They’re Already Adults…Why Consider An Autistic Disorder Now? Does it Make a Difference, Does it...

They’re Already Adults…Why Consider An Autistic Disorder Now?Does it Make a Difference, Does it

Really Help?

Terese Pawletko, Ph.D.

Licensed Psychologist/Certified School Psychologist

AER 2010 – Little Rock, Arkansas

As a result of this presentation the attendees will…• Be able to identify the key features of autism

spectrum disorders (ASD) and diagnostic considerations

• Come to appreciate the benefit of getting a diagnosis from the perspective parents of adults

diagnosed with ASD• Be able to identify areas of function and the links

to intervention

Why important to begin to understand?

• Recent CDC estimates (2009) of the prevalence of autistic disorders are 1 in 110

Is this a new epidemic or have there always been children and adults with ASD?

Attendees at workshops …

“I shudder to think of the students I’ve had that likely were on the autism spectrum – I wish I had this information then and could have intervened differently!” suggesting there have always been some children warranting a dual diagnosis (see Chess, 1972; Gense, 1994).

Implications of these missed diagnoses?

• Adults in vocational rehabilitation and rehabilitation teaching systems may be undiagnosed and/or lacked the benefit of interventions matching their particular learning style (evidence: families and professionals raised issues in discussions on the AER- and other Listserves over the past couple of years

What diagnoses fall under the umbrella of autism spectrum disorders?

Pervasive Developmental Disorders DSM IV/Autism Spectrum Disorders

Autism Asperger’s Syndrome

Pervasive Developmental Disorder NOS

Rett’s DisorderChildhood Disintegrative Disorder

Autism/ASD is a behaviorally defined syndrome…

• Diagnosed by presence of various behaviors

• Syndrome – cluster of behaviors

• Not etiology specific though biologically based: represents developmental dysfunction in CNS within areas responsible for social & communication development (Gillberg, 1989; Volkmar & Cohen, 1988), other areas of brain re: regulation, integration, etc.

Terese Pawletko, Ph.D.@2010

What do they (autism, Asperger’s Syndrome, pervasive developmental disorder) have in common?

Common Features across the Spectrum*

• Impairments in social interaction• Impairments in communication• Impairments in imaginative play; stereotyped

behaviors (e.g., repetitive motor mannerisms); restricted range of interest, activities

* DSM-IV TR is under revision…

Terese Pawletko, Ph.D.@2010

A Practical Definition of Asperger Syndrome (adapted from Bolick, 2002)

• Awkwardness in communication, despite strongvocabulary and grammar (e.g., literal, pedantic; problems with nonverbal communication (including vocal quality)

• Difficulty “reading” behavior and intent of others• Difficulty with reciprocal conversation; may be

perseverative, bothersome, nonselective re: place/time/person with whom discuss topic

• Preference for predictability• Tendency toward specific and intense interests

Terese Pawletko, Ph.D.@2010

• May have challenges:– integrating sensory information

– regulating anxiety or mood– perspective taking, negotiating, compromising– developing and maintaining social

relationships; occupational functioning – in executive functioning (e.g., directing

attention, shifting attention; monitoring performance; organizing approach, organizing

materials; inhibiting response)

Terese Pawletko, Ph.D. @2010

Additionally/currently…No clinically significant general delay in language

(single words used by age 2 years, communicative phrases used by age 3 years).

No clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)

• Referred to as atypical autism - used when achild does not meet the criteria for autism or Asperger’s and yet there is a severe and

pervasive impairment in specified behaviors

Terese Pawletko, Ph.D.@2008

Social, communication Cognitive

Sensory Sensitivities

Motor

Executive Functioning (e.g., attention, organization, regulatory)

Receptive Language

Expressive Language

Play

ASD are spectrum disorders in the fullest sense of the word…

Autism Spectrum Disorders

(Autism, PDD/NOS, Asperger’s)

curingoxygen.comBrain_Autism.png

Picture of a healthy brain with areas involved in ASD

“To diagnose or not to diagnose, that is the question…”

Why get the diagnosis?

“How can we throw another label at the parents, especially when it is the BIG A?”They already get services under visual

impairment…

Terese Pawletko, Ph.D.@2010

Adult on a list serve for blind/autistic adults explains…

“The Asperger’s causes me many more problems across a wide spectrum which blindness does not do and it has ever since I was a small child. The symptoms of both autism and depression have been devastating throughout. When I was growing up, my tantrums from sensory over stimulation were attributed to being a spoiled child and I was treated as such leaving me with a sense of inferiority and hopelessness…”

Terese Pawletko, Ph.D. @2010

Different needs…Different assumptions…Different orientation…Different approaches…

Terese Pawletko, Ph.D.@2010

Monologue vs. conversation(Difficulties with persp. taking, shifting attention, flexible use of language)

Holds ears when hears people talking (Difficulties regulating sensory input)

Avoids eye contact (may have difficulty with facial complexity or with looking and listening)

No pretend play (literal interpretation, diff. w/persp tkg)

Tantrums with change (relies on routine for stability, predictability; LITERAL)

Why might you be seeing it?

The why is beneath the surface…and is important to understand…

What are you seeing

Keep the iceberg in mind!!

Terese Pawletko, Ph.D.@2010

Not a ‘team player,’ can’t take constructive criticism(Difficulties with persp. taking, egocentric/rigid/unilateral literal view of task or situation)

Critical of co-workers’ behavior (Rigid interpretation of rules, work standards – e.g., 10 min. break means 10 minutes, not 10.5)

Why might you be seeing it?

The why is beneath the surface…and is important to understand…

What are you seeing

Keep the iceberg in mind!!

Terese Pawletko, Ph.D.@2010

Corrects boss, not ‘respect’ the ‘chain of command’ (literal, egocentric view of word or task; may assume boss has to ‘earn’ the client’s respect by being ‘true to his/her word;’ may not tolerate/understand flexible interpretation of statements made by boss; corrects spelling, etc.)Excellent attention to detail, works beyond ‘quitting time’ to finish a job; fabulous Braille proofreader (literal; understands ‘the code’ at the surface level; ‘finishing job’ means ‘finishing,’ may take longer due to literal interpretation of standards)

Why might you be seeing it?

The why is beneath the surface…and is important to understand…

What are you seeing

Keep the iceberg in mind!!

Realities/Case Studies…

• Matthew (ROP, LD, anxiety, explosive disorder)

• Katie (SOD/ONH)• Christopher (ROP, LD)• Elise (anophthalmia)

Contact information:

Terese Pawletko, Ph.D.

22 Wildlife Drive, Eliot, Maine 03903

Ph: (603) 396-1645

Email: TERESEPAWL@yahoo.com

Any reproduction of any portion of these materials must provide documentation of their source. Failure to do so violates copyright (2010). Thank you.