Autism

The Spectrum of Autistic Disorders in Children

Clinical Presentations and Therapeutic Interventions across the age groupsOscar Purugganan, MD, MPHColumbia University Medical CenterDepartment of Pediatrics

Learning ObjectivesTo recognize the clinical presentations of Autism Spectrum Disorders (ASD) across the age groups in childrenTo identify the earliest symptoms of ASDsTo identify therapeutic interventions and resources that may be useful for children with ASDsAutism Spectrum Disorder =Pervasive Developmental Disorder

Autism Spectrum DisorderRepetitiveBehaviorsLanguageSocializationHistorical Background1944

KannerAsperger

EpidemiologyPrevalence Graph

EpidemiologyPrevalence Graph

IDEADSM-IVHistorical BackgroundDiagnostic and Statistical Manual (DSM) DSM-III 1980DSM-IV 1994DSM-V 2013 .

Historical BackgroundPublic LawsPL 94-142 (1975) Education for All Handicapped Children Act FAPE for all children 3-21 y

PL 99-457 (1986) Part H : incentives for programs for 0-3 y

Renamed Individuals with Disabilities Education Act (1990, 1997, 2004) Part H renamed Part C (Early Intervention Program)

What may account for the increase in prevalence of ASD?Changes in case definitionIncreased awareness of professionals and parentsDiagnosis made earlierMore valid diagnostic toolsDiagnostic substitution

Fountain, C., King, M., & Bearman, P. (2011). Age of diagnosis for autism. Journal of Epidemiology and Community Health, Volume 65: 503-510 Autism Spectrum DisorderRepetitiveBehaviorsLanguageSocializationAutism Spectrum DisorderRepetitiveBehaviorsLanguageSocializationOnset before 3 years of ageImpairment in functioning Impairment in social interactionImpairment in communicationRestricted and stereotyped patterns of behaviorClinical Symptoms depend on the Age of presentation andSeverity of Symptoms Spectrum

Presentations during Toddlerhood to Preschool (18 months- 5 years)Speech / Language delaysAtypical language e.g. echolalia, scripting, pop-up wordsSocialization IssuesBehavioral IssuesGood rote skillsStereotypies usually appear after 2 yearsAtypical Non-symbolic PlaySensory issues

Preverbal MilestonesResponse to Name8-10 monthsFollow a point10-12 monthsProtoimperative pointing12-14 monthsProtodeclarative pointing14-16 months

Joint Attention!Presentation during Infancy/ Early Toddler (