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Autism Spectrum Disorder

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Rupinder Atwal

on 1 November 2012

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Transcript of Autism Spectrum Disorder

Rupinder Atwal
Raminder Hayre
Patrick Klassen
John Lazzer Autism Spectrum Disorder 1.Qualitative impairment in social interaction, as manifested by at least two of the following:

a.marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures and gestures to regulate social interaction

b.failure to develop peer relationships appropriate to developmental level

c.a lack of spontaneous seeking to share enjoyment, interests or achievements with other people (e.g. by a lack of showing, bringing or pointing out objects of interest)

d.lack of social or emotional reciprocity. Definition of Autism
(DSM-IV-TR, 2000, p. 70) 2.Qualitative impairments in communication as manifested by at least one of the following:

a.delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

b.in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

c.stereotyped and repetitive use of language or idiosyncratic language

d.lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level. 3.Restricted repetitive and stereotyped patterns of behaviour, interests and activities, as manifested by at least one of the following:

a.encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

b.apparently inflexible adherence to specific, non-functional routines or rituals

c.stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-of-body movements)

d.persistent preoccupation with parts of objects.

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. Characteristics
(Brown, Gerber & Olivia, 2012) 1.Social interaction impairments
a.Difficulty making eye contact with others

b.Show little body language or facial expressions when interacting

c.Difficulty developing relationships with peers

d.Seem uninterested in sharing experiences

e.Engages less in give-and-take social interaction with caregivers, siblings and other close relations 2.Speech, language
and communication
impairments a.Difficulties communicating with speech or with gestures

b.Difficulty understand what others are saying to him/her

c.Difficulty using language to interact with others

d.Difficulty starting or continuing a conversation

e.Difficulty using own sentences and may instead repeat what others say (referred to as echolalia) 3.Repetitive or
unusual behaviour a.Show interest in very few objects or activities and play with them in repetitive ways

b.Perform repetitive routines and have difficulty with changes in these routines

c.Spends time in repetitive movements (i.e. waving hand in front of face) Prevalence According to Centers of Disease Control (CDC)
and Prevention (CDC, 2012): 1.About 1 in 88 children are identified with ASD

2.ASD are reported to occur in all racial, ethnic and socioeconomic groups

3.ASD are almost 5 times more common among boys (1 in 54) than girls (1 in 252). Prevalence rates are supervised by Autism and Developmental Disabilities Monitoring (ADDM) network; which is a group of programs funded by the CDC. Prevalence rates have been increasing in the past 20 years (CDC, 2012)
Estimates have ranged anywhere between 5 to 72 cases per 10 000 children (Levy, Mandell & Schultz, 2009). Why? ? ? Improvements in screening for ASD
Revisions in ASD definition
Greater awareness of ASD Beginning of the 20th Century:
People with Autism were viewed as feeble minded and autism was considered a childhood psychosis. 1930's:
Freud argued that parents who were emotionally unavailable during their child's younger years, caused their students to grow up emotionally disturbed. 1940's:
Kanner coined the term 'refridgerator mom;' describing mothers who were deemed cold and unaffectionate, during their child's first few years of life. Thus allowing their child to grow up unnattached, therefore turning away from their peers and becoming autistic. 1960's:
The cultural viewpoint towards autism started to shift from parental blame to a genetic focus. Jacques May founded The League for Emotionally Disturbed Children. People continued to argue against this shift in thinking, as technology was less advanced, further research was still needed. 1980's - 1990's:
The Diagnostic and Statistical Manual adopted autism and aspergers syndrome. A focus on vaccines causing autism became prevalent within the scientific community. Although their was no direct study that proved such claims, parents became quite concerned and refused to vaccinate their children. Casual Factors The perception of autism and its causes has changed throughout the years. With technological advances, scientists have been able to provide more insight into the roots of autism and its causal factors (Mercer, J., 2010, Love to Know Corporation, 2012, & Autism Science Foundation, 2012). Facts Causes of Autism As Autism Speaks Inc. (2012) states, present day research shows that there is not one type of autism and therefore, not one cause of autism. Dynamic relationship between biological and environmental factors
Within the last 5 years, scientists have been able to link rare gene mutations to autism
Autism stems from children having a high number of risk genes combined with environmental factors which influence early brain development Environmental risk factors usually
take place prior to, or during birth, including (Autism Speaks Inc., 2012): Parental age for both men and woman (older parents)
Maternal diabetes
Maternal illness during pregnancy
Premature birth
Low birth weight
Oxygen deprivation during pregnancy or birth It should be noted that, even though science has proven a relationship between these causal factors and autism; these factors combined with genetic aspects increase the risk of being born with autism, but individually show no direct cause. Autism Canada Foundation (2011) has completed a range of studies looking into genetic causal factors regarding autism in twins State that environmental factors play an equal, if not, more important role in children developing autism
Identical VS fraternal twin studies
Despite having the same DNA, not all identical twins develop autism Since there is not a single cause for autism, it becomes difficult for parents, scientists and educators to prevent autism.
Currently, there are no preventative measures that directly correspond to children being free from autism. However, Prevent Autism (2012) has outlined some preventative measures that the scientific community has agreed upon that parents can take into considerations - Mothers should take prenatal vitamins containing folic acid, or eat a diet rich in folic acid, during the months before and after conception.

- Mothers should breast feed and add non-casein formula to their baby’s diet (Casein is a protein found in dairy products).

- Mothers should eliminate casein and gluten from their child’s diet

- Mothers should eat organic and all natural foods during pregnancy.

- Parents should avoid pesticides and avoid taking their children around pesticides.

- Parents should feed their child pro-biotics when they need antibiotics.

- Mothers should avoid vaccines during pregnancy as much as possible.

- After the child is born, vaccinations should be broken up into separate shots and spread out over time. Important to remember that there are no prevention methods known to directly prevent the development of autism
Instead, health professionals encourage parents to educate themselves on the characteristics of autism and possible interventions if necessary
Early intervention is strongly promoted and has been the most successful method of working with and supporting students with autism Preventing Autism The assessment of ASD is a tedious procedure as it requires
health professionals to work effectively and collaboratively
with one another to ensure accuracy of diagnosis. Parents are encouraged to work collaboratively with their child’s teacher and if concerned about the possibility of ASD; they should refer to these guidelines before approaching a physician (Clark, Gulati & Johnston, 2008): 1.No gesturing-pointing or waving by 12 months

2.No single signs by 16 months

3.No two-sign (not imitated or echoed) combinations by 24 months

4.Any loss of any language or social skills at any age Effective assessment is a systematic process that involves
the following stages (Clark et al., 2008):

1. Information gathering
a. Conduct interviews
b. Collect and review medical & developmental history

2. Direct observations of child

3. Formal assessments/tests

4. Diagnostic Formulation

5. Discussion and collaborative planning 1. Information gathering involves interviewing the parents and finding out any relevant information concerning (Clark et al., 2008):

a. Pregnancy & birth history
i. Prenatal or perinatal complications

b. Family history
i. Genetic history of ailments

c. Social history
i. Child’s interaction with family members and other close individuals

d. Medical & Developmental history
i. Serious illnesses or hospitalizations
ii. The stage the child’s growth & nutrition is in comparison to their biological age

e. Nature and characteristics of parents’ concern
i. What factors or situations have they noticed that have in the past caused alarm 2.Direct observation of child (Dua, 2003)

a.Child psychologist/psychiatrist, or paediatricians conduct a detailed clinical diagnostic assessment where he/she observes
the child in multiple settings; such as, in the home and at school to find patterns of ASD symptoms that the child may exhibit

b.A standardized procedure is used to ensure accuracy and increases validity of each observation 3.Formal Assessments/tests

i.Psychological assessment (Dua, 2003)

Communication and Symbolic Behaviour Scales Developmental Profile (Clark et al., 2008)

a.1-page infant-toddler checklist
b.4-page caregiver questionnaire
c.Behavioural observation of child and caregiver interaction

ii.Speech-language-communication assessment (Dua, 2003)

MacArthur-Bates Communicative Development Inventories (Clark et al., 2008)

a.Receptive and expressive vocabulary checklists for 8-18 months
b.Expressive vocabulary checklist for 16-30 months

iii.Medical evaluation (Dua, 2003)

Communication and Symbolic Behaviour Scales (Clark et al., 2008)

a.Gathers information about child’s abilities from multiple sources
b.Measures and compares age milestones to general population

iv.Functional behaviour assessment (Dua, 2003)

Observe and record child’s behaviour to decipher and locate a pattern of abnormal behaviour which may shed light to possible environmental triggers

v.Other assessments that may be required depending on the individual case (Dua, 2003)

1.Occupational therapy assessment
2.Comprehensive family assessment
3.Psychiatric assessment b. Parents can also use the CHAT (Checklist for Autism in Toddlers) test if they have concerns that their child may have autism (Help Autism Now, 2012)

i. Questionnaire that parents and health physicians complete by answering yes or no to a series of questions when an infant is between 18 to 24 months of age

ii. Categorizes the risk level that the child is in for having or developing ASD; it is meant to be used as a precautionary tool 4. Diagnostic Formulation (Clark et al., 2008)

a. The health professional team must work collaboratively with parents, teachers and the community to ensure correct diagnosis of ASD

b. Must be able to rule out that the ASD symptoms are not a manifestation of other disorders.

Some medical conditions that resemble ASD are (Dua, 2003):
i. Angelman Syndrome
ii. Tuberous sclerosis
iii. Fragile X syndrome
iv. Thyroid Disorders
5. Discussion and collaborative planning (Clark et al., 2008):

a. The child’s family, primary care physician(s), IEP and the
clinical team must work together to provide avenues of opportunity for a child with ASD

b. Through a collective team mind-frame, the child’s best interests will be served; there should be regular meetings and contact with the child to see if adjustments or alterations are in order Assessment (cc) photo by theaucitron on Flickr Intervention & Education
(Ministry of Education BC, 2000) Instructional Approaches 1.Visual Approaches

a.Organize student’s activities
b.Provide directions or instructions through pictures
c.Labelling and organizing the classroom environment
d.Explicit social interactions
e.Explicit self control 2. Plan tasks to match appropriate skill level

a. Scaffold students learning.
i. Students with autism are particularly vulnerable to anxiety
and are intolerant of feelings of frustration. 3. Provide precise, positive praise
while the student is learning. 4. Use meaningful reinforcements
a. Reward positive behaviour using students’
interests (free time, stickers, gum, etc...) 5. Provide opportunities for choice 6. Break down oral instructions into
steps, using task analysis 7. Pay attention to processing
and pacing issues. Strategies for Classroom Management 1) Provide a structured, predictable
classroom environment 2) Provide a customized visual
daily schedule 3) Be aware of the student’s sensory concerns a)Auditory
d)Vestibular (movement)
e)Gustatory and Olfactory (Taste and Smell) Strategies for Communication &
Development 1)Learn to listen
2)Develop oral language comprehension
3)Developing Oral Language Expression
4)Developing conversational skills Teaching & Building
Social Skills 1.Waiting
2.Taking turns
4.Changing topics of conversation
Visual supports and teaching the student to observe others in the class
7.Being flexible
Social stories combined with photographs or pictures can be particularly useful
8.Being quiet American Psychiatric Association. (2000). Autism Spectrum Disorder. In Diagnostic and
Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC.

Autism Science Foundation. (2012). Autism and vaccines. Autism Science Foundation. Retrieved
from http://autismsciencefoundation.org/autismandvaccines.html on July 11, 2012.

Autism Speaks Incorporated. (2012). What causes autism. What is Autism? Retrieved from
http://www.autismspeaks.org/what-autism on July 11, 2012.

Brown, F., Gerber, S., & Olivia, C.M. (2012). Characteristics of Children with Autism.
Retrieved from: http://www.pbs.org/parents/inclusivecommunities/autism2.html

Centers for Disease Control and Prevention. (2012). Why are Autism Spectrum Disorder
Increasing? Retrieved from: http://www.cdc.gov/ncbddd/autism/hcp-dsm.html

Clark, T., Gulati, S., & Johnston, J. (2008). Diagnosis and Assessment of Autism Spectrum
Disorder. Retrieved from The Children’s Hospital website: http://www.childrenshospital.org/clinicalservices/Site2143/Documents/Autism%20+%20Deaf%20FINAL%20%28Copy%20Proctected%29.pdf

Dua, V. (2003). Standards and Guidelines for the Assessment and Diagnosis of Young
Children with Autism Spectrum Disorder in British Columbia. Retrieved from The British Columbia Ministry of Health Planning website: http://www.health.gov.bc.ca/library/publications/year/2003/asd_standards_0318.pdf

Help Autism Now. (2012). CHAT (Checklist for Autism in Toddlers): Autism Screening at 18
–24 months of age. Retrieved from: http://www.helpautismnow.com/CHAT_Checklist_English.pdf

Levy, S.E., Mandell, D.S., & Schultz, R.T. (2009). Autism. Lancet, 374(9701), 1627-1638.

Love to Know Corporation. (2012). History of Autism. Autism. Retrieved from
http://autism.lovetoknow.com/History_of_Autism on July 11, 2012.

Mercer, J. (2010). Whose Fault is Autism? A Historical View of Placing Blame. Psychology
Today. Retrieved from http://www.psychologytoday.com/blog/child-myths/201004/whose-fault-is-autism-historical-view-placing-blame on July 11, 2012.

Ministry of Education BC. (2000). Teaching students with autism: A Resource guide for schools.
Office Products Centre, Victoria, BC. Retrieved from http://www.bced.gov.bc.ca/specialed/docs/autism.pdf on July 10, 2012.

Prevent Autism. (2012). Parents can prevent autism...today! Retrieved from
http://www.prevent-autism.org on July 11, 2012. References Group Activity
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