User:Ongmianli/Portfolios/Autism

Demographic Information

Table 1: Base rates of ASD in Children and Adolescents (in different Clinical Populations)

Setting (Reference)	Base Rate	Demography	Diagnostic Method
The Autism and Developmental Disabilities Monitoring (ADDM) Network (2014) - 8 year olds	1.5% (1 per 68)	11 ADDM sites in the United States	DSM-IV-TR criteria
National Health Statistics Report (NHIS; 2014), 3-17 year olds	2.24% (1 per 45)	43,283 household surveys in the United States	Phone interviews (caregiver report) from 43,283 parents with children ages 3-17 yrs-- checklist of diagnoses was based off of DSM-IV-TR language
The Autism and Developmental Disabilities Monitoring (ADDM) Network (2014) – 8 year olds	1 in 42 boys (2.38%), 1 in 189 girls (.05%)	11 ADDM sites in the United States: Male/Female Ratio	DSM-IV-TR
Interactive Autism Network (IAN): Individual Sibling Recurrence (2010)	ASD status occurred in an additional child in 10.9% of families	came from family registry for those who had children under 18 years old in United States	DSM-IV-TR criteria
The Autism and Developmental Disabilities Monitoring (ADDM) Network (2014) – 8 year olds Race/Ethnicity -Non-Hispanic White -Non-Hispanic Black - Hispanic - Asian	1 in 63 (1.58%) 1 in 81 (1.23%) 1 in 91 (1.10%) 1 in 81 (1.23%)	Race ethnicity-- 11 ADDM sites in the United States	DSM-IV-TR criteria for ASDs
The Autism and Developmental Disabilities Monitoring (ADDM) Network (2010) – 8 year olds Race/Ethnicity - Non-Hispanic White - Non-Hispanic Black - Hispanic - Asian - Other	60.3% 15.7% 17.2% 3.3% 3.5%	United States	DSM-IV-TR criteria for ASDs
Epidemiological study: Review of 43 studies (2009)	4.2% (4.2:1)	United States: Male/Female Ratio	DSM-IV/Rating Scales/Clinical

Diagnostic Changes

Autism spectrum disorder is a new DSM-5 name that reflects a scientific consensus that four previously separate disorders are actually a single condition with different levels of symptom severity in two core domains. ASD now encompasses the previous DSM-IV

• autistic disorder (autism)
• Asperger’s disorder
• childhood disintegrative disorder
• pervasive developmental disorder not otherwise specified

ASD is characterized by

1. deficits in social communication and social interaction and
2. restricted repetitive behaviors, interests, and activities (RRBs).

Because both components are required for diagnosis of ASD, social communication disorder is diagnosed if no RRBs are present.

Empirically Supported Treatment

Behavior and Communication Approaches

A. Applied Behavior Analysis (ABA)²⁰: method of teaching appropriate behaviors by breaking tasks down into small discrete steps and training in a systematic and precise way called discrete trial training (DTT). Based on the context that children with ASD have significant difficulties with learning, learning through imitation and listening as typical peers do.

*Early Intensive Behavioral Intervention (EIBI)²⁰: focuses on remediation of deficient language, imitation, pre-academics, self-help and social interaction skills broken down into discrete components, taught on a one-to-one basis in school and/or at home. Typically using discrete trial teaching, reinforcement, backward chaining, shaping, extinction, prompting and prompt fading. Parent involvement is essential.

*Pivotal Response Training (PRT)²³: derived from ABA, an approach that teaches the learner to seek out and respond to naturally occurring learning opportunities. Goals include the development of communication, language and positive social behaviors and relief from disruptive self-stimulatory behavior.

B. Early Start Denver Model (ESDM)²¹: a comprehensive early behavioral intervention for infants (as young as 12 months) to preschool- aged children with ASD, integrating applied behavior analysis (ABA) approaches with developmental and relationship-based approaches.

C. Developmental, Individual Differences, Relationship-Based Approach (DIR or “Floortime”)²²: objectives are to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors.

D. Treatment and Education of Autistic and related Communication-handicapped CHildren (TEACCH)²⁴: statewide, community based intervention program that emphasizes environmental organization and visual supports, individualization of goals, and the teaching of independence and developmental skills. Teaching strategies are taught within the natural environment and within context. Includes early intervention services through adulthood.

F. Others: (Treatments tackling symptoms not exclusive to ASD) Cognitive Behavioral Therapy (CBT); Occupational Therapy; Sensory Integration Therapy; Speech Therapy; Picture Exchange Communication System (PECS).

Medication

The data on other relevant diagnoses indicate that children and youth are frequently treated with medication under an ASD diagnosis, despite the fact that the target symptoms may be commonly associated with other mental disorders (ADHD, Anxiety, Depression, etc.). Approximately 70% of children with ASD ages 8 and up receive some form of psychoactive medication. Before recommending medication as a form of treatment, consult a supervisor and a medical doctor.^26,27

Process and Outcome Measures

Table 3. Clinically Significant Change Benchmarks with Common Instruments

		Cut Scores*			Critical Change (Unstandardized Scores)
Measure		A	B	C	95%	90%	SEdifference
Benchmarks Based on Published Norms
Autism Diagnostic Observation Schedule - Generic (ADOS-G)6,12	Module 1 SA Total Module 1 RR Total Module 2 SA Total Module 2 RR Total Module 3 SA Total Module 3 RR Total	8.1 0.4 7.7 1.2 3.7 -0.4*	12.5 4.4 10.4 4.9 9.8 3.3	10.2 2.7 9.1 3.2 7.1 1.9	2.3 1.1 2.0 1.1 2.1 0.9	1.9 0.9 1.7 0.9 1.8 0.8	1.1 0.5 1.0 0.6 1.1 0.5
Childhood Autism Rating Scale (CARS)	Parent Total	23.0	18.0	18.6	1.6	1.4	0.8
Social Responsiveness Scale (SRS)5 Caregiver Report (Appendix B)	Total	72.7	62.8	66.8	11.3	9.5	5.8

“A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.
Note. ADI-R total scores: Comm-V Total=Communication Total for Verbal subjects; Comm-NV=Communication Total for Restricted, Repetitive Behavior Total. ADOS Module scores: Reported scores for Modules 1-3, Module 4 was not included and is typically used for higher-functioning adolescents and adults; SA=Social Affect Total; RR=Restricted, Repetitive Behavior Total. CARS: Clinician scores for typical sample were not reported.
*Negative cut scores may occur in the case when the minimum score on a measure (in this case, the ADOS-G domain RR) is 0.

Process Measures

There are many processes that may be considered important when evaluating a child or an adolescent with ASD; however, due to the homogeneity of the population, there are too many to narrow down. Clinical judgment is recommended when deciding what additional measures should be included (e.g. executive functioning, sensory processing, cognitive flexibility). The two measures provided below are commonly used to assess adaptive behaviors (including communication and socialization, core deficits in ASD) and may provide important information regarding levels of daily functioning of individuals with ASD.

A. Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) --  The ADOS-2 is a semi-structured, play-based assessment of social and communicative behaviors indicative of autism. There are several different modules that can be used based off of the individual’s speech/communication level. Training is necessary to conduct the ADOS-2.

B. Autism Diagnostic Interview, Revised (ADI-R) -- The ADI-R is a caregiver interview that helps to provide a developmental history (ages 4-5) and current functioning level of restricted and repetitive behaviors and social impairment. Training is necessary to conduct the ADI-R. Due to the homogeneity of the population, there are many other process measures that can be used in autism assessments. Clinical judgment is recommended when deciding what additional measures should be included (e.g. executive functioning, sensory processing, cognitive flexibility, motor functioning, comorbidity). The two measures provided below are commonly used to assess adaptive behaviors (including communication and socialization, core deficits in ASD) and may provide important information regarding levels of daily functioning of individuals with ASD..

A. Vineland Adaptive Behavior Scales-Second edition (VABS-II) – Parent report recommended with careful attention paid to the Daily Living domain. More commonly used with children.

B. Adaptive Behavior Assessment System, Second Edition (ABAS-II) – Parent report recommended with special attention to the Global Adaptive Composite (GAC). More commonly used with adults.

References

1. Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Morbidity and Mortality Weekly Report, 61 (3), 1–19. Kogan, M. D.,
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