APP2031 Disorders of Childhood 1 Lecture Outline

1
APP2031 Disorders of Childhood 1Lecture Outline

• Autism
• History Terminology
• Diagnostic Criteria (DSM-IV)
• Prevalence of Autistic Spectrum Disorders
• Language Communication in Autism
• Behavioural Features of Autism
• Aetiology
• Treatment
• Characteristics of effective intervention

2
History of Autism

• Autism first described by Leo Kanner in 1943
• Recognised a consistent pattern of behaviour in
  this subset of children
• Maudsley Hospital (1960s) - triad of deficits
• Failure to develop social relationships
• Language retardation
• Ritualistic and compulsive behaviours
• No cure for Autism or definitive treatment
• Lifelong disorder (Axis 2 in DSM-IV)

3
Current Terminology

• Autism is considered a Pervasive Developmental
  Disorder
• Current terminology
• Autism Spectrum Disorders (because of varied
  levels of impairment)
• Within the autism spectrum there are three main
  diagnostic labels
• Autistic disorder
• Asperger's disorder
• Pervasive Developmental Disorder Not Otherwise
  Specified (PDDNOS)

4
Diagnostic Criteria (DSM IV)

• A total of six (or more) from (a), (b) and (c),
  with at least two from (a), and one each from (b)
  and (c).
• a. Qualitative impairment in social interaction.
• Impaired use of non-verbal behaviour
• Failure to develop peer relationships
• Lack of spontaneous seeking to share
• Lack of social or emotional reciprocity

5
Diagnostic Criteria (DSM IV)

• b. Qualitative impairments in communication
• Delay or lack of spoken language
• Impairment in the ability to sustain conversation
• Stereotyped and repetitive use of language
• Lack of make-believe play

6
Diagnostic Criteria (DSM IV)

• c. Restricted repetitive and stereotyped patterns
  of behaviour, interests, and activities
• Stereotyped and restricted patterns of interest
• Adherence to routines or rituals
• Stereotyped and repetitive motor mannerisms

7
Diagnostic Criteria (DSM IV)

• Delays or abnormal functioning with onset prior
  to age 3 years
• Language delay most prominent
• Associated features
• Frequent intellectual disability
• Unusual patterns of skills
• Behavioural symptoms
• Non-specific neurological signs

8
Prevalence of Autistic Disorders

• About 2 to 5 cases autism per 10,000.
• More males affected
• Increased incidence in recent years?
• Aspergers Disorder incidence higher, up to 24-36
  per 10,000
• Full prevalence for entire autism spectrum up to
  4-5 per 1000

9
Atypical Language Features

• Varied pattern from no impairment (Aspergers) to
  no functional language or communication
• Some people may display features of
• reduced expressive and receptive language
• dyspraxia (reduced skilled coordinated movement)
• echolalia
• sing-song or robotic qualities of speech
• inability to recognise emotional content of speech

10
Atypical Communication Socialisation

• Pattern varies from person to person
• Reduced pragmatic language functioning
• Poor conversational skills and social reciprocity
  
• Social anxiety
• Display inappropriate behaviours
• Reduced or inability to experience and/or
  understand emotions
• Reduced attachment to people incl. parents

11
Atypical Stereotyped/Repetitive Behaviours,
Interests or Activities

• Type, intensity and severity differ but common in
  almost all children
• Low High level stereotyped behaviours
• Low level
• Self stimulatory behaviour
• Repetitive manipulation of objects self-harm
• High level
• Obsessive interests in activities or objects
• Task compulsion (related to obsession)
• Difficulties in environmental or routine changes

12
Other atypical behaviours and clinical features

• Sensory deficits may be present
• lack of or overreaction to sensory stimulation
• hyperacusis common/ toe walking/ food aversion/
  tactile
• Cognitive Functioning
• savant like skills (rare, but can be with their
  restricted interest)
• attention and executive functioning deficits
• Behaviour
• tantrum behaviour
• head banging or other self-injurious behaviour

13
Aetiology

• Environmental
• Refrigerator parents
• Perinatal complications
• Autistic diathesis
• Genetic
• Twin studies/Familial risk
• Atypical brain development
• Overgrowth in early childhood (Redclay
  Courchesne, 2005)
• Atypical connections in white matter
• Aberrant grey matter proliferation

14
Treatment

• Promote normal development
• Planned periods of interaction
• Structuring of learning experiences
• Facilitate social communication
• Intervention aim social use of language
• Structure interactions opportunities for
  reciprocal communication
• Reduction of rigidity/stereotypy
• Graded changes structure environment because
  stereotypical behaviour tends to occur in barren,
  unstimulating environments
• Elimination of maladaptive behaviour
• Small manageable steps, feedback reinforcement
  of alternative responses
• Alleviation of family distress

15
Characteristics of Effective Intervention

• Begins early (Neural Plasticity)
• Duration
• Six months or more 15 hours per week or more
• Therapists
• High adult-child ratio
• Well trained therapists
• Environment Emphasis of intervention
• Individual assessment
• Predictable, structured consistent environment
• Emphasis on building skills e.g., communication
  understanding
• Family rather than child based
• Minimise verbal cues

16
Readings

• Required
• Sigelman, CK Rider, EA. (2006). Lifespan Human
  Development, 5th Edn. Thomson Wadsworth
  Australia.
• Ch. 16 pp. 460-464
• Wickelgren, I. (2005). Autistic brains out of
  synch? Science, 308, pp. 1856-1858
• Interesting Extras
• DSM-IV-TR for additional information on Pervasive
  Developmental Disorders
• Diagnostic and Statistical Manual of Mental
  Disorders, 4th Ed, Text Revision, available in
  Reference section of library at FP,FN