What is Autism?

1. What is Autism?

2. Where is the diagnostic criteria? • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association (1994) (DSM IV) • Section: Disorders usually First Diagnosed in Infancy, Childhood, or Adolescence

3. DSM IV Autism

4. Diagnostic Criteria for Autistic Disorder From DSM IV A total of six (or more) items from (1), (2), and (3), with at least two from (1) and one each from (2) and (3): • qualitative impairments in social interaction • qualitative impairments in communication • restricted repetitive and stereotyped patterns of behavior, interests, and activities Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: • social interaction • language as used in social communication • symbolic or imaginative play. The disturbance is not better accounted for by Rhett’s Disorder of Childhood Disintegrative Disorder.

5. 1. Qualitative impairments in social interaction As manifested by at least two of the following: • marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction • failure to develop peer relationships appropriate to developmental level • 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 • Lack of social or emotional reciprocity

6. 2. Qualitative impairments in communication As manifested by at least one of the following: • 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 and mime) • in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others • stereotyped and repetitive use of language or idiosyncratic language • lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental levels

7. 3. Restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following: • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus • apparently inflexible adherence to specific, nonfunctional routines or rituals • stereotyped and repetitive motor mannerisms (e.g.,hand or finger flapping or twisting, or complex whole body movements) • Persistent preoccupation with parts of objects

8. How is autism diagnosed and by whom? • By a comprehensive assessment by a psychologist, neurologist, or psychiatrist with experience with children with pervasive developmental disorders • Instruments • Checklists for Autism in Toddlers (CHAT) • Autism Behavioral Checklist (ABC) • Autism Diagnostic Interview-Revised (ADI-R) • Autism Diagnostic Observation Schedule-General (ADOS-G) • Childhood Rating Scale (CARS) • Often clinicians rule out Fragile X (blood test)

9. Prevalence • DSM-IV (1994): 2-5 cases in 10,000 • NYS Clinical Practice Guidelines (1999): 10-15 cases in 10,000 • Center for Disease Control (2003): 2-6 per 1,000 • The National Health Interview Survey (NHIS)(2003-2004) reported autism prevalence among children ages 4-17 as 5.7 in 1000, or 1 in 175 • The National Survey of Children’s Health (NSCH) (2003-2004) reported a prevalence rate of 5.5 in 1000 or 1 in 181. • Total number of children in the US between the ages of 4 and 17, in 2003 and 2004, more than 300,000 children had an autism diagnosis. Gender: • DSM-IV: 4 to 5 times higher in males

10. Associated Features • 75% meet the criteria for mental retardation • Hyperactivity • Aggressiveness • Odd responses to sensory stimuli • Short attention span • Abnormalities of mood or affect • Lack of fear in response to real danger • Excessive fearfulness in response to harmless objects • PICA • Self-injurious behavior

11. What causes autism? • Research from various disciplines support the concept that autism is a biologically based developmental disorder • There is no known cause at this time

12. Treatments • Data based vs. non data based treatment options • Data based meaning peer review published studies • It is replicable

13. Treatments • Miracle cures & faddish “breakthroughs” • Some Warning Signs • High success rate • Rapid effects • Therapy is easy to administer • Promoters resist objective evaluation by others • Testimonials, anecdotal reports with no objective evidence

14. Learning Characteristics and Teaching Strategies

15. Learning Characteristics and Teaching Strategies

16. Applied Behavior Analysis • Research states ABA is the best intervention for children with autism. • Systematic use of behavioral teaching techniques • Intensive Direct Instruction by therapist • Extensive parent training and support so parents can provide additional hours • Minimum of 20 hours + parent time • Clearly identify target behaviors

17. ABA is appropriate for…… • ALL learners • However, it is often used with: • Children with autism/PDD • Children and adults with developmental disabilities such as mental retardation • Children and adults with psychiatric disabilities

18. Applied Behavior Analysis • Applied:is determined by the social significance of the behavior under investigation. The behavior chosen must have an immediate importance to the subject in the study. • Behavioral:The behavior chosen for study must be in need of improvement. The behavior chosen must be observable and measurable. • Analysis: demonstration of functional relations between manipulated events and the behavior. The experimenter must be able to control the occurrence or non-occurrence of the behavior.

19. Quality ABA Programs • Are comprehensive, that is they address all skill areas • Skills are addressed by direct observation • Skills are broken down into components • Components are taught using a prompt, a student’s behavior, and reinforcer

20. Characteristics of ABA • Start simple, build to more complex skills • Children are provided with many learning opportunities, in a variety of learning contexts: • 1:1 • Group • Inclusion settings

21. Characteristics of ABA • Focus is on teaching new skills, not just decreasing challenging or inappropriate behavior • Requires formal training and experience to oversee

22. ABA really is… • Fun for the student…..emphasis is placed on determining how the student learns and what they prefer • Individualized to the student’s skill level, attention level, and learning style • All about success…ABA used correctly results in a highly successful student!