Overview Clinical Features Diagnostic & Statistical Manual IV - - PDF document
Jessica Greenson, Ph.D. Autism Center University of Washington Overview Clinical Features Diagnostic & Statistical Manual IV (DSM IV) ( ) Prevalence Course of Onset Etiology Early Recognition Early Recognition
Jessica Greenson, Ph.D. Autism Center University of Washington
Poor conversational skills
A form of high‐functioning autism in which there
Cognitive skills average to above average Key feature: impairment in social function
Usually detected later in development
Severe and pervasive impairment in social and
Severe and pervasive impairment in social and communication skills or stereotyped behavior, interests and activities
Does not meet criteria for another PDD Often used when onset after 3 Less severe presentation
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Occur in 1 per 110 (in the U.S.) 6x more common than deafness, childhood cancer & Down Syndrome Current estimates are 7‐10x higher than in 1970s
Affects all social classes and racial/ethnic groups
% of twins with trait
100 40 60 80 Autism Identical twins
%
20 Fraternal twins
% of twins with trait
100 40 60 80 Autism spectrum Autism Identical twins
%
20 Fraternal twins
% of twins with trait
100 40 60 80 Social and/or language Autism spectrum Autism Identical twins
%
20 Fraternal twins
Learning disabilities
population
Typical 1 year old 1 year old with autism
Osterling & Dawson, 1994; Werner et al., 2000; Osterling et al., 2002
Siblings are at higher risk of developing autism than
general population
Recruit infants siblings of children with ASD
T l k t th f t
To look at the emergence of symptoms To look at predictors of diagnosis
Early signs from 8 18 months
at 36 months
BUT they may have other impairments
age 19 months)
Lack of social smile, eye contact, facial expression
Lack of social smile, eye contact, facial expression
Not vocalizing (b, d, m) At 6‐9 babies should:
Babble Wave Understand “no” and name Reach for objects Imitate sounds
Failure to orient to name or words
Failure to orient to name or words
Lack of social smile, eye contact, facial expression +
GESTURES
Limited vocalizing & babble At 9‐12 babies should:
Have speech like babble
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Follow simple directions (give me, show me) Be active listeners Play social games
Little vocalization/odd vocal/or no words by 18
/ / y months
Lack of understanding of language Eye contact, facial expression + GESTURES (limited) Limited vocalizing & babble At 12‐18 babies should: H d ( 8 d b 8 h ) i l di “ i ”
Have words (18 words by 18 months) including “mine” Coordinate words w/EC Imitate words and actions Point to objects (receptive language)
Limited language/communication fx/intonation
g g
No 2 word combos by 2 Inability to follow directions Overly attached to objects At 18‐24 toddlers should:
Have a blossoming vocabulary (50 min) Label objects, protest, describe, pronouns
Label objects, protest, describe, pronouns
Combine words Ask simple questions Demonstrate functional and symbolic play (placeholder) Imitate the actions of others (delayed)
Lack of understanding of directions Minimal vocabulary, single word speech Repetitive play Difficulty with transitions At 2‐3 years preschoolers should:
Have 500 words Speak in phrases Ask and answer “wh” questions Ask and answer wh questions Engage in to and fro conversation Have an interest in peers Engage in novel play sequences Understand the emotions of others
Not understanding directions and questions
Not understanding directions and questions
Not using plurals, action words, changing verb tenses,
mixing pronouns
At 3‐4 years children should:
Speak in sentences with varied vocabulary Tell stories Ask questions and show curiosity Share with others Seek out companionship/have conversation
Not able to deliver a simple message
p g
Unable to id objects by function or category Not asking questions Lack of imaginative/symbolic play Unable to play simple games (1:1 and group) At 4‐6 years children should:
Speak in full/clear sentences/be conversational Speak in full/clear sentences/be conversational Define words/ask “why” Behave differently depending on environment/person Show empathy Indicate preferred playmates
Developmental surveillance be incorporated at every
well‐child preventive care visit.
Any concerns raised during surveillance should be
promptly addressed with standardized developmental screening tests.
Developmental screening tests should also be Developmental screening tests should also be
administered at the 9‐, 18‐, and 24 or 30‐month visits
Autism specific tool at 18 and 24 or 30 months
Pediatrics 2006/2007
Level 1: Designed for population based Level 1: Designed for population based
Broad based approach To identify children with unrecognized or
Level 2: Targeted screening of symptomatic
For children where already some clear
Parent report questionnaires
The Infant Toddler Checklist (ITC) The Infant Toddler Checklist (ITC)
12 months
Early Screening for Autistic Traits (ESAT)
14‐24 month olds
Modified‐Checklist for Autism in Toddlers (M‐CHAT)
24 months and older
S b t f 6 it d t i d t b “ iti l”
Subset of 6 items was determined to be “critical” Cutoff criteria was set to 2 critical items, or any 3 items
1 Does your child take an interest in other children? 1. Does your child take an interest in other children? 2. Does your child ever use his/her index finger to point, to indicate interest in something? 3. Does your child ever bring objects over to you to show you something? 4. Does your child imitate you? (e.g., you make a face— will your child imitate it?) 5. Does your child respond to his/her name when you call? 6. If you point at a toy across the room, does your child look at it?
g y ( )
50% of parents report that they suspected
Autism is often not diagnosed until
Research suggests that children who Research suggests that children who
b7
Slide 38 b7 I might highlight this point ... different color text, etc.
bcolle, 3/9/2010
Developed by Rogers and
Comprehensive
Integrates developmental
Appropriate for children
Funded by NIH STAART Centers program Conducted at University of Washington Dawson, PI in collaboration with Sally Rogers, UC Davis All children below 2.5 years of age when intervention began Randomized study 2 year intervention 25 hours per week (20 therapist 2 year intervention – 25 hours per week (20 therapist‐
delivered, 5 parent‐delivered)
Outcome measures include ERPs to faces, speech, and EEG
coherence
p < .05 p < .05 p < .05
Dawson et al., Pediatrics, 2010
p < .051 p < .05
Dawson et al., Pediatrics, 2010
NS p < .05
Dawson et al., Pediatrics, 2010
90 60 70 80 neland Composite Score Intervention Community p < .05
NS
40 50 Baseline 1 year 2 years Vin
Dawson et al., Pediatrics, 2010