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Kellie Maisenbacher

on 1 October 2013

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Transcript of ASD

Autism Spectrum Disorder
Differential Diagnosis
Autism Spectrum Disorder

US Center for Disease Control and Prevention: 1 in every 88 children in the U.S. has autism
“…the burden of proof is upon anybody who feels that there is NOT a real increase here in the number of kids affected.” Dr. Thomas Insel
Why the rapid increase?
Greater awareness
Changes in diagnosis
Increase in parental age

Autism Occurence statistics
Autistic Disorder
Pervasive Development Disorder
Asperger Syndrome
Diagnostic Criteria
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

1.Deficits in social-emotional reciprocity.

2. Deficits in nonverbal communicative behaviors used for social interaction.

3.Deficits in developing, maintaining, and understanding relationships.
Diagnotic Criteria Cont'd
B.Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
1. Stereotyped or repetitive motor movements, use of objects, or speech.
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior.
3. Highly restricted, fixated interests that are abnormal in intensity of focus.
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

C. Symptoms must be present in the early developmental period.
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by Intellectual disability or global development delay.
Diagnostic Criteria Cont’d

No one cause of autism.
Gene changes or mutations
Combination of risk genes/environmental factors
What Causes Autism?
No big smiles or other joyful expressions by six months
No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
No babbling by 12 months
No back-and-forth gestures by 12 months
No words by 16 months
No meaningful, two-word phrases by 24 months.
Any loss of speech, babbling or social skills at any age.
Red Flags
Rett Syndrome –
Typically between ages 1-4 autistic features show, however individuals with Rett syndrome improve their social communication skills and autistic features are no longer a major area of concern.
Selective Mutism-
Early development is not typically disturbed. Child usually exhibits appropriate communication skills in certain contexts and settings.
A prodromal state has been described in which social impairments and atypical interests and beliefs occurs, which could be confused with the social deficits seen in autism spectrum disorder.

Language disorders and social communication disorder-
Can be a combined diagnosis however the autism spectrum disorder supersedes the social communication disorder whenever the criteria for autism spectrum disorder are met. If not all criteria met will be social commination disorder on its own.

Intellectual disability without autism spectrum disorder-
Intellectual disability is the appropriate diagnosis when there is no apparent discrepancy between the level of social-communicative skills and other intellectual skills.
Stereotypic movement disorder-
Motor stereotypies are among the diagnostic characteristics of autism spectrum disorder. An additional diagnosis of stereotypic movement is not necessary if it is better explained by autism spectrum. Also may be added to the client’s diagnosis if there is self-injury behavior.
Attention-deficit/hyperactivity disorder-
Diagnosis of ADHD should be considered when attentional difficulties or hyperactivity exceeds that typically seen in individuals of comparable mental age.

Differential Diagnosis cont'd
Prevalence in the US
Implications for the Future
Autism costs the nation over $137 billion per year, which is a number that is expected to significantly increase in the next decade
“The increase in prevalence rate cannot be explained by better diagnosis alone. Some have suggested that autism is just being better diagnosed today versus years ago and that many cases of mental retardation are now being coded as autism.”

The Autism Epidemic
“People don’t change that fast…labels do.” Allen Francis
Are children being mislabeled?
Still unclear of any environmental factors
“Researchers say the differences are too wide to represent true disparities in the prevalence of autism. More likely, they are the signature of social and cultural forces, reflecting how new perceptions and attitudes about autism have taken root to different degrees in different places.”

diagnosed 4x more in males than females.
Girls are more likely to develop an intellectual disability.
Girls more likely to develop depression/anxiety.
Internalizing vs. Externalizing behaviors.
Are females less likely to be diagnosed with ASD because they are raised differnt than boys in our social context?
Parental report
Diagnosis less likely in poorer communities.
Eastern Asia has high prevalence, but not as high as US.
Study comparing US to South Korea, Israel and the UK.
Behavior and Communication Approaches
o Applied Behavior Analysis
 Discrete Trial Training
 Early Intensive Behavioral Intervention
 Verbal Behavior Intervention
 Pivotal Response Training
o Developmental, Individual Differences, Relationship Based Approach
o Treatment and Education of Autistic and Related Communication – Handicapped Children (TEACCH)
o Occupational Therapy
o Sensory Integration Therapy
o Speech Therapy
o The Picture Exchange Communication System

Treatment Cont'd
Special Diets
Alternative Treatments
Less Support For Adults with ASD?
o College

DSM-IV criteria
DSM 5 criteria
What will these changes mean?
Changes in the DSM-5
Full transcript