THE EVOLVING NOMENCLATURE OF AUTISM

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THE EVOLVING NOMENCLATURE OF AUTISM

• Kanners autism
• Aspergers syndrome
• Need for international
  classification
• DSM and ICD systems
• 1988 Autistic Disorder/ Pervasive Developmental
  
• Disorder (DSM III-DSM III R)
• 1994 Autistic Disorder/PDD
• (DSM IV- ICD 10)
• 1995 Autistic Spectrum Disorders

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Autistic Spectrum Disorders

• A group of biologically based disorders which
  comprise a number of different medically
  diagnosed conditions
• The shared behavioral characteristics include a
  triad of impairments
• There is a neurologic dysfunction and genetic
  factors are involved

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AUTISTIC SPECTRUM DISORDERS
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Definition of terms

• Autistic Spectrum Disorder (ASD) termed
  Pervasive Developmental Disorders PDDs in the
  DSM 4th edition (text revision) DSM-IV-TR

This refers to developmental disorders of varying
clinical presentations that share a core feature
of pervasive and qualitative impairments in
reciprocal social interaction.
Source Carr and Le Blanc, ASDs in Early
Childhood, Primary Care Clin Office Pract, 2007
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THE AUTISTIC SPECTRUM
Prevalence

• How many individuals with
• autism are there?
  

1- 6 per 1000 Fombonne 2004
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Autism or Autistic Disorder
To qualify for a diagnosis, they must meet 6
criteria at least 2 in social interaction
one each in communication and restrictive,
repetitive behavior
Notes for Parents Good sources on diagnostic
criteria DSM IV-TR The World of the
Autistic Child by Bryna Siegel , 1996 p. 18
Autism Spectrum Disorders by Chantal Sicile
Kira, 2004 p. 21
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Autism /Autistic Disorder
Substantial social impairment , poor peer
interaction Moderate to profound language
impairments Restricted and repetitive behaviors
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Asperger Syndrome/ Disorder

• To qualify for a diagnosis,
• there should be at least
• 2 characteristic criteria in
• social interaction
• 1 characteristic criteria in
• restricted, repetitive behavior
• No language delay/cognitive
• impairment

Notes for Parents Good sources Asperger
Syndrome by Tony Attwood
The Oasis Guide to Asperger Syndrome by
Bashe and Kirby ,
2005
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Pervasive Developmental Disorder Not Otherwise
SpecifiedPDDNOS
This diagnosis is used for milder problems. An
individual with PDDNOS may exhibit
behavior similar to those diagnosed with autism
or Asperger Syndrome but does not meet the
criteria for one of these disorders
Food for thought Some doctors use PDDNOS
provisionally when the child is so young and
some criteria are felt too difficult to see
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The Diagnostic Evaluation Process

• Medical Examination
• Should be performed by
• qualified health professional
• Regression or if with
• clinical neurologic
• abnormalities like
• microcephaly or
• neurologic asymmetries

Physical Exam dysmorphisms growth impairments neurocutaneous
Neurologic exam neurologic abnormalities
Laboratory tests as needed
Genetic tests High resolution karyotype Fragile X
Neurological tests EEG MRI/CT scan
Newsweek December 4, 2006
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Screening and Referral

• Screening for ASD should be conducted in
  conjunction with routine developmental
  surveillance

RED FLAG INDICATORS No babbling by 12 months
No gestures like pointing, showing, reaching or
waving by 12 months No words by 16 months
No 2 word meaningful phrases by 24 months ANY
loss of speech, babbling and social skills at ANY
age
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Parental concerns that should be addressed as
soon as possible

• Delayed or deviant language
• Poor social interaction ( lack of eye contact, no
  peer relations)
• Delayed language and poor social interaction
• Inappropriate/unusual , self injurious or
  aggressive behaviors language delay

Knowledge of normal development is important !
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Prevalence Data

• Autism is the fastest growing childhood
  developmental condition in the USA with 1 child
  in 166 affected
• US Centre for Disease Control 2004
• One child in 100 in the UK
• Office of National Statistics 2004
• Rates for autism in 50 prevalence reports
  reported 50 to 80 per 10000
• Blaxill M.F. 2004 www.publichealthreports.org

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Increasing prevalence Is it better detection or
better awareness ?
U.S. DATA Population data CDC/NCHS
PHILIPPINE DATA Hospital records PGH/PCMC
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THE AUTISTIC SPECTRUM

• a BEHAVIORAL syndrome

• There is a cluster of unusual behavior patterns
• The triad of impairments
• poor social interaction
• poor social communication
• restricted activities and interests

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Social Development in ASD
No interest in playmates
Pulls hand for needs
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The Nature of Communication in ASD

• Lacks communicative intent
• (can learn to request and protest)
• Lack of joint attention
• (cannot direct attention to things, poor
• pointing , use of here vs there, my vs
• yours)
• Lack of awareness of shared knowledge or
  experience
• Lacks reason for communicating

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Communication in ASD

• VERBAL
• Language delay and loss
• Echolalia and odd use of language
• Pragmatics

• NON VERBAL
• Gestures
• Gaze
• Use of space
• Expression of
• emotions