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)

.

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.

From DSM-IV to DSM V

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

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

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%)

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)

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.

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….

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).

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)

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

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

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.

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)