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Intellectual Disability and Autism Spectrum Disorder Goals of Presentation Identifying IQ Functioning along the Bell Curve Identifying IQ Functioning along the Bell Curve Learning about Focal Regions of the Brain Learning about Focal Regions of the Brain Appreciating the Full Scale IQ and the Specific Indexes Appreciating the Full Scale IQ and the Specific Indexes Better Understanding Adaptive Functioning Better Understanding Adaptive Functioning Learning about DDS Eligibility Determination Learning about DDS Eligibility Determination Understanding Autism Spectrum Disorder Understanding Autism Spectrum Disorder 2P

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1 Percentile Rank 100 Full Scale IQ is the total score that summarizes performance across multiple cognitive abilities. When unusual variability is observed in the subtests, it is most useful to examine the index scores. 3P

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Average FSIQ = 100 Standard Deviation = 15 4P

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25 Less intelligent than average More intelligent than average 4055 70 Intellectual Developmental Disorder: Intellectual andIntellectual Developmental Disorder: Intellectual and adaptive deficits with onset during the developmental period adaptive deficits with onset during the developmental period that occurs between birth to 18 years old. that occurs between birth to 18 years old. I/DD is noted to have over 250 syndromal (25%) and non-syndromal causes (75%).I/DD is noted to have over 250 syndromal (25%) and non-syndromal causes (75%). Degrees of Severity Mild 85% Moderate 10% Severe 3% Profound 2% 5P

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Hemispheric FunctionsHemispheric Functions Contra-lateralizationContra-lateralization Corpus CallosumCorpus Callosum 6T

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The brain has three parts: Frontal lobes for higher-order thinking and executive functions: These include a sense of time and context, planning, inhibiting and initiating action, and empathic understanding. Limbic system that governs emotions Brainstem that controls physical functions and survival responses 7T

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Intellectual Functioning Indexes Verbal Comprehension: General knowledge and reasoning skills. Related to formal and informal education. Language is central our ability to label, organize and manage our internal experiences and the external environment. Difficulty putting feelings and needs into words makes individuals prone to frustration, aggression, and depression. Perceptual Organization: Visual-spatial skills. Ability to create solutions, especially in novel situations. 8T

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Intellectual Functioning Indexes Working Memory: In-the-moment reasoning tied to attention, concentration, and short-term memory. Important to learning, flexibility, planning, and self- monitoring. Sensitive to anxiety and depression. Related to trauma responses and anger management Processing Speed: Ability to work quickly and efficiently. Sensitive to motivation and persistence. PS may negatively effect overall cognitive functioning. Intellectual impairment is often related to problems delaying gratification, controlling impulses, and tolerating frustration. Best approach is building on strengths and minimizing weaknesses. 9T

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DDS Eligibility Determination Process Connecticut General Statute Section 17a-210b; Subsection 1-1g is the law that DDS is required to use in order to determine whether someone has an intellectual disability and to determine eligibility along three criteria. A significant limitation in intellectual functioning and deficits in adaptive behavior (existing concurrently) that originated during the developmental period before eighteen years of age. 11P

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Autism Spectrum Disorder Jennifer Bogin, M.S.ed, BCBA Director Division of Autism Spectrum Disorder Services Department of Developmental Services 12J

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On March 27, 2014 the Centers for Disease Control and Prevention (CDC) released new data on the prevalence of autism in the United States. This surveillance study identified 1 in 68 children (1 in 42 boys and 1 in 189 girls) as having Autism Spectrum Disorder (ASD). 13J

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Old estimate for autism: ~ 1/2500 (1985) Recent estimates for autism: ~ 1/500 (1995) Newest estimates for ASD: 1/150 (CDC, 2002) 1/110 (CDC, 2006) 1/88 (CDC, 2008) NOW- 1/68 (CDC, 2010) 14J

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New diagnostic measures Autism Diagnostic Interview (1989, 1994) Autism Diagnostic Observation Schedule (1989, 2000) Screening tools/algorithms/instruments in wide use: MCHAT / AAP guidelines SCQ SRS Why are numbers increasing: Better tools? 15J

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Diagnostic changes Categories Broadening Better tools and identification process Awareness Mental health providers, pediatricians, schools Media, parents Other factors: Previous underestimates Methodology for obtaining epidemiological data What else? Why are numbers increasing: Lots of reasons? 16J

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Restricted & Repetitive Behavior Impaired Social Communication/ Interactions AUTISM SPECTRUM DISORDER Language Disorders Intellectual Disabilities ADHD Social Anxiety OCD Aggression Epilepsy- EEG abnormalities Motor problems: Apraxia Immune Dysfunction Gastro-intestinal Dysfunction Sleep Disturbance 17J

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1943 Leo Kanner Infantile autism 1944 Hans Asperger 1960s Separation from schizophrenia 1970s Biology / genetic underpinnings 1980 DSM-III Pervasive Developmental Disorders 1987 DSM-III-R - Autistic Disorder / PDD-NOS 1994 DSM-IV Aspergers Disorder 2013- DSM-5- Autism Spectrum Disorder 19J

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Distinctions can be difficult both within the spectrum and across other disorders Autism Spectrum Disorder Autistic Disorder AspergersPDD-NOS 21J

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Deficits in social communication (all 3): Deficits in nonverbal communication Deficits in social and emotional reciprocity Deficits in maintaining relationships Restricted, repetitive patterns of behavior, interest, and activities (2 out of 4) Stereotyped motor or verbal behavior Unusual sensory behavior Excessive adherence to routines and ritualized behavior Restricted, fixated interests Symptoms present in early childhood (manifest when social demands exceed capabilities) 22J

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Individuals with a well-established DSM-IV diagnosis of autistic disorder, Aspergers disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise need criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder. 23J

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Severely Affected Non-verbal Intellectual Disability Severe behaviors (e.g. self-injury) Little to no social skills (in their own world) Less Noticeably Affected Average to above average IQ Verbal Lack of social understanding Inability to see anothers perspective (ToM) Insistent on sameness 25J

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