Autism and Other Autism Spectrum Disorders (ASDs) or Pervasive Developmental Disorders (PDDs) Institute for Development of Mind and Behavior Masataka Ohta June 13, 2007　

OUTLINE • Concept and Diagnosis of Autism and other ASD including Behavioral Problems • Biology of Autism • Developmental Psychopathology of Autism • Treatment of Autism • Cognitive Developmental Therapy • Medication • Family Support Programs

Earlier Descriptions about Autism Spectrum Disorders Kanner L. , 1943 “Autistic Disturbances of Affective Contact” (1944 Early infantile autism) 　 Asperger, H., 1944 “Autstisch Psychopathen im Kindersalter”

Three myths of autism on psychoanalytic theories 1.“Autism”; defense against parents esp.mother. 2. good or excellent potential intelligence. 3. no brain biological problems.

Collapse of the three myths and Appearance of new concept •Collapse of the myths and Development of

　　 　a new concept as drain dysfunction　 •Defined as behavioral syndrome 　at present

Historical Change of Terminology for Autism 　　　　　DX System Terms 1968 1978 1980 1987 1991 1994

DSM-II ICD-9 DSM-III DSM-III-R ICD-10 DSM-IV

Higher Category

childhood type infantile autism infantile autism autistic disorder childhood autism autistic disorder

Schizophrenia Psychosis PDD PDD PDD PDD

ICD: International Classification of Diseases (WHO) DSM: Diagnostic and Statistical Manual of Mental Disorders (APA) PDD: Pervasive developmental disorder

Diagnostic Criteria of Childhood Autism •Qualitative impairments in reciprocal interaction •Qualitative impairments in communication •Restricted, repetitive, and stereotyped patterns of behavior, interests and activities •Developmental abnormalities must have been present in the first 3 years for the diagnosis to be made (ICD-10 WHO , 1994;　DSM-IV-TR APA, 2000) ( See the attached paper )

Abnormal Behaviors frequently associated with Autism In Childhood hyperactivity, sleep disturbance, oversensitivity to sounds, abnormalities in eating etc

After Adolescence OCD like behaviors, self-injurious behavior, aggressive behavior to other persons, mood swing or mood disorders etc

Pervasive Developmental Disorders(ICD-10) • • • • •

Childhood autism A typical autism Rett's syndrome Other childhood disintegrative disorder Overactive disorder associated with mental retardation and stereotyped movements • Asperger's syndrome • Other pervasive developmental disorders • Pervasive developmental disorder, unspecified

ICD-10-DCR (1993) Pervasive Developmental Disorders Other PDD

Childhod Autism Overactive Asperger syndrome

Desintegrative

Rett

Atypical Autism Unspecified

DCR: Diagnostic Criteria for Research

Pervasive Developmental Disorders(DSM-IV-TR) • • • • •

Autistic disorder Rett's disorder Childhood disintegrative disorder Asperger's disorder Pervasive developmental disorder NOS

DSM-IV -TR　(2000) Pervasive Developmental Disorders

Atutistic disorder Overactive Asperger syndrome

Desintegrative

PDDNOS I ncl udi ng At ypi cal Aut i sm Rett

Early Symptoms of Autism

See the table on the resume

Associated Behavioral Problems Infancy to childhood; sleep disturbances, hyperkinesis, peculiarities in perception (ex. oversensitivity to sounds) Puberty to young adulthood Inertia, obsessive-compulsive disorder(OCD) , self-injurious behavior(SIB), aggressive behaviors, mood swings

Intelligence and cognition • Since autism is a behavior syndrome, each autistic child have different intelligence • Cognitive skills are usually uneven • Intelligence develops with age

Social Interaction Types in Adults with ASD • • • •

Aloof Subgroup Passive Subgroup Active-but-Odd subgroup Subgroup with Stilted Interaction (Wing, L. 1992)

Wing’s Subgroups and Ohta Staging III-2> Aloof 4 Passive 9 Active-Odd 13 Total 26

III-1< Total (%) 18 22 (45.8) 3 12 (25.0) 1 14 (29.2) 22 48

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