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What is Autism spectrum disorder?

• Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges (CDC, 2016).
• Group of complex neurodevelopment disorders of the brain. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors (Autism Speaks, 2016).

What is AUTISM Spectrum disorder?

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, published in 2013) includes autistic disorder, Asperger syndrome and pervasive developmental disorders not otherwise specified (PDD-NOS) as part of ASD rather than as separate disorders.

What is AUTISM Spectrum disorder?

• ASD affects how one communicates with and relates with others and affects how they make sense of the world around them.
• Learning, thinking, & problem-solving abilities can range from very gifted to severely challenged.
• The term “spectrum” refers to the wide range of symptoms, skills, and levels of disability in functioning that can occur in people with ASD.

autism can co-occur with:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Obsessive-Compulsive Disorder (OCD)
• Learning Disabilities
• Intellectual Developmental Disorder
• Certain genetic and chromosomal conditions (fragile X syndrome)
• Sensory Processing Disorder (SPD)

Incidence of AUTISM SPECTRUM DISORDER

• 1 in 68 children has been identified with autism spectrum disorder (ASD) in the United States, (CDC, 2014).
• Boys (1 in 42) are 4.5 times more likely to have autism spectrum disorder as girls (1 in 189), (CDC, 2014).
• Affects all racial, ethnic & socioeconomic groups and is growing at a faster rate than any other developmental disability (CDC, 2014).

causes

• There is no known cause of ASD & there is no known cure.
• Current research points to both genetic & environmental factors.
• Researchers have identified a number of genes associated with the disorder.

Causes

• Studies suggest that ASD could be a result of disruptions in normal brain growth very early in development. These disruptions may be the result of mutations in genes that control brain development and regulate how brain cells communicate with each other (NIH, 2016).

RISK FACTORS

• Advanced parental age
• Having a sibling diagnosed with ASD
• Use of prescription drugs, valproic acid and thalidomide during pregnancy.
• Critical period for developing ASD occurs before, during, and immediately after birth.
• Multiple studies have shown that vaccination to prevent childhood infectious diseases does not increase the risk of autism.

Signs & symptoms

• ASD is often called the "Invisible Disability," because there are no physical markers.
• Observable signs of ASD are identified by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction.
• Symptoms can vary greatly from person to person depending on the severity of the disorder.

Early Signs

• no babbling or pointing by age 1
• no single words by age 16 months or two-word phrases by age 2
• no response to name
• loss of language or social skills previously acquired
• excessive focus on or lining up of toys/objects
• no smiling or social responsiveness

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Later Indicators

• impaired ability to make friends with peers
• difficulty initiating or sustaining a conversation
• absence or impairment of imaginative and social play
• repetitive behaviors (hand flapping, spinning)
• abnormally intense or focused interest
• preoccupation with certain objects or subjects
• inflexible adherence to specific routines

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diagnosis

• Health care providers often use questionnaires & screening instruments to gather information about a child’s development and behavior.
• A comprehensive evaluation requires a multidisciplinary team, that may include a developmental pediatrician, child psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose and treat children with ASD.

Diagnosis

• All children should be screened for developmental delays and disabilities during regular well-child doctor visits at: 9,18, 24 & 30 months of age
• Additional screening might be needed if a child is at high risk for ASD (e.g., having a sibling or family member with ASD) or if behaviors associated with ASD are present

Interventions

• Early Intervention (birth to 3 yrs) is critical
• Behavior and communication approaches (Applied Behavioral Analysis, facilitated or augmentative communication).
• Speech, occupational, physical therapies, sensory integration therapy and music therapy
• Medication
• Dietary Approaches
• Complementary and Alternative Approaches

ImplicationS for PT

• Delays in both large movement skills & use of hands for small movement skills
• Difficulty with imitating, planning and sequencing movements
• Lack of coordination
• Poor balance
• Instability when walking

IMPLICATIONS FOR PT

• Difficulty controlling posture
• Decreased eye–hand coordination
• Difficulty using sensory information for movement (may range from a low energy level and slow motor responses to exaggerated motor responses or craving of movement opportunities)

considerations

• Postural strength and control
• Functional mobility (walking and running)
• Body and safety awareness
• Coordination
• Play skills + Interests and motivators
• Ability to transition between different activities
• Participation in daily routines in the home, community, and school

SEnsory processing disordeR

SEnsory processing disorder

• Sensory processing is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses.
• Sensory Processing Disorder (SPD, formerly known as "sensory integration dysfunction") is a condition that exists when sensory signals don't get organized into appropriate responses (SPDF, 2016).

SEnsory processing disorder

• Pioneering occupational therapist and neuroscientist Jean Ayres, PhD, likened SPD to a neurological "traffic jam" that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly.
• Presents within a broad spectrum of severity & often occurs with other developmental disorders (autism, ADHD, deafblindness)

INCIDENCE of spd

• At least 1 in 20 people in the general population may be affected by SPD (Miller & McIntosh, 2004)
• In children who are gifted or those with ADHD, Autism, and fragile X syndrome, the prevalence of SPD is much higher than in the general population.
• Can affect one or multiple senses

causes

• The exact cause of sensory processing disorder has not yet been identified (Miller & McIntosh, 2004).
• Heredity may be one cause of the disorder. Prenatal and birth complications, as well as environmental factors may also be involved.
• Differences found in how mid-brain and brain stem regions of the CNS process sensory information (Stein, Stanford & Rowland, 2009)

Signs & red flags

• Problems eating or sleeping
• Irritable when being dressed; uncomfortable in clothes
• Resists cuddling, arches away when held
• Unable to calm self
• Floppy or stiff body, motor delays

EARlY Signs

• Over-sensitive to touch, noises, smells, other people
• Continued difficulty dressing, eating, sleeping, and/or toilet training
• Clumsy; poor motor coordination skills; weak
• In constant motion; no regard for personal space
• Frequent or long temper tantrums

LATER signs & red flags

• Easily distracted, fidgety, craves movement;
• Easily overwhelmed
• Unaware of pain and/or other people
• Difficulty making friends
• Difficulty staying focused & completing tasks
• Poor self-esteem; afraid of failing at new tasks

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DIAGNOSIS

• Sensory processing disorder (SPD) can be identified and categorized by a developmental pediatrician, psychologist, or an occupational therapist with advanced training in SPD
• Standardized assessments and questionnaires (Sensory Integration & Praxis Test - SIPT)
• Developmental assessments (adaptive skills, gross and fine motor skills)
• Observation of free play & functional activities

Sensory modulation disorder (SMD)

• Sensory modulation is the process of conveying information about intensity, frequency, duration, and complexity of a sensory stimuli
• Sensory over-responsivity
• Sensory under-responsivity
• Sensory craving/seeking

Sensory-based motor disorder (SBMD)

• Disorganized motor function that results from incorrect processing of sensory information
• Dyspraxia/coordination disorder
• Postural disorder

Sensory discrimination disorder (SDD)

• Involves the incorrect processing of sensory information from the senses
• Visual, auditory, smell & taste
• Tactile/touch, vestibular (balance/movement) proprioception (body awareness)

Sensory integration therapy

• Just right challenge (be successful)
• Adaptive response (adapts behavior with use of new strategies)
• Active engagement of child
• Child-directed (child's preferences considered to drive therapy)
• Intensity and duration
• Developmental approach

Implications for PT

• Reduce over-stimulation by assessing environmental sensory demand
• Lower overhead lights, create smaller space, eliminate excessive noise, move slower
• Preparation activities - swinging, deep pressure, heavy work
• Add intensity to activity to engage an under-responsive child

Implications for PT

• Provide opportunities for sensory-based movement for children with seeking/craving behaviors
• Improve organization, modulation and self-regulation while addressing motor skills.
• Keep it fun!