DSM-IV Autism Spectrum Disorders: Then
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Transcript of DSM-IV Autism Spectrum Disorders: Then
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DSM-IV Autism Spectrum Disorders: Then
Autism previously classified as one of five Pervasive Developmental Disorders (American Psychiatric Association, 2000):
1. Autistic disorder2. Asperger’s disorder3. Rett’s disorder 4. Childhood Disintegrative
Disorder5. Pervasive Developmental
Disorder-Not Otherwise Specified (PDD-NOS)
.
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DSM-5 Diagnosis Criteria for ASDCurrently, or by history, must meet criteria A, B, C & D A. Persistent deficits in social communication and social
interaction across contexts, not accounted for by general developmental delays.
B. Restricted, repetitive patterns of behavior, interests, or activities.
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities
D. Symptoms together limit and impair everyday functioning.
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From DSM-IV to DSM V
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Summary of Important ChangesSingle Diagnosis: Autism Spectrum DisorderOut Goes Asperger’s syndrome & Rett’s
DisorderRequires symptoms to begin in “early
childhood” rather than before 3.
For more in-depth analysis please consult other slides on new criteria and DSM-V
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Common Diagnosis Yet Drastic Differences in Behaviours….
-Varying levels of ID 20% IQ above 70, 20% 50-70, 60%
below 50 Determining IQ difficult b/c people w/
autism tend to: – Score low on verbal and abstract
reasoning tasks– Score high on tasks requiring
memory/visual spatial or manipulative skills
-Hyperactivity-Aggression-Self-injurious behaviours-Seizures – 1 /4 (NIMH, 2008)- Brain unable to balance sensory input - Highly
attuned or have painful sensitivity to certain sounds, textures, tastes, and smell
-Temper tantrums-Sleep disturbances
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High Functioning Autism (Formerly Associated with Asperger’s Syndrome)
Milder & more functional type of ASD.
Normal IQ - Often exceptionally talented in specific area.
Variety of behaviours ranging from mild to severe including:
- Lack of social skills/transitions- Obsessive behaviours- Difficulty reading nonverbal
cues/body language- Over sensitivity to sounds, tastes
and bothered by sounds/lights others do not notice.
- ‘Motor clumsiness’ (50%)
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Savant SyndromeApprox 10%50% of all people with
Savant syndrome have autism.
Ability to perform musical, artistic, computational, athletic, or other skills at exceptional levels without benefit of instruction.
May be genetic or acquired (Treffert, 2009)
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How Has ASD Been Viewed In The Past?
1940-1960s: Dr. Leo Kanner described autism for the first time (1943) Medical model saw children as schizophrenic.1960s Social model more effort to identify symptoms/treatment.1970s Research focused on medications: LSD/electric shock/and behavior change techniques.1990s-Present: Behavior therapy leading approach http://www.autism-pdd.net/autism-history.html/ http://www.webmd.com/brain/autism/history-of-autism.
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Why Has ASD Become Such a Topic of Discussion in Recent Times?
Current prevalence: Nearly 1/110 (CDC, 2010).
Nearly 200,000 Canadians with ASD.
4x more common in males (Horvat et al., 2008)
Dramatic increase in cases.
Revised diagnostic criteria alone does not seem to explain rise….
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What Causes Behaviours Associated With ASD?
Specific cause remains unknown.
Hypotheses include:1. - Neurobiological (Linked
to childhood disease e.g. rubella, encephalitis or metabolic/brain injury)
2. - Genetic (Specific gene not yet found)
3. - Environmental “Trigger” Heavy metals e.g. mercury (Minshew et al., 2001), Thimerosal in vaccines?(Rabinovitz, 2009).
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When/How is ASD First Evident/Diagnosed???
ASD often detected in “early childhood” by three – occasionally as early as 18mths.
Much earlier than 20yrs ago.Comprehensive evaluation by a
multidisciplinary team e.g. pediatrician/psychologist/psychiatrist/social worker/PT/OT.
Based on: (1) History;
(2) Diagnostic tools: Childhood Autism Rating Scale (CARS), Autism Diagnostic Interview - Revised (ADI-R) AND
(3) Observations: Autism Diagnostic Observation Schedule (ADOS-G)
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Intervention ApproachesEarly intervention may
be effective at:1. Improving development
(motor, language & behaviour).
2. Prevention of secondary conditions: anxiety, depression, obesity etc (.Filipek, Accardo, et al., 1999).
Usually multifaceted – combined w/medication to manage symptoms.
Variety of motor learning/educational approaches (see image)
Higashi School
Lovaas Method
TEACCH
• Vigorous activity = release of endorphins to reduce anxiety
•Early intervention
•Consistent routine (Normal-ization)
•Increased motor coordination = greater body control and behaviour control
•Intensive - 40 hrs per week
•Focus on learner’s interests & strengths
• Interaction = learn to cooperate with others
•Applied Behavioural Analysis
•Individualized environment
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Planning the Physical Activity ProgramLess active than peers (Yu-Pan, 2008).Respond positively to moderate-
vigorous physical activity e.g. Improve exercise capacity, fitness and lower BMI (Pitetti et al., 2007).
Individualized assessment key.Challenging task for teachers to meet
needs & requires initiative/imagination...
Goal of assessment two-fold(1) Determine what a child needs to learn
AND(2) how best to present and teach each
child
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Applying TEACCH in Physical Education/ActivityTreatment and Education of
Autistic and Related Communication Handicapped Children.
Structured/routine-based models for learning.
Multifaceted approaches and create program based on EACH child’s level of function/interests.
Adapt environment to accommodate specific needs of the child (Mesibov, 2006).
Behaviour changes based on environment.
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Recommendations For Physical Activity (TEACCH) Visual boundaries minimize
confusion (Blubaugh & Kohlmann, 2006) e.g. Colour coded areas, tape.
Familiar routine crucial(Boswell & Decker, 2000).
Remove all extra stimuli. Limit verbal directions Visual schedule e.g. Cue
cards/pictures of activities make transitions easier (Schultheis et al., 2000).
Individuals will often NOT respond to test directions = Inaccurate scoring.
Safe activities as unaware of danger.
Always consider... Social interaction and
social learning Impairments Language and speech
impairments Difficulty responding
appropriately Motor planning and
executive control problems Unusual responses to
sensory input Pathological resistance to
change Attention problems (Need
for quick. Transitions)