Autism M01

AUTISM AND OTHER PERVASIVE DEVELOPMENTAL DISORDERS
Online Continuing Education Course Presented by Care and Compliance Group, Inc.
IMPORTANT NOTICE
Care and Compliance Group, Inc. and the authors of this course have attempted to offer useful information and assessment tools that have been accepted and used by professionals. Nevertheless, changes in the health care delivery regulations and medical technology will alter the application of some concepts and techniques presented in this course. Care and Compliance Group, Inc. and the authors of this course disclaim any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, of the use and application of any of the concepts in this course. All rights reserved. No part of this course may be reproduced or utilized in any form, by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from Care and Compliance Group, Inc. Enrolled learners have permission to print the materials in this course for their own use only as a study aid during their completion of this course.
www.careandcompliance.com support@careandcompliance.com 800-321-1727
Course Description
This course presents current information on the Autism Spectrum Disorders (ASD). Common terminology, characteristics, screening recommendations, diagnostic criteria, and management of ASD is presented. Participants will learn the diagnostic criteria and distinguishing characteristics of Autism, Asperger's Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified. Best practices and intervention planning for individuals of all ages are discussed.
Course Objectives: Module 1

Course Objectives: By the end of this course the participant will be able to:
Module 1 Objectives:
1. Define the term Autism Spectrum Disorders (ASD). 2. Name the three (3) primary conditions encompassed within the Autism Spectrum Disorders. 3. Discuss the common characteristics or indicators frequently seen in persons with Autism Spectrum Disorders. 4. Distinguish the differences according to diagnostic criteria for Autistic Disorder, Aspergers Disorder, and Pervasive Developmental Disorder-NOS. 5. Discuss the causes of ASD. 6. Name the other medical conditions frequently seen in people with ASD. Continued--
Course Objectives: Module 2

Course Objectives: By the end of this course the participant will be able to:
Module 2 Objectives:
1. Discuss key concepts in identifying and managing Autism Spectrum Disorders. 2. Describe the screening and diagnostic evaluation process as they relate to Autism Spectrum Disorders in children and adults. 3. Describe treatment options and common procedures for ASDs. 4. Discuss the best practice recommendations for children and adults with ASDs.
TERMINOLOGY
Various terms related to resident care are used throughout this course. While most of these terms are commonly accepted in the industry, there is some variation from state to state, and within different organizations. To clarify these terms and to improve your understanding of their meaning a brief explanation is provided on the following two pages.
Continued--
TERMINOLOGY, cont.
Terminology used in this course:
Community: The care setting is referred to as an assisted living
or residential care community. Although the term "facility" is often used in state regulations and by some in the industry, we feel it is important to distinguish a group home, adult residential facility, and/or an assisted living or residential care residence as a home, rather than strictly a clinical facility. When the word "community" is used in this course it is referring to the care setting, not the community at large. Clarification will be provided if necessary. In some cases, such as when quoting from regulations, the term facility will be used.
Continued--
TERMINOLOGY, cont.
Terminology used in this course:
Caregiver: This is the person providing care. Although there are
exceptions, typically this person is not a licensed medical professional.
Resident: The resident is the individual receiving care. In other

healthcare settings the term "patient" or "client" are more common, but to foster a homelike atmosphere the term resident is used in the assisted living and residential care industries.
Additional Terminology
Autism: a spectrum disorder which encompasses a range of neurological afflictions ASD: autism spectrum disorders (may also be called autistic spectrum disorders or pervasive developmental disorders) PDD-NOS: pervasive developmental disorder-not otherwise specified DSM-IV-TR: Diagnostic and Statistical Manual of Mental DisorderFourth Edition, Text Revision NIMH: National Institute of Mental Health
Welcome!
Lets review the VERY IMPORTANT DIRECTIONS before you get started:
This course is self-paced. Feel free to take as much time as you need to read each slide.
You may go forward to the next slide or backwards to a previous slide within this course.
More VERY IMPORTANT DIRECTIONS:
Within this course may be some questions to help you check your understanding. These questions are not graded; they are included to help you with the material. At the end of this course is a Final Exam to make sure you understand the material. You must complete the Exam to complete the course. This course starts with a pretest to help you assess your knowledge. You must complete the pre-test before beginning the instruction in the course.
Module 1 Introduction
This course is divided into two learning modules. In this first module the information is presented in the following section topics:
Introduction Statistics Autism Spectrum Disorders: Definitions and Types Common Characteristics or Indicators of ASD History: Autistic Disorder History: Aspergers Disorder Research: ASD and the Brain ASD and Other Problems ASD: Diagnostic Criteria
INTRODUCTION
Introduction
Pervasive Developmental Disorders (PDDs) are also known as Autism Spectrum Disorders (ASDs). In this course we will be using the terms interchangeably. PDDs cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. PDDs are usually first diagnosed in early childhood.
Introduction, cont.
The term Autism Spectrum Disorders includes five separate conditions. The first three are the primary ASDs: Autistic Disorder Aspergers Disorder Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) These conditions all have some of the same symptoms, but they differ in terms of when the symptoms start, how severe they are, and the exact nature of the symptoms.
Introduction, cont.
The three primary ASDs listed on the previous page, along with two rare conditions called Rett Syndrome and Childhood Disintegrative Disorder, make up the broad diagnosis category of Pervasive Developmental Disorders (PDD) or Autism Spectrum Disorders (ASD).
Introduction, cont.
Autism is the most common of the five Autism Spectrum Disorders (ASD). Although the classic form of autism can be easily distinguished from other forms of autistic spectrum disorders, the terms autism and autism spectrum disorders are often used interchangeably.
Introduction, cont.
In this course we will focus on the three most common Autism Spectrum Disorders (ASD): Autism Disorder, Aspergers Disorder, and Pervasive Developmental Disorder-NOS.
STATISTICS
Statistics
Estimates of the prevalence of autism vary widely depending on diagnostic criteria, age of children screened, and geographical location. State departments of education around the country are reporting alarming increases in the numbers of children receiving an autism diagnosis. One of the most hotly debated autism topics is whether rates of incidence are actually rising or if improved diagnostic techniques account for the rises seen throughout the country.
Statistics, cont.
The number of reported cases of autism increased dramatically in the 1990s and early 2000s, prompting investigations into several potential reasons:
More children may have autism; that is, the true frequency of autism may have increased. There may be a more complete finding of cases as a result of increased awareness and funding. The diagnosis may be applied more broadly than before as a result of the changing definition of the disorder, particularly changes in DSM-III-R and DSM-IV diagnostic criteria. Successively earlier diagnosis in each succeeding cohort of children, including recognition in preschool, may have affected apparent prevalence, but not incidence.
Statistics, cont.
A 2009 study of California data found that the reported incidence of autism rose 7- to 8-fold from the early 1990s to 2007. Changes in diagnostic criteria, inclusion of milder cases, and earlier age of diagnosis probably explain only a 4.25-fold increase. The study did not quantify the effects of wider awareness of autism, increased funding, and expanding treatment options resulting in parents' greater motivation to seek services.
Statistics, cont.
In summary, the reported increase is largely attributable to changes in diagnostic practices, age at diagnosis, and public awareness. But, these changes apparently do not account for all the increase in prevalence that is seen. Researchers believe that the actual frequency of autism has increased.
Statistics, cont.
According to the Centers for Disease Control (February 2007), autism spectrum disorders affect approximately 1 in 150 children (6.6 per 100 children). ASD diagnosis commonly occurs between the ages of ten (10) months and three (3) years of age, with a majority of diagnoses taking place by the age of one.
Statistics, cont.
While ASD diagnosis most commonly occurs prior to the age of three, there are some children who are not properly diagnosed until they begin kindergarten at the age of five (5) or later. Some cases of ASD may not be properly diagnosed until adulthood, even late adulthood. Some cases may never be appropriately diagnosed.
Statistics, cont.
In an effort to avoid these delayed diagnoses, families, teachers, and others who care for children, especially children considered at risk for ASD, are familiarized with assessments, tools, guidelines, and best practices for detecting ASD.
Varying Autism Spectrum Disorder Statistics

A review of the literature demonstrates that statistical estimates of the prevalence of ASDs do not always agree.
In 2005, the National Institute of Mental Health (NIMH) stated the "best conservative estimate" as 1 in 1000 persons in the United States. In 2007, the NIMH stated the "best conservative estimate" as 26 in 1000 persons in the United States. And, as mentioned before, in 2007 the Centers for Disease Control (CDC) estimated that ASDs may affect as many as 6.6 per 1000 in the United States.
Varying Autism Spectrum Disorder Statistics, cont.

Statistical variations aside, the one fact that everyone agrees upon is that ASDs are being diagnosed with increasing frequency.
AUTISM SPECTRUM DISORDERS: DEFINITIONS AND TYPES
Autism Spectrum Disorders (ASDs) Defined

All autism spectrum disorders are life-long neurodevelopmental disabilities characterized by:
An onset of symptoms before 36 months (3 years) that never improve. These symptoms remain constant in children and adults (from young to aging).
Autism Spectrum Disorders (ASDs) Defined, cont.

All children and adults (including the elderly) with ASDs demonstrate deficits in:
Social interaction Verbal and non-verbal communications Repetitive or ritualistic behaviors or interests
They will often have unusual responses to sensory experiences, such as certain sounds or the physical appearance of certain objects. Each of these symptoms runs the gamut from mild to severe and will present differently in each individual child, adult, and elderly adult.
Understanding Autism Spectrum Disorders, cont.

ASDs impact varies significantly from individuals who are nearly dysfunctional and apparently mentally disabled to those whose symptoms are mild or remedied enough to appear unexceptional ("normal") to others. Many "high-functioning" people of all ages and/or those with a relatively high IQ suffering from ASD are under diagnosed; thus, the assumption that ASD automatically implies retardation is inaccurate.
Autism Spectrum Disorders

The five (5) Autism Spectrum Disorders, also known as pervasive developmental disorders (PDDs), are shown on the chart on the following slide.
Autism Spectrum Disorders, cont.
Primary Types of Autism Spectrum Disorders

The three primary ASDs that are closely related include:
1. Autistic Disorder Often referred to as: Classic Autism Traditional Autism Typical Autistic Disorder Kanners Disorder 2. Aspergers Disorder (or Asperger Syndrome) 3. Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) Also known as: Atypical Autistic Disorder Atypical PDD
Rare Types of Autism Spectrum Disorders

Two other ASDs that are rare include:
1. Rett Syndrome Rare type of ASD Not widely recognized by healthcare professionals 2. Childhood Disintegrative Disorder Extremely rare type of ASD Not widely recognized by healthcare professionals
Check for Understanding

Based on Autism Spectrum Disorder Statistics, reported in 2007 by the Centers of Disease Control, persons in the United States who deal with some form of Autistic Spectrum Disorder is:
A. 1 in 1000 B. 1 in a million C. 1 in 150

Based on Autism Spectrum Disorder Statistics, reported in 2007 by the Centers of Disease Control, persons in the United States who deal with some form of Autistic Spectrum Disorder is:
A. 1 in 1000 B. 1 in a million C. 1 in 150
COMMON CHARACTERISTICS OR INDICATORS OF ASD
Common Characteristics or Indicators of ASD

The following pages list some of the behavioral characteristics seen which can be possible indicators of ASDs in children and/or adults. We have presented the characteristics according to age group; however, many of these characteristics can be seen at any age.
Possible Indicators of Autism Spectrum Disorders in Children

Does not babble, point, or make meaningful gestures by 1 year of age Does not speak single words by 16 months Does not combine two words by 2 years Does not understand the concept of pointing - will look at the hand pointing rather than object to which the hand points
Continued-
Possible Indicators of Autism Spectrum Disorders in Children, cont.

Doesn't seem to know how to play with toys Excessively lines up toys or other objects Doesn't smile Consistently cries or absence of crying Failure to use 'I', 'me', and 'you', or reversal of these pronouns Delayed toilet training Limited development of play activities, particularly imaginative play
Continued-
Possible Indicators of Autism Spectrum Disorders in Children, cont.

Likes to spin in a circle Overly active, uncooperative, or resistant Very independent, even at a very young age Gets things for himself/herself only
Possible Indicators of Autism Spectrum Disorders in Children and Adults

Tunes others out not interested in others in his/her own world Unusual attachments to toys, objects, or schedules Walks on his/her toes Unconcerned about - or completely oblivious to dangers around him/her (e.g., standing in the middle of the street without worrying about getting hit by a car)
Continued-
Possible Indicators of Autism Spectrum Disorders in Children and Adults, cont.

Unusual responses to other people. Shows no desire to be cuddled or hugged Has a strong preference for familiar people and may appear to treat people as objects rather than a source of comfort. Marked repetitive movements, such as hand-shaking or flapping, prolonged rocking or spinning of objects.
Continued-

Extreme resistance to change in routines and/or environment Avoidance of social situations, preferring to be alone Sleeping problems Absence of speech, or unusual speech patterns such as repeating words and phrases (echolalia) About half of the children who are non-verbal in the preschool years will acquire some speech later in life Extreme distress caused by certain noises and/or busy public places such as shopping centers Social judgments are difficult
School behavior problems can often occur.
Continued-

Ritualistic and compulsive behavior patterns. Hyperactivity and a poor attention span are often observed, usually because the child has trouble understanding instructions from the teacher and classroom 'rules'. Significant levels of anxiety, often from the child's difficulty in understanding other people and interpreting what is going on around them. Many children will show a lack of motivation or desire to please others. Difficulty transferring skills learned in one setting to another setting (e.g., school to home).
Continued-

Cannot express or explain what he/she wants Does not respond to name Regresses in language or social skills Stares into open areas, not focusing on anything specific Poor eye contact
Continued-

Doesnt follow directions Has odd movement patterns Throws tense or violent tantrums Often puts hands on ears At times seems to be hearing impaired
Possible Indicators of Autism Spectrum Disorders in Adolescents and Adults

Normal adolescent behavioral challenges and broad mood fluctuations are exaggerated for those with an Autism Spectrum Disorder.
It may start a little later than normal adolescence and continue into late teens and early twenties, but eventually there is a resumption of calmer behavior.
A few adolescents show marked improvement in their behavior and skills, while others may show serious behavioral regression. Sexual development and interest varies with physical development, but in general is delayed.
Continued-
Possible Indicators of Autism Spectrum Disorders in Adolescents and Adults, cont.

The commencement of menstruation and sexual drive are usually tolerated calmly, but exhibitionism and public masturbation are sometimes problems.
This behavior can usually be redirected using behavior modification techniques.
The presence of a disability seems to become more obvious in the physical appearance of the older person, especially if they also have an intellectual disability. Epilepsy or seizures may develop in a number of adolescents with an Autism Spectrum Disorder.
Continued-
Possible Indicators of Autism Spectrum Disorders in Adolescents and Adults, cont.

Increased levels of anxiety and the development of depressive symptoms often occur.
Caregivers need to be alert to this and seek professional supports for the person. Psychotropic medication, as prescribed by a psychiatrist, can assist with anxiety management.
If they have received specialist intervention, adults with an Autism Spectrum Disorder are able to partly overcome their difficulties but continue to require sensitive and sustained support, usually from their families.
Other Common Characteristics

Keep in mind that no ratios are clear-cut in those with ASD:
Intellectual disability occurs in at least 70% More common in males than females (3:1) An accompanying condition of epilepsy is common and can onset at any age Anxiety is common, due to poor communication skills, over-stimulation, etc. May develop behavior disorders

Possible indicators of Autism Spectrum Disorders in children and adults include all of the following except:
A. Walks on his/her toes B. Smiles all the time and loves to have conversations with peers C. Doesnt seem to know how to play with toys D. Often puts hands on ears

Possible indicators of Autism Spectrum Disorders in children and adults include all of the following except:
A. Walks on his/her toes B. Smiles all the time and loves to have conversations with peers C. Doesnt seem to know how to play with toys D. Often puts hands on ears
HISTORY: AUTISTIC DISORDER
History of Autistic Disorder

The word "autism" was first used in the English language in a 1911 issue of the American Journal of Insanity. The term was originally used to talk about people who seemed to have very little social communication with others. Autism was actually confused with schizophrenia during the early stages of observation.
Continued-
History of Autistic Disorder, cont.

Historically, many behaviors displayed by blind and deaf children and adults (including the elderly) were seen as "autistic-like" and attributed to their blindness or deafness, rather than considering the possibility of Autism Spectrum Disorders.
Continued-

Dr. Leo Kanner was an Austrian psychiatrist and physician. He emigrated to the U.S. in 1924 and became an Associate Professor of Psychiatry at Johns Hopkins Hospital in 1933. Dr. Kanner is considered the creator of the autism classification and published his first paper identifying autistic children in 1943.
Continued-

The classification of autism as a separate disorder or disease did not occur until after Dr. Kanners 1943 paper that suggested the term "autism" to describe the fact that the children seemed to lack interest in other people. Almost every characteristic originally described by Dr. Kanner is still regarded as typical of the autistic spectrum of disorders.
HISTORY: ASPERGERS DISORDER
History of Aspergers Disorder

At the same time Dr. Kanner was making his discoveries, an Austrian scientist named Dr. Hans Asperger made similar observations, although his name has since become attached to a different, higher-functioning form of ASD, known as Asperger syndrome.
History of Aspergers Disorder, cont.

Dr. Hans Asperger was born on a farm outside of Vienna, earned his medical degree in 1931, and spent 20 years as the Chair of Pediatrics at the University of Vienna. In the 1940s, Dr. Hans Asperger published the first definition of Asperger syndrome in 1944. Dr. Asperger's findings were largely ignored and disregarded in his lifetime. Finally, in the early 1990s his findings began to gain notice, and today Asperger syndrome is recognized as a diagnosis in a large part of the world.
Continued-
Aspergers Disorder
Aspergers Disorder is diagnosed by the presence of social interaction impairments and repetitive and restricted interests. There is usually no significant language delay, yet there are impairments in the social use of language often leading to isolation. This disorder is more common in males (13:1)*.
*Note: this disorder may be under-diagnosed in females.
Continued-
Aspergers Disorder, cont.

While the DSM-IV-TR does not include level of intellectual functioning in the diagnosis, those with Asperger's syndrome tend to function better than those with Autistic Disorder. People with Aspergers Syndrome often have a great discrepancy between their intellectual and social abilities. This fact has produced a popular conception that Asperger's Syndrome is synonymous with "higherfunctioning autism," or that it is a lesser disorder than autism.
Continued-

Children and adults with Asperger Syndrome generally have few facial expressions apart from anger or misery. Most have excellent rote memory and musical ability, and become intensely interested in one or two subjects (sometimes to the exclusion of other topics).
Continued-

People with this disorder may talk at length about a favorite subject or repeat a word or phrase many times. Children and adults with Aspergers Syndrome tend to be "in their own world" and preoccupied with their own agenda. The onset of Aspergers Syndrome commonly occurs after the age of three (3).
Continued-

Some individuals who exhibit features of autism, but who have well-developed language skills, may be diagnosed with Aspergers Syndrome. Children with Aspergers Syndrome have a better prognosis than those with other pervasive developmental disorders and are much more likely to grow up to be independently functioning adults.
Typical Characteristics of Aspergers Disorder in Children and Adults

Clumsiness Concrete, pedantic speech (a narrow, often tiresome focus on or display of book learning and formal rules) Lack of common sense Intolerance of change Anxiety
Aspergers Disorder in Adults/Elderly

Aspergers Disorder is thought to be under-diagnosed in many adults and the elderly. The Cambridge Lifespan Asperger Syndrome Service (CLASS), an organization in the United Kingdom that works with adults with Asperger's, has developed a simple ten question checklist to identify the possible presence of Aspergers.
Continued-
Aspergers Disorder in Adults/Elderly, cont.

CLASS checklist, cont. Individuals answering yes to some or most of these questions, should consider obtaining input from a medical professional. I find social situations confusing. I find it hard to make small talk. I did not enjoy imaginative story-writing at school. I am good at picking up details and facts.
Continued-
Aspergers Disorder in Adults/Elderly, cont.

CLASS checklist, cont. I find it hard to work out what other people are thinking and feeling. I can focus on certain things for very long periods. People often say I was rude even when this was not intended. I have unusually strong, narrow interests. I do certain things in an inflexible, repetitive way. I have always had difficulty making friends.
PDD-NOS Defined
The third primary ASD is Pervasive Developmental DisorderNot Otherwise Specified. Pervasive Developmental DisorderNot Otherwise Specified is included in DSM-IVTR to encompass cases where there is marked impairment of social interaction, communication, and/or stereotyped behavior patterns or interest, but when full features for another explicitly defined PDD are not met.
PDD-NOS Criteria & Management

Criteria Core autistic behaviors are present Full criteria for Autistic Disorder or another PDD is not met Management Management of PDD-NOS is the same as Autistic Disorder
PDD-NOS Information
Although PDD-NOS is a well-recognized form of ASD, studies on PDD-NOS are less common than those on Aspergers Disorder and Autistic Disorder. PDD-NOS has less diagnostic research on it than any other ASD.

The following disorder is more common in males and has a popular conception of being a higherfunctioning autism, or at least a lesser autistic disorder. A. B. C. D. Retts Disorder Kanners Disorder Childhood Disintegrative Disorder Aspergers Disorder

The following disorder is more common in males and has a popular conception of being a higherfunctioning autism, or at least a lesser autistic disorder. A. B. C. D. Retts Disorder Kanners Disorder Childhood Disintegrative Disorder Aspergers Disorder
RESEARCH: ASD AND THE BRAIN
Causes of ASD
There is no known single cause for autism. It is generally accepted that autism is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism versus non-autistic children. Researchers are investigating a number of theories, including the link between heredity, genetics and medical problems.
Causes of ASD, cont.

Autism does not have a clear unifying mechanism at either the molecular, cellular, or systems level; it is not known whether autism is a few disorders caused by mutations converging on a few common molecular pathways, or is (like intellectual disability) a large set of disorders with diverse mechanisms.
Research
Because of its relative inaccessibility, scientists have only recently been able to study the brain systematically. But with the emergence of new brain imaging tools the study of the structure and the functioning of the brain can now be done. Postmortem and MRI studies have shown that many major brain structures are implicated in autism. This includes the cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem. Other research is focusing on the role of neurotransmitters such as serotonin, dopamine, and epinephrine.
ASD affects many parts of the brain.
Major Brain Structures Implicated in Autism, cont.
ASD and The Brain

Recent neuroimaging studies have shown that a contributing cause for autism may be abnormal brain development beginning in the infants first months. This growth dysregulation hypothesis holds that the anatomical abnormalities seen in autism are caused by genetic defects in brain growth factors. Autism appears to result from developmental factors that affect many or all functional brain systems, and to disturb the timing of brain development more than the final product.
ASD and The Brain, cont.

The heads of children with ASD tend to be larger than what is considered normal and researchers confirm that these children have bigger and heavier brains than those children without ASD.
This occurs at the 1-2 month mark, as babies with ASD are born with smaller heads, but they rapidly grow. It is possible that sudden, rapid head growth in an infant may be an early warning signal that will lead to early diagnosis and effective biological intervention or possible prevention of autism.
By the age 18, the brain in a majority of people with ASD is of normal weight.
ASD and Genetics

Research into the causes of autism spectrum disorders is being fueled by other recent developments. Evidence points to genetic factors playing a prominent role in the causes for ASD. Twin and family studies have suggested an underlying genetic vulnerability to ASD.
ASD and Vaccines

The Institute of Medicine (IOM) conducted a thorough review on the issue of a link between thimerosal (a mercury based preservative that is no longer used in vaccinations) and autism. The final report from IOM, Immunization Safety Review: Vaccines and Autism, released in May 2004, stated that the committee did not find a link.
ASD and Environmental Factors

A U.S. study looking at environmental factors including exposure to mercury, lead, and other heavy metals is ongoing.
Causes of ASD
Much of ASD remains a mystery, and some researchers are focusing on environmental factors, as others continue to investigate genetics. Current theory holds that ASD results from a combination of genetics and environmental factors.

Based on research, which of the following statements is false?
A.No single cause for ASD is known B.Environmental factors are being studied to determine their role in ASD C.Genetic factors are thought to pay a role in the causes of ASD D.None; all of the above are true

Based on research, which of the following statements is false?
A.No single cause for ASD is known B.Environmental factors are being studied to determine their role in ASD C.Genetic factors are thought to pay a role in the causes of ASD D.None; all of the above are true
ASD AND OTHER PROBLEMS
ASD and Other Problems

People who have ASD often have other medical or behavioral problems. Some of the most common are described in this section.
ASD and Other Problems, cont.

Sensory problems. Many ASD children are highly attuned or even painfully sensitive to certain sounds, textures, tastes, and smells. In ASD, the brain seems unable to balance the senses appropriately. Some children find the feel of clothes touching their skin almost unbearable. Some soundsa vacuum cleaner, a ringing telephone, a sudden storm, even the sound of waves lapping the shorelinewill cause these children to cover their ears and scream. Some ASD children are oblivious to extreme cold or pain. An ASD child may fall and break an arm, yet never cry. Another may bash his head against a wall and not wince, but a light touch may make the child scream with alarm.
Continued--

Mental retardation. Many children with ASD have some degree of mental impairment. Seizures. One in four children with ASD develops seizures, often starting either in early childhood or adolescence.
Continued--

Tuberous Sclerosis. Tuberous sclerosis is a rare genetic disorder that causes benign tumors to grow in the brain as well as in other vital organs. It has a consistently strong association with ASD. One to 4 percent of people with ASD also have tuberous sclerosis.
Continued--

Fragile X syndrome. This disorder is the most common inherited form of mental retardation. It was so named because one part of the X chromosome has a defective piece that appears pinched and fragile when under a microscope. Fragile X syndrome affects about two to five percent of people with ASD. It is important to have a child with ASD checked for Fragile X, especially if the parents are considering having another child.
ASD: DIAGNOSTIC CRITERIA
Diagnosis of ASD
Accurate diagnosis of Autism Spectrum Disorder is important for a number of reasons, including: Assessment can assist in understanding why someone is different and understand his/her strengths, challenges, and needs Early intervention and appropriate educational programs can be implemented Access to support services can be facilitated
Influences in Behavior
Common difficulties encountered with the management of ASD in children and adults are:
Difficult behavior, such as tantrums, obsessions, aggression, etc. Communication problems Disturbed routine, such as sleep or finicky eating Social issues such as inappropriate behavior, isolation, teasing, bullying, etc.
DSM-IV-TR Criteria
The Diagnostic and Statistical Manual of Mental Disorder Fourth Edition (DSM-IV-TR), published by the American Psychiatric Association, Washington, D.C. is the main diagnostic reference of mental health professionals in the United States. The DSM-IV-TR outlines specific diagnostic criteria for each of the five Autism Spectrum Disorders (ASDs), also called Pervasive Developmental Disorders (PDDs).
All PDDs
All of the Pervasive Developmental Disorders are characterized by severe and pervasive impairment in several areas of development including: 1. reciprocal social interaction skills 2. communication skills, or 3. the presence of stereotyped behavior, interests, and activities. The qualitative impairment that define the different ASD conditions are described in the following pages.
Diagnostic Criteria
The following pages present the specific diagnostic criteria that is found in the DSM-IV-TR for all 5 of the Autism Spectrum Disorders.
DSM-IV-TR Criteria 299.00 Autistic Disorder

A. 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):
(1) Qualitative impairment in social interaction as manifested by at least two of the following: a) 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. b) Failure to develop peer relationships appropriate to developmental level. c) Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people. d) Lack of social or emotional reciprocity.
DSM-IV-TR Criteria 299.00 Autistic Disorder, cont.

(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) Restrictive, repetitive, and stereotyped patterns of behavior, 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 inflexibility adherence to specific, nonfunctional routines or rituals. c) Stereotyped and repetitive motor mannerisms. 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 three years: Social interaction Language as used in social communication Symbiotic or imaginative play C. The disturbance is not better accounted for by Retts Disorder or Childhood Disintegrative Disorder.
DSM-IV-TR Criteria 299.80 Aspergers Disorder

All areas must be met to qualify: (1) Qualitative impairment in social interaction as manifested by at least two of the following:
a) 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. b) Failure to develop peer relationships appropriate to developmental level. c) Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people. d) Lack of social or emotional reciprocity.
DSM-IV-TR Criteria 299.80 Aspergers Disorder, cont.

(2) Restrictive, repetitive, and stereotyped patterns of behavior, 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 inflexibility adherence to specific, nonfunctional routines or rituals. c) Stereotyped and repetitive motor mannerisms. d) Persistent preoccupation with parts of objects.
DSM-IV-TR Criteria 299.80 Aspergers Disorder, cont.

(3) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. (4) There is no clinically significant general delay in language (e.g. single words used by age 2 years, communicative phrases used by age 3 years). (5) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. (6) Criteria are not met for another specific pervasive developmental disorder or schizophrenia.
DSM-IV-TR Criteria - 299.80 Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)
This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal and nonverbal communication skills, or with the presence of stereotyped behavior, interests, and activities, but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder.
DSM-IV-TR Criteria 299.80 Retts Disorder

A. All areas must be met to qualify:
1. Apparently normal prenatal and perinatal development. 2. Apparently normal psychomotor development through the first 5 months after birth. 3. Normal head circumference at birth.
DSM-IV-TR Criteria 299.80 Retts Disorder, cont.

B. Onset of all of the following after the period of normal development:
1. Declaration of head growth between ages 5-48 months. 2. Loss of previously acquired purposeful hand skills between ages 5-30 months with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing). 3. Loss of social engagement early in the course (although social interaction often develops later). 4. Appearance of poorly coordinated gait or trunk movements. 5. Severely impaired expressive and receptive language development with severe psychomotor retardation.
DSM-IV-TR Criteria - 299.10 Childhood Disintegrative Disorder

A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and non-verbal communication, social relationships, play, and adaptive behavior. B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas: 1. 2. 3. 4. 5. Expressive or repetitive language Social skills or adaptive behavior Bowel or bladder control Play Motor skills
DSM-IV-TR Criteria - 299.10 Childhood Disintegrative Disorder, cont.

C. Abnormalities of functioning in at least two of the following areas:
1. Qualitative impairment in social interaction (e.g. impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity). 2. Qualitative impairments in communication (e.g. delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied makebelieve play). 3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms.
D. The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.
Disclaimer Notice
As previously noted in this presentation please remember that there is much to learn about ASD and that the information presented is the best available at this time.
Summary: Module 1
This is the end of the information in Module 1. In this module you learned:
The terminology, definitions, and the five conditions associated with Autism Spectrum Disorders (ASD). Common characteristics or indicators frequently seen in persons with Autism Spectrum Disorders. The differences in diagnostic criteria for each of the five ASDs. The causes of ASD. Other medical conditions frequently seen in people with ASD.
Module 2 Content
In Module 2 we will build upon the information you learned in this module. In Module 2 we will discuss:
Key concepts in identifying and managing Autism Spectrum Disorders. The screening and diagnostic evaluation process as they relate to Autism Spectrum Disorders in children and adults. Treatment options and common procedures for ASDs. Best practice recommendations for children and adults with ASDs.
Module 1 Completed
This is the end of Module 1 Next, you will begin Module 2 If you feel you are ready, please close this window and proceed to Module 2 from the main Curriculum Contents window.

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Autism M01

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AUTISM AND OTHER PERVASIVE DEVELOPMENTAL DISORDERS

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Course Objectives: Module 1

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Course Objectives: Module 2

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Resident: The resident is the individual receiving care. In other

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More VERY IMPORTANT DIRECTIONS:

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Varying Autism Spectrum Disorder Statistics

Varying Autism Spectrum Disorder Statistics, cont.

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AUTISM SPECTRUM DISORDERS: DEFINITIONS AND TYPES

Autism Spectrum Disorders (ASDs) Defined

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Autism Spectrum Disorders (ASDs) Defined, cont.

Understanding Autism Spectrum Disorders, cont.

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Autism Spectrum Disorders

Autism Spectrum Disorders, cont.

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Primary Types of Autism Spectrum Disorders

Rare Types of Autism Spectrum Disorders

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A. 1 in 1000 B. 1 in a million C. 1 in 150

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A. 1 in 1000 B. 1 in a million C. 1 in 150

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COMMON CHARACTERISTICS OR INDICATORS OF ASD

Common Characteristics or Indicators of ASD

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Possible Indicators of Autism Spectrum Disorders in Children

Possible Indicators of Autism Spectrum Disorders in Children, cont.

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Possible Indicators of Autism Spectrum Disorders in Children, cont.

Possible Indicators of Autism Spectrum Disorders in Children and Adults

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Possible Indicators of Autism Spectrum Disorders in Children and Adults, cont.

Possible Indicators of Autism Spectrum Disorders in Children and Adults, cont.

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Possible Indicators of Autism Spectrum Disorders in Children and Adults, cont.

Possible Indicators of Autism Spectrum Disorders in Children and Adults, cont.

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Possible Indicators of Autism Spectrum Disorders in Children and Adults, cont.

Possible Indicators of Autism Spectrum Disorders in Adolescents and Adults

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Possible Indicators of Autism Spectrum Disorders in Adolescents and Adults, cont.

Possible Indicators of Autism Spectrum Disorders in Adolescents and Adults, cont.

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Other Common Characteristics

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