the doctors
  office.
• The next step depends on the complexity of the
  child, the age of diagnosis, the comfort of the
  childs Pediatrician and the level of
  specialization of the area or state the child
  and family are in. These are possible next step
  referrals.
• Developmental Pediatrics Office with possible
  care management
• Pediatric Neurology office
• Child Psychiatry office

14
Care and Case Management (continued)

• ASD referrals to school systems follow the law
  described in the Individuals with Disabilities
  Education Act (IDEA). This special education law
  is divided into three major venues Early
  Intervention ages 0-3, Preschool disability ages
  3-5 and Special Education ages 5 through 21. The
  management of the psychological , speech and
  language, occupational therapy and physical
  therapy workup can be evaluated and assigned as
  needed in all three venues.
• The obstacle is ages 0-3 where the state has the
  choice of which agency handles the Early
  Intervention Programs and the servicing of it.
  States can initiate it through the department of
  education, the department of health, the division
  of retardation or developmental disability or
  even a behavioral health division.
• An Early Intervention Program EAP manager can
  wind up in a case or care management role or a
  screening role for a family. They have to sort
  out where to start and to make sure follow-up
  takes place. Much of the coverage may not be
  linked to the employees mental health plan. An
  EAP needs to create medical and educational
  linkage. They also may be asked by many parents
  difficult to answer questions about diagnosis,
  treatment qualifications, treatment approaches,
  progress measures and times that treatment should
  be in place. An EAP needs to stay current to
  answer these questions or refer them to the
  personnel in the treatment team that can.

15
ASD Treatments Often Discussed and Current
Evidence, Efficacy, and Risks
Intervention Evidence Basis Risks Reported Lead Professional Comments
Applied Behavioral Analysis (ABA) Controversial and non-replicable Overuse high financial risk extended timeframes and non-delineated ages Special Education/Psychologist Requires a coordinated team, a trained parent, and a credentialed ABA Therapist better than traditional psychotherapy for changing abnormal, maladaptive behaviors
Chelation None Significant MD Mostly Testimonial
Intravenous Immunoglobulin None Significant MD Mostly Testimonial
Dimethyl glycine None unclear MD or nutritionist Mostly Testimonial
B6-Magnesium None unclear MD or nutritionist Some attempts at controls
Casein and gluten-free diet None Can make dietary OCD even worse MD or nutritionist The wrong child can get worse
Secretin Enzyme None GI Problems MD or nutritionist
Cranio-sacral Therapy None Can cause spinal complications with incorrect manipulation Chiropractor
Speech and Language Therapies including Auditory and Sensory integration, Sign Language None alone None reported Speech and Language Therapists May be useful as ancillary treatment approaches
16
Effectiveness of Medications Prescribed for ASD
Symptom Relief. All Medication Treatment
Approaches Should be Low dose and Slow
Type of Medications Stimulants Alpha Adenergics SSRIs Remeron Anti-Convulsant Mood Stabilizers Glutamatergics Neurolepic-Haldol Atypical Antipsychotics Risperdol only one approved by FDA for ASD use
Target Systems
Hyperactivity and impulsivity Possibly Effective Possibly Effective Occasionally Effective
Explosivity Aggressivity and Poor Conduct Control Occasionally Effective Occasionally Effective Possibly Effective
Perseveration, Compulsive Behavior and Stereotypic Behavior Occasionally Effective Possibly Effective
Psychotic Thinking Occasionally Effective Occasionally Effective
Social Isolation Occasionally Effective Occasionally Effective
Anxiety, Depression and Self Injury Possibly Effective Occasionally Effective Occasionally Effective
Irritability and mood instability Occasionally Effective Possibly Effective
Sleeplessness Occasionally Effective Occasionally Effective
17
Side Effects Profile for Different ASD
Medications
Stimulants Alpha Adenergics SSRIs Remeron Anti- Convulsant Mood Stabilizers Glutamatergics Neurolepic- Haldol Atypical Anti- Psychotics-Risperdol only one approved by FDA for ASD use
Side Effects
Agitation and Hypomania Mild Moderate
Suicidal Thoughts Mild
Sedation Moderate Mild Mild
Weight Gain Mild Mild Mild Significant
Increase Prolactin Effect Mild
EPS Severe Mild
Higher Sugar and Lipid Profile Moderate
Moodiness Moderate
Irritability Moderate
Tics Mild
Poor Appetie Moderate
Poor Sleep Moderate
Changed Pulse Rapid Slowed
Arrhythmia Mid Mild
18
NJ-ASD Slides (18-25)ASD in Children Enrolled
in New Jerseys Behavioral Health System of Care
(n215)
Average Age 11.7 years Children 13 and under
61
Gender Distribution within entire NJ System of
Care population Male 63, Female 37
19
ASD in Children Enrolled in New Jerseys
Behavioral Health System of Care (n215) cont
Average IQ 59 71 of sample had an IQ below 70
and are therefore Mentally Retarded (MR)
20
Challenges and Complexities

Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215)
Developmental Disabilities Developmental Disabilities Developmental Disabilities Developmental Disabilities Developmental Disabilities Developmental Disabilities 215 100
Special Education Special Education Special Education Special Education Special Education Special Education 213 99
Neurological Factors Neurological Factors Neurological Factors Neurological Factors Neurological Factors Neurological Factors 202 94
Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical 185 86
Mental Health Mental Health Mental Health Mental Health Mental Health Mental Health 180 84
Psychotropic Meds Psychotropic Meds Psychotropic Meds Psychotropic Meds Psychotropic Meds Psychotropic Meds 157 73
Questionable Best Practice Meds by way ofTexas Algorithms Questionable Best Practice Meds by way ofTexas Algorithms Questionable Best Practice Meds by way ofTexas Algorithms Questionable Best Practice Meds by way ofTexas Algorithms Questionable Best Practice Meds by way ofTexas Algorithms Questionable Best Practice Meds by way ofTexas Algorithms 157 73
Biological, Adoptive, Relative, Foster Parent or GuardianAbuse, Neglect, Medical Disorder, Psychiatric Disorder,Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or GuardianAbuse, Neglect, Medical Disorder, Psychiatric Disorder,Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or GuardianAbuse, Neglect, Medical Disorder, Psychiatric Disorder,Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or GuardianAbuse, Neglect, Medical Disorder, Psychiatric Disorder,Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or GuardianAbuse, Neglect, Medical Disorder, Psychiatric Disorder,Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or GuardianAbuse, Neglect, Medical Disorder, Psychiatric Disorder,Developmental Disorder or Criminality 118 55
Reaction to Trauma Reaction to Trauma Reaction to Trauma Reaction to Trauma Reaction to Trauma Reaction to Trauma 112 52
Protective Services Protective Services Protective Services Protective Services Protective Services Protective Services 105 49
Delinquency Delinquency Delinquency Delinquency Delinquency Delinquency 31 14
Substance Abuse Substance Abuse Substance Abuse Substance Abuse Substance Abuse Substance Abuse 3 1

21
Challenges and Complexities (continued)

Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215)
Dangerousness within study population Dangerousness within study population Dangerousness within study population Dangerousness within study population Dangerousness within study population Dangerousness within study population 163 76
Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness    
Danger to Others Danger to Others Danger to Others Danger to Others Danger to Others Danger to Others 103 63
Self-Mutilation Self-Mutilation Self-Mutilation Self-Mutilation Self-Mutilation Self-Mutilation 41 25
Suicidal Suicidal Suicidal Suicidal Suicidal Suicidal 39 19
Sexual Aggression Sexual Aggression Sexual Aggression Sexual Aggression Sexual Aggression Sexual Aggression 20 12
Firesetting Firesetting Firesetting Firesetting Firesetting Firesetting 13 8

22
Medical Features (despite incomplete histories)

Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children
Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical 184 86
Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use 78 36
Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome 36 17
Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) 36 17
Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) 32 15
NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) 22 10
Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea 19 9
Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system 17 8
Asthma Asthma Asthma Asthma Asthma Asthma Asthma 14 7
Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) 16 7
Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes 10 5
Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years 11 5
Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) 11 5
Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) 9 4
Obesity Obesity Obesity Obesity Obesity Obesity Obesity 6 3

23
Family Features

Family Features of the 215 Children Family Features of the 215 Children Family Features of the 215 Children Family Features of the 215 Children Family Features of the 215 Children
Percentage of Families with documented features Percentage of Families with documented features Percentage of Families with documented features Percentage of Families with documented features Percentage of Families with documented features 119 55
Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect 44 20
Psychiatric Features Psychiatric Features Psychiatric Features Psychiatric Features Psychiatric Features 35 16
Substance Abuse Features Substance Abuse Features Substance Abuse Features Substance Abuse Features Substance Abuse Features 33 15
Physical Illness Features Physical Illness Features Physical Illness Features Physical Illness Features Physical Illness Features 25 12
Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features 20 9
Retardation Features Retardation Features Retardation Features Retardation Features Retardation Features 14 7
Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict 10 5
Criminal Features Criminal Features Criminal Features Criminal Features Criminal Features 8 4

24
ASD in Children Enrolled in New Jerseys
Behavioral Health System of Care (n215) cont
Referral Source Breakout
Due to the complexity of cases the average time
for key parties to decide services and level of
care or placement is 23hrs
Family Juvenile Court -1
Dept of Children Families -44
Dept of Developmental Disabilities 8
Protective Services (DYFS) 18
DCBHS Administration 1
DCBHS Case Management
Organizations 24
DCBHS Mobile Response 1
25
Hard to Place ASD Children

• In state placement may not be possible because of
  the combination of special needs. At one time 49
  ASD children or 23 of total (215) were placed
  out of state.
• The problem of Sexual Aggression often leads to
  Out of State Placement. Fourteen ASD children or
  7 of the total (215) had this dangerous problem.
  The same 14 children made up 29 of the ASD Out
  of State population (49).
• Out of state placements can create special needs
  in visitation, state expenses and state staff
  supervision.

26
ASD Summary and Conclusion

• Early childhood onset
• Chronic, extensive, pervasive neurologic
  disorders
• Inclusive of more than one developmental domain
• Conditions often exist on Axis I, II, and III
• Diagnoses are rarely precise
• The evaluation, diagnosis and treatment are
  COMPLEX
• Child psychiatrists and mental health
  professionals are often involved after Pediatric,
  Developmental Pediatric, and Pediatric
  Neurological professionals
• Much of the intervention is conducted in
  educational settings

27
ASD Summary and Conclusion (continued)

• Cost of treatment is high. The funding is complex
  and often involves federal early screening,
  diagnosis, and treatment funds special education
  (including speech, occupational and physical
  therapy) funds Medicaid Medicaid Waiver funds
  Medicare funds and private insurance funds where
  applicable.
• Individual and adjustable treatment planning is
  important because of growth potential and changes
  in treatment course. The latter includes
  vocational training when needed.
• A mature integrated system of care works best for
  an ASD child.
• Continued and expanded research is needed in ASD
  because of its confusing and complex nature. The
  federal government through the 2006 Combating
  Autism Act (CAA) has created a special Road Map
  for ASD to gather all the different initiatives,
  and research proposals in all federal departments
  and agencies involved through the Inter-Agency
  Autism Committee. This committee will make a
  yearly report to Congress on gains in the field
  of Autism.

28
General References

• Summary of best practices and policy
  recommendations from NIMH Subcommittee
  http//www.nimh.nih.gov/autismiacc/summary.pdf
• Autism and Hope, Symposium at the Brookings
  Institute, December 14, 2005
  http//www.brookings.edu/comm/events/20051216autis
  m.htmTRANSCRIPT
• Dawson, G, Watling, R. (2000) Interventions to
  facilitate auditory, visual, and motor
  integration in Autism A review of the evidence.
  Journal of Autism and Developmental Disabilities,
  30 No.5 415-422
• Filipek, P.A. et.al. (1999) The screening and
  diagnosis of autistic spectrum disorders. Journal
  of Autism and Developmental Disorders, 29,
  439-484
• Herbert, J. D. , Sharp, I. R. , Guadiano, B. A.
  (2002) Separating fact from fiction in the
  etiology and treatment of Autism A scientific
  review of the evidence. The Scientific Review of
  Mental Health Practice
•  Lovaas, O. I. (1987) Behavioral Treatment and
  Normal education and intellectual functioning in
  young autistic children. Journal of Consulting
  and Clinical Psychology 155, 3-9
• Posey, D. J, McDougle C. J, Autism A three-step
  practical approach to making the diagnosis
  Current Psychiatry Vol. 1, No. 7, July 2002,
  20-28
• Smith, T. , Groen, A. D. , Wynn ,J. W. (2000)
  randomized trial of intensive intervention for
  children with pervasive developmental disorder.
  American Journal of Mental Retardation
  105,285-296 . Erratumin Americal Journal of
  Mental Retardation, 105,508 and 106, 208.
• Smith, T. ,Lovaas, N. W. ,Lovaas O. I. (2002)
  Behaviors of children with high- functioning
  autism when paired with typically developing
  versus delayed peers. Behavioral Interventions
  17, 129-143
• The National Autistic Society. Diagnostic
  options a guide for health professionals
  www.nas.org.uk/nas/jsp/polopoly.jsp?d306a3280
• Aspergers Disorder links http//www.disabilityr
  esources.org/ASPERGERS.html

29
Resources for Families

• Resources are also available through the Center
  for Disease Control National Center for Birth
  Defects and Developmental Disabilities, 1-800 -
  CDC-INFO and online at www.cdc.gov/ncbddd/autism/
  actearly/
• Local resources can also be found by contacting
  the Autism Society of America (ASA) at 1 -800
  -3AUTISM or online at www.autism-society.org.
• To locate the appropriate resource in specific
  states, parents can call 1-800-695-0285 or log on
  to the National Dissemination Center for Children
  with Disabilities at www.nichcy.org/
• American Academy of Pediatrics
  http//www.keepkidshealthy.com/welcome/conditions/
  autism.html
• National Institutes of Mental Health
  http//www.nimh.nih.gov/publicat/autism.cfm
• Reaching for a Brighter Future Service
  Guidelines for Individuals with Autism Spectrum
  Disorders/Pervasive Developmental Disorders
  (ASD/PDD) http//www.psychmed.osu.edu/AutismBook_
  1.pdf
• Autism Society http//www.autism-society.org
• Learn the Signs developmental milestones
  http//www.cdc.gov/ncbddd/autism/actearly/default.
  htm
• Autism Research Institute http//www.autismwebsi
  te.com/ARI/index.htm