terminology, epidemiology, and pathogenesis of autism phc,dammam
TRANSCRIPT
050323 الذاريات 1 سورة
050323 2
Terminology epidemiology and pathogenesis of autism
spectrum disorders (ASD)
DR NOOR ALMADAWI PEDIATRIONNATIONAL GUARDPHCDAMMAM
050323 3
ASDs are a range of neurological disorders marked by impairment in social functioning communication and repetitive and unusual patterns of behavior
(Autism Society of America 2008)
050323 4
Leo Kanner in 1943 described 11children with ldquoAutistic disturbances of affective contactrdquo1048708 Poor social skills1048708 Quantitative and qualitative defects ofcommunication1048708 Professional high achieving parentsCoined the term Refrigerator mother
Hans Asperger in 1944 described ldquoautistic psychopathyrdquoPoverty of social interactionFailure of communicationOddities of non-verbal communication ndash gaze aversion prosodyAttractive appearanceSimilarities between the parents and childrenResistance to change
HIS
TOR
Y
050323 5
050323 6
Childhood psychosis
Kannerrsquos syndrome
Autism
Pervasive developmental disorder
Autistic spectrum disorder
Terminolog
y
050323 7
bull Communication is defined asAccording to the Webster Dictionary
communication is defined as a act of connecting with act of connecting with or or
conveying either by verbal or non verbalconveying either by verbal or non verbal
Webster Dictionary Published 1997 Landoll Inc
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 2
Terminology epidemiology and pathogenesis of autism
spectrum disorders (ASD)
DR NOOR ALMADAWI PEDIATRIONNATIONAL GUARDPHCDAMMAM
050323 3
ASDs are a range of neurological disorders marked by impairment in social functioning communication and repetitive and unusual patterns of behavior
(Autism Society of America 2008)
050323 4
Leo Kanner in 1943 described 11children with ldquoAutistic disturbances of affective contactrdquo1048708 Poor social skills1048708 Quantitative and qualitative defects ofcommunication1048708 Professional high achieving parentsCoined the term Refrigerator mother
Hans Asperger in 1944 described ldquoautistic psychopathyrdquoPoverty of social interactionFailure of communicationOddities of non-verbal communication ndash gaze aversion prosodyAttractive appearanceSimilarities between the parents and childrenResistance to change
HIS
TOR
Y
050323 5
050323 6
Childhood psychosis
Kannerrsquos syndrome
Autism
Pervasive developmental disorder
Autistic spectrum disorder
Terminolog
y
050323 7
bull Communication is defined asAccording to the Webster Dictionary
communication is defined as a act of connecting with act of connecting with or or
conveying either by verbal or non verbalconveying either by verbal or non verbal
Webster Dictionary Published 1997 Landoll Inc
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 3
ASDs are a range of neurological disorders marked by impairment in social functioning communication and repetitive and unusual patterns of behavior
(Autism Society of America 2008)
050323 4
Leo Kanner in 1943 described 11children with ldquoAutistic disturbances of affective contactrdquo1048708 Poor social skills1048708 Quantitative and qualitative defects ofcommunication1048708 Professional high achieving parentsCoined the term Refrigerator mother
Hans Asperger in 1944 described ldquoautistic psychopathyrdquoPoverty of social interactionFailure of communicationOddities of non-verbal communication ndash gaze aversion prosodyAttractive appearanceSimilarities between the parents and childrenResistance to change
HIS
TOR
Y
050323 5
050323 6
Childhood psychosis
Kannerrsquos syndrome
Autism
Pervasive developmental disorder
Autistic spectrum disorder
Terminolog
y
050323 7
bull Communication is defined asAccording to the Webster Dictionary
communication is defined as a act of connecting with act of connecting with or or
conveying either by verbal or non verbalconveying either by verbal or non verbal
Webster Dictionary Published 1997 Landoll Inc
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 4
Leo Kanner in 1943 described 11children with ldquoAutistic disturbances of affective contactrdquo1048708 Poor social skills1048708 Quantitative and qualitative defects ofcommunication1048708 Professional high achieving parentsCoined the term Refrigerator mother
Hans Asperger in 1944 described ldquoautistic psychopathyrdquoPoverty of social interactionFailure of communicationOddities of non-verbal communication ndash gaze aversion prosodyAttractive appearanceSimilarities between the parents and childrenResistance to change
HIS
TOR
Y
050323 5
050323 6
Childhood psychosis
Kannerrsquos syndrome
Autism
Pervasive developmental disorder
Autistic spectrum disorder
Terminolog
y
050323 7
bull Communication is defined asAccording to the Webster Dictionary
communication is defined as a act of connecting with act of connecting with or or
conveying either by verbal or non verbalconveying either by verbal or non verbal
Webster Dictionary Published 1997 Landoll Inc
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 5
050323 6
Childhood psychosis
Kannerrsquos syndrome
Autism
Pervasive developmental disorder
Autistic spectrum disorder
Terminolog
y
050323 7
bull Communication is defined asAccording to the Webster Dictionary
communication is defined as a act of connecting with act of connecting with or or
conveying either by verbal or non verbalconveying either by verbal or non verbal
Webster Dictionary Published 1997 Landoll Inc
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 6
Childhood psychosis
Kannerrsquos syndrome
Autism
Pervasive developmental disorder
Autistic spectrum disorder
Terminolog
y
050323 7
bull Communication is defined asAccording to the Webster Dictionary
communication is defined as a act of connecting with act of connecting with or or
conveying either by verbal or non verbalconveying either by verbal or non verbal
Webster Dictionary Published 1997 Landoll Inc
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 7
bull Communication is defined asAccording to the Webster Dictionary
communication is defined as a act of connecting with act of connecting with or or
conveying either by verbal or non verbalconveying either by verbal or non verbal
Webster Dictionary Published 1997 Landoll Inc
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 8
Verbal Communication
bull Language we all have a gift of speakingbull Using the right words at the right timebull Account for all the words you say and
meaningbull Saying the right thing at the wrong time
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 9
Non-Verbal
bull Body Languagebull What message are you giving by your
Expressionsbull Judging by visual expressionsbull Saying a positive thing with a negative
expression
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 10
Pervasive االعامة Developmental Disorders (PDD)
bull Biologically based
neurodevelopmental disorders characterized by impairments in three major domains
bull Socialization bull Communicationbull And behavior
Pervasive Developmental Disorders In American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TRreg) American Psychiatric Association Washington DC 2000 p 70
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 11
Triad of Autistic Impairment
Impairment of social interaction
Impairment of language and communication
Impairment of flexibility of thought
ADS
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 12
Ears
Noise
words
personEyes
Non-Verbal
Body
VerbalYou
Autistic Individuals donrsquot see the big picture
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 13
t
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 14
Prevalence bull The majority of studies conducted from the
mid-1990s indicates a prevalence of approximately 1 in 1000 for autism and 2 in 1000 for ASD compared to 04 to 05 per 1000 in previous decades
bull NOW2009 __________ 1 IN 91bull bull 100000 saudi child has autism in 2008bull Now in saudia arabia 1 every 144 is autistic
bull Four times more prevalent in boys than in girls
National Autism Association Article Date 07 Oct 2009 - 200 PDT
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 15
These disorders include
Autistic disorder (classic autism sometimes called early infantile autism) Childhood Autism or Kanners autism)
Rettrsquos disorder
Childhood disintegrative disorder
Aspergerrsquos disorder (also known as Asperger syndrome)
Pervasive Developmental Disorder Not Otherwise Specified (Pdd-nos) Including Atypical Autism
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 16
specific criteria to diagnose autistic disorder
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 17
Diagnostic criteria for autistic disorder
A B C
1 Qualitative impairment in social interaction as manifested by at least two of the following
a Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze facial expression body posture and gestures إيماءاتto regulate social interaction
b Failure to develop peer relationships appropriate to developmental level
c A lack of spontaneous seeking to share enjoyment interests or achievements with other people (eg by a lack of showing bringing or pointing out object of interest)
d Lack of social or emotional reciprocityتبادل
A A total of 6 or more items from 1 2 and 3 with at least two from 1
and one each from 2 and 3
Cnt
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 18
bull 2 Qualitative impairments in communication as manifested by at least one of the following
a Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
b In individuals with adequate speech marked impairment in the ability to initiate or sustain conversation with others
c Stereotyped and repetitive use of language or idiosyncratic language
d Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Cnt
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 19
bull 3 Restricted repetitive and stereotyped patterns of behavior interests and activities as manifested by at least one of the following
a Encompassing preoccupationإنهماك with one or more stereotypedنمطي and restricted patterns of interest that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific nonfunctional routines or ritualsطقوس
c Stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting or complex whole-body movements
d Persistent preoccupation with parts of objects
Cnt
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 20
bull B Delays or abnormal functioning in at least one of the following areas with onset prior to age 3 years
1 social interaction 2 language as used in social communication or 3 symbolic or imaginative play
bull C The disturbance is not better accounted for by Retts Disorder or (CDD) Childhood Disintegrative Disorder
Cnt
Reproduced from American Psychiatric Association (DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders 4th ed text revision American Psychiatric Association Washington DC 2000 Copyright copy2000 American Psychiatric Association
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 21
Screening tools for autism spectrum disorders
bull Screening is defined as a brief formal standardized evaluation the purpose of which is the early identification of patients with unsuspected deviations from normal
bull A screening instrument enables detection of conditionsconcerns that may not be readily apparent without screening
bull Screening does not provide a diagnosis it helps to determine whether additional investigation (eg a diagnostic evaluation) by clinicians with special expertise in developmental pediatrics is necessary
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 22
Several screening tools have been developed for use in children younger than
three years of agebull Checklist for Autism in
Toddlers (CHAT) bull Quantitative Checklist for
Autism in Toddlers (Q-CHAT) bull Modified Checklist for Autism
in Toddlers (M-CHAT) bull Checklist for Autism in
Toddlers-23 (CHAT-23) bull Pervasive Developmental
Disorders Screening Test II Primary Care Screener (PDDST-II PCS)
bull Screening Tool for Autism in Two-Year-Olds (STAT)
Johnson CP Myers SM Identification and evaluation of children with autism spectrum disorders Pediatrics 2007 1201183
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 23
Checklist for Autism in Toddlers (CHAT (lt18mbull Section A - Ask Parent bull Yes or Nobull ____ 1) Does your child enjoy being swung(يتأرحج bouncedيقفز on
your knee etcbull ____ 2) Does your child take an interest in other childrenbull ____ 3) Does your child like climbing on things such as up stairsbull ____ 4) Does your child enjoy playing peek-a-boo خاطفة -hide نظرة
and-seekbull ____ 5) Does your child ever pretendيتظاهر for example to make
a cup of tea using a toy cup and teapot or pretend other thingsbull ____ 6) Does your child ever use hisher index finger to point to ask
for somethingbull ____ 7) Does your child ever use hisher index finger to point to
indicate interest in somethingbull ____ 8) Can your child play properly with small toys (eg cars or
bricksطوب) without just mouthing fiddling هام or dropping غيرthem
bull ____ 9) Does your child ever bring objects over to you to show you something
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 24
bull Section B - GPs observationbull Yes or Nobull ____ i) During the appointment has the child made eye contact with youbull ____ ii) Get childs attention then point across the room at an interesting object and
say Oh look Theres a (name a toy) Watch childs face Does the child look across to see what you are pointing at
bull NOTE - to record yes on this item ensure the child has not simply looked at your hand but has actually looked at the object you are pointing at
bull ____ iii) Get the childs attention then give child a miniature toy cup and teapot and say Can you make a cup of tea Does the child pretend to pour out the tea drink it etc
bull NOTE - if you can elicit an example of pretending in some other game score a yes on this item
bull ____ iv) Say to the child Wheres the light or Show me the light Does the child point with hisher index finger at the light
bull NOTE - Repeat this with Wheres the teddy اطفال or some other unreachable لعبةobject if child does not understand the word light To record yes on this item the child must have looked up at your face around the time of pointing
bull ____ v) Can the child build a tower of bricksطوب (If so how many) (Number of bricks)
bull Indicates critical question most indicative of autistic characteristics
Cnt
British Journal of Psychiatry (1996) 168 pp 158-163Psychological markers in the detection of autism in infancy in a large population AUBaron-Cohen S Cox A Baird G Swettenham J Nightingale N Morgan K Drew A Charman T SOBr J Psychiatry 1996 Feb168(2)158-63
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 25
Quantitative Checklist for Autism in Toddlers (Q-CHATQuantitative Checklist for Autism in Toddlers (Q-CHAT)
1
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 26
2
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 27
3
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 28
4
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 29
22
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 30
M-CHAT 2006 أألطفال عند التوحد استبيان قائمة
1
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 31
2
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 32
IQ in autism
50 IN 5050-70 in 2070-100 in 30 the last is the BESTBUT IN ONE SIDE OF ARTHigh functioning autism is the term used to
describe individuals with intelligence quotient (IQ) gt70 (ie borderline and above intelligence)
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 33
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 34httpwwwgulfkidscomarbooks-9htm
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 35
bull Medical conditions associated with autism bull Between 45 and 60 percent of children with autism are
mentally retarded bull Seizures occur in 11 to 39 percent of children with
ASD The risk of seizures is higher in individuals with more severe intellectual disability (mental retardation)
bull A minority (fewer than 10 to 25 percent) of cases of ASD are associated with a medical condition or syndrome such as phenylketonuria fetal alcohol syndrome tuberous sclerosus fragile X syndrome or Angelman syndrome These syndromes are usually diagnosed at or shortly after birth
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 36
The pathogenesis of ASD is incompletely understood
bull There is increasing evidence for the role of genetic factors in the etiology of autism
bull Evidence for the strong genetic contribution to development of ASD is derived from the following observations
bull Unequal sex distribution with 41 male predominance
bull Increased prevalence in siblings of patients with ASD compared to the general population
bull High concordance rate among monozygotic twins
Pediatrics 2007 Nov120(5)1183-215 Epub 2007 Oct 29
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 37
bull Neuroimaging and autopsy studies in patients with autism suggest that brain abnormalities play an important role
bull These abnormalities include diffuse differences in total and regional gray and white matter volumes sulcal and gyral anatomy brain chemical concentrations neural networks brain lateralization and cognitive processing compared to individuals without autism
Cnt
NA-MIC AHM Salt Lake City UTNA-MIC AHM Salt Lake City UT Jan 11 2007Jan 11 2007
MRI findings in 77 children with non-syndromic autistic disorder 20094(2)e4415 Epub 2009 Feb 10
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 38An Autistic Brain result or causeof autism
Larger frontal lobes due to excess white matter
bull Corpus Collosum is undersized
bull Amygdala is enlarged10 larger hippocampus This region is responsible for memory ASD patients rely onmemory to interpret situations
bull Cerebellum is larger also due to excess white matter
Too many cables within local areas but not enough linking different regions
Cnt
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 39
bull Parental age mdash Advanced parental age (both paternal and maternal) have been associated with an increased risk of having a child with ASD
bull This is perhaps related to de novo spontaneous mutations andor alterations in genetic imprinting
Advancing paternal age and autism Gen Psychiatry 2006 Sep63(9)1026-32
Arch Pediatr Adolesc Med 2007 Apr161(4)334-40
Advanced parental age and the risk of autism spectrum disorder J Epidemiol 2008 Dec 1168(11)1268-76 Epub 2008 Oct 21
Cnt
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 40
bull Lack of association with immunizations mdash Some authors have attributed regressive autism to vaccine exposure (particularly measles vaccine and thimerosal [a mercury preservative used in vaccines]) However the overwhelming majority of epidemiologic evidence does not support an association between immunizations and autism
Thimerosal and the occurrence of autism negative ecological evidence from Danish population-based data Pediatrics 2003 112604AUTISM AND VACCINESthe TRUTH beyond the CONTROVERSYPediatrics on the Parkway November 15 2008
Cnt
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 41
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 42
Possible Red Flags for Autism
bull The child does not respond to hisher name
bull The child cannot explain what heshe wants
bull The childrsquos language skills are slow to develop or speech is delayed
bull The child doesnrsquot follow directions
bull At times the child seems to be deaf
bull The child seems to hear sometimes but not other times
bull The child doesnrsquot point or wave ldquobye-bye
bull The child seems to prefer to play alone
bull The child gets things for himherself only
The child used to say a few words or babble but now heshe doesnrsquot The child throws intense or violent tantrums The child has odd movement patterns The child is overly active uncooperative or resistant The child doesnrsquot know how to play with toys The child doesnrsquot smile when smiled at The child has poor eye contact The child gets ldquostuckrdquo doing the same things over and over and canrsquot move on to other things
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 43
bull The child is very independent for hisher age bull The child does things ldquoearlyrdquo compared to other children bull The child seems to be in hisher ldquoown worldrdquo bull The child seems to tune people out bull The child is not interested in other children bull The child walks on hisher toes bull The child shows unusual attachments to toys objects or schedules
(ie always holding a string or having to put socks on before pants) bull Child spends a lot of time lining things up or putting things in a
certain order
bull
Cnt
The National Institute of Child Health and Human Development (NICHD) Autism Overview What We Know 2005
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 44
Asperger syndrome bull First identified by Hans Asperger in 1944bull unusual social styles even lack of eye contact in
interactions or poor social skillsbull Difficulty making friendsbull Difficulty reading or communicating through non verbal
social cues such as facial expressions Cannot read body language
bull Have difficulty introducing themselves into groups of people or conversations
bull Obsessive focus on a narrow interestdifferent way of thinking and interacting with their
environment
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 45
Where Aspergerrsquos Syndrome Differs from Autism
Autism Aspergerrsquos Syndrome
Severe problems with language
No significant language delay or problems with
structure
Significant learning difficulties
Learning difficulties less severe
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 46
In facthellip
People with Aspergerrsquos Syndrome usually have average or above average intelligence
LITTLE PROFESSORShellip
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 47
bull Individuals with AS have low-IQbull Effect of bad parentingbull Person should be able to control their behavior
Strengths
Individuals with AS are quirky but are also Individuals with AS are quirky but are also creative and intelligentcreative and intelligentCan be successful in ldquonarrowrdquo careers IT Can be successful in ldquonarrowrdquo careers IT EngineeringEngineeringHave a unique perspective Have a unique perspective
Com
mon
Misconception
s
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 48
bull Rettrsquos disorderbull It was described in 1966 by Andreas Rett an Austrian
neuropediatrician
bull Its quite rare with only one affected out of every ten to fifteen thousand childrenbull bull a neurodevelopmental disorder that occurs almost exclusively in
females
bull Affected patients initially develop normallybull then gradually lose speech and purposeful hand use sometime
after 18 months of age
bull Most cases result from mutations in the MECP2 gene
bull Characteristic features includebull deceleration of head growth (in contrast to acceleration of head
growth which occurs in other ASD) bull stereotypic hand movementsbull Dementia seizures autistic features ataxia and breathing abnormalities
subsequently develop
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 49
bull Deceleration of brain growth begins after birth bull In a postmortem study of 39 patients 3 to 35 years
old most RETTrsquoS brains were smaller than normal and did not grow after age four years
bull In contrast the heart kidneys liver and spleen grew at a normal rate until 8 to 12 years of age At that time their growth rate decelerated but continued so that organ weights were appropriate for height which was also reduced Adrenal organ weights were normal
Armstrong DD Dunn JK Schultz RJ Herbert DA Organ growth in Rett syndrome a postmortem examination analysis Pediatr Neurol 1999 20125
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 50
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 51
Cnt
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 52
Exclusion Criteria
bull Evidence of intrauterine growth retardationbull Organomegaly or other signs of storage diseasebull Retinopathy or optic atrophybull Microcephaly at birthbull Evidence of perinatally acquired brain damagebull Existence of identifiable metabolic or other
progressive neurological disorderbull Acquired neurological disorders resulting from
severe infections or head trauma
Cnt
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 53
DSM-IV Diagnosis of Rettrsquos Disorderbull A All of the following
ndash (1) apparently normal prenatal and perinatal developmentndash (2) apparently normal psychomotor development through the first 5
months after birthndash (3) normal head circumference at birth
bull B Onset of all of the following after the period of normal developmentndash (1) deceleration of head growth between ages 5 and 48 monthsndash (2) loss of previously acquired purposeful hand skills between ages
5 and 30 months with the subsequent development of stereotyped hand movements (eg hand-wringing or hand washing)
ndash (3) loss of social engagement early in the course (although often social interaction develops later)
ndash (4) appearance of poorly coordinated gait or trunk movementsndash (5) severely impaired expressive and receptive language
development with severe psychomotor retardation
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 54
Rettrsquos Disorder
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 55
bull Rettrsquos Disorder
ndash Mostly femalesndash Deterioration in developmental
milestones head circumference overall growth
ndash Loss of purposeful hand movements
ndash Stereotypic hand movements (hand-wringing hand washing hand-to-mouth)
ndash Poor coordination ataxia apraxia
ndash Loss of verbalizationndash Respiratory irregularityndash Early seizuresndash Low CSF nerve growth factor
bull Autistic Disorder
ndash Mostly malesndash Abnormalities present from
birth
ndash Stereotypic hand movements not always present
ndash Little to no loss in gross motor function
ndash Aberrant language but not complete loss
ndash No respiratory irregularity ndash Seizures rare if occur
develop in adolescencendash Normal CSF nerve growth
factor
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 56
Childhood Disintegrative Disorder bull is a regressive disorder bull This favors boys and does not begin to show symptoms
before three to four yearsbull By this time the child has meet many of their early milestones They are
walking potty trained affectionate and will be speaking Theyll enjoy playing with their peers
bull Then it will begin without warning and over the space of just a few months all this progress will stop The child will lose whatever language they have and will no longer be able to control their bowel or bladder They may begin to have seizures and will usually have a low IQ This is the most dramatic of all the types of autism as the once sunny smiling child will turn sullen uncommunicative and lose all they have learned
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 57
Pervasive Developmental Disorder not
Otherwise Specified PDD -NOS bull is the name used for people who have
many of the symptoms of autism but not enough of one kind to be labeled with it and so they are put in this general category The person may have most of the symptoms a very few or almost none It is not a diagnosis of a disorder but merely a term to cover off the symptoms of an unknown neurodevelopmental disorder
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 58
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 59
Treatments
bull Speech and Language Therapybull Behavioral managementbull Physical and Occupational Therapybull Music Therapybull Computer Therapybull Socialization Therapy
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 60httpwwwgulfkidscomarbook9-1836htm
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 61
httpwwwgulfkidscomarbook9-2038htm
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 62
More referencesbull Edelson M (2006) Are the Majority of Children With Autism Mentally Retarded A
Systematic Evaluation of the Data Focus on Autism and Other Developmental Disabilities 21 (2)66-83
bull Bellini S And Hopf A (2007) The Development of the Autism Social Skills Profile A Preliminary Analysis of Psychometric Properties Focus on Autism and Other Developmental Disabilities 22 (2) 80-87
bull Koegel R And Koegel L (1995) Teaching Children with Autism Baltimore Paul H Brookes Publishing Co Inc
bull Murdock L Cost H and Tieso C (2007) Measurement of Social Communication Skills of Children With Autism Spectrum Disorders During Interactions With Typical Peers Focus on Autism and Other Developmental Disabilities 22 (3) 160-172
bull Myles B Lee H Smith S Tien K Chou Y Swanson T and Hudson J (2007) A large-Scale Study of the Characteristics of Asperger Syndrome Education and Training in Developmental Disabilities 42 (4) 448-459
bull Richard G (1997)The Source for Autism Illinois LinguiSystems Incbull Sewell K (1998) Breakthroughs How to Reach Students with Autism Wisconsin
Attainment Publicationbull Simons J and Oishi S (1987) The Hidden Child The Linwood Method for Reaching
the Autistic Child Maryland Woodbine Housebull Tyron P Mayes S Rhodes R and Waldo M (2006) Can Aspergerrsquos Disorder be
diffrentiated from Autism Using DSM-IV Criteria Focus on Autism and Other Developmental Disabilities 21 (1)pp 2-6
فر+ج (bull لبيب عثمان 2002د العربي) المجلس الطفولة مرحلة في الذهنية اإلعاقات - القاهرة و+التنمية للطفولة
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 63
Thanks
What
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-
050323 64
See youNext
lecture
- Slide 1
- Terminology epidemiology and pathogenesis of autism spectrum disorders (ASD)
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Verbal Communication
- Non-Verbal
- Pervasive االعامة Developmental Disorders (PDD)
- Triad of Autistic Impairment
- Slide 12
- t
- Prevalence
- Slide 15
- specific criteria to diagnose autistic disorder
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Screening tools for autism spectrum disorders
- Several screening tools have been developed for use in children younger than three years of age
- Checklist for Autism in Toddlers (CHAT (lt18m
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- The pathogenesis of ASD is incompletely understood
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Possible Red Flags for Autism
- Slide 43
- Asperger syndrome
- Where Aspergerrsquos Syndrome Differs from Autism
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Exclusion Criteria
- DSM-IV Diagnosis of Rettrsquos Disorder
- Slide 54
- Slide 55
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder not Otherwise Specified PDD -NOS
- Slide 58
- Treatments
- Slide 60
- Slide 61
- More references
- Slide 63
- Slide 64
-