AUTISM Outline

 

A Brief History of Autism

 

Leo Kanner (1943) published an article describing 11 children he had seen in his psychiatric practice.  Prior to this article, people with autism were labeled insane or retarded or both. Hans Asperger (1944) described a similar syndrome now called "Aspergers" syndrome.  Once thought related to schizophrenia; presumed to worsen with time.

 

Autism or Aspergers?

 

DSM-IV: Two separate and distinct disorders with the primary difference being perceived cognitive ability

DSM-IV: Autism and Aspergers are Pervasive Developmental Disorders

Some people believe Autism is a "continuum" of symptoms which affects each individual differently

 

Diagnoses of Autism

 

DSM-IV

Autism Checklists

 

Some behavioral characteristics you may see when someone has autism

 

Lack of eye contact

Unfocused vision

Ignores people

Cares greatly for certain objects

Upper body rocking

Finger or hand flapping

Spinning--self or objects

Head banging

Scratching

Screaming

Repeating phrases or vocalizations

Walking on tip toes

Avoidance of human touch

Putting hands over ears

Repeated jumping

Lack of startle response

Distractible

Indistractible

Stilted speech

Ritualistic

Failure to initiate

Unusual or placid facial expression

 

A Few Important Facts

 

Autism is not a "thing" people "have" like a heart condition.  Symptoms result from various factors, which are not yet fully understood or known.  Generally, autism may be considered as a developmental disability that typically occurs during the first three years of life, in 1/500 individuals across all populations, but four times more often for boys than girls.

 

 

 

Possible Causes of Autism

 

Neurological

Genetic

Environmental

Chemical

Biological

Autoimmune

Cognitive

 

Neurological findings

 

Midbrain, frontal lobe, and brainstem differences

Cerebellum of children with autism different-Smaller

More densely packed cells

 

Genetics:

 

Familial patterns

Identical twins

Fraternal twins

Siblings

Other Family members

 

Other things which may be correlated with autism

 

Congenital issues like maternal rubella

Food allergies-Especially wheat and dairy

Environmental factors such as pollution-Highly speculative

 

Sensory Sensitivities

 

Unusually high sensory sensitivities which may affect behavior

"Normal" individuals subjected to sensory overload may exhibit same behaviors.  We cannot assume people with autism are motivated by the same intentions as typically developing individuals--they may or may not be.

 

Sensory Sensitivities

 

Tactile sensitivity

Hearing sensitivity

Deep pressure

Olfactory Sensitivity

Emotional sensitivity

Visual sensitivity

 

Interventions:

Categories of Interventions Used to Treat the Symptoms of Autism

 

Aversives

Medical

Behavioral

Communication

Sensory Approaches

Movement Differences Approach

 

Aversives: No research support

 

The use of pain to control behavior:

Electric shock helmets

Ammonia squirts

White noise

"Bad" tastes (pepper)

Rubber band snaps

Pinches

Cold showers

 

Medical

 

Secretin--a medication used for a test on the pancreas, now touted as a medical intervention for autism--still being researched

Tricyclic antidepressants and anti-anxiety meds

Major tranquilizers-Haldol, Thorazine

Vitamin therapy-Bernard Rimland is the leading advocate

 

Medication Cautions

 

Temple Grandin:

medications should have a dramatic effect

use with extreme caution with children

Always consult a pharmacist for drug interactions and ALL effects

 

Behavioral

 

Behavioral interventions are applied to visible manifestations called behaviors.

Behavioral interventions grew out of the behavioral theory of psychology which said that all human action is a reaction to a prior action.

Changes in the stimulus/response to a behavior should change the behavior.  If behavioral interventions do not work, says behavior theory, it is because of poor application, not bad theory.

 

ABA

Advantages

Provides consistency

Widely implemented

Systematic

Addresses what is "seen"

Limitations

May reinforce rigidity of behavior

Addresses what is "seen"

Maintains myth of cause and effect relationship between inner intention and visible action

 

Discrete Trial Training

 

Under the umbrella of ABA

May be useful to teach some concrete tasks such as setting the table

Some experts believe exclusive use of DTT is emotionally hard on the child

Like other ABA applications, may increase or maintain perseverance and rigidity

 

Lovaas

 

Lovaas therapy uses the DTT model

Practitioners directly affiliated with Ivor Lovaas "do" Lovaas

A method for very early intervention which builds on child's strengths in visual processing and memory for routines.

Lovaas emphasizes child's need to feel successful

 

Some skills which may be taught with ABA:

 

Attending

Imitation

Receptive and

Expressive language

Pre-Academic

Self-help

Social

Abstract Language

Academic

School Readiness

 

Communication

 

Signing

Alternative/Augmentative Communication

Picture Exchange

Word/Picture Boards

Facilitated Communication

Writing/Reading

Computers

 

Sensory Approaches

Irlen lenses

Auditory Integration Training

Sensory Integration Training

 

Sensory Integration Training

 

Movement Differences Approach