Differentiating Features of ASD and ADH D Behaviors Differences from ASD Similarities with ASD • Does not need to exhibit delays, alth ough may (Per Russell Barkley, 2006): demon st rate excessive speech . • Delayed expressive language disorders ( 10 - • Delayed internalization (vs. non-internalization ) of 54%). ~~- speech . • Pragmatic deficits in 60% of children with ~ J:l. • Stan dardized assessment should find skills within the ADHD. normal range of functioning. • Poor Theory of Mind . • Often lacks age-appropriate social sk ills, but • Disrupted social interactions . demonstrates a desire to engage in social interaction . . Delayed social skills, • Often able to initiate but not maintain relationships. • May look as if there is a disinterest in Social • Has Theory of Mind, although may appe.ar insensitive developing social relationships. Interaction or uncaring due to impulsivity and immaturity. • Few successful interpersonal relationships. • As adults: > time talking on phone, w atching TV, and • Cannot talk or play quietly, disruptive, difficulty socializing (per R. Barkley, 2006). ,.-.. aiting turns • Appears self-centered - poor Theory of Min d . • ADH D is an executive functioning, self-regulation, • Both may ,display disruptive behaviors, but ~~_ru:, (e.g., Impulsive, Hyperactive, etiology is dissimilar (e.g., child with ASD m ay Restless and fidgety, Disorganized an d forgetful). be disruptive due to difficulty with Patterns of • Appears to enjoy multiple activities going on at one environmental demands vs. child with ADH D Behavior time. being disru ptive because of level of • Difficulty completing l~, but has skills to do so . energy/impulsivity). • Gravitates to dangerous activities (vs. not aware of • No sense of time (" temporal dysfunction"). aanger ). • works 1mpu1s1ve1y, careless mistakes, poor • Redu ced capacity for rule-governed behavior . attention t o detail. • Uneven gr-oss/fine motor skills or clumsiness . • May seek high sensory input . • May display ~~ motor activity. • Difficulty accepting soothing or holding when younger . Responses to Sensory

CRP- Services September 2007 www.crporegon .org Differentiating Features of ASD and Adjustment Disorders (With , With Mixed Anxiety/Depressed Mood, With Disturbance of Conduct, With Mixed Disturbance of Emotions)

Behaviors Differences from ASD Similarities with ASD . Communication develops at a normal rate, uni ess . May exhibit some communication challenges at child has a secondary communication disorder. the point the child meets criteria for Adj ustment Disorder. ~~ . Lack of communication is due to a specifically fM.i.Q(l. identified social .

• Prior to onset, normal seeking of social interaction . • May exhibit delayed/ impaired social interaction . . Social development is congruent with cognitive . May exhibit little seeking to share enjoyment or abilities. interests with others. Social . Limited social-emotional reciprocity. Interaction . Difficulty initiating or maintaining adequate relationships.

. Cognitive skills are not affected by onset of . Patterns of behavior may appear con stricted Adj ustment Disorder. and/ or stereotypic ( often in an attempt to . Disorder is direct result of a psychosocial stressor(s) control environment ). Patterns of (e.g., divorce, translocation, ~ ) and not t o a Behavior biological/ genetic disorder.

. Normal responses to sensory input prior to onset of . May exhibit irritability/anger/ rage wh en sensory Adj ustment Disorder. information is perceived as " too much" , Responses to Sensory

CRP-Autism Services September 2007 www.crporegon .org Differentiating features of ASD and (, , Specific or Social , OCD, PTSD, Acute DO, Generalized Anxiety DO, Anxiety Disorder, NOS)

Behaviors Oifferences from ASD Similarities with ASD • Expressive and receptive language skills are • Communication can be very stilted and limited . commensurate with cognitive level. • Can look as if there is a delay or absence of • Does not typically exhibit idiosyncratic or repetitive spoken language when child is highly anxious . ~~ language, ~ Q(l, • Can demonstrate conversational reciprocity.

• When in comfort zone, able to demonstrate age- • Poor eye contact, appropriate socialization skills. • Lm·.i initiation of socializing with others . • Seeks to share enjoyment or interests with others, • Limited circle of friends . Social • Can demonstrate ability to engage in social- • Developmentally immature. Interaction emotional reciprocity - Theory of Mind, • Impaired use of non-verbal behaviors (e.g., eye • Can demonstrate empathy/insight into others contact, facial expression, gestures . feelings/thoughts. • Failure to develop age-appropr iate peer • Can imitate and engage in pretend play, relationships,

• When in comfort zone, can demonstrate spontaneity • May engage in stereotypical behavior to control and ability to transition from one activity to another . environment when in an anxiety provoking situation . Patterns of Behavior

• Typically when in comfort zone, not hypo- or !l,~ • May become overwhelmed and demonstrate am~. !l,~~I(, in anxiety provoking situations. Responses to Sensory

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and

Behaviors Differences from ASD Similarities with ASD • Speech/ language skills developmental history is • Depending on phase of disorder, speech may congruent with child's cognitive abilities. appe.ar odd/ stilted/ pr essured/ rapid or absent , • Standardized assessment should find skills withi, the • Grandiose belief in personal abilities that defy ~~ normal range of functioning. laws of logic (knows more than teachers, etc.), ~ J:l. • Social skill developmental history is congruent ,·.ith • Due to phase of disorder, 1'ay appe.ar inhibited child"s cognitive abilities. and poor quality. • Typically do better when t, ere is an established Social "safel' person. Interaction • Withdrawal from others - prefer to be alone. • Difficulty establishing and maintaining relationships. • Difficulty engaging in play with others . • Inappropriate or precocious sexual behavior . • Bipolar diso·der is a chronic, lifetime condition that • Impaired j udgment , can be managed (not cured) with medication an,j • Engagement in high-risk behaviors. lifestyle ch;;nges. Symptoms wax and wane on own • Hyperactivity/agitation and distractibility. Patterns of and with changes in child"s development, therefore • Explosive, lengthy, and often destructive rages. Behavior managing disorder via medication and environmental • / Crying for no apparent reason , support can be challenging, • Self-inj urious or self-destructive behaviors. • BP affects areas of the brain that regulate memory, speech, thought, emotions, personality, planning, ;in xi~t y, fru~tr;itinn , ;iggrP_C..!=:inn, ;inrl imnul~~ r:nntrol.

• Greatly increased or decreased sexual drive. • Extreme irritability. • Increased strength and energy along with decreased • Generally tend to better with "environmental sleep. planning" , Responses to • Often perform better in an environment that Sensory reduces distractions and improves ability to focus and behave appropri3tely , • Difficulty with novel situat ons .

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Central Auditory Processing Disorder (CAPO)

Behaviors CAPD is different from ASD because the student ... CAPD & ASD MAY share SOME sim ilarities, such as ... . I s able to read nonverbal cues and adj ust behavior . Difficulty processing verbal information when accordingly. presented with competin g stimuli. . Eye cont act is normal. . Difficulty following multi -step directions. ~~ . Difficulty remembering information presented fMWJ:l. aurally, may prefer visual. . Orients to spoken language, but information comes in scrambled.

. I s motivated to orient to speaker, but message . Difficulty sustaining and directing attention, may be "scrambled" especially against competing noises. . I s socially motivated and demonstrates social . Difficulty following long -conversations. Social knowledge and use, . Confusion over words with similar sounds. Interaction . I s able to use perspective taking; theory of mind . Lack of awareness of speaker. intact. . Lack of understanding of speech , . I s able to use executive functioning skills. . Difficulty with organization , . I s generally compliant . . VIQ < PIQ . I s nexible around transitions. . Poor performance in auditory-based Patterns of ~~~ tests. Behavior . Reading, spelling or speech problems. . Unexplained poor academic performance, . Child does not hear phon ics acutely, . Sensitive to certain sound frequencies, and has . Unusual sensitivity or complaints about noise, difficulty distinguishing sounds, but does not have . May have auditory memory problems. Sensory a multi-sensory disorder. .. ASD and CAPD "s1m 1lant1es" section, from the work of Martin L. )WJ,llru:,(2005), "Kids In the Syndrome Mix"

CRP-Autism Services September 2007 1w1w.crporegon .org Differentiating Features of ASD and Childhood Disintegrative Disorder (CDD)

Childhood Disintegrative Disorder is a condition occurring in 3· 4 year ~i!l.~.9~~Lv ~J:it~~~ and language functioning, I t is also known as Disintegrative or Heller's Syndrome. This rare condition was described many years before autism but has only recently been officially recognized . With COD, chil dren develop a &QR(!iggo ~·1!:)iQl resembles autism but only after a relatively prolonged period of normal development . This condition differ s fr om autism in the pattern of onset, cour se, and outcome. The gener al pr ognosis for this condition is WORSE than that for autism . Fewer than two children per 100,000 with ASD could be classified as having COD -~ E. (2002) The etiology is unknown but several lines of evidence suggest that it arises as a result of some form of central nervous system pathology, More boys than gir ls a re affected, Treatment is similar to ASD due to the overlapping characteristics of both disorders. There needs to be a coordinated effort by parents, teachers and therapists to work together to support development in social adj ustment and speech development in the child. Posit ive reinforcement in appropriate language an d behavio• responses have bee successful in supporting skill development .

Behaviors Differences from ASD Similarities with ASD • Seemingly normal development for up to the first • Impairment in non-verbal behaviors. ~~ 2 years of life, with age-appropriate verbal and • Delay or lack of spoken language. ~ Q(l. nonverbal communication , • Inability to initiate or sustain a conversation . • Loss of expressive or receptive language skills begins at 3· 4 years old or later. • Seemingly normal development for up to the first • Failure to develop peer relationships. Social 2 years of life, with age-appropriate social • Lack of or limited varied make believe play. Interaction relationships and interactions, imaginative play, and modified behavior. • Loss of social interaction skills and/ or social interest begins at 3· 4 years old or later. • Significant loss of previously gained appropriate • Frequently: severe mental retardation . Patterns of developmental skills. Method of play becomes • Restricted patterns and stereotyped patterns of Behavior ritual. behavior, interests and activities including motor • Loss of motor skills . ~P.ffl..~ and mannerisms. • Loss of bowel and bladder control. Responses to • Greater abnormality in auditory responsiveness. Sensory

CRP•Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Depressive Disorders

Behaviors Differences from ASD Similarities with ASD • Early onset communication delays are not present • May exhibit communication deficits due to in relationship to meeting other criteria of mood depression , disorder. ~~ • Standardized assessment should find skills within ~ J:l. the normal range of functioning, • May display Poor Theory of Mind due to lack of engagement in world. • Tend to do well in Cognitive Behavioral Therapy, • Until is diagnosed, normal social • Social interaction may be blunted due to lack of development . enthusiasm in entering in to social interchange,

Social Interaction

• Developmental patterns are normal until onset of • Low frustration tolerance . depression . • Difficulty with abstraction , • Irritable or cranky mood may develop (rather than Patterns of sad or dejected mood). Behavior • May appe.ar abrupt or rude. • Executive Function deficits. • Self-inj urious or self-destructive behaviors .

• May be under-stimulated by sensory input , • May demonstrate irritability/ low tolerance to sensory input Responses to Sensory

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Down §,yndrome

Etiology: Down ~~ is a genetic syndrome caused by u:i,¾tU,I( of chromosome 21 and is the most common chromosomal cause of mental retar dation . Associated medical conditions include: multiple developmental brain abnormalities, con genital heart disease, vision/dental issues, seizures, abnormalities of gastrointestinal/cardiac/endocrine/ ligaments, disor ders of blood, higher risk of leukemia, predisposition toward Alzheimer's disea se, and distinctive physical/facial characteristics . 9...S:£m 1/800 births ( 7-10% of these will have ASD too)(Average age at ASD diagnosis: 9-14 year s old). Behaviors Differences from ASD Co-existing with ASD • Communication development • Delay in or total lack of development of spoken language, commensurate with developmental level. • I f verbal, marked impairment in ability to initiate/ sustain ~ • Lack of verbal language is compensated conversation with stereotypic/idiosyncr atic use of language. fMWJ:l. by use of gesture or mime, • May show dramatic loss or plateau in acquisition/ use of sign or verbal skills (usually occurring between age 3-7 years), • Social/emotional skills development • Marked impairment in use of eye gaze/ facia I (including Theory of Mind) is more expression/gestures. typical but aligned with cognitive delays. • Failure to develop peer relations equal to developmental level. Social • Responsive to interaction , • May display excessive irritability/ anxiety or dramatic loss in Interaction • Peer relationships/ pretend ~_g~ acquisition/ use of social relating skills (usually between age 3- with delays dependent on degree of 7 years), cognitive impairment . • Lack of varied, spontaneous pretend play or social imitative • Use eye gaze, gesture, lil£iiil expression play appropriate to developmental level. appropriate for developmental level. • Cognitive (thinking, reasoning, • Marked stereotypic/repetitive motor mannerisms. Onset may understanding) is the key affected area follow period of more 'typical' ( overall delayed) development of development with profile of skills (regression usually noted between age 3-7 years), Patterns of evenly delayed. • !Disruptive behaviors (aggression, tantrums, extreme non- Behavior • Interests, nexibility, attention develop compliance), appropriately for developmental level. • Hyperactivity, short attention, impulsivity . • Encompassing preoccupation-stereotyped/restricted pattern of interest . • I nnexible adherence to specific, nonfunctional routines/ rituals . • Persistent preoccupation with parts of obj ects, nonfunctional t oy use • ~ I(, extremely low tone. • l!Jnusual responses (especially to sounds, lights, touch or pain ), • Excessive mouthing of nonfood obj ects . • Food refusal/limited diet (preferred textures or tastes), Responses • Self-inj urious behavior (skin picking, head hitting/ banging, to Sensory eye-poking, or biting), • Sleep disturbances . Sources include: Glenn ¼!~(1 998); Capone, G., ~ , M. et al (2005)

CRP-Autism Services September 2007 www.crporegon.org Differentiating Features of ASD and Qysi:1raxia (Developmental Qysi:1raxia of Speech)

Behaviors Oevelopmental .0.Y.SAt il.l.lii! of Speech Some Similarities with / Oifferences from ASD • Difficulty with speech due to motor planning, • May co-exist with ASD . • Articulation more impaired as utterance lengthens. • Articulation not key element in ASD . • Comprehension better than expressive, • Comprehension deficit. ~~ • Prosody may be effected but secondary to speech • Prosody affected. ~ Q(l. effort. • May repe.at words or phrases. • May repe.at same word, trying to come up with the next word. • May be little to no babbling or idiosyncratic speech . • May be little to no babbling in infancy. • May be slow language development , • Slow language development ,

• Theory of mind intact . • Theory of mind deficit. • Re.ading nonverbal within normal limits. • Difficulty re.ading nonverbal. • Compensation with non-speech modalities. May • Global communication impairment , Social develop complex gesture system to compensate, Interaction • May experience frustration/ low self-esteem. • May experience frustration/ low self-esteem, • May impact behavior and social (not related to • Qualitative difference related to underlying theory of mind deficit). comprehension and theory of mind deficit.

• May have other fine motor difficulties. • May have fine motor difficulties. Patterns of • May have difficulties acquiring re.ading, written • May have difficulties with re.ading comprehension, Behavior expression, and spelling. written expression, and spelling ( or may be a strong speller ).

• May be feeding issues in history. • May be feeding issues in history. Responses to • May be hypotonic. • Usually not significant in ASD unless coexisting Sensory with other disorders. • May have hypersensitivities. • Seen in some with ASD.

American Speech-Language and He.aring Assoc,at,on, 1997-2007 (www.3sha.org) ~~Jl, S.L. (2002) ·w·w·w .apraxia~kids. org

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Expressive Language Disorder:

Behaviors Expressive Language Disorder ASD . Spontaneous Remarks twice as often as in ASD . Fewer Spontaneous Remarks . Primary topics more likely about ongoing . May have innexible topics game/activity ~~ . Use of appropriate or prompted immediate . Use of appropriate or prompted immediate fM.i.QQ, echolalia echolali a . Seldom uses delayed echol alia . Delayed echolalia is more frequent . More intact comprehension of language . More significant comprehension impairment . More syntactical impairmen t . Syntax often not impaired . Less automatic/nonverbal/other utterances (hums, . More au tomatic/nonverbal/other utterances grunts) . Gestures within normal lim its . Global communic. impairment- gestures impacted . Comprehension of nonverbal is w/in normal limits . Comprehension of nonverbal is impaired . More communicative intent . May be less communicative intent . Less apt to have significant pragmatic impairment . Pragmatic impairment . Compensation with other forms . All communicative forms are impaired Social . Nonverbal early play is mor e typical . Nonver bal early play skills are impaired Interaction . Theory of Mind is intact . Theory of Mind deficits are central to ASD . Difficulty with peer relation.ships may increase as they get older but are qualitatively different from those in ASD

Patterns of . Not pervasive. . Pervasive Behavior . Not intense or pervasive . Intense/pervasive except possible in those with Responses . May be distractible ~L Syndrome or as the child gets older. to Sens·ory

To qualify as a child with a language disorder (as per the DSM-IV), criteria must not be met for POD-NOS

Sources: Cantwell, Baker, ~ & ~ q (1989); ?..ii~~& Cox (1977); Cantwell, Baker & ~(1978); ~~.,cwt & ~ 2000 I CRP-Autism Services September 2007 www .crporegon .org Differentiating Features: ASD & Fetal Alcohol ~ndrome(FAS)/ Fetai Alcohol Affects(FAE): Fetal Alcohol Syndrome disorders are caused by a prenatal exposure to alcohol. The effects may include physical, mental, behavioral, and/ or learning disabilities with possible lifelong implications. The facial features associated with Fetal Alcohol Syndrome form during a very short time of the pregnancy and if there is no drinking during that time the child may have the same brain damage but ,a more invisible disability. The Institute of Medicine has identified three other related diagnoses: Partial FAS: facial anomalies and other symptoms withou t all the signs of FAS • Alcohol-related w~JQPMJllill disorder (ARND): CNS defects & behavior problems or cognitive deficits (e.g., speech delays, hyperactivity) • Alcohol-related birth defects (ARBD): damage to organs, bones, or muscles• Prevalence of FAS is estim ated to be 0.5-2 per 1,000 births. Prevalence of FAS, ARND, & ARBD combined is at least 10 per 1,000 ( 1 % of all llirth.sl! Behaviors Differences from ASD Similarities with ASD No period of typical development followed by . Delayed language developmen t . ~~ loss of skills. . Pragmatic difficulties, Literal in terpretation , fMJ.Q(l, . Language production higher th an comprehension , . Word retrieval difficulties . . Interest in social engagement but poor social skills . Social . Delays in development of play skills. Interaction . Indiscriminant attachment to others. . Depression, social isolation , . Naive childlike manner . . Difficulties with peer relationsh ips . . Difficulty reading social cues/ adj usting behavior to match environment. No period of typical development followed by . Difficulty learning from past experiences, grasping concept Patterns of loss of skills. of historic & future time, matching aspirations to ability. Behavior . Good performance on concrete tasks but poor abstract reasoning. . Learning and memory problem s . . Difficulty seeing cause/ effect, poor ~~Wld,Qg_, poor j udgment . . Difficulty handling change in routine. May ~ on previous activity or routine, Responses to . Fine motor difficulties . Sensory . Poor attention/ Distracted/ Hyperactive/ Impulsive, . Easily ~.sum,~ -becomes confused or agitated and disorganized. 1. Stratton, K., Howe, C., & ?)l,m,gJ.ii!, F. (Eds.), (1996.L~ ~-G9.a~~QQ!1, Resource Guide: http://www.def. state. n .us/mentalhealth/pu blications/fasq uide. pdf

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Fragile X Syndrome Fragile X syndrome is a genetic condition (mutation of FMRl gene on X Chromosome) that causes a range of developmental problems including le.arning disabilities and mental retardation . Usually males are more severely affected by this disorder than females. Most males with fragile X have character istic physical features that become more apparent with age. Fragile X syndrome occurs in approximately 1 in 4,000 males and 1 in 8,000 females . An estimated 15-30% of those with Fragile X also have autism (Rogers, et . al., 2001). Professor s at Emory University recently determined that a region of the mutated FMRl gene repe.ats a ~~- sequence of DNA bases 200-1,000 times (normal is 6- 55 repeats)....,This causes the absence of the FMR protein normally pr oduced by the gene. They will be screening/ identifyin g the best dru gs to try and correct the deficiencies that result from fragile X syndrome. I 1:1uan.ta, ••9L J..RIJlZ~JJ.P.l l. Behaviors Differences from ASD Similarities with ASD • $~~M_g, aw.tiam. in girls. • Delayed development of speech and language . • Lack of/difficulty with oral speech for • Many benefit from augmentative communication and will boys often due to differences in physical transition to oral speech . ~~ structures. • Many girls - VIQ (vocabulary/ syntax) may be in the normal ~Q(l. range with weakness in conversational skills/ pragmatics . • Voice often high-pitch, loud volume, harsh tone. ~ speech . • Difficulty with multiple meaning/ abstract terms. • P.grn.~xgrn.tiY.!l. speech, echolalia, movie tal<, self-talk . • Interested in social interaction, e.ager to • Poor eye contact, poor topic maintenance, tangential comments. Social make contact. • Poor awareness of facial expression, nonverbal cues, tone of Interaction voice,, • . • Those w/BDTH more cognitive impact • Hand napping. than 'just' ASD or 'just' Fragile X. • Attention, memory, sequencing difficulties - incre.asing tasks • Girls: better reading/ writing skills. May become more abstract. Patterns of be specific LD & low i)_¼Q; mild cog delay. • Weak auditory memory. Behavior • Boys: better on self-care, household • Boys: visual perception/matching/ memory is a strengt h management than on • Pattern of strengt hs/weaknesses (good memory for movies, social/communication . songs). • Success ,·,/memory tasks strongly • Many achieve more than expected given cognitive scores. innuenced by me.aningfulness. • Boys: more li

CRP-Autism Services September 2007 www.crporegon .org Differentiating features of ASD and Mental Retardation

Behaviors Differences from ASD Similarities with ASD • Delays are consistent across receptive, expressive Significant communication delays are evident and non-verbal language rather than an including: inconsistent pattern. • Delay or lack of development of spoken language. ~ • Lack of developmentally appropriate make-believe • Inability to initiate or sustain a conversation . ~ J:l. play/symbolic play (but does exist at the • Poorly developed Theory of Mind developmental level of the child). • Social interaction skills are delayed, but child seeks • Significant social interaction delays are evident . to interact with the world around him or her at the • Poorly developed Theory of Mind. cognitively app. developmental level. Social • Social/emotional reciprocity. Interaction • Ability to engage in play and games • Joint Attention . • Nonverbal communication . • Global delays across all adaptive behavioral and • Patterns of behavior may be quite cognitive levels (e.g., communication, daily living repetitive/stereotypic, unimaginative, and rote. Patterns of skills, problem solving, gross and fine motor, • May engage in self-stimulatory behavior (without Behavior socialization ). understanding social mores). • Delays in all areas of adaptive functioning .

• May not exhibit marked responses to sensory • May exhibit responses to sensory - can be input . "quirky" to sensory input . Responses to Sensory

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Nonverbal Learning Disability (NVLD)

Behaviors NVLD is diffe re nt from ASD because the student.. .. NVLD and ASD may share some similarities, such as. .. . I s more interested in symbolic play. . Trouble integrating nonverbal communication with ~ . Has verbal skills average to above average, verbal communication in order to achieve full social @.i9):l. interaction , . Exceptional ~ speech, memory. . Has proximity issues to others and obj ects (due . Functional and pragmatic use of language is to poor spatial orientation ), impaired. Social . Clearly wants social acceptance, . Poor social intuition , Interaction . Appears self-centered, rude, weird, kU~, . Misinterprets social cues . . Has difficulty with visual perception , . Difficulty with adj ustments to change, . Has difficulty scanning the visual field and . Poor spatial orientation , processing what is seen or attending to teaching Academic problems: Patterns of strategies that use visual modality. . Exceptional decoding, poor comprehension , Behavior . Has difficulty with tactile perception , . Poor organization, difficulty with inferential reading. . Does not have the ability to identify something . Math facts are better than concepts. by touch alone or attend to teaching strategies . Focuses on details, misses big picture, using tactile, . PIQ

From the work of Martin )WJ,llru:,(2005), "Kids m the Syndrome Mix."

CRP-Autism Services September 2007 www.crporegon .org Differentiating features of ASD and Obsessive Compulsive Disorder

Behaviors Differences from ASD Similarities with ASD . Communication skills developmentally age . May exhibit difficulties with interactive ~~ appropriate. communication [in OCD it may be due to obsessions fM.i.Q(l. (thoughts) or compulsions (behavior) that cause severe stress or are so time-consuming they interfere with normal routine and ability to interact with social world], . Social skills development is age appropriate, . May demonstrate social awkwardness or an inability to interact with others [in OCD it may be due to obsessions (thoughts) or compulsions (behavior) Social that cause severe stress or are so time-consuming Interaction they interfere with normal routin e and ability to interact with social world], . Cognitive development is age appropriate (child . Constricted, repetitive, stereotypic (Patterns of is fully cogn izant of obsessions and compulsions behavior may look very similar t•O behavioral patters and understands thoughts/ behaviors are for children with ASD). Patterns of senseless/ unreasonable, Behavior . Typical OCD onset after early childhood versus early childh ood onset for autism , . Medication and cognitive behavioral treatment highly successful in treating disorder vs. little or no effect.

. In OCD, behavior/ sensory input is sought to . May demonstrate odd responses to sensory input . neutralize or prevent discomfort vs. behavior Responses to derives pie.a sure or reassurance, Sensory

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Post Tra umatic Stress Disorder (PTSD):

Post Disorder is a mental and emotional condittion that has its origins in a physical and/ or ment ally traumatic event that occurred anywhere from a few days to several years in the past. The causative factors may include exposure to traumatic event, threats or serious injury/exposure to event cau.sing intense fear, helplessness or horror.

Behaviors Differences from ASD Similarities with ASD . Attempts to avoid thoughts, feelings or . Restricted range of facial expressions. discussion of trauma, ~~ . Communication skills are intact. ~ J:l. . Attempts to avoid activities, places or people . Co occurring anxiety disorder, depression , that arouse memories. Social . Feelings of detachment or estrangement from Interaction others. . Social-cognitive skills are intact. . Intense distress at exposure to cues that . ~ _g_. symbolize part of the event . . Trouble sleeping or staying asleep. Patterns of . An inability to remember important details of t he . Poor concentration, Behavior trauma. . t:J.i..~ sequence trauma events when recalling trauma . Strongly lowered interest in significant activities. event . . Sense of hopelessness about the future, . Compulsive repetition in play of traumatic events. . Physical response on exposure to cues . Irritability or outbursts of anger. symbolizing the event , . An exaggerated startle response, Responses to Sensory

CRP-Autism Services September 2007 www.crporegon.org Differentnating Features of ASD and Reactive (RAD):

RAD: Disturbed and developmentally inappropriate social relatedness, before age of five years, directly subsequent to grossly pathological care, This pathological behavior may inclu de forms of neglect, abuse, mistreatment or abandonment .

Behaviors Differences from ASD Similarities with ASD • Able to make good eye contact -except when • Constant chatter/ nonsense questions . angry or lying. • Problems making eye contact, • May have intact communication skills (within • Abnormal speech patterns. ~~ normal limits). • Uninterested in le.arning communication skills. &mQQ, • Superficially charming and engaging (particularly • Indiscriminant affection -often to strangers but not around strangers or those they can m anipulate). on parents' terms. • Demanding or clingy, often at inappr opriate • Trouble understanding cause and effect, Social times. • Little or no empathy; often have not developed a Interaction • Argu mentative, often over silly things. conscience . • Lyin g for no apparent reason . • Have difficulty in forming healthy relationships with • Cruelty to animals. peers, caregivers and families . • False allegations of abuse . • • A severe w_gg_ to control everything and everyone, • ~Freq uent tempe- r tantrums or rage, often over which worsens as child gets older. trivial things. • ~ - Patterns of • False allegations of abuse. • Developmental/ learning delays. Behavior • Destructive to property or to self. • Ste.aling, • Fascination 1.-Jith fire, blood, gore, ,.-., e.apons, evil .

• Hyperactive. • Poor impulse control.

Responses to Sensory

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and ~ Syndrome

&,U. Syndrome is a disorder of brain development that occurs almost exclusively in girls. After 6-18 months of apparently normal development, girls with the classic form of &,U. syndrome develop severe problems with language, communication, le.arning, coordination, and other br ain functions. Affected girls lose pur,oseful use of their hands and begin making repe.ated hand wringing/washing or clapping motions. Other symptoms can include br e.athing abnormalities, seizures, an abnormal curvature of the spine (scoli osis), and sleep disturbances. There are several variants of &,U. syndr ome with overlapping signs and symptoms. Most cases of classic &,U. syndrome are caused by mutations in the MECP2 gene (pr ovides instructions for making a protein (MeCP2) that is critical for normal brain development ). The atypical forms ran ge from a mild type, in which speech is preserved, to a very severe type that has no period of normal development . &n.taffects an estimated 1 in 10,000-15,000 females (affected males usually die before birth/ in infancy).

Behaviors Differences from ASD Similarities with ASD • Communication efforts improve in Stage III. • Loss of language skills in Stage II, ~~ • Crying is main mode of communication • Expressive Language severely affected. ~Q(l. • Some may retain speech ,

• Increase in eye contact, social a,.·.,areness in • Loss of eye contact/decreased interest in Social Stage III. environment or social interaction begins @ 6-18 Interaction • Prefer people ~ obj ects. months (Stage I ). • Intense eye contact/eye pointing, • Laugh/cry/scream without apparent reason . • Early normal head growth is followed by • Less attention span during regression deceleration starting in infancy • May retain purposeful hand use, Patterns of • Loss of purposeful hand use. • Understand more than they can express. Behavior • Repetitive hand movements (usually at midline) can be nearly constant- even in sleep (wringing, hand mouthing, clapping). • I f ambulatory: stiff-legged gait • oe walking • Poor circulation in legs/feet • Seizures Responses to • Loss of Normal Sleep Patterns Sensory • ?~ • Constipation • High pain tolerance or inconsistent response to pain . ~~Rockville, MD: National Institute of Child Health and Human Development, 2001

CRP-Autism Services September 2007 www.crporegon .org Differentiating Features of ASD and Sensory Processing Disorder Behaviors Oifferences from ASD Similarities with ASD ~ 00.IJ.W.O.i~ . ~ aJiil, not common . . Delays in speech and/ or language, fM.i.QQ. . Usually interested in social interactions. . Social difficulties and/ or emotional problems. . Adequate awareness of facial expression , . May appear defiant to authority figure, difficulty following Social . Often overly affectionate with others. directions Interaction . Oversensitivity to criticism . Poor self-concept. . Avoids eye contract. . Difficulty makin g friends . . Repetitive motor mannerisms less • Tends to be easily distracted. Difficulty paying atten tion . common (hand napping), . Impulsive, lackin g in self-control. . Difficulty transitioning from one situation to another . . Inability to unwind or calm self . . Delays in academic achievement . . Restless and fidgety. Jumps from one activity to another Patterns of frequently and it interferes with play. Behavior . Memory difficulties and/ or problems following direct ions. . Seems anxious, . May lack nexibilit y -explosive reactions/tantrums . Repetitive motor mannerisms (hand napping), . Jumping, swingin g and spinning excessively, . Lack of creativitry/Variety in play. (i.,e., plays with same toys -same manner -over & over; only wants to watch same TV shows or videos over and over. . Difficulty handling small obj ects such as . Over &;or under reactive to touch/movement/sights/sounds. buttons or snaps (also seen in SOME with • Activity level that is unusually high and/ or unusually low , ASD but not a defining characteristic of • Physical clumsin,ess or apparent carelessness. the disability), • Gravitational insecurity -anxious when feet leave th•e ground. . Difficulty calming after exercise • Tactile defensiveness - may withdraw when touched, avoids getting hands clirty. • Avoids certain food textures/ tastes/smells that are trypically Responses to part of children's diets. Sensory • Avoids certain clothing textures/bothered by tags, seams. . May have decreased awareness of pain or temperatu re, . May walk on toe.s . . Difficulty calming after emotional upset Source: S.~e,- 5. & Qal,Qt!, L (2004)

CRP-Autism Services September 2007 www .crporegon .org Differentiating Features of ASD and Visual Impairment/ Bli ndness

Beh aviors Differences from ASD Co-existing with ASD • Conversational skills develop within normal • Language may not ,develop or may be ~_rop~, range. 1.-Jithout communicative intent, • May have brief pronominal reverse period. stereotyped/ repetitive/ idiosyncratic, ~~ • Limited experien ces may contribute to • Extended period of pronominal reversal. f.,(filQ(l. language development that is delayed (but n ot • Marked pragmatic impairments in those with adequate distorted) and difficulties with abstract speech (Little or no conversational reciprocity, t alk language. primarily on topic of ~ interest). • Relationships m ay be delayed but will develop. • Peer relationships n on-existent or distorted . • Shows pleasure in social exchanges & social • Shows little social curiosity/ interest or actively avoids curiosity. social interaction , Social • Will seek to share information and experiences. • Treats others as obj ects. Interaction • Can demonstrat e empathy toward others. • Does not seem to u nderstand social given/take. • Can engage in socially appropriate give/take • Lack of pretend play/social imitative play appropriate relative to developmental level. to developmental level. • Imitative & pretend play may be compromised • Affective behaviors not consistent with developmental at early ages due to vision impairment/lack of level. concrete experiences. • Relatively easy to engage in a variety of • Not responsive to typical interventions for young activities and redirect from 'arun' behavior. children with visual impairments (multi-sensory • Normal nexibility in normal life events. approaches, narrating events for the child, hand -over- Patterns of • Obj ects, with appropriate instructions, are hand presentation ), Beh avior typically used functionally for child's • Highly restricted interests. Materials used more developmental age, repetitively than pu rposefully & persistent • Stereotypic beh aviors & restricted interests (if preoccupation with parts of obj ects. present ), decrease as child gains skills in • Repetitive/stereotypic behaviors (hand napping, interacting with the environment . complex body movements & nonfunctional rout ines) are pervasive and ~ resistant to interruption , • Very innexible durin g transition/change in routine . • Attends to relevant stimuli. • Does not explore alternative sensory modalities or • Very alert to su rroundings via other senses . exhibit appropriate sensory responses. • Hypersensitive responses (if present ) to Responses to touch/sound/ smell are compensation for visual Sen sory loss and decrease as child gains skills in interacting with the environment . • Eye-poking due to lack of other visual stimulation is amenable to redirection ,

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