Could It Be Autism?

I could this be autism is the theme of this session I've been working in this area for over 40 years and I'm going to pass on some of the new bits of information that we've picked up from research but also from clinical experience and one of the things we're looking at is how early on can you pick up autism well we seem to have three developmental directorís the first is a child who is different from early on they may have been premature there may have been difficulties during pregnancy or the birth low birth weight there can be reflux problems sleep problems epilepsy and a whole range of factors that means that that child is of medical concern and then maybe at 18 months or so confirmed autism but there are concern from early on now for the second group autism emerges slowly but it does emerge there's a developmental plateau the child initially seems to be achieving skills but the rate of progress slows down we'll explore that in a moment the third trajectory is one in four who actually lose skills between 14 and 24 months they may lose vocabulary social interest and imaginative play and parents watch over days or weeks that child seemed to retreat into a world of their own now we look at the second pathway developmental plateau autism emerges slowly so at six months there's nothing much you could say that was that different about that child but as you can see by the graph the rate of progress is starting to slow down but is still continuing and parents are thinking well he'll catch up one day by about 12 months there's a significant gap but it's not sufficient to say the developmental delay or a particular path emerging but by 18 months to two years yes the developmental delay and the autism profile now let's have a look at that in a bit more depth so at 12 months less likely to respond when his or her name is called that is the essential part of ASD is understanding people what is my definition of ASD someone who is found in life something more interesting than socializing and this is a parent from early on newborn infants look more at the human face than any other geometric shape but this particular child isn't showing as much interest in the social world as you'd expect now fewer gestures than typical children and this is one of the problems with ASD that those who don't develop speech do not replace a lack of speech by a rich gestural communication as occurs in children who are deaf so it seems as a major problem in communication not only with speech but body language to understands for your phrases so there's language delay occurring and difficulties in disengagement from visual attention they find something absolutely fascinating from fingerprints to blades of grass or whatever it may be I'm just totally fixated by the color the symmetry the patents in ASD you're looking for patterns and sometimes with visual acuity equivalent to Eagles so you spot those fascinating components of someone's hair is actually like strings of spaghetti that's absolutely fascinating for that person and looking at others less frequently they're not important in your life in fact they're quite intrusive and stop you doing what you'd like to do and if they're going to look at your face they may look at your mouth not your eyes and your mouth to try and work out how you speak and how your mouth moves to help that child actually learn to speak so often looking at the person's mouth rather than the eyes and that's a lifelong problem I was working with a couple husbands got Asperger's syndrome wife hasn't and she's concerned that in interactions he doesn't seem to give us much eye contact as she would like and she was encouraging him with our help to look at her eyes he was getting on well and she was congratulating him on how lovely it is to see his beautiful eyes in the conversation and she look he looks at her eyes so well now and he said yeah but I don't know which eye to look at and that gives you some idea I can look but can't read is like a typical kid just because he looks at books doesn't mean he can read the words accurately just because they look at faces doesn't mean to say they read faces now by 12 months those differences on almost every scale of development by about two to three months but that's still within the normal range but the gap is getting wider so global developmental delay and macro sefa Li larger head circumference some of the kids I see the notes say three years old or to your dog say two years old but in comes our kid the height of a three-year-old with a larger head circumference and a larger brain in one in four cases why don't know now well if you don't know you don't know I can't can't fake it we just don't know bigger brains diminished eye contact also diminished social engagement in other words finding solitude okay it's being alone not lonely and hate being interrupted and want to explore the world yourself as one mum said he's in a world of his own and I'm not invited into that world so there's a limited interest in social games and turn-taking activities preference for solitude and now visual attention is more fascinated by objects than people especially the symmetry of train tracks with the sleepers and parallel lines and so on and all the carriages behind each other now there's a limited range of facial expression the face seems very blank this is why when I see those with Asperger's and I say well sometimes it does assburgers in my wife side of the family and we have a son with asparagus and you have the phrase smile for the camera and the Asperger person goes and anybody else looking with it constipated and they say how can I make my face look happy when I don't feel happy and the face can be quite blank there's less sharing of effect smiling looking at others unusual hand and finger mannerisms can emerge with an interest in the patterns that are occurring walking on tiptoes and all these features exist in the ordinary population you will see little preschoolers toe walking and as soon as mum turns around they stop so none of the features are unique sometimes typical kids want to play by themselves thank you very much that's why when our granddaughter was born a year ago because I was watching and and because if she looked away she's may have autism you know she looked away now she was overloaded she's only three months old she's got too much going on and she's pulling back she's not autistic difficulty adapting to new situations and coping with a change of routine variety is not the spice of life and you go to the shops twice this particular way right that's it that's for the tops if you go a different route you're not going to the shops then that person hits the panic button as a teenager said when asked what's your definition of hell he said surprises mmm okay that makes Christmas with its socialising its emotions and surprising not necessarily an enjoyable experience now 12 to 24 months interesting visually repetitive phenomenon such as ceiling fans and tumble dryers and spinning it seems to be there's an absolute mesmerizing fascination unusual attachment to an object not a teddy bear which is soft and squidgy and round and reminds you of mum but it's a battery because it's useful and you puddle a battery because you need it for your toys and so on so and communitive acts are disproportionately I want that rather than oh look at the airplane let's share the moment together pointing things out because we'll find them interesting and share them and less likely to indicate look at me and bring an object to an adult for joint interest so in other words you're starting to live a life alone be quite content by that and when others try and engage you you may resist that engagement there are unusual sensory interests from spinning things to sniffing feet legs hair food and you seem to be exploring the world by sensory qualities rather than necessarily imaginative or constructive play or afraid of some everyday sounds we now know this is lifelong what the adults do is try and avoid them more successfully or they just cope with the sound of the hairdryer the vacuum cleaner dogs barking sharp noises smells hating teachers not because they don't like the teacher it's uh perfume or the clothes that she wears and the scent throughout some of the kids avoid the playground not because of the social but because of the kids shouting to each other and running fast and can knock into you and I ask you them which teacher do you like and not like I hate teachers who shout and shouting is something that's abhorrent and it's a very limited range of food because of sensory sensitivity and over-reactive to tickling which is that tactile sensitivity there's limited imitative play copying mum and dad and either while often overactive which can be for a variety of reasons from ADHD anxiety making you restless can't keep still a form of akathisia or you're seeking sensory experience and uncooperative is what I or the Frank Sinatra my way and we'll new only do it my way and a lack of interest in other children because they're boring and stupid and adults are intelligent and help you so extremes of temperament yes this can be a lifelong problem hits the panic button and explodes especially the girls with ASD huge explosion but they can't be consoled by affection or distraction easily you just got to wait till the storm goes naturally now less imaginative or pretend play that he's shared with others less complex babbling and word productions or language delays apparent and delay in receptive and expressive language that means the first person to see that child maybe a speech pathologist is he deaf because he doesn't respond when his name is called and so on the next group we call regressive and they seem to be progressing as well as we can tell we now know that by watching home movies families have filmed that kid almost every day for out their whole life and you can look back over the movies and say spot ASD no you can't he's socializing he's engaging all those sorts of things are occurring and then over weeks or days he's no longer interested in Dada returning home from work he's not interested in using his vocabulary and instead of playing imaginatively he lines things up and makes them symmetrical so the play socialization and language can deteriorate quite significantly good news is but many that will recover but it is one of the pathways what's going on between 14 and 24 months we don't know for sure so the regression is really a broader 10 to 30 months peak at 18 loss of previously acquired words stops talking less eye contact and lose interest in social games being with people and parents and the parents start to think what did I do measles mumps rubella coincidental not causal what happened his brother was born was it that he was jealous of his brother he had a bad cold was we don't know but this seems to be one of the pathways of losing skills now dsm-5 is just out to diagnose autism spectrum disorders what we'd like is a sorting hat and we just put the sort if you know Harry Potter if you don't know Harry Potter I feel sorry for you but anyway just put the hat on and that's it and I think in 20 years time we will have that with the neurology of ASD being identified that there will be structural abnormalities identified in the brain psychologists may then progress to other things but it seems that when we look at this stage we don't have a mechanism that's failsafe now these are the new criterion which I'll explain criterion a is persistence deficits in social communication and social interaction across contexts manifested by all three of the following deficits in social emotional reciprocity what does that mean kid with ASD group of kids playing over here there's three options one is kid thinking I don't like it I don't get it I'll turn my back on them and if they come close I'll slug them and they'll go away because the person likes to be alone because if you share you lose control more on that later but it's splendid isolation or instead of being shy introverted and involved in your own activity they go over right at it you know that no you do that and they stand that far away and they are too intrusive and intense and they dominate and they don't give the signals that others will say as he finished as he walks off because he doesn't say farewell or anything or it plays wrestling outside the classroom when you shouldn't really do that and this can occur then with the adults who can upset other people by standing too close dominating conversation and intensive and intrusive or your goal with ASD girls are smarter and more creative and Intel in how they cope because they go wow isn't that interesting who's popular Rebecca right I don't get it but Rebecca does so I'll become Rebecca I want to be called Rebecca I'll wear what she's wearing I will play those games I will observe I will analyze and I will imitate when I imitate I'll either win an Oscar or become a psychologist because you've been observing and analyzing people since you were three years old yes there are some famous and colleagues I know with psychologists who are asking you what I would want in the future is psychotherapy designed by a space for a space conducted by a space right so it's that reciprocity it's nonverbal communication it's the ability to read body language it's the ability to express body language but it's also the ability to find the words to describe feelings one person may be asked with ASD later years when that event occurred what were you feeling what were you thinking I don't know come on you can tell me every dinosaur in the Jurassic period what were you thinking or feeling when you hit him I don't know come on you must know I don't know you're being obtuse I'll now complete their sentence I don't know how to grasp the many thoughts and emotions swirling in my head hold one identify it label it and communicate in speech so that you will understand so they say I don't know one of their greatest difficulty is converting thought and emotion to speech there's also difficulty developing and understanding and maintaining relationships and it goes from those who don't want to interact to those who do desperately how do I make friends or the teenage boys how do I get a girlfriend can I buy one no it's illegal you know and all those sorts of things but it's looking for a relationship and those with Asperger's do get relationships oh yes because one of the causes is genetics and if somebody didn't fall in love with an ass B it would have died out years ago so the person who's likely to fall in love with an ass B is often someone from the caring professions you didn't know that when you did your training in the caring professions one of the occupational hazards is falling in love with an Aspie yes because you're talented in reading the inner message it's seeing the heart not the behavior so I say to the teenagers with us be the boys if you're not popular with the girls don't worry wait till girls are in their mid-20s when they get maternal then they'll fall in love with you so other components can be difficulties sharing imaginative play now this is important because some of those with ASD have a very rich vivid enjoyable imagination but it's not shared sometimes the imagination is so appealing it's better than real life so they are literally off talking to the fairies or with imaginary friends now criterion B is restrictive repetitive patterns of behavior least two of the following repetitive motor movements that's that signature flap the rock the actions that sometimes the mannerisms clearly indicate autism there's that signature movement profile as much as there's a signature language profile so it can be lining things up looking at things from a certain perspective symmetry flipping objects pinning them and so on now insistence on sameness inflexible adherence to routines or ritualized patterns of behavior or excessive resistance to change interesting hmm sameness routines and rituals I think this is actually a behavioral coping mechanism for high levels of anxiety we know neurologically that those with ASD in a part of the brain called the amygdala are prone to high levels of anxiety routines mitchell's sameness not coping with change are all adaptations for high levels of anxiety so the treatment really is for an anxiety disorder so there can be extreme distress small changes why new situations are fraught with failure sensory sensitivity not being able to cope or understand so you want sameness and predictability and your special interest is a thought blocker to stop the intrusive anxious thoughts so criterion B unusual interests yeah lots of kids like Thomas the Tank Engine but he knows every engine off by heart and holds them or a fascination with drain covers I had no idea how artistic drain covers are and how they vary all over the world until people with Asperger's taught me that and so I would just come back from Europe and I was in various play I was in Poland wow what a fascinating drain cover and I just sat so they're wearing war look at that when we look at the causes remember it's infectious the more you live with or work with ASD people the more ASD you become if you can't beat them join them so when we look at this there seems to be an intense attachment to objects again it's something that seems to be non personal it's the texture of that object and the interests are unusual in intensity lots of girls like horses but she just moved a mattress into the stable or it's very unusual for anyone to be interested in that topic we had one four-year-old who knew all the different types of grass and could just look at a blade of grass he was four and tell you what type of grass it was now hyper or hypo reactivity to sensory input this is one of the first times or that really the Diagnostic and Statistical Manual has included and legitimate sensory sensitivity it's one of the first signs we look for in infancy the startled reaction that doesn't diminish by habituation or experience and throughout their life there are certain sounds or Roma's and textures that are unpleasant and some adults will say in answer to the question which fragment of ASD if we could would you like us to remove many will say sensory sensitivity and what do you do that means you can cope with it because I can't see how you do you don't put your fingers in your ear you don't rock to self-soothe but you seem to be able to cope with it what are you doing now that can be a sensitivity to sounds touch etc but sometimes a lack of sensitivity to pain and temperature and sometimes a first or a searching for sensory experience so now when we do the assessments we will assess social development language we will also assess sensory sensitivity because sometimes challenging behavior is escape behavior to get away from an overloading environment worst environments supermarkets because they are designed for a sensory explosion or shopping malls and you learn don't take kids with autism shopping it's going to be a disaster now in dsm-5 criterion see 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 later in life yeah taps in to classic autism diagnosed between two and four years Asperger's in boys four to eight years Asperger's in girls teenage years and adult years because they can fake it they can imitate they can observe and analyze in via goody-two-shoes and not be noticed at primary school socializing is relatively easy they're interesting and they may have one friend who's an unpaid teacher aid in the classroom in return the ASPI girl is not very kind good friend and this girl scripts her guides her repairs but if this girl typical girl that befriends her moves interstate she's no idea what to do but when he gets to the secondary school the high school level that person is overwhelmed by the changes of puberty the changes of friendship the schoolwork etc and the wheel falls off people with Asperger's can socialize very well eventually by intellectual effort which is exhausting so some ass pisses adults for 2 to 3 hours can be the life and soul of the party but next day social migraine under the covers in the cupboard that's it nobody must see that but for 2 hours are made it I was successful but when there are changes and too much stress the wheels fall off so there can be learned strategies and later in life of imitation and support from key people criterion D is clinically significant impairment in social occupational other important areas of functioning and that's important because at what PI point do you draw the line and yes we're involved in diagnosis but I'm involved in something new which is contentious sore a boy when he was 7 years old been diagnosed by the pediatrician as Asperger's I saw him absolutely no doubt my involvement was to teach him social skills and friendship skills for school over two year period 9 years old lost contact which is usually a good sign because I normally get them coming back if there's a problem but no sign of him he's 19 years old now and his mum phones me up and says could you help he's done really well but for so long he wanted to become a police officer he was so keen on being a police officer he went to all the First Aid courses watched all the TV's cop shows and all those sorts of things totally dead set on it but he's a speak he's honest and on the application for the Queensland police force he wrote that he has Asperger's they then immediately wrote back more or less saying how dare you suggest that someone with Asperger's could be a police officer interesting because you have to dismiss about 15% of the police force because they're excellent in the vice squad because they're incorruptible but they usually end up in traffic very pedantic but she said this is totally catastrophic news he's got no plans for the future can you guide him where to go now so I saw him we sent chatted and as we were chatting I thought where's the Asperger's gone I'm chatting to a 19 year old button right so I did a reassessment we now have new tools to quantify the nature of Asperger's and the depth of Asperger's in adults and a score of 65 and above confirms the diagnosis yeah and he score was 42 so he was below the threshold so I wrote a letter to the police department saying the signs were apparent in his childhood he has grown out of those signs it is now subclinical please assess his suitability for the police force on the basis of any citizen of that age applying and he got in yeah Wow however a few weeks later I got a letter from him Tony thanks for the support kind of the police force didn't like it he says but I've just joined the Navy and it's great and I'm on the radar systems and all those sorts of things so the Asperger's hasn't totally disappeared but he's learnt many of the skills that were thought in possible years ago good support good job etc are very now criterion II it's not intellectual disability or global developmental delay in other words it's a distinct Pam the concern is anyone with a social confusion or lack of social understanding the assumption is must be autism no there's a very distinct profile people can have social confusion for many reasons other than autism now you must specify with or without intellectual impairment now for these guys I strongly recommend an IQ test when they are 6 7 8 years old yes there may be an issue is there intellectual disability as well but for those for whom they're attending an ordinary school I want to know their IQ profile for their learning profile some of visualizers they learn by demonstration and iPads and computer programs others of verbalizes and they have a remarkable ability to learn by reading and have a fantastic vocabulary and information they have problems with processing time it takes them ages to get their act together to reply because they're too thorough rather than should we say they take too much time to consider the answer so with or without accompanying language impairment there is a language profile speech pathologists may assess that and whether its associated with any known medical often epilepsy or genetic condition or environmental fact that there's a high link with auto immune disorders as well and genetic factors because in half the cases we see it runs in families where we meet mom and dad greater chance than expected of dad to be engineer accountant information technology and mum in the caring professions yes and so for some it does go through the family family characteristics also Saudia with another neurodevelopmental or mental or behavior disorder anxiety disorders and so on and catatonia we're only just starting to discover this but in the teen years and slightly above they may have fries of movements not schizophrenia but movement disturbance now I'm just going to check time oh I'm okay good now what you've got to do is specify severity level gone is the word Asperger's syndrome I don't agree with losing it because I think it had value for many reasons however what's happening now is you're supposed to put ASD levels one two and three three is classic autism high support two substantial support and requiring support is one but they haven't really defined what that is so I now write in reports ASD level one brackets Asperger's syndrome because people know about Asperger's you can't remove it from conversation the books on Asperger's syndrome teachers and parents will know what Asperger's is so they can't remove it but why they had to I don't know they don't like autonomous named after people diagnostic groups but anyway that's what it is ASD level one is brackets the old Asperger syndrome so when we look at the components of a diagnostic assessment ASD criterion a it's that reciprocity that balance its nonverbal social communication of reading social cues I described because I've just come back from Europe I can now say that in some conviction they're like French drivers no Italian drivers because I've been to Athens and Paris now Athens Paris and Rome the worst of Paris they're like French drivers you see as I look at you guys French drivers don't observe traffic signals they park wherever they want I've got bit they Park on pedestrian crossings they they break the speed limit they expect an extra tip because they broke the speed limit and so on so I describe those with ASD like French drivers they don't read the signals that's why I am here looking at you guys in the front because your face is a traffic lights if you nod and smile green light I keep going if you're confused and the light slow down France speed up and explain red light angry I'd stop but these kids don't see the no tailgating signs and invade your personal body space they don't see the woman at work sites and keep interrupting so they don't read the signals if they don't get a formal diagnosis they'll get a moral diagnosis so what I'm saying is that they need to learn the social communication the codes of conduct and so on and that's our role is to teach them how to understand humans why they do these weird things and trying to understand how to make friends and get on with other people and some can be successful in that process so there's a whole new generation coming through who seem to have much greater skills so the next one is repetitive speech movements of mannerisms or uses of objects that's more classic autism routines and rituals and if you change that there's a panic attack also unusual interests that may be a source of employment and that's why when I go to universities I play a game of spot the ASPI because universities are social workshops such I was like sheltered workshops for the socially challenged so I find that and you actually get paid for your special interest so that can be a distinct advantage and also unusual sensory sensitivity that we're starting to explore how life for those with ASD is very difficult I call them as my heroes because they're having to cope with social understanding communication skills the problem is when you teach it's a social conversational context these kids were much better a hundred years ago you sat on your own and you remembered facts from the teacher now you work in groups and the teacher relates to you so life is tough for the a space where were they in Europe a thousand years ago in the monasteries enjoying the monastic routine lifestyle so we now expect a much greater degree of socialization and live you in ASD sometimes journalists will say those who suffer from ASD no ASD doesn't give you stomach cramps or pain in the joints but you can suffer because of the attitude and ignorance of other people and my biggest concern is not ASD it's bullying and teasing and when I explore what's going through the mind of those who are depressed I find out no those thoughts those beliefs didn't come from your parents they didn't come from teachers they came from other kids the tragedy is you believe them did not have friends to contradict them because it was said so often that became your way of viewing yourself but in many ways the most significant advances in science and art have been made by a space we actually need their characteristics because when we say to think outside the box those were those do you say what box and have solutions ok I think I come to an end ok thank you you

Channel: Generation Next

Views: 395,146

Keywords: Generation Next, mental health, youth, wellbeing, autism, Autism Spectrum Disorders, ASD, disability, diagnosis, youth wellbeing, youth mental health, learning supports, practical strategies, early intervention

Id: HIrxgD3oqYc

Length: 36min 53sec (2213 seconds)

Published: Sun Jan 24 2016