Autism Spectrum Disorder - 1st Edition

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Autism
Spectrum
Disorder
Edited by

Martin J. Lubetsky, MD
Western Psychiatric Institute and Clinic of UPMC
University of Pittsburgh School of Medicine
Pittsburgh, PA

Benjamin L. Handen, PhD, BCBA-D

Western Psychiatric Institute and Clinic of UPMC
University of Pittsburgh School of Medicine
Pittsburgh, PA

John J. McGonigle, PhD

Western Psychiatric Institute and Clinic of UPMC
University of Pittsburgh School of Medicine
Pittsburgh, PA

1
1
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Copyright © 2011 by Oxford University Press, Inc.
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All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
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Library of Congress Cataloging-in-Publication Data
Autism spectrum disorder / edited by Martin J. Lubetsky, Benjamin L. Handen, John J. McGonigle.
p. ; cm. — (Pittsburgh pocket psychiatry series)
Includes bibliographical references and index.
ISBN 978-0-19-975385-7 (alk. paper)
1. Autism in children—Diagnosis. 2. Autism in children—Treatment. I. Lubetsky, Martin J.
II. Handen, Benjamin L. III. McGonigle, John J. IV. Series: Pittsburgh pocket psychiatry series.
[DNLM: 1. Autistic Disorder—diagnosis. 2. Adolescent. 3. Autistic Disorder—therapy.
4. Child. WS 350.6]
RJ506.A9A92374 2011
618.92'85882—dc22 2010054146

9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper

This material is not intended to be, and should not be considered, a substitute for medical or other
professional advice. Treatment for the conditions described in this material is highly dependent on
the individual circumstances. And, while this material is designed to offer accurate information with
respect to the subject matter covered and to be current as of the time it was written, research
and knowledge about medical and health issues is constantly evolving and dose schedules for
medications are being revised continually, with new side effects recognized and accounted for
regularly. Readers must therefore always check the product information and clinical procedures
with the most up-to-date published product information and data sheets provided by the
manufacturers and the most recent codes of conduct and safety regulation. The publisher and the
authors make no representations or warranties to readers, express or implied, as to the accuracy or
completeness of this material. Without limiting the foregoing, the publisher and the authors make
no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in
the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility
for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or
application of any of the contents of this material.
To the children, adolescents and adults with autism and their families with
whom we have worked and who teach us so much.
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 vii

Series Introduction

We stand on the threshold of a new Golden Age of clinical and behav-

ioral neuroscience with psychiatry at its fore. With the Pittsburgh Pocket
Psychiatry series, we intend to encompass the breadth and depth of our
current understanding of human behavior in health and disease. Using the
structure of resident didactic teaching, we will be able to ensure that each
subject area relevant for both current and future practicing psychiatrists is
detailed and described. New innovations in diagnosis and treatment will be
reviewed and discussed in the context of existing knowledge, and each book
in the series will propose new directions for scientific inquiry and discovery.
The aim of the series as a whole is to integrate findings from all areas of
medicine and neuroscience previously segregated as “mind” or “body,”
“psychological” or “biological.” Thus, each book from the Pittsburgh Pocket
Psychiatry series will stand alone as a standard text for anyone wishing to
learn about a specific subject area. The series will be the most coherent and
flexible learning resource available.

David J. Kupfer, MD
Michael J. Travis, MD
Michelle S. Horner, DO
This page intentionally left blank
 ix

About Autism Spectrum

Disorder
It has been our experience that many professionals are seeking additional
training in working with individuals who have autism spectrum disorder
(ASD). With a prevalence rate of one in 110 people having a diagnosis of
ASD, more medical, behavioral health, and allied health care professionals
are needed to serve this growing population. Consequently, there is a need
for increased training in ASD, especially for psychiatry residents and child
and adolescent psychiatry fellows, as well as residents in pediatrics, neu-
rology, family medicine, internal medicine, and other fields in medicine.
Medical schools are increasingly recognizing the importance of training phy-
sicians in how to screen, diagnose, and treat individuals with ASD. Primary
care physicians are more frequently being expected to provide early identi-
fication and ongoing care for individuals with ASD. In addition, allied health
care professionals, such as psychologists, dentists, speech and language spe-
cialists, occupational therapists, and physical therapists, as well as educators
and teachers, are more involved in providing services to this population.
In the future, adult health care professionals will provide clinical care to an
increasing number of adults with ASD.
It is our goal in writing and editing Autism Spectrum Disorder–Pittsburgh
Pocket Psychiatry Series to compile relevant and useful instruction from
educators, clinicians, and researchers at Western Psychiatric Institute
and Clinic (WPIC), University of Pittsburgh Medical Center (UPMC), the
University of Pittsburgh, and the School of Medicine. Throughout the text
we will refer to autism spectrum disorder as ASD (the term “autism”
will be used in the chapter on historical perspective). With the upcoming
changes in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders–5,
American Psychiatric Association), the separate diagnostic classifications
under “pervasive developmental disorder” (PDD) may be subsumed under
one category of ASD (DSM-5 Workgroup, APA). ASD will now include
autistic disorder (autism), Asperger’s disorder, childhood disintegrative
disorder, and pervasive developmental disorder—not otherwise specified.
Also, we will refer to “intellectual disability” rather than the old terminology
of “mental retardation,” which is also likely to be changed in DSM-5.
The reader will find a standard format for each chapter. Key Fact boxes
summarize pertinent points to remember. Tables and diagrams are used
to organize selected important information. Questions are located at the
end of each chapter to test the reader’s knowledge, and each chapter has
further readings to help enhance understanding.
We hope that the reader will gain clinically useful knowledge from Autism
Spectrum Disorder—Pittsburgh Pocket Psychiatry Series and will share it with
other professionals, and that families will find it useful as well.

Martin J. Lubetsky, Benjamin L. Handen, and John J. McGonigle

Pittsburgh, Pennsylvania, 2011
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 xi

Contents

1 Autism—Historical Perspective, Theories,

and DSM Diagnostic Criteria 3
Tiberiu Bodea and Martin J. Lubetsky
2 Recognition of Autism Spectrum
Disorder—Early Identification and Diagnosis 19
John J. McGonigle, Virginia Martin, and
Martin J. Lubetsky
3 Medical Evaluation and Comorbid
Psychiatric Disorders 41
Carla A. Mazefsky, Robyn Filipink,
Jodi Lindsey, and Martin J. Lubetsky
4 Neurobiology of Autism Spectrum Disorder 85
Kathryn McFadden, Nancy J. Minshew, and
K. Suzanne Scherf
5 Functional Behavioral Assessment (FBA) 115
Jennifer B. Alfieri, Rebecca Burkley, and
John J. McGonigle
6 Introduction to Treatment Chapters:
Treatment Overview 135
Benjamin L. Handen, Johanna Taylor,
Kylan Turner, and Martin J. Lubetsky
7 Early Childhood Interventions 147
Louise A. Kaczmarek, Kylan Turner, and
Jennifer B. Alfieri
8 Language Interventions 173
Diane L. Williams and Lori J. Marra
xii CONTENTS

9 Feeding, Sleep, and Toileting Interventions 193

Kristine Kielar, Cynthia R. Johnson, and
Benjamin L. Handen
10 Educational Issues: School-Age 215
Michelle Lubetsky, Virginia Martin, and
Benjamin L. Handen
11 Transition-Age and Adult Interventions 231
John J. McGonigle, Allen Meade Gregory, and
Martin J. Lubetsky
12 Addressing Behavioral and
Emotional Challenges in School-Age
Children and Adolescents with ASD 253
Carla A. Mazefsky and Benjamin L. Handen
13 Social Challenges and Social Skills Interventions 271
Michelle Lubetsky, Melissa Smiley Jacobson, and
Benjamin L. Handen
14 Pharmacological Interventions 295
Benjamin L. Handen, Tiberiu Bodea,
Rameshwari V. Tumuluru, and Martin J. Lubetsky
Future Directions 325
Martin J. Lubetsky, Benjamin L. Handen,
John J. McGonigle, and co-authors

Index 329
 xiii

Contributors

Jennifer B. Alfieri, MS, BCBA Cynthia R. Johnson, PhD,

Western Psychiatric Institute and BCBA-D
Clinic of UPMC Departments of Pediatrics and
Pittsburgh, PA Psychiatry
Children’s Hospital
Tiberiu Bodea, MD of UPMC
Western Psychiatric Institute and University of Pittsburgh School of
Clinic of UPMC Medicine
University of Pittsburgh School of Pittsburgh, PA
Medicine
Pittsburgh, PA Louise A. Kaczmarek, PhD
Department of Instruction &
Rebecca Burkley, MS Learning
Western Psychiatric Institute and School of Education
Clinic of UPMC University of Pittsburgh
Pittsburgh, PA Pittsburgh, PA
Robyn Filipink, MD Kristine Kielar, MS, BCBA
Division of Child Neurology Western Psychiatric
Children’s Hospital of Pittsburgh Institute and Clinic
of UPMC of UPMC
University of Pittsburgh School of Pittsburgh, PA
Medicine
Pittsburgh, PA Jodi Lindsey, MD
Department of Pediatrics
Allen Meade Gregory, MA Children’s Hospital of Pittsburgh
Western Psychiatric Institute and of UPMC
Clinic of UPMC University of Pittsburgh School of
Pittsburgh, PA Medicine
Pittsburgh, PA
Benjamin L. Handen, PhD,
BCBA-D Martin J. Lubetsky, MD
Western Psychiatric Institute and Western Psychiatric Institute and
Clinic of UPMC Clinic of UPMC
University of Pittsburgh School of University of Pittsburgh
Medicine School of Medicine
Pittsburgh, PA Pittsburgh, PA
Melissa Smiley Jacobson, Michelle Lubetsky, MEd,
MSW, LCSW BCBA
Western Psychiatric Institute and Allegheny Intermediate
Clinic of UPMC Unit
Pittsburgh, PA Homestead, PA
xiv CONTRIBUTORS

Lori J. Marra, MA, CCC-SLP K. Suzanne Scherf, PhD

Department of Speech-Language Center for the Neural
Pathology Basis of Cognition
Duquesne University Department of
Pittsburgh, PA Psychology
Carnegie Mellon
Virginia Martin, PsyD University
Western Psychiatric Institute and Pittsburgh, PA
Clinic of UPMC
Pittsburgh, PA Johanna Taylor, MEd, BCBA
Department of Instruction &
Carla A. Mazefsky, PhD
Learning
Western Psychiatric Institute and University of Pittsburgh
Clinic of UPMC School of Education
University of Pittsburgh Pittsburgh, PA
School of Medicine
Pittsburgh, PA Rameshwari V. Tumuluru,
Kathryn McFadden, MD MD
Department of Pathology Western Psychiatric
University of Pittsburgh Institute and Clinic
School of Medicine of UPMC
Pittsburgh, PA University of Pittsburgh
School of Medicine
John J. McGonigle, PhD Pittsburgh, PA
Western Psychiatric Institute and
Clinic of UPMC Kylan Turner, MEd, BCBA
University of Pittsburgh Department of Instruction &
School of Medicine Learning
Pittsburgh, PA University of Pittsburgh
School of Education
Nancy J. Minshew, MD Pittsburgh, PA
Departments of Psychiatry and
Neurology Diane L. Williams, PhD,
Western Psychiatric Institute and CCC-SLP
Clinic of UPMC Department of Speech-Language
University of Pittsburgh Pathology
School of Medicine Duquesne University
Pittsburgh, PA Pittsburgh, PA
Autism
Spectrum
Disorder