1. AUTISM
SPECTRUM
DISORDER

2. History of Autism…
• The word "autism," which has
been in use for about 100 years,
comes from the Greek word
"autos," meaning "self.“
• The term describes conditions in
which a person is removed from
social interaction -- hence, an
isolated self.
• Eugen Bleuler, a Swiss
psychiatrist, was the first person
to use the term. He started using
it around 1911 to refer to one
group of symptoms of
schizophrenia.
Leo Kanner, used it to describe
the withdrawn behavior of
several children he studied.

3. What Is Autism Spectrum Disorder
• Autistic spectrum disorder (ASD) is a condition that affects
how the brain functions. It affects how a person
communicates with, and relates to, other people. It also
affects how they make sense of the world around them.
• A person who has autism is said to have ASD. This is because
the symptoms of autism can vary from person to person, and
can range from mild to very severe.

4. According to IDEA:
• A developmental disability
significantly affecting verbal and
non-verbal communication and
social interaction usually evident
before age 3 that adversely affects a
child’s educational performance.

5. ASD Characteristics Vary
Measured Intelligence
Severe---------------------------------------------------Gifted
Social Interaction
Aloof-----------------Passive-------------Active but odd
Communication
Nonverbal----------------------------------------------Verbal
Behaviors
Intense-----------------------------------------------------Mild
Adaptive Functioning
Low-------------------------Variable----------High in areas

6. Pervasive Developmental Disorders (PDDs) to
Autism Spectrum Disorder (ASD)
Pervasive Developmental Disorders:
Autistic disorder
Asperger’s
PDD-NOS
Retts
CDD
Autism Spectrum
Disorder
DSM-IV,TR
1994, 2000
DSM-5
May 2013
Diagnostic and Statistical Manual (DSM), American Psychiatric Association

7. Changes from DSM-IV to DSM-5
DSM-IV DSM-5

8. Types Of Autism Spectrum Disorder
• Autism is one of five types of autism spectrum
disorder. Autism spectrum disorders are
developmental brain disorders. These disorders
are characterized by impaired social interaction
and communication skills, and a limited range of
activities and interests.
• Other types of autism spectrum disorder
include:
Asperger syndrome
• Childhood disintegrative disorder
• Rett syndrome
• Pervasive developmental disorder-- not
otherwise specified (PDD-NOS, including
atypical autism).

9. PDD_NOS:
Pervasive development disorder, not otherwise
specified (PDD-NOS): This category is used to refer to
children who have significant problems with
communication and play, and some difficulty
interacting with others, but are too social to be
considered autistic. It's sometimes referred to as a
milder form of autism

10. • Asperger's Syndrome
• Asperger's Syndrome or Asperger's Disorder is also usually
thought of as being on the autism spectrum. People with
Asperger's are high-functioning but still often have issues with
socialization and don't pick up on social cues. A social cue is
unspoken body language. For example, if you're talking on
and on about the latest episode of Oprah I may get bored and
send you little signals intended to get you to change the
subject. Maybe I'll roll my eyes or sigh. Maybe I'd tap my foot
while gazing in another direction. Those are social cues. Also,
people with Asperger's have no clinically significant delay in
language or cognitive development

11. • Childhood Disintegrative Disorder
• After at least 2 years of seemingly typical
development this disorder is marked by the loss of
skills previously acquired. The areas of significant loss
may be expressive and receptive language, social
skills and adaptive behavior, bowel or bladder
control, play, or motor skills. Many parents see this
disorder quickly lead to autism.
• Rett's Syndrome
• With symptoms that match up closely with the other
Pervasive Developmental Disorders people with
Rett's Syndrome have one major difference: After
appearing typical at birth and developing normally
for the first 5 months they experience a deceleration
of head growth between 5 months of age and 4
years.

12. What is autism?
• Autism is a lifelong developmental disability that
affects the way a person communicates and relates
to people around them. Children and adults with
autism have difficulties with everyday social
interaction. Their ability to develop friendships is
generally limited as is their capacity to understand
other people's emotional expression.

13. Symptoms
• The first symptoms of ASD usually appear when the
person is under two years old, and last throughout
life. Some people who have autism also have a
learning difficulty. This is when they find it harder
than most people to learn new skills.
• Symptoms of ASD can be divided into three main
groups. They are:
• social interaction,
• communication, and
• routine and repetitive behaviour.

14. Social interaction Issues
• A child who has ASD may find it hard to get on with
other people. They may:
• seem distant or detached,
• have little or no interest in other people, and find it
difficult make friends,
• not seek affection in the usual way, or resist physical
contact such as kissing and cuddling,
• find it difficult to make eye contact
with other people,
• not understand other peoples
emotions, and prefer to spend time
alone.

15. Communication Issues
• A child who has ASD may develop speech later than other
children, or never learn to speak. When their speech does
develop, the language and choice of words they use may be
wrong.
• A child with ASD may also:
• not be able to express themselves well,
• not be able to understand gestures, facial expressions, or
tones of voice,
• use more words than is necessary to explain simple things,
very literal in their use of words.
• make up their own words or phrases,
• not use their hands to make gestures when they
• speak, and find it difficult to understand
• difficult commands.

16. Routine and repetitive behaviour
• Children with ASD may:
• play the same games over and over, or play with games
designed for children younger than themselves,
• get upset if their daily routines are interrupted in any way,
and
• repeat actions, such as rocking back and
forth or head banging.
• These symptoms may lead to hyperactivity
in younger children.
• Older children and adults may develop
obsessions. For example, with specific
objects, lists, timetables or routines.

17. Sensory difficulties
• Some children with ASD also have sensory
difficulties. This means that they may get upset if
they are over or under stimulated. For example, they
may prefer being indoors if they are over sensitive to
light, or they may bump into people
• if they are under sensitive to touch.
• Sensory difficulties can also lead to
• problems with movement. A person
• with ASD may appear clumsy or have
an unusual way of walking.

18. • Causes of ASD
• Genetics
Genetic factors may be the most
significant cause for autism spectrum
disorders. in the rest of the general
population.

19. • Prenatal environment
• Maternal age
• Infectious processes
• viruses such as rubella (German measles).
• Enviromental factor
• Pollution,lead poisoning
• Perinatal environment
• Autism is associated with some perinatal and obstetric
conditions.

20. • Postnatal environment
• Mercury
• mercury poisoning,
• Vaccine
• MMRI
• Autoimmune disease
• antibodies
• Amygdala neurons
• Viral infection
• Excessive hygiene.

21. Diagnosis
• Difficult to diagnose
• There is no medical test to diagnose ASD
• Proper age for diagnosis
• The most common age for diagnosis is between three and four years old.
• Diagnosis in adults
• Some people aren’t diagnosed with ASD when they are children, especially
when symptoms are very mild.
• Multi disciplinary team approach
• diagnostic evaluation involves a multi-disciplinary team of doctors
including a pediatrician, psychologist, speech and language pathologist
and occupational therapist

22. Childhood autism rating scale(CARS)
CARS:
15 items behavioral rating scale
Used to categorize behaviors from mild to moderate
to severe.
Range:
From a low 30 to a high 60
Lower the score fewer the autistic behaviors
Higher the score higher the autistic behavior

23. The Modified Checklist of Autism in
Toddlers (M-CHAT)
• It is a list of informative questions about child.
The answers can indicate whether he or she
should be further evaluated by a specialist
such as a developmental pediatrician,
neurologist, psychiatrist or psychologist.

24. Clinical evaluation of language
fundamentals CELF _4
• The celf -4 is a standerdized,individual test ,
for the identification, diagnosis and follow up
evaluation of language and communication
disorder
• It is comprised of 16 subsets.
• Celf is based a four level assessment model
1. Identify whether or not there is a language
disorder

25. Continue….
2.Describe the nature of the disorder
3.Evaluate underlying clinical behavior
4.Evaluate language and communication in
context.

26. DSM-V criteria for a diagnosis of
autism spectrum disorder
• Autism Spectrum Disorder 299.00 (F84.0)
A. Persistent deficits in social communication and social interaction across
multiple contexts, as manifested by the following, currently or by history.
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal
social approach and failure of normal back-and-forth conversation; to
reduced sharing of interests, emotions, or affect; to failure to initiate or
respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction,
ranging, for example, from poorly integrated verbal and nonverbal
communication; to abnormalities in eye contact and body language or
deficits in understanding and use of gestures; to a total lack of facial
expressions and nonverbal communication.

27. 3. Deficits in developing, maintaining, and understanding relationships,
ranging, for example, from difficulties adjusting behavior to suit various
social contexts; to difficulties in sharing imaginative play or in making
friends; to absence of interest in peers.
Severity is based on social communication impairments and restricted
repetitive patterns of behavior

28. B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by history
1. Stereotyped or repetitive motor movements, use of objects, or speech
(e.g., simple motor stereotypies, lining up toys or flipping objects,
echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized
patterns or verbal nonverbal behavior (e.g., extreme distress at small
changes, difficulties with transitions, rigid thinking patterns, greeting
rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus
(e.g, strong attachment to or preoccupation with unusual objects,
excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory
aspects of the environment (e.g., apparent indifference to
pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or
movement)

29. C. Symptoms must be present in the early developmental period
(but may not become fully manifest until social demands
exceed limited capacities, or may be masked by learned
strategies in later life).
D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual
disability (intellectual developmental disorder) or global
developmental delay. Intellectual disability and autism
spectrum disorder frequently co-occur; to make comorbid
diagnoses of autism spectrum disorder and intellectual
disability, social communication should be below that
expected for general developmental level.

30. Facts about treating autism
There is no treatment that can ‘cure’
autistic spectrum disorder (ASD).

31. Intervention For ASD
• There are many ways ‘interventions’ in which a person with ASD can get
support to manage their condition.
• Many people with ASD will require specialist care and support throughout
their lives.
• A lot of different health professionals will work as a team to care for
them.
• The aim of interventions is to help a person with ASD to speak and
communicate better, and to get along better in education and at work.
• ASD differs from person to person, the type of
support a person needs will depend on their
own individual circumstances.
• Although not a treatment in itself, a pathologist
sets goals to help decide the best treatment
options.

32. Special problems in treating children with
ASD
• Does not accept change in routine
• their isolation and self stimulation
interferes in their effective
teaching
• Difficult to motivate them
• Over selectivity of attention

33. To be effective with these children
Reinforcements
• Autistic children work well with
reinforces.
• They may be
• Physical
• Verbal
• edible

34. Treatment plans and interventions
1. Applied behavior analysis ABA
based intervention
2. Dietary interventions
3. Biomedical interventions
4. Pharmacological interventions
5. Other interventions and
therapies
6. TEACCH (Treatment and
Education of Autistic and
Related Communication
Handicapped Children

35. TEACCH
• Structured teaching developed by Professor
Eric Schopler and colleagues at the University
of North Carolina at Chapel Hill.
• The TEACCH method is not considered an
actual therapy but rather a therapeutic tool to
help autistic individuals understand their
surroundings.

36. TEACCH
• Difficulty with receptive and expressive
language, sequential memory, and handling
changes in the environment are targeted.
TEACCH provides structure & organization.
This method relies on five basic principles
• Physical structure
• Scheduling
• Work system
• Routine
• Visual structure

37. ABA applied behavior analysis based
interventions
ABA is effective to teach
1.Complex communication
2.Self help skills
3.Social skills
4.Play.
Children will do best with 40 hours
of early intensive behavioral
intervention per week.
ABA presents following techniques
a.Discrete trial training (DTT).
b.Incidental teaching-Applied
Verbal Behavior.
c.(PECS)

38. ABA applied behavior analysis
based interventions
a. Discrete trial training:
In this approach a teacher gives a
discriminative stimuli and provides
consequences for a correct or incorrect
response.
b. Incidental teaching –Applied Verbal
behavior:
It focuses teaching verbal behaviors
through a collection of highly effective
procedures. One of the effective
procedure is picture exchange
communication system (PECS).

39. • Applied Behavioural Analysis (ABA) is useful
for children who are low functioning. Reward
positive behaviour whenever you see it,
distract child from negative behaviours and
provide an alternative.
• Floortime Technique is useful for higher
functioning children. Distract the child from
the negative behaviour, or join in and expand
it into positive behaviour through modelling.

40. Picture exchange communication
system(PECS)
The most effective and widely used
technique for autism and other speech
language and behavioral disorders.
Introduction:
Developed by Andrew S. Bondy, Ph.D. &
Lori Frost, M.S., CCC/SLP, in 1985.
Application:
As an augmentative/alternative
communication intervention package.

41. Picture exchange communication
system(PECS)
PECS focuses on:
• Initiation component of
communication
• Does not require expensive and
complex materials
• Created for families, educators
and resident care providers
• Readily used in a range of
settings.

42. Picture exchange communication
system(PECS)
Application:
PECS begins with giving a desired
picture to a communicative partner
for fulfillment of desire
Teaches discrimination of pictures
Then how to put them in order for a
sentence building.
It is based on B.F. Skinner’s
Prompting and reinforcement
strategies.

43. The six phases of PECS
Phase I
How to
communicate;
Students learn to exchange single
picture for items they require

44. The six phases of PECS
Phase II
Distance and
persistence :
Still using single picture,
students learn to generalize to
different people, place and
long distances.

45. The six phases of PECS
Phase III
Picture discrimination
Pictures are placed on a Velcro strip with
a ring binder books. Students select from
these pictures what their requirement is.

46. The six phases of PECS
Phase IV
Sentence structure
Students learn to use simple sentences
on a detachable sentence strip using an
“I want” picture followed by a picture of
the item being requested.

47. The six phases of PECS
Phase V
Answering questions
Students learn to use PECS to answer
questions for example
“ what do you want?”

48. The six phases of PECS
Phase VI
Commenting
Students are taught to comment in
response to questions such as,
“what do you see?”
“what do you hear?”
“what is it?”
They learn to make sentences like
“ I see”
“ I hear”
“ It is a”

49. Dietary interventions:
a. Gluten free
Gluten is an elastic protein in wheat
that gives cohesiveness to dough
b. Casein free
Casein is a protein in milk, cheese and
other dairy products.

50. Bio- medical intervention
Researchers hope that bio-
medical interventions,
including chelation
(designed to rid the body of
possible heavy metal toxins)
and vitamin therapy will
prove to be effective.

51. Pharmacological interventions
Scientist have found some
medicines that could be
effective in treating hyperactive
behaviors. But the idea of using
medication should be dealt by
a competent doctor.

52. Other interventions and therapies
Speech therapy:
Language deficits are the main aspects. The
therapist would help and guide in
communication development
Occupational therapy:
This mode of therapy works on improving
fine motor and functional skills.
Physical therapy:
Some autistic children qualify for it for their
weak motor coordination and hypotonic.

53. References
• 1-Braunschweig D, Ashwood P, Krakowiak P et al..
Autism: maternally derived antibodies specific for
fetal brain proteins. Neurotoxicology.
2008;29(2):226–31.
doi:10.1016/j.neuro.2007.10.010. PMID 18078998.
Lay summary: Science Daily, 2008-02-12.
• 2- Martin LA, Ashwood P, Braunschweig D, Cabanlit
M, Van de Water J, Amaral DG. Stereotypies and
hyperactivity in rhesus monkeys exposed to IgG from
mothers of children with autism. Brain Behav
Immun.