Autism - BackgroundAutism - Background

Pervasive developmental disorder Pervasive developmental disorder (PDD)(PDD)

Differential diagnosis important Differential diagnosis important – Similar symptoms with several disordersSimilar symptoms with several disorders– Often considered a “spectrum” disorderOften considered a “spectrum” disorder

AutismAutism

Primary CharacteristicsPrimary CharacteristicsA.A. Social relationship problemsSocial relationship problems

1.1. Nonverbal behaviorsNonverbal behaviors

2.2. Failure to develop peer relationshipsFailure to develop peer relationships

3.3. Lack of spontaneous sharing with othersLack of spontaneous sharing with others

4.4. Lack of social or emotional reciprocityLack of social or emotional reciprocity

Primary characteristics cont’Primary characteristics cont’

A.A. Language problemsLanguage problems1.1. Delay in or lack of language developmentDelay in or lack of language development

2.2. Impairment in ability to initiate or sustain a Impairment in ability to initiate or sustain a conversation with othersconversation with others

3.3. Stereotyped or repetitive use of languageStereotyped or repetitive use of language

B.B. Stereotypic behaviorsStereotypic behaviors– Repetitive motor movementsRepetitive motor movements

Additional characteristicsAdditional characteristics

1.1. Abnormal responses to environmentAbnormal responses to environment

2.2. Decreased intellectual functioningDecreased intellectual functioning

Age of onsetAge of onset

CourseCourse

PrevalencePrevalence

Differential DiagnosisDifferential Diagnosis

Childhood schizophreniaChildhood schizophrenia Developmental aphasiaDevelopmental aphasia Mental retardationMental retardation Asperger’s DisorderAsperger’s Disorder

1.1. Impairment in social interactionImpairment in social interaction

2.2. Restricted or repetitive behaviorRestricted or repetitive behavior

3.3. Differences: language, attachment, Differences: language, attachment, intellectualintellectual

EtiologyEtiology Many common theories disproved:Many common theories disproved:

– Autism as withdrawal to cope with psychological Autism as withdrawal to cope with psychological painpain

– Chronic under-arousal in RASChronic under-arousal in RAS– Learning of self-stimulationLearning of self-stimulation– MMR vaccineMMR vaccine

Have looked at assoc. between intro. of vaccine and Have looked at assoc. between intro. of vaccine and autism rates in different countries and different points of autism rates in different countries and different points of timestimes

Genetics : concordance rates 36 – 95% for MZ Genetics : concordance rates 36 – 95% for MZ and 0-5% for DZand 0-5% for DZ

Neuropsychological factorsNeuropsychological factors– Diffuse damage, excess white matterDiffuse damage, excess white matter

Treatment/InterventionsTreatment/Interventions

Medications – help only minority of childrenMedications – help only minority of children Behavioral approachesBehavioral approaches

1.1. TEACCH – UNC Chapel HillTEACCH – UNC Chapel Hill– Structured teaching (structuring the environment)Structured teaching (structuring the environment)– ““social story”social story”– Visual informationVisual information

2.2. Lovaas’ behavior modificationLovaas’ behavior modification– Intense behavioral therapyIntense behavioral therapy– 40 hrs. per week, over 2 years40 hrs. per week, over 2 years

Both most effective if initiated early ages (by preschool)Both most effective if initiated early ages (by preschool)