Module 1_Autism History and Characteristics & Statistics.pdf

Module 1: Autism History and Characteristics & Statistics 1. Introduction What will we cover today? 2. History of Autism Diagnosis 3. Historical Views about the Causes of Autism 4. Current Research on the Causes of Autism 5. Characteristics of Autism 6. Statistics 7. Contact Information 1. Int...

Module 1: Autism History and Characteristics & Statistics 1. Introduction What will we cover today? 2. History of Autism Diagnosis 3. Historical Views about the Causes of Autism 4. Current Research on the Causes of Autism 5. Characteristics of Autism 6. Statistics 7. Contact Information 1. Introduction 1.Introduction • A little about me and my professional background: • I am a Board Certified Behavior Analyst who is currently working as a Clinical Director for the regional operations of an Applied Behavior Analysis (ABA) provider. I have a caseload of my own where I provide direct clinical direction to teams of Behavior therapists, provide parent consult, conduct intake assessments (Functional Behavioral Assessments, and Functional Analyses), and create treatment plans • Education: • Bachelor’s of Science in Biology and Psychology • Masters of Science in Psychology with a Specialization in ABA I have a passion for working directly in the field and using ABA to make adaptive positive changes in the lives of the clients and the families by teaching them skills that would lead them to achieve their highest potential for independence. 2. Autism Diagnosis & its History Timeline 1920s ● 1926: Grunya Sukhareva writes about six children with autistic traits in a scientific journal. ● 1928: Grunya Sukhareva's work on autism is published in a German psychiatry and neurology journal. 1930s ● 1938: Louise Despert details 29 cases of childhood schizophrenia that resemble today's classification of autism. 1940s ● 1943: Leo Kanner publishes a paper describing 11 patients with a condition he later named 'infantile autism'. ● 1944: Hans Asperger publishes a case study describing children with autism and notices that the parents of the children from the case study shared similar personalities. He hypothesizes that there is a genetic link. He also coins the term Asperger’s Syndrome to describe high functioning Autism ● 1949: Kanner theorizes that autism is caused by 'refrigerator mothers', parents who are cold and detached. 1950s ● 1952: Children with symptoms of autism are labeled as having childhood schizophrenia in the DSM. ● 1956: Leon Eisenberg publishes findings on autistic children in adolescence. ● 1959: Bruno Bettelheim writes about Joey, a 9year-old with autism, in Scientific American. 1960s ● 1964: Bernard Rimland challenges the 'refrigerator mother' theory and discusses neurological factors in autism. ● 1964: Ole Ivar Lovaas develops Applied Behavioral Analysis (ABA) therapy for autistic children. ● 1965: The Sybil Elgar School begins teaching and caring for children with autism. ● 1965: The National Society of Autistic Children, now the Autism Society of America, has its first meeting. 1970s ● Lorna Wing proposes the concept of autism spectrum disorders. ● Identification of the "triad of impairment" social interaction, communication, and imagination. 1975 ● The Education for All Handicapped Children Act is enacted to protect the rights of children with disabilities, including autism. 1977 ● Susan Folstein and Michael Rutter publish the first study of twins and autism, emphasizing the genetic risk factor. 1980s ● The DSMIII includes criteria for diagnosing infantile autism. ● Recognition of autism as a distinct disorder. 1990s ● Autism is included as a disability category in the Individuals with Disabilities Education Act (IDEA), ensuring access to special education services. ● Temple Grandin publishes "Emergence—Labeled Autistic", sharing her firsthand experiences with autism. 1998 ● Andrew Wakefield publishes a discredited paper suggesting a false link between the MMR vaccine and autism. 1999 ● The Autism Society adopts the Autism Awareness Puzzle Ribbon as the universal sign of autism awareness. 2000s ● The Global and Regional Asperger Syndrome Partnership (GRASP) is formed, providing support for individuals with Asperger's and autism. ● Publication of "Recovering Autistic Children" by Bernard Rimland and Stephen Edelson. ● Establishment of the Autistic Self Advocacy Network (ASAN) by Ari Ne'eman. ● Foundation of the Academic Autistic Spectrum Partnership in Research and Education (AASPIRE). ● The Combating Autism Act is signed to support autism research and treatment. • Autism has almost always existed in human populations. • It was not recognized as a distinct condition until the mid-twentieth century. • Before that, individuals with autism were included in an undifferentiated group of those who were described as simpletons, or imbeciles, or feeble-minded. • More able people with autism- who might be described as having Asperger's now- were merely seen as withdrawn or eccentric. 3. Historical Views about the causes of Autism 3. Historical Views about the causes of Autism • Genetic linkage of the causes of Autism • Those associated with the chromosomes inherited from biological parents, the genes that make up the chromosomes, and the chemical constituents of genes and gene products. • This genetic inheritance is referred to as a genotype. • Individual genotypes are unique except in the case of identical twins (or monozygotic (MZ) twins). • Twins who develop from different fertilized eggs and do not share identical genotypes are referred to as dizygotic (DZ) twins. 3. Historical Views about the causes of Autism • Genetic linkage of the causes of Autism • Twin Studies: • In monozygotic twins, if one of the twins has an ASD, an ASD also occurs in the second twin in approximately 60% of cases. • Moreover, in a further 30% of cases, the second twin has some autism-related behaviors. • In dizygotic twins, approximately 90% of second twins show no signs of autism • The high rate of concordance in monozygotic twins, contrasted with the high rate of discordance in dizygotic twins, provides irrefutable evidence that genetic factors strongly predispose individuals towards developing an ASD. 3. Historical Views about the causes of Autism • Genetic linkage of the causes of Autism • Study of Relatives: • The chance of an individual with an ASD having a brother or sister with full-blown autism is between 2-6% (Rutter, Silberg, & Simonoff, 1999). • This statistic is far higher than the incidence of ASDs in the general population which equates to about a 1% according to the highest estimation. • The fact that ASDs tends to run in families not only provides evidence of the role of genetic factors but also demonstrates that the genetic factors underlying ASDs are familial. 3. Historical Views about the causes of Autism • Environmental Causes: • Prenatal/post-natal environmental effects on the developing embryo and fetus • Can include impinging on the individual outside, and also constituted by internal bodily states • Ex. Each gene operates in an environment created by the activities of other genes Each neurochemical involved in building a brain operates in the environment created by other neurochemicals. Each brain system in the developing child is affected by the state and activities of other brain systems. ❖ It is important to note that environmental factors does not only refer to diet, parenting, illnesses… It may be much broader than that! 3. Historical Views about the causes of Autism • Environmental Causes: • Prenatal Risk Factors • Various teratogens (toxic substances to which an embryo or fetus is exposed) are known to cause autism if present early in pregnancy. • These include maternal rubella, thalidomide (a drug prescribed for morning sickness until its effects were known) and valproic acid (an anticonvulsant medication). • People with ASDs are unusually likely to have the physical malformations. • Many parents report that, looking back, they realize that their child was different from the state. • Brain regions most reliably affected in people with ASDs are areas that develop early in post-conception • 3. Historical Views about the causes of Autism • Environmental Causes: • Risk Factors in Childhood • Viral Infections • Can affect the CNS causing irreversible brain damage • It is known that the herpes simplex virus can cause autism (or autism-related behaviors). • Immune System Abnormalities • The triple measles, mumps, and rubella (MMR) vaccine • Has been hotly debated topic 3. Historical Views about the causes of Autism • Environmental Causes: • MMR vaccine and the lack of evidence for a link • Theories as to ways in which MMR vaccine might be implicated in autism: • Measles component of the vaccine causes a gut disorder that produces chemicals that are carried in the bloodstream to the brain causing regressive autism in previously typically developing children. • Brief exposure to a substance used to preserve vaccines, thimerosal, can cause or precipitate autism • Thimerosal contains mercury, which is a known toxin that effects the brain. • The preservative in the MMR vaccine was discontinued once the possible risk was recognized. • There is now accumulated evidence from numerous large and careful studies carried out in several different countries showing that MMR vaccinations is not significantly implicated as a casual factor in autism. 3. Historical Views about the causes of Autism • Environmental Causes: Other causes that have been debated but have little or no evidence to support: • Cytomegaloviral (CMV)infection in the mother during pregnancy. • Type of Herpes virus that is present in most people, usually in latent form. • Stress during pregnancy • Heavy smoking or alcohol abuse in early pregnancy • Abnormally high levels of the male hormone testosterone during fetal development 4. Current Research Findings on the causes and Development of Autism 4. Current Research Findings on the causes and Development of Autism 1. Genetic factors: are established and validated by current and historical research: a. Mutations in numerous identified genes have been linked to the development of autism 2. Environmental Factors: a. Prenatal environment: Some prenatal factors have been associated with an increased risk of ASD, including maternal exposure to certain medications, infections, or environmental toxins during pregnancy. b. Advanced parental age: Older parents, particularly older fathers, have a slightly increased risk of having a child with ASD. c. Preterm birth and low birth weight: Premature birth and low birth weight have been linked to a slightly higher risk of ASD. d. Maternal health: Certain maternal health conditions, such as gestational diabetes and obesity, have been associated with a higher risk of having a child with ASD. 4. Current Research Findings on the causes and Development of Autism 3. Neurobiological Factors: a. Abnormal brain development: Brain imaging studies have shown structural and functional differences in the brains of individuals with ASD, including altered connectivity and brain regions associated with social and communication functions. b. Imbalances in neurotransmitters: Changes in the balance of neurotransmitters (chemical messengers in the brain) have been implicated in ASD. 4. Current Research on the Causes of Autism Brain Structure: ● Increased Brain Size: Some individuals with ASD may have larger brain volume, particularly in early childhood, although this varies among individuals. ● Abnormalities in Brain Regions: Structural MRI studies have shown differences in the size and structure of specific brain regions, including the amygdala, hippocampus, and the frontal and temporal lobes. ● Dysregulation of White Matter: Aberrant white matter connectivity and fiber tracts have been observed in the brains of individuals with ASD, affecting information transmission between brain regions. ● Cortical Thickness Variations: Variations in cortical thickness and surface area are present, potentially impacting sensory processing and integration. 4. Current Research on the Causes of Autism Brain Function: ● Altered Connectivity: Functional MRI (fMRI) studies reveal atypical connectivity patterns in the brains of individuals with ASD, affecting how different brain regions communicate. ● All these factors can lead to the development of symptomology of autism including: ● Enhanced Perceptual Abilities: ● Impaired Social Processing: ● Repetitive Behaviors: ● Reduced perspective Taking: ● Language Processing: ● Enhanced Attention to Detail: Some individuals with ASD may demonstrate a focus on details and patterns, which can be related to unique brain functioning. ● Overreactivity to Sensory Input: It's important to note that there is significant variability in brain structure and function among individuals with ASD, and not all individuals will exhibit the same patterns. These differences are part of the complexity of the autism spectrum and can contribute to the wide range of behaviors and abilities seen in individuals with ASD. 5. Characteristics of Autism 5. Characteristics of Autism DIAGNOSTIC CHARACTERISTICS • Delay and impairement in Language • Social Communication • Restricted, Repetitive, Stereotypic Behaviors A spectrum of neuropsychiatric disorders characterized by deficits in social interaction and communication, and unusual and repetitive behavior. The DSM-5 reduces this triad to a dyad – impairment of social interaction and communication (now be regarded as one combined domain) and restricted repetitive and stereotyped patterns of behaviour (APA, 2011). 5. Characteristics of Autism The diagnostic criteria for Autism Spectrum Disorder (ASD) as per the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) are based on several key criteria. Please note that these criteria are outlined for clinical professionals and are used to make a formal diagnosis. Here are the core criteria: Criterion A: Persistent Deficits in Social Communication and Social Interaction ● Deficits in social-emotional reciprocity, such as difficulties in engaging in back-and-forth conversations, sharing emotions, or responding to social cues. ● Deficits in nonverbal communication behaviors, including challenges with eye contact, facial expressions, body language, and gestures. ● Deficits in developing and maintaining relationships, which can involve difficulties in forming friendships, adjusting behavior to different social contexts, and sharing imaginative play or activities with others. 5. Characteristics of Autism Criterion B: Restricted, Repetitive Patterns of Behavior, Interests, or Activities ● Stereotyped or repetitive motor movements, use of objects, or speech (e.g., hand-flapping or echolalia). ● Insistence on sameness or inflexible adherence to routines, which may manifest as distress over minor changes in environment or daily routines. ● Highly restricted, fixated interests with abnormal intensity or focus. ● Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment, such as indifference to pain or excessive reactions to specific sounds or textures. 5. Characteristics of Autism Criterion C: Symptoms Must Be Present in the Early Developmental Period ● Symptoms must be present in the early developmental period, even if they may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life. Criterion D: Symptoms Cause Clinically Significant Impairment in Social, Occupational, or Other Important Areas of Functioning ● ● The symptoms of ASD must result in clinically significant impairment in social, occupational, or other important areas of functioning. 5. Characteristics of Autism Criterion E: These disruptions cannot be attributed to intellectual disability (intellectual developmental disorder) or global developmental delay as more plausible explanations. ● It's worth noting that intellectual disability and autism spectrum disorder often appear together. To establish concurrent diagnoses of autism spectrum disorder and intellectual disability, the level of social communication difficulties should be lower than what is typical for an individual's overall developmental stage. 5. Characteristics of Autism It's important to note that in addition to these core criteria, the DSM-5 also includes specifiers to describe the level of severity of ASD based on 3 levels: Level 3 – requires very substantial support, Level 2 – Requires substantial support, Level 1 – requires support. *Diagnoses are established by trained licensed psychologists or licensed physicians. 6. Statistics 6. Statistics ● Historical Prevalence: In the 1940s, the estimated prevalence of autism was around 4 or 5 in 10,000. ● Increase in the Mid-1990s: By the mid-1990s, the estimated prevalence increased to 10 per 10,000 (1 in 1,000) for autism and 22 per 10,000 for pervasive developmental disorder (PDD). ● Recent data: 1 in 36 children in the US were diagnosed with autism (CDC, 2020) ● Recent International Prevalence: A review of studies from 1966 to early 2013 across 23 countries found a mean international prevalence rate of 66 per 10,000, or 1 in 152. ● Underdiagnosis: Low socioeconomic status (SES), minority, and immigrant populations experience underdiagnosis of ASD. ● Regression in Children: Regression, or loss of skills, occurs in 1 in 4 children diagnosed with ASD and is associated with more severe symptoms. ● Co-Occurrence of Intellectual Disability: Approximately 69% of individuals with ASD have a co-occurring intellectual disability. 6. Statistics ● Epilepsy: Epilepsy is 10 to 30 times more prevalent in individuals with ASD, particularly in those with moderate to severe intellectual disabilities. ● Prevalence in the United States (2012): The Autism and Developmental Disabilities Monitoring (ADDM) Network estimated the prevalence of ASD in the United States at 1 in 68, based on data from 11 states. ● State Variations: Prevalence rates vary among states, with New Jersey reporting the highest rate (1 in 41) and South Carolina the lowest (1 in 81). ● Ethnic Disparities: White non-Hispanic children are more likely to be identified with ASD compared to Black non-Hispanic and Hispanic children. ● Delayed Evaluation: Black and Hispanic children are less likely to be evaluated for concerns by age 3 compared to White children. ● Age of Diagnosis: The majority of children with ASD do not receive a diagnosis by a community provider until age 4. 6. Statistics ● Role of Special Education: Special education systems play an important role in identifying children with ASD. ● Increase in Identification Over Time: There is increased identification of ASD over time, with higher prevalence rates in 8-year-olds compared to 4-year-olds. ● Factors Contributing to Prevalence Increase: Possible factors include increased awareness, broadening of classification criteria, different case-finding methods, and service availability. ● Cultural Phenomenon: Some epidemiologists argue that ASD is influenced by biological, cultural, and psychological factors, and its conceptualization affects diagnosis and treatment. ● Differences in Gender: ASD is about 4.5 times more common among boys than among girls. Keep in touch [email protected] ● I am available to for questions via my email ● Please feel free to schedule a meeting with me by sending me an email along with 2 or 3 days and times that you have availability and I will love to schedule a meeting to discuss any questions and support you need related to the class ● NOTE: I am in the Pacific Standard Time Zone but anytime we schedule a meeting, I will be scheduling in Eastern Standart Time zone Thank you