Lecture 22 + 23 - Autism

Question 1

Prevalence & Age of Onset

Answer 1

Onset typically between 2 and 3 years of age, but is now believed to occur as early as 8-12 months of age

Very rare; 0.05%-0.22%, more common in boys
Prevalence is growing

Question 2

Why is there more prevalence?

Answer 2

Diagnostic criteria is more encompassing, and less stigma, more awareness

Question 3

Diagnostic Criteria

Answer 3

Deficits in social-emotional reciprocity
Deficits in nonverbal communicative
Deficits in developing, maintaining, and understanding relationships
Specify current severity - 3 levels based on help needed
Restricted, repetitive patterns of behavior, interests, or activities

Question 4

Associated characteristics of Autism

Answer 4

Mental retardation: 75%-80%
• Deficits in abstract and conceptual thinking, language and social understanding
• Relative strengths in visual-spatial skills, rote learning, rote memory
• Savant abilities: spectacular, but usual, intellectual skills (mental arithmetic, memory tasks, calendar calculations, drawing, music). Rare

Question 5

Brain abnormalities

Answer 5

Increased cell density, less dendritic branching, and abnormal cell migration in the following areas:
• Abnormalities in the cerebellum (smaller), important for motor movement and associated with other functions (attention, language, learning, emotion)
• Abnormalities in medial temporal lobe and associated limbic structures, important for learning, emotion regulation, and memory (reduced activation)
• Abnormalities in the frontal lobe development (reduced activation, medial PFC), important for executive function, emotion regulation, social behavior.

Question 6

Heritability

Answer 6

STRONG

Question 7

Reading 9 - Ingersoll

How early can Autism be detected?

Answer 7

Typically diagnosed between 2 and 3 years age
• Nonverbal social-communication skills are abnormal in infants by 12 months of age
• Social orienting
• Joint attention
• Imitation
• However, diagnostic assessments are not reliable at 12 months of age, as these skills are still emerging
• Need for new validated assessment tools at this early age.

Question 8

Developmental Cascade Model (Ingersoll)

Answer 8

Age: 0-12months
Genes = Neurodevelopmental abnormalities in brain development –> non-verbal communicative deficits (social orienting, joint attention, imitation) = Learning opportunitues disrupted/impeded (AGE: 12-24monts)
–> Deficits in verbal language, symbolic play, social cognition (age: 24+ months) = diagnosis

Question 9

Outcomes in adulthood

Answer 9

• 1-2% undistinguishable from others
• 10% good outcome, near-normal functioning
• 20% fair outcomes, made social and occupational gains despite handicaps in speech and other areas
• 70% poor outcome, unable to live independently
• Best predictors of good outcome are IQ and language development

Question 10

what is the UCLA Young Autism Project

Answer 10

3 year intensive treatment program
• Primarily behavioral intervention, using operant techniques and skills training.
• Goals are..
 - to decrease maladaptive behaviors 
 - to increase verbal behaviors
 - to increase interactive play,
 - to improve emotional expression/understanding,
 - to improve social behaviours
 - Promote school adjustment

Group 1= experimental group, 40 hours per week, intensive intervention
Group 2= Control group, special education classes, 10 hours per week of one-on-one intervention.
Group 3= Control group, special education class only
Children began program, on average, at age 2.5, and these are age 7 assessment data. n=59

Advocates a social-communicative treatment approach
Should be initiated early (prior to age 3)
Parents can implement the treatment
Low cost
Preliminary evidence that this approach works as stand-alone treatment. At the least, it should be part of any comprehensive treatment plan
Two important limitations
• No long term follow-up
• No evidence that the social interventions generalize to the child’s functioning with other children

Question 11

Early Start Denver Model (ESDM) Treatment Study (Dawson et al, 2010)

Answer 11

• Recruited 48 toddlers with ASD, 18 –30 monthsof age
• Randomly assigned to either the ESDM or “referral to the community” treatment (i.e. treatment as usual).
• 2 year intervention

Intervention:
• Included 2 hour sessions with therapist, 2X per day, 5 days per week, for 2 years with toddlers
• Included parent training, with parent practicing skills with toddlers daily in the home
• Interventions were social–communicative and behavioral
• Interpersonal exchange
• Expressing positive affect
• Shared engagement
• Adult responsivity and sensitivity to child cues
• Verbal and non-verbal communication
• Operant conditioning

Results:
ESDM was highly efficacious compared to A/M (“assess and monitor”-the treatment as usual group) for both language and social behavior

Follow up:

1. On some measures, all the children are getting better over time
2. The Early Start (ESDM) children have maintained treatment gains