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2014 Convention News
Washington DC, February 18–21

Up Close: Autism Spectrum Disorder and Mental Health in the Classroom

By James Coplan

Examples of Sessions Addressing ASD

You have more than 1,000 paper, mini-skills, symposia, and poster presentations from which to choose that are included in your convention registration. Following are examples of some sessions addressing autism spectrum disorders. For the listing of all sessions available at the conventions, visit the 2014 Convention website.

MS006 Assessment and Diagnosis of Autism Spectrum Disorder, Asperger, and ADHD

MS021 Autism Evaluations Best Practice Methods and the DSM-5

MS024 Autism Evaluations: Student Interview Techniques to Individualize the Diagnosis

MS167 ASD Consultation Toolkit: Effective Consulting to Support Students With ASD

MS192 Integrated Approach to Multidisciplinary Team Evaluation of Autism Spectrum Disorders

PA099 An Analysis of Language for Preschoolers With Autism Spectrum Disorder

PA141 Identifying Current and Needed Transition Services for Students With Autism

PA142 Increasing Social Engagement in Elementary-Age Children With Autism

PA166 Developmentally Appropriate Social Skill Interventions for Children With Autism

PA202 Providing Services for Students With Autism Within an RTI Framework

PA211 Behavioral and Social Impacts of Having a Sibling With Autism

PA214 Supporting Neurotypical Siblings of Children With Autism Spectrum Disorders

PA216 Peer Mediation to Improve Social Communication of Adolescents With Autism

PA266 Facilitating Healthy Interpersonal Relationships for Adolescents With Autism Spectrum Disorders

PA274 If the Shoe Fits: ADHD Interventions for High Functioning Autism

PA275 Including Students With Autism: A Peer Support Intervention

PA297 Psychosocial Functioning in Siblings of Children With Autism.

PA304 Video Self-Modeling Among Young Adults on the Autism Spectrum

PA323 Parent Decision Making Regarding Treatment Selection for Autism Spectrum Disorders

PA353 Using the CBCL to Evaluate Emotional– Behavioral Disorders in Autism

PA411 Home–School Collaboration: A Parent Driven Video Self-Modeling Intervention

PA474 Home–School Communication for Students With Autism Using Direct Behavior Rating

PA557 Mother's Experiences Raising Children With Autism From Around the World

PA616 Examining the Cognitive Nonverbal Profile in Autism Spectrum Disorders

PA626 Conducting a Comprehensive Autism Spectrum Disorder Assessment in the Schools

The third installment in our “Up Close” series of Q&As with 2014 convention presenters takes a closer look at some key factors related to autism spectrum disorder (ASD), an increasingly prevalent diagnosis among school-age children. Convention workshop presenter James Coplan, MD (Neurodevelopmental Pediatrics of Main Line, Rosemont, PA) discusses some of the issues concerning comorbid mental health problems in children with ASD. This is the primary focus of the workshop he will present at the convention, WS021: Mental Health Issues in ASD on Thursday, February 20, 8:30–11:30 a.m. Specific registration is required for workshops, which provide documented NASP- and APA-approved CPD. Relevant Domains of Practice (NASP Practice Model): 1, 3, 4, 7, and 8.

Seventy years have passed since Leo Kanner added “autism” to the medical lexicon. His seminal article from 1943, “Autistic Disturbances of Affective Contact,” remains the best description of what we now refer to as ASD. To access this original article, go to www.drcoplan.com, and click on Related Links.

NASP: What causes ASD?

Coplan: The leading confirmed causes of ASD are all genetic. There are 30,000 genes in the human genome; half of these genes are expressed in the brain, and hundreds of individual gene defects have been identified in persons with ASD. Some of these defects are common; others are rare. Collectively, however, genetic factors account for the overwhelming proportion of cases in which a cause can be identified. Despite much publicity in the lay press, there is no convincing evidence that immunizations cause ASD.

NASP: Can you speak to the reports of increasing incidence of ASD?

Coplan: There is no proof that we are experiencing an epidemic (i.e., actual increased incidence) of ASD. On the other hand, the proportion of children identified as having ASD (the “administrative prevalence”) has increased sharply in the past decade, but most of this increase probably reflects changes in federal law (prior to 1990, autism was not a federally recognized educational disability) and broadening of diagnostic criteria.

NASP: How frequently do students with ASD experience comorbid mental health problems?

Coplan: Mental health disorders occur frequently in children with ASD. Internalizing behaviors (anxiety, obsessive thinking, and perfectionism) are extremely common. Depression probably goes underdiagnosed, but is also common (at least, among adults with ASD). Given the highly genetic nature of ASD, it is not surprising that one or both parents of a student with ASD often have mental health issues themselves—typically anxiety, but sometimes depression, obsessive–compulsive disorder, or bipolar disorder. Mental health issues in a parent often impede the parent's ability to respond to the child's needs in an adaptive fashion. The combination of mental illness in a parent plus ASD (with or without mental health issues) in the child is a potentially catastrophic combination.

NASP: Do you believe that medical intervention is ever indicated for students with ASD?

Coplan: Students with ASD frequently experience anxiety, and the use of selective serotonin reuptake inhibitors (SSRIs such as fluoxetine) is an accepted mode of treatment for childhood anxiety disorders. The SSRIs do not treat ASD per se, but they can substantially reduce the burden of anxiety and cognitive rigidity, and enable the child to benefit more fully from behavioral interventions.

Dysregulation of attention is also common in children with ASD. As in children with garden-variety attention deficit hyperactivity disorder, pharmacologic intervention (stimulants, alpha-2 agonists) is often beneficial. Some children with ASD have neurologically driven disruptive behavior, which may lead to spontaneous periods of aggression. This is different from the disruptive behavior seen as a direct consequence of anxiety, rigidity, and perfectionism, where there is a clear antecedent (e.g., inability to complete a task perfectly). In these situations, treatment with one of the atypical neuroleptics (risperidone, aripiprazole, etc.) may be helpful.

NASP: Do you have any recommendations for behavioral interventions when pharmacological treatment is not recommended?

Coplan: Virtually all children with ASD would benefit from a positive behavior support plan for internalizing behavior. Importantly though, functional behavioral assessments (FBAs) should more regularly take internalizing problems into account. FBAs rarely list anxiety or perfectionism as antecedent conditions, and usually fail to consider that disruptive or task-avoidant behavior may be serving the function of anxiety reduction rather than simple escape from task. As a result, behavior plans often overfocus on compliance, rather than anxiety reduction. This is another area where active collaboration between school psychologists (who have a broader concept of child development) and behavioral psychologists (who traditionally disregard “private mental events”) would be of tremendous value in terms of reorienting the underlying premises and basic thrust of the behavior plan.

NASP: What do you see on the horizon for our understanding of ASD?

Coplan: At present, ASD remains a condition defined by its symptoms rather than by its underlying biology, although we have a few pieces of the puzzle in place. In the coming decade, we can look forward to a more biologically based definition, taking advantage of rapid developments in neuroscience and behavioral genetics. A firm understanding of the underlying biology of ASD will, in turn, lead to rationally based medical and developmental interventions. Services for adults with ASD—especially those with high functioning ASD who are capable of living independently—will begin to receive the attention they deserve. This will require the creation of service systems not now in existence.

James Coplan, MD, is a neurodevelopmental pediatrician in Rosemont, Pennsylvania.