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Autism Spectrum Disorder (including Asperger's Syndrome)

Autism Spectrum Disorder (ASD) is a Pervasive Developmental Disorder. ASD is a life-long condition that affects around 1 in 88 individuals according to estimates by the U.S. Centre for Disease Control. ASD effects both men and women.

There have been significant changes in the way that Autism has been redefined in the recently released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). As well as ASD there is now the related diagnosis of Social Communication Disorder.

Moving away from the previous 'Categorical' approach, the DSM-5 now recognises ASD as a spectrum of characteristics and identifies 2 dimensions, Social Communication and Restricted, Repetitive Behaviours which assist in classifying the individual's level of impairment and thus level of support required. There are 3 Levels identified, ranging from Level 1 - "Requiring support" to Level 3 - "Requiring very substantial support".

At the Geneva Centre for Autism in 2012 the changes in the DSM-5 were discussed and presented in the following format:

Figure 1: Dimensional Approach Defines the disorder empirically on dimensions ranging from:

Autism



Figure 2: Multidimensional Model

Autism




Autism Spectrum Disorder

According to the new DSM-5 definition, the profile of strengths and weaknesses of individuals on the Autism Spectrum include:

A.
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
B.
Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following, currently or by history
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualised patterns or verbal nonverbal behaviour (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C.
The disorder may also include a hypersensitivity to specific auditory and tactile experiences and problems with organisation and time management skills.
D.
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 in later life).
E.
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.


Asperger's Syndrome (High Functioning Autism)

The condition of "Asperger's"was defined separately in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and currently remains as a separate disorder in the ICD-10. Individuals with Asperger's (or High Functioning Autism: HFA) are usually of average or above average intelligence, and have a distinct profile of abilities that have been apparent since early childhood.

It is now known that individuals with HFA may exhibit some or all of these characteristics to a greater or lesser degree. Professor Tony Attwood, a Clinical Psychologist, describes these individuals as having a "different but not defective way of thinking". This includes more concrete thinking, with a tendency to focus on detail rather than the overall gestalt (big picture) and also often have poor imagination. Moreover, they often have a strong desire to seek knowledge, learn and problem-solve.

As individuals, they may value creativity over being co-operative or meeting the social or emotional needs of others. They tend to have poor Theory of Mind (a poor understanding of the thoughts, feelings, behaviours and intentions of others). Children and adolescents with HFA often get into trouble at school, exasperate teachers and are the subject of teasing and bullying. As a result, many tend to experience isolation, rejection and a lack of understanding of their everyday lives. This often results is frustration, anger, anxiety, depression and poor self-esteem.

Given the above patterns of strengths and weaknesses, it is likely that individuals with HFA may have a negative effect on couple, family and working relationships. Problems such as poor communication (coupled with a lack of awareness that the individual is on the Autism Spectrum), sexual concerns, misunderstandings, and a feeling of not being valued or understood frequently occur. These problems can impact both those individuals with HFA and the people living with them.

On a brighter note, individuals with HFA desire to be part of the group and can often learn to encode social cues intellectually rather than instinctively. Likewise, parents, friends, partners and employers can also learn to work with difference and enjoy the rewards that arise from sharing their lives with these unique individuals. Therapists who are cognisant of the implications of HFA are able to provide effective coping strategies and can offer employers, work colleagues, partners and parent's greater understanding of individuals with HFA and how to interact successfully with them.


Co-occurring Conditions

Approximately 60-70% of individuals with ASD have one or more separately co-occurring psychiatric conditions. A co-occurring condition is defined as a condition that co-exists or co-occurs with another diagnosis so that both share a primary focus of clinical and educational attention. Research indicates that individuals with ASD show a high prevalence for meeting criteria for other psychiatric conditions, such as Attention Deficit/Hyperactivity Disorder (ADHD), depression, anxiety disorders, disruptive behaviour disorders (ODD and Conduct Disorder), learning and language disorder/difficulties, and dyspraxia (motor planning disorder with poor short-term memory), all of which contribute to overall impairment.

Individuals with ASD also display a greater prevalence of co-occurring medical conditions such as sleep disorders, gastrointestinal issues (constipation, diarrhoea, colitis), weak/low muscle tone, loose ligaments (hypermobility) metabolic and hormonal differences, hypothyroidism, immune related conditions (ear infections, allergies, asthma, eczema), headaches and migraines, and epilepsy.


Social Communication Disorder

A.
Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
B.
The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C.
The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).

Diagnostic Services

ETOH provides 'best practice' assessment and diagnosis for Autism Spectrum Disorders from early childhood through to Adulthood.

A multidisciplinary approach is adopted to collect and utilise data from numerous reliable sources in order to make accurate diagnostic assessments. These sources may include class teachers, paediatricians, psychiatrists, general practitioners, speech pathologists, occupational therapists and family members.

Parents are encouraged to provide previous reports from other health professionals prior to the appointment. Following the assessment, strategies will be developed and advice given.

A typical diagnostic assessment may include:
Autism Screening Tools
The Autism Diagnostic Observation Schedule - Second Edition (ADOS II)
The Autism Diagnostic Interview (ADI-R)
An Assessment of Adaptive Behaviour (Vineland-II)
An Assessment of Communication and Social Skills
(Spence Social Skills and Social Worries Questionnaires)
An Assessment for Anxiety and Depression (Spence Children's Anxiety Scale and Child Depression Inventory)
School or home observation when necessary
Behavioural Assessments


Intervention Services

Problem-solving

1-hour appointments are offered for advice about managing problems associated with Autism or Asperger's Syndrome. During the appointment the problems will be explored and a plan of action devised. Further therapy or assessment may be recommended as part of the plan.

A wide range of therapeutic interventions are utilised at ETOH and are tailored for each unique individual. They include: Cognitive Behaviour Therapy, Behavioural Analysis, Play Therapy, Relationship Therapy (Couple and Family Therapy), Sexual Health Therapy and Specific Skill Training.

Specific Skill Training

Skills training provided through ETOH include: Emotion management and regulation, stress management & social skill training, plus extensive Parental and Carer Training. This may be done individually or in a Group setting.


Helping Children with Autism

The Federal Government provides funds to assist children with autism and their families. Your family may be able to access this funding to assist with costs associated with attending appointments at Embracing the Other Half Psychology Clinic.

The Helping Children with Autism Initiative's Medicare items are in addition to existing programs (including the GP Mental Health Care Plans), and provide parents and caregivers with an additional way of accessing health services under Medicare. The Autism/Pervasive Developmental Disorder (PDD) items focus on early intervention for children with a new diagnosis.

To be eligible for this funding, certain initial steps need to be followed, as outlined below.

Assessment

Assessment can only be carried out on children under 13 years old.

Make an appointment for your child to see a GP for PDD behaviours to be identified. If identified, the GP will then refer your child to a paediatrician or a psychiatrist.
The paediatrician or psychiatrist will collect history and take some initial observations and assessment data.
If the paediatrician or psychiatrist feels that a PDD diagnosis should be considered, your child will be referred to the therapist that he/she feels is appropriate; for example, a psychologist, speech pathologist or occupational therapist. The family can claim four assessments with any combination of these therapists.
The therapist(s) then send their report(s) back to the referring paediatrician or psychiatrist, giving a summary of their results and clinical opinion. If the paediatrician or psychiatrist feels that a diagnosis of PDD is warranted, then he/she meets with the family to advise of the diagnosis and develop a treatment plan.

Treatment

Where a diagnosis of PDD has been given (prior to the child turning 13), a paediatrician or psychiatrist can refer children under 15 years old for treatment sessions to a psychologist, speech pathologist or occupational therapist.

A paediatrician or psychiatrist is required to write the treatment plan either at the consultation when the results of the diagnostic assessment are shared, or, for children already diagnosed, during a scheduled appointment to discuss the child's current needs.
Ten therapy sessions can be initiated before a review is required, and these can be made up by a combination of the three professionals (psychologist, speech pathologist or occupational therapist). The paediatrician or psychiatrist, in consultation with the therapists and the family, decide how these sessions are to be divided up.
After ten sessions a review of the treatment plan is required. At this time, the paediatrician or psychiatrist may wish to schedule a direct consultation with the family, prior to writing to the therapists advising how the next ten sessions are to be distributed.
Copyright Embracing the Other Half Psychology Clinic 2014