AUTISM SPECTRUM DISORDER

Fouad Tahan, M.D.

Psychiatrist
WHAT IS AUTISM?
Very complex, often severe
developmental disability

First described by Leo Kanner

in 1943 as early infantile autism
 What is Autism Spectrum
Disorder?
Autism Spectrum Disorder (ASD) is a disorder of
brain development

Onset in childhood; continues into adulthood

Children and adults with ASD may social

communicate, social interact, behave, and learn in
ways that are different than most people

Abilities of people with ASD can range from gifted

to severely challenged

CDC Learn the Signs. Act Early. www.cdc.gov/actearly

What is Autism Spectrum Disorder?

Autism Restricted and

Social Spectrum Repetitive
Communication Disorders Behaviors

Expressive Language Level

Level of Support Needed

Diagnostic and Statistical Manual-5th Edition

What is Autism Spectrum Disorder?
Children or Adults with ASD might:
Not point at objects to show Repeat actions over and over
interest
Not look at objects when another again(without purpose)
person points at them Play with toys or objects that
Have trouble relating to others or are non-functionally (toys
not have an interest in other
people at all mmanzoo3een)
Appear to be “in their own world” Have trouble adapting when a
Avoid eye contact (to people)and routine changes
want to be alone
Have trouble understanding other Have unusual reactions to the
people’s feelings or talking about way things smell, taste, look,
their own feelings feel, or sound (under or over
sensitive to sensory stimuli
Have unusual motor
(Social Communication) movements
(Restricted & Repetitive Interests)

CDC Learn the Signs. Act Early.

What Causes ASD?
No one cause of
autism has been
identified
Most cases involve a
complex and variable
combination of
genetic risk and
environmental factors
that influence early
brain development

Autismspeaks.org
 What Causes ASD?
Good agreement in general that autism is caused
by abnormalities in brain development,
neurochemistry, and genetic factors (down Sd,
fagile X Sd, Rett Sd)

Having a sibling with ASD

Having older parents

Very low birth weight

 How common is ASD?
1 in 68 children has an autism
spectrum disorder (CDC, 2014)
More common in boys than girls (4
times more)
ASD occurs in all racial, ethnic, and
social groups
Very likely neurological in origin
No known racial, ethnic, or social
boundaries
No relation to family income,
lifestyle
 WHAT IS AUTISM?
3 categories for autism ?
Today, autism is a severe form of a
broader group of disorders
These are referred to as pervasive
developmental disorders (later)
Typically appears during the first 2-3
years of life
 WHAT IS AUTISM?
Autism impacts normal development of
the brain in areas of social
interaction and communication
skills.
Difficult to communicate with others
and relate to the outside world.
Occasionally, aggressive and/or self-
injurious behavior may be present.
 WHAT IS AUTISM?
May exhibit repeated body
movements (hand flapping, rocking).
Unusual responses to
people(aggressive maslan)
Attachment to objects(byejo ma3
there toy to the clinic
Resistance to change in routine
Sensory and motor sensitivites
 WHAT ARE THE TYPES?
Actually, the “umbrella” heading is
Pervasive Developmental Disorder
(PDD).
Autism is one of the 5 PDDs.
All have commonalities in
communication and social deficits
Differ in terms of severity
 1. Autistic Disorder
Impairments in social interaction,
communication, and imaginative
play.
Apparent before age 3. [yq3ni 1-3 year
Also includes stereotyped behaviors,
interests, and activities
 2. Asperger’s Disorder
Impairments in social interactions, and
presence of restricted interests and
activities
No clinically significant general delay in
language
Average to above average intelligence (IQ)
3. Pervasive Developmental Disorder –
Not Otherwise Specified (PDD-NOS)

Often referred to as atypical autism

Used when a child does not meet the
criteria for a specific diagnosis, but
there is severe and pervasive
impairment in specified behaviors
 4. Rett’s Disorder
Progressive disorder which, to date, has
only occurred in girls.
Period of normal development and then
the loss of previously acquired skills
Also loss of purposeful use of hands,
which is replaced by repetitive hand
movements
Beginning at age of 1-4 years
5. Childhood Disintegrative
Disorder
Normal development for at least the
first 2 years
Then significant loss of previously
acquired skills
 Conclusions on Types
Autism is a spectrum disorder
This means that symptoms and characteristics can
present themselves in wide variety of
combinations, from mild to severe
Autistic individuals can be very different from
each other
“Autism” is still commonly used to refer to any of
the 5 PDDs (it is type of the 5 pdd, its more like a
misnomer)
 How is Autism Diagnosed?
No definitive medical test
Team uses interviews, observation, and specific
checklists developed for this purpose.
Team might include psychiatrist, neurologist,
psychologist, developmental pediatrician,
speech/language therapist, learning consultant,
etc.
Must rule out Mental retardation, hearing
impairment, behavior disorders, or eccentric habits
 CHARACTERISTICS
1. Communication/Language
2. Social Interaction
3. Behaviors
4. Sensory and movement disorders
5. Resistance to change (predictability)
6. Intellectual functioning
1. Communication/language
Broad range of abilities, from no verbal
communication to quite complex skills
Two common impairments:
A. Delayed language
B. Echolalia
 A. Delayed language
Pronoun reversal: “You want white icing
on chocolate cake.” bye7ki byseeghet 2el
sha5s 2el tani
Difficulty in conversing easily with others
Difficulty in shifting topics
Look away; poor eye contact
 B. Echolalia
Common in very young children (Age 3)
Immediate or delayed (even years)
 2. Social Interaction
One of hallmarks of autism is lack of
social interaction
1. Impaired use of nonverbal
behavior(he cant point to object)
2. Lack of peer relationships
3. Failure to spontaneously share
enjoyment, interests, etc. with others
4. Lack of reciprocity
 3. Behaviors
Repetitive behaviors, including
obsession, and perseveration
Will need positive behavior supports
A. Self-injurious behavior
B. Aggression
4. Sensory and movement
disorders
Very common
Over- or under-sensitive to sensory stimuli
Abnormal posture and movements of the
face, head, trunk, and limbs
Abnormal eye movements
Movement disorders can be detected very
early – perhaps at birth
 5. Predictability
Change in routine is very stressful
May insist on particular furniture
arrangement, food at meals, TV shows
Interventions need to focus on
preparing students for change if
possible
 6. Intellectual functioning
Autism occurs in children of all levels of
intelligence, from those who are gifted to those
who have mental retardation
In general, majority of individuals with autism
are also identified as having mental retardation
– 75% below IQ 70
 DSM 5 Diagnostic Criteria for
Autism Spectrum Disorder
A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by the following, currently or by
history (examples are illustrative, not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from
abnormal social approach and failure of normal back-and-forth
conversation; to reduced sharing of interests, emotions, or affect; to
failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in eye contact and body
language or deficits in understanding and use of gestures; to a total lack
of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding
relationships, ranging, for example, from difficulties adjusting behavior to
suit various social contexts; to difficulties in sharing imaginative paly or in
making friends; to absence of interest in peers.

Have to specify the severity with the following categories: “requiring

support” (Level 1); “requiring substantial support” (Level 2);
“requiring very substantial support” (Level 3).
 DSM 5 Diagnostic Criteria for
Autism Spectrum Disorder (cont.)
B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by history (examples are illustrative, not
exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining up
toys or flipping objects, echolalia, idiosyncratic phrases).

2. Insistence on sameness, inflexible adherence to

routines, or ritualized patterns or verbal nonverbal behavior
(e.g., extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat food every day).
 DSM 5 Diagnostic Criteria for Autism
Spectrum Disorder (cont.)
3. Highly restricted, fixated interests that are abnormal
in intensity or focus (e.g., strong attachment to or
preoccupation with unusual objects, excessively circumscribed
or perseverative interest).

4. Hyper- or hyporeactivity to sensory input or unusual

interests in sensory aspects of the environment (e.g., apparent
indifference to pain/temperature, adverse response to specific
sounds or textures, excessive smelling or touching of objects,
visual fascination with lights or movement).

*Specify Severity
 DSM 5 Diagnostic Criteria for
Autism Spectrum Disorder (cont.)
C. Symptoms must be present in the early developmental period (but
may not become fully manifest until social demands exceed limited
capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social,

occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability

(intellectual developmental disorder) or global developmental delay.
Intellectual disability and autism spectrum disorder frequently co-occur;
to make comorbid diagnoses of autism spectrum disorder and
intellectual disability, social communication should be below that
expected for general developmental level.
 DSM 5 Diagnostic Criteria for
Autism Spectrum Disorder (cont.)
Note: Individuals with a well-established DSM-IV
diagnosis of autistic disorder, Asperger’s 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
meet criteria for autism spectrum disorder, should be
evaluated for social (pragmatic) communication disorder.

DIFFERENTIAL DIAGNOSIS IS IMPORTANT!

ODD vs. ASD
 TREATMENT
It should begin as soon as possible after
diagnosis.
No single best treatment for ASD.

Medication: treat some symptoms like:

- irritability, aggression, repetitive behavior,
attention problems, anxiety, depression…
 TREATMENT
Behavioral
Psychological
Educational

 Involving parents, sibling and other

family members.