UNIVERSITA' DEGLI STUDI DI PALERMO POLO DI CALTANISSETTA

AUTISM

Ignazio Gueli e Marco Alise

Overview
What is Autism? Is there more than one type of Autism? What causes Autism? How is Autism diagnosed? What are the characteristics of Autism? What are the most effective approaches to treating Autism? Is there a cure?

WHAT IS AUTISM?
First described by Leo Kanner in 1943 as early infantile autism children are locked within themselves. For next 30 years, considered to be an emotional disturbance

WHAT IS AUTISM?
Today, autism is a severe form of a broader group of disorders These are referred to as pervasive developmental disorders (later) Typically appears during the first 3 years of life

Autism is associated with several other conditions:

Genetic disorders. About 1015% of autism cases have an identifiable Mendelian (single-gene) condition, chromosome abnormality (7-15), or other genetic syndrome. (multifactorial)twins Mental retardation. Epilepsy, with variations in risk of epilepsy due to age, cognitive level, and type of language disorder. Several metabolic defects, such as phenylketonuria, are associated with autistic symptoms. Downs Syndrome Fragile X Syndrome

Very likely neurological in origin not emotional, not the refrigerator mom The 'refrigerator mother' label was based on the assumption now discredited among most, mental health professionals that autistic behaviors stem from the emotional frigidity of the children's mothers 4 times more prevalent in boys No known racial, ethnic, or social boundaries No relation to family income, lifestyle

WHAT IS AUTISM?

WHAT IS AUTISM?
Autism impacts normal development of the brain in areas of social interaction and communication skills (amygdala, Hippocampus, cerebellum). Difficult to communicate with others and relate to the outside world. Occasionally, aggressive and/or self-injurious behavior may be present.

WHAT IS AUTISM?
May exhibit repeated body movements (hand flapping, rocking). Unusual responses to people Attachment to objects Resistance to change in routine

WHAT ARE THE TYPES?

Pervasive Developmental Disorder (PDD). Autism is one of the 5 PDDs. All have commonalities in communication and social deficits Differ in terms of severity

1. Autistic Disorder
Impairments in social interaction, communication, and imaginative play. Apparent before age 3. Also includes stereotyped behaviors, interests, and activities

2. Aspergers Disorder
Impairments in social interactions, and presence of restricted interests and activities No clinically significant general delay in language

3. Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

Often referred to as atypical autism Used when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors

4. Retts Disorder
Progressive disorder which, to date, has only occurred in girls. Period of normal development and then the loss of previously acquired skills Also loss of purposeful use of hands, which is replaced by repetitive hand movements Beginning at age of 1-4 years

5. Childhood Disintegrative Disorder

Normal development for at least the first 2 years Then significant loss of previously acquired skills

Conclusions on Types
Autism is a spectrum disorder This means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severe Autistic individuals can be very different from each other Autism is still commonly used to refer to any of the 5 PDDs

What causes (and doesnt cause) autism?

Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry, and genetic factors Bettleheims theory of psychogenesis? The 'refrigerator mother'

How is Autism Diagnosed?

No definitive medical test Team uses interviews, observation, and specific checklists developed for this purpose. Team might include neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, etc.

CHARACTERISTICS
1. 2. 3. 4. 5. 6. Communication/Language Social Interaction Behaviors Sensory and movement disorders Resistance to change (predictability) Intellectual functioning

1. Communication/language
Broad range of abilities, from no verbal communication to quite complex skills Two common impairments: A. Delayed language B. Echolalia

A. Delayed language
50% of autistic individuals will eventually have useful speech Pronoun reversal: You want white icing on chocolate cake. Difficulty in conversing easily with others Look away; poor eye contact

B. Echolalia
Common in very young children (Age 3) Immediate or delayed (even years) Is there communicative intent with echolalia?

2. Social Interaction
One of hallmarks of autism is lack of social interaction 1. Impaired use of nonverbal behavior 2. Lack of peer relationships (deafness) 3. Failure to spontaneously share enjoyment, interests, etc. with others 4. Lack of reciprocity

3. Behaviors
Repetitive behaviors, including

obsessions, tics, and perseveration

Impeding behaviors (impede their learning or the learning of others) Will need positive behavior supports A. Self-injurious behavior B. Aggression

4. Sensory and movement disorders

Very common Over- or under-sensitive to sensory stimuli Abnormal posture and movements of the face, head, trunk, and limbs Abnormal eye movements Movement disorders can be detected very early perhaps at birth

5. Predictability
Change in routine is very stressful May insist on particular furniture arrangement, food at meals, TV shows Symmetry is often important

6. Intellectual functioning
Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardation In general, majority of individuals with autism are also identified as having mental retardation 75% below 70

Interventions
Individualization and early intervention are the keys Positive behavior support Social stories (music therapy?)

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