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ECHO Autism

What is Autism?

This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under cooperative agreement UA3 MC11054 – Autism
Intervention Research Network on Physical Health. This content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be
inferred by HRSA, HHS or the US Government. This work was conducted through the Autism Speaks Autism Treatment Network serving as the Autism Intervention Research Network on Physical Health.
Speaker Disclosures
• We have nothing to disclose and no
conflict of interest.
• Our sincere thanks to the ECHO Autism
team led by Dr. Kristin Sohl at

ECHO Autism
ECHO Autism
What is Autism Spectrum
Disorder?
• Neurodevelopmental Disorders
– Affect brain function
– Occur early in life (pre or postnatal)
– Have developmental consequences
• Symptoms manifest in core areas
– Social Communication
– Restrictive and Repetitive Behaviors

ECHO Autism
ECHO Autism
The Autism Spectrum
• A spectrum of symptoms
• Symptoms vary
– In severity
– In number
– Across time
– Between individuals

ECHO Autism
ECHO Autism
DSM-5 Criteria
• Deficits in social communication and social
interaction (3 of 3)
• Restricted, repetitive and stereotyped patterns
of behavior, interests or activities (2 of 4)
• Symptoms present in early childhood
• Symptoms cause clinically significant impairment
in functioning
• Symptoms can’t be better explained by intellectual
disability (ID)

ECHO Autism
ECHO Autism
Social Communication
A-1. Deficits in social-emotional reciprocity:
• Little or no initiation of social interaction
• Reduced imitation of others’ behaviors
• Language one sided, lack of normal back and forth
conversation
• Reduced sharing of interests, emotions, or affect

ECHO Autism
ECHO Autism
Social Communication
A-2.Deficits in nonverbal
communicative behaviors used for
social interaction:
• Impaired joint attention- initiating and
responding
• Absence ,atypical or poorly integrated
eye contact and body language
• Deficits in understanding others’
nonverbal communication
• Differences in prosody (speech
intonation)
• Lack of facial expression or gestures
ECHO Autism
ECHO Autism
Social Communication
A-3. Deficits in developing, maintaining, and
understanding relationships ranging from:
• Absence of /Difficulties sharing imaginative play
• Difficulties adjusting behavior to suit different social
contexts
• Absence of/difficulties in making friends

ECHO Autism
ECHO Autism
Restricted/Repetitive Behavior
B-1.Stereotyped or repetitive motor movements,
use of objects, or speech, such as:
• Simple motor stereotypies
• Lining up toys or flipping objects
• Echolalia
• Idiosyncratic phrases

ECHO Autism
ECHO Autism
Restricted/Repetitive Behavior
B-2. Insistence on sameness, inflexible
routines, or ritualized behavior:
• Need to take same route or eat same food every
day
• Extreme distress at small changes
• Difficulties with transitions
• Rigid thinking patterns
• Greeting rituals

ECHO Autism
ECHO Autism
Restricted/Repetitive Behavior
B-3. Highly restricted, fixated interests that are
abnormal in intensity or focus:
• Strong attachment to/preoccupation with unusual
objects
• Excessively circumscribed or perseverative
interests

ECHO Autism
ECHO Autism
Restricted/Repetitive Behavior
B-4. Hyper‐ or hypo‐reactivity to sensory input
or unusual sensory interests:
• Indifference to pain/temperature
• Adverse response to specific sounds or textures
• Excessive smelling/touching objects
• Visual fascination with lights or movement

ECHO Autism
ECHO Autism
Changes with DSM-5
• Single diagnostic category (Autistic Disorder,
Asperger's, PDD NOS → ASD)
• 3 symptom domains to 2

Reciprocal Social Interaction Social/


Communication
Communication
Restrictive,
Restrictive, Repetitive & Repetitive
Stereotyped Behavior Behavior

ECHO Autism
ECHO Autism
Severity Criteria
• Addition of severity criteria (Levels 1
through 3) to capture heterogeneity of
disorder
• Level 1: Requiring support
• Level 2: Requiring substantial support
• Level 3: Requiring very substantial support

ECHO Autism
ECHO Autism
Intellectual Disability
(ID)
• General intellectual impairment / global
developmental delays
– ~30% of children with ASD have ID
– An additional 25% have “borderline IQ”
• Comorbid diagnosis of ID+ASD when:
– Social communication & interaction are
impaired relative to the developmental level of
the individual’s nonverbal skills

ECHO
ECHO
ECHO Autism
Autism
Autism
ASD vs. Intellectual Disability

More like ASD


Symptom More like ID

Lack of response to Typical response to


name Social Reciprocity name

Limited facial Variety of facial


expressions
Nonverbal expressions
communication
Lack of gestures Use of gestures

Poor eye contact Eye Contact Typical eye contact

ECHO
ECHO
ECHO Autism
Autism
Autism
ASD vs. Intellectual Disability

More like ASD


Symptom More like ID

May be present Repetitive May be present


behaviors

Skills are lower than Social Skills are consistent


expected for with developmental
developmental level communication level

Poor social skills, Peer interaction Interacts better with


limited younger children than
approach/response problems same-age

ECHO
ECHO
ECHO Autism
Autism
Autism
Attention-Deficit/Hyperactivity
Disorder (ADHD)
• Inattention and/or impulsivity/hyperactivity
– 30-80% of children with ASD have ADHD
• Comorbid diagnoses can be considered when
symptoms exceed what would be expected for
the child’s developmental level

ECHO
ECHO
ECHO Autism
Autism
Autism
ECHO Autism
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