Exam 2

Neurodevelopment

Refers to the brain’s development of neurological pathways that influence performance OR function

These behaviors include intellectual functioning, reading ability, social skills, memory, attention and focus skills

Executive Functioning

A set of cognitive processes that allows individuals to plan, organize and execute a task, manage their thoughts/actions, and achieve goals (i.e., cognitive control)

What types of behaviors require the processes of executive functioning?

1. Working Memory - hold/manipulate information in your mind over short periods.

2. Flexible Thinking - ability to shift thinking when faced with novel information

3. Self-Control - ability to regulate emotions/behaviors/impulses. Aids in resisting distractions.

4. Planning - ability to map out steps to achieve a goal, and in a logical sequence

5. Self-monitoring - tracking one’s behaviors/performance

6. Time Management - ability to estimate time availability + time it takes to do a task

7. Organization - keeping things in a structured and logical order

8. Attention - ability to maintain focus on task/relevant information WHILE ignoring distractions

Developmental Milestones

A set of goals or markers that a child is expected to achieve during maturation.

4 Developmental Milestones to Identify

1. Cognitive

2. Social/Emotional

3. Language & Communication

4. Physical (Gross + Fine motor)

Cognitive Developmental Milestones

These milestones include ability in:

• Thinking

• Reasoning

• Problem-solving

Social/Emotional Developmental Milestones

These milestones include ability in:

• initiating peer contact

• group play

• adaptive skills (dressing, eating)

Language & Communication Developmental Milestones

These milestones include ability in:

• Babbling/signing

• Speaking

Physical Developmental Milestones

These milestones include ability in:

Gross Motor - use of LARGE muscle groups

• walking

• crawling

• rolling over

Fine Motor - use of SMALLER muscle groups; more precise movements

• Drawing

• stacking

• throwing/catching

Developmental Milestone “Red Flags” during early infancy

• 2 months - lack of fixation

• 4 months - lack of visual tracking

• 6 months - Failure to turn to sound/voice

• 9 months - Lack of babbling consonant sounds

• 24 months - failure to use single words

• 36 months - failure to speak in three-word sentences

Protection and Prevention of psychological disorders in children

• Prenatal Care

• Positive Parenting

• Nutrition

• Social Support

• Trauma Awareness

• Psychoeducation

• Sleep

• Postpartum depression/anxiety

• Avoid substance use

• Prevention programs

Prenatal Stress

Conceptualized as the combination of prenatal anxiety, perceived stress, and depression during a mother’s pregnancy period

Prenatal Stress and Child Development

Prenatal stress has been negatively associated with infant neurodevelopment (King and Laplante, 2005)

Fetal Programming Hypothesis

Because the fetal brain is exceptionally plastic, changes caused by intrauterine environment (in the womb) during critical periods of tissue growth can permanently alter organ structure, function and health outcomes for infants

Sleep Disorders

Conditions that disrupt normal sleep patterns

Sleep disorders and child psychopathology

Sleep disorders often mimic or worsen many symptoms of the major psychopathological disorders in children.

Trajectories of Sleep

Early Life - sleep patterns and needs drastically change

• Newborns - Sleep 16-17 hours/day

  • Often experience night-waking issues

• Toddlers - ~13 hours/day + daytime naps (1-2 hrs)

Adolescence - Increased need for sleep, but get less sleep than in early childhood

Older Adults - Sleep patterns shift, with many changes in their NREM sleep (negative changes!)

Overview of Sleep Disorders in Children

Sleep disorders in children can range from difficulties falling asleep to excessive sleepiness and sleep disruptions

Disorders include:

• Insomnia

• Hypersomnolence

• Narcolepsy

• Breathing-Related Sleep Disorders

• Circadian Rhythm Sleep Disorder

• Nightmares

• NREM Sleep Arousal Disorders

  • Sleep Terrors

  • Sleepwalking

Prevalence and age of onset vary, with some disorders common among toddlers, preschoolers, or adolescents

Insomnia Disorder

Difficulty initiating OR maintaining sleep; Sleep that is not restorative (i.e., waking up tired); in infants, ID is accompanied by repetitive night waking + inability to fall asleep

Prevalence: affects 25-50% of 1-3 yos

Hypersomnolence Disorder

Excessive daytime sleepiness that is illustrated by prolonged sleep episodes or daytime sleep episodes

Prevalence: common among YOUNG CHILDREN

Narcolepsy

Neurological disorder that affects the brain’s ability to control sleep-wake cycles. Difficulty staying awake and randomly falling asleep + loss of muscle control (cataplexy)

Prevalence: <1% of children/adolescents

Breathing-Related Sleep Disorder

Sleep disruptions caused by sleep-related breathing difficulties, leading to insomnia or sleepiness

Prevalence: 1-2% of young children

Circadian Rhythm Sleep Disorder

Mismatch between internal sleep-wake cycles (circadian rhythm), and environmental schedule, causing insomnia or sleep disruptions.

Symptoms - late sleep onset, difficulty awakening in morning, sleeping in, resistance to sleep changes.

Prevalence: ~7% of adolescents (older children)

Nightmare Disorder

Repeated awakenings with detailed recall of long, frightening dreams; generally occur during 2nd half of sleep period

Prevalence: common among 3-8 yos

NREM Sleep Arousal Disorders

Sleep Terrors - abrupt awakenings with panic, crying, sweating, and distress during 1/3 of the sleep cycle; no memory of the terror episode

Prevalence - 3% of 18 mo-6 yos

Sleepwalking - episodes of walking during sleep, usually occurring in the 1/3 of the sleep cycle; no memory of the episode.

Prevalence - 15% of children have 1 episode; 1-6% have 1-4 attacks PER WEEK; rare in adolescence.

3 Treatments of Childhood Sleep Disorders

1. Natural Subsiding: sleep difficulties in infants/toddlers often resolve on their own

   • Strategies - reducing stress before bed and incorporating afternoon naps

2. Behavioral Interventions:

   • teach parents to attend to the child’s need for comfort

   • gradually withdrawing from the room to promote independent sleep.

3. Positive Reinforcement & Sleep Hygiene:

   • establishing good sleep hygiene (that fits the child’s development stage)

   • use of praise, star charts or other reinforcement methods to encourage consistent bedtime routine

Sleep Hygiene

Set of healthy habits and environmental factors that can help a child sleep better.

Signs of POOR sleep hygiene

Having a hard time falling asleep, experiencing frequent sleep disturbances, and suffering daytime sleepiness.

Ways to improve sleep hygiene

• Set a sleep schedule - fixed wake up and bedtimes

• Don’t force yourself to sleep

• avoid caffeine, alcohol and nicotine

• Avoid napping (adults)

• Include naps (child)

• Only use your bed for sleeping

• Exercise and eat well

• sleep in comfortable environment

• Relaxation techniques

• no dining late

• dim the lights

• unplug

Studies of environmental effects on sleep disorders in childhood

1. Impacts of COVID-19 lockdown on sleep in children with ASD

   • Found that changes due to quarantine resulted in significant changes in bedtime routine and showed increases in sleep disturbances

Juvenile Arthritis

Most common form of arthritis in child is Juvenile Idiopathic Arthritis (JIA)

• Childhood Arthritis can cause permanent physical damage to joints. This can make it hard for the child to do daily task, and can result in disability

NOT A DSM-V DISORDER

Tic Disorders (2)

1. Tourette’s Disorder

2. Persistent Motor or Vocal Tic Disorder

Tourette’s Disorder

Definition - chronic neurodevelopmental disorder that causes people to have sudden, repetition and involuntary motor AND vocal burst, called “tics”. Has NOT been attributed to substance use or other medial conditions

Symptoms

• the motor or vocal tics present during the illness

• tics may wax and wane, but have persisted for more than 1 year since first tic onset

Onset - before 18 years old

Persistent Motor/Vocal Tic Disorder

Definition - a person has had motor OR vocal tics for at least 1 year. Does NOT have motor and vocal tics at the same time.

Symptoms

• the motor or vocal tics present during the illness

• tics may wax and wane, but have persisted for more than 1 year since first tic onset

• diagnosed if child never met criteria for Tourette’s

Onset - before 18 years old

Case Vignette: Zandy (11-year-old; private school)

Primary Diagnosis

• Generalized Anxiety Disorder (GAD)

• Motor tic disorder (linked to anxiety)

Treatment Recommendations

• “Cool Kids Anxiety Program” - structured cognitive-behavioral program that is designed to reduce anxiety in children

• Behavioral interventions - introduce relaxation techniques or Habit Reversal Therapy (HRT) to help manage motor tics that increase with anxiety

  • HRT - replacing unwanted habits with other actions

• Anxiety Management - exposure therapy, mindfulness techniques

Diabetes

Definition - chronic condition that occurs when the body doesn’t produce enough insulin or can’t use it properly.

Symptoms

• Fatigue

• Thirst

• Hunger

• Frequent urination

• weight loss despite excessive eating

Treatments

• daily treatment regime (e.g., blood-glucose monitoring; insulin injections)

• dietary restrictions

NOT A DSM DISORDER

Health Issues that Occur with Diabetes

1. Insulin regulation

   • Too LITTLE/HIGH insulin = diabetic coma

   • Too LITTLE insulin = hypoglycemia

2. Hypoglycemia

   • episodes are unpleasant

   • can include irritability, headaches, and shakiness

Case Vignette: Brandon (14 y; ADHD, T1MD) — Parents referred
him for treatment due to difficulties with emotion dysregulation and social skills. He is also very smart but has slow processing speed scores. He struggles with organization skills, and his grades sometimes do not reflect his understanding because of these difficulties.

1. Diagnoses:

   • ADHD

   • T1MD

2. Behavioral Concerns

   • emotional dysregulation

   • social skills

   • slow processing speed scores

   • organizational skills

   • poor grades (despite good understanding of material)

Case Vignette: Brandon (14 y; ADHD, T1MD)

1. How might these two disorders play a role in his presentation?

1. Presentation

   • ADHD - contributes to difficulties with emotion regulation, organization and slow processing speed. This can affect social skills and academic performance despite intelligence.

   • T1MD - T1 diabetes; can affect mood/energy levels due to blood sugar fluctuations, potentially exacerbating emotional dysregulation, making it difficult to focus on task

Case Vignette: Brandon (14 y; ADHD, T1MD)

3. How are parents resources?

2. Parental Resources

   • ADHD: ADHD-specific support groups; educational workshops on managing ADHD in adolescents

   • T1MD: diabetes education programs for parents AND child; support groups for families

Case Vignette: Brandon (14 y; ADHD, T1MD)

3. IEP in place? How can the school help?

3. IEPs

   • IEP should address both child’s ADHD and processing speed issues:

   • School should provide extended time on tests/assignments; offer organizational/time management coaching

Obesity

Definition - chronic disease that occurs when someone has too much body fat

Prevalence - for children aged 2-19:

• 19.3% (~14.4M)

  • 13% among 2-5 yo, 20% among 6-11 yo, and 21 among 12-19 yo

Obesity, Attention, and ADHD in childhood

1. Research links obesity to attention deficits and ADHD-like symptoms

2. Impulsivity and inattention may increase food intake, then weight gain

3. Sleep Difficulties associated with obesity may cause increase of inattention during the school day

Enuresis

Definition - repeated unloading of urine into bed/clothes

Symptoms

• Occurs at least 2x a week for 3 consecutive months

• distress

• impairment in social, academic, or other important areas of functioning

Onset - 5 years old (or equivalent in developmental stage)

Behavior is not attributed to physiological effects of a substance or other medical conditions.

Encopresis

Definition - pooping/release of feces in inappropriate places

Symptoms

• Occurs each month over 3 months

Onset - 4 years old (or equivalent in developmental stage)

Behavior is not attributed to physiological effects of a substance or other medical conditions (unless using constipation related medication)

Why are Enuresis and Encopresis included in the DSM?

• These disorders can lead to psychological distress and limitations on social activities (think: 4 D’s)

• negatively impacts self-esteem and can create social ostracism

• Can indicate significant developmental, psychological or medical issues.

DSM is used to help diagnose these conditions to ensure appropriate treatment, and mitigate mental disorders.

Multi-method Assessment Approach

A way of using multiple types of test to gain knowledge about an individual or construct (i.e., novel disorders)

Incorporates data collected from a variety of informants from a variety of settings:

1. Clinical interviews

2. Observations

3. Checklist and Rating Scales

4. Testing

How does Multi-method assessment approach aid clinicians in diagnosing and treating intellectual disabilities in children?

• Aids clinicians to formulate more detailed assessment

• Develop more precise and targeted treatments/interventions for the child

• identify problems that might otherwise go unnoticed

Child Clinical Assessment

An evaluation of a child’s emotional, social/behavioral, and cognitive functioning, as well as their family/school environments and functioning in these areas

Used to identify factors contributing to a child’s difficulties and strengths

What are the Two Types of Child Clinical Assessments?

1. Psychodiagnostic - determines if the child meets criteria for a disorder

2. Psychoeducational - focuses on understanding how and why a child is performing a certain way in school

What is the main goal of Child Clinical Assessment?

• Enhance a child’s development and wellbeing

• The assessment process tailors interventions to address both difficulties and strengths the child has, improving outcomes in emotional, cognitive, and social/behavioral areas.

Non-verbal Reasoning Test (a type of cognitive assessment)

Used to evaluate problem-solving abilities, logic, and abstract thinking. Often included in intelligence tests or psychodiagnostic assessments for children to measure pattern recognition and visual-spatial processing.

Biases when assessing cognition in childhood: IQ Test

History - IQ tests have been historically used to assess intelligence, but have also shown biases AGAINST certain groups (racial/ethnic)

Bias in Black-White IQ Differences - research has found average point differences between Black/White test-takers IQ. These differences are influenced by socioeconomic, cultural and educational factors rather than pure cognitive ability

How has IQ test been used to discriminate against those with intellectual disabilities?

IQ tests were used to justify discriminatory practices, including eugenics, anti-disability laws, and immigration restrictions

How can we identify bias within a psychology test?

An identifying factor is if the test predicts different outcomes based on the group taking it, rather than accurately reflecting academic/cognitive ability across all groups

How was IQ Score Curve previously used to diagnose Intellectual Disability (ID)?

IQ score curve classified individuals with an IQ test score below 70 (~2SD below the mean) as having an intellectual disability.

However, later realized that adaptive functioning (personal independence + social skills) and age of onset needs to be considered before diagnosing ID.

Intellectual Disability

Characterized by deficits in intellectual functioning and difficulties in adaptive functioning that we expect to occur at a given developmental period

DSM-V Criteria for Intellectual Disability

THREE criteria must be met:

1. Deficits in intellectual functions, confirmed by BOTH clinical assessment and individualized intelligence testing (i.e., reasoning, problem-solving, planning, academic learning, etc.)

2. Deficits in adaptive functioning that result in failure to meet developmental AND sociocultural standards

3. Age of Onset of the signs identified in 1 and 2

Genetic vs Organic Disorders

Genetic disorders are caused by abnormalities in a person’s DNA, whereas organic disorders are caused by physical or biochemical changes in the body

Etiology of Intellectual Disability (origins)

• Over 1,000 genetic disorders associated with ID, in addition to organic causes

• Scientist are unsure of the causes of a majority of IDs, even mild ID

Categories of intellectual disabilities (FOUR)

1. Biomedical - related to biologic processes, such as genetic disorders or nutrition

2. Social - related to social/family interaction, such as child stimulation and adult responsiveness

3. Behavioral - harmful behaviors, such as maternal substance abuse.

4. Educational - related to availability of family and educational supports that promote mental development and gains in adaptive skills

Health and Other Related Disorders

1. Sleep Disorders

2. Juvenile Arthritis

3. Tic Disorders (Tourette’s and Persistence Motor/Vocal Tic Disorders)

4. Diabetes

Prevalence of intellectual disabilities in children

Overall -1-3%

• Male to female ratio = 2:1

• Mild ID is more prevalent among children of lower SES, and minority groups

  • At more severe ID these differences are almost equal among racial/economic groups

Prevention and Treatment of ID

No “cure”

• abortion used to be presented as an option if it is detected that the baby is abnormaling developing during gestation

• Can try to prevent ID in SOME cases (i.e., mitigating maternal infections, heavy metal exposure, etc.)

Early Intervention is the most beneficial and CRUCIAL for treatment of ID

Types of Intervention for childhood intellectual disabilities

EARLY INTERVENTION!!

1. Behavioral interventions

2. Family-based interventions

Types of treatment/intervention for children with intellectual disabilities

Treatment involves caregivers and other adults who participate in early, intensive, child-focused activities:

1. Behavioral Therapy and Management

2. Parent Training and Education

3. Language training for children

4. School support AND services (ex. accommodations)

What are some difficulties that came up in providing education for children with intellectual disabilities during the pandemic?

1. Limited Access to Resources - many children lacked access to technology and internet connectivity for online learning

2. Inconsistent Support - family support varied, affecting the consistency for educational engagement

3. Disruption of Routines - Changes in daily routines led to increased anxiety and difficulty focusing

4. Lack of Specialized Instruction -Difficulty to provide tailored support due to remove learning constraints

5. Social Isolation - reduced interaction with peers, which is crucial for social and emotional development

What are some ways in which psychologist respond to difficulties in education for children with intellectual disabilities?

1. Advocacy for Resources - promote policies that ensure equitable access to technology and educational resources

2. Individualized Support - develop tailored treatment plans that meet each child’s needs, and making it flexible to adapt to potential changes

3. Parental Guidance - provide parental training and resources for parents to support their child’s learning at home

History of Autism Spectrum Disorder

Ancient stories suggest children with ASF have been around for centuries

“Elfin children” were thought to be children that were left in place of real, human babies that were stolen away. These children were described as strange and remote, much like a child w/ ASD would be described.

Dr. Leo Kanner and Autism Research (1943)

Dr. Kanner was a psychiatrist who published the FIRST system description of childhood autism disorder

Children (w/ ASD) displayed:

• more attention to objects than normal people

• lacked social awareness

• limited to no language

• displayed stereotyped motor activities (i.e., preservation of sameness)

Preservation of Sameness

A behavioral characteristic of those with ASD, where the person exhibits a strong need for consistency and resists changes in routines, environments, or objects

Dr. Hans Asperger and ASD research (1944)

Dr. Asperger’s is noted for his early studies in atypical neurology, more specifically diagnosing milder forms of ASD in childhood.

Described a milder form of ASD that became known as Asperger’s Disorder; compared them to “absent-minded professors”

Asperger’s Syndrome

A form of Autism Spectrum Disorder (neurodevelopmental), characterized by:

• Difficulty interacting socially, understanding social situations and body language.

• Monotone voice

• Repetitive behaviors and standing firm on beliefs

Onset - symptoms usually present around 3 yo, but official diagnosis doesn’t occur until age 7.

Childhood Disintegrative Disorder (CDD)

Children develop normally through age 3-4, then over a few months, they lose language, motor, social and other skills that they have already learned (ectopic development)

Pervasive Developmental Disorders (PDD)

Delays in the development of socialization/communication skills. Parents may see symptoms as early as infancy, although typical age of onset is before 3 yo (delayed development)

ASD and Classifications under DSM-5

Categories under ASD (DSM-5)

1. Autism

2. Childhood Disintergrative Disorder (CDD)

3. Asperger’s Syndrome (AS)

4. Pervasive Developmental Disorder (PDD)

DSM uses this classification because the symptoms and severity of the neurodevelopmental condition can vary widely between individuals, so there is a “spectrum” of presentations

NOS classification under DSM-5

“Not Otherwise Specified”

Used to described conditions/disorders that had symptoms that fit a general diagnosis, but don’t meet the criteria for a specific diagnosis

Behaviors of Autism Spectrum Disorder (DSM-5)

1. Persistent deficits in social communication and social interaction across MULTIPLE contexts

2. Restricted repetitive patterns of behavior, interests or activities

3. Present from early childhood

4. Impair or limit everyday functioning

5. May be comorbid with intellectual disability, but ID is NOT part of the diagnostic criteria for ASD

Development of Behavioral Symptoms and Atypical Neural Pathways of ASD (AT BIRTH)

• Behavioral - Atypical Response to Social Cues

  • Decreased preference for social stimuli

  • Decreased social orienting (i.e., no response when name is called)

  • Decreased anticipatory pleasure associated with social stimuli (smiling at faces)

• Neural Pathways - Decreased Activation of Neural Reward System

  • amygdala activation

  • prefrontal cortex (PFC) activity

Development of Behavioral Symptoms and Atypical Neural Pathways of ASD (12-18 MONTHS)

• Behavioral - Impaired Social Communication

  • Inability to conduct Joint Attention

  • Inability of social imitation

  • Poor face processing

• Neural Pathways - Impaired neural connections

  • Decreased activation/development of brain regions responsible for social perception and representations

    • Fusiform gyrus

    • Superior Temporal Sulcus (STS)

    • Language Regions

DSM Criteria for ASD - Social Communication Deficits (A)

Persistent Social deficits that manifest as ALL the following:

1. Deficits in social-emotional reciprocity - difficulties in back-and-forth conversation, reduced sharing of interests, and a failure to initiate/respond to social interactions

2. Deficits in nonverbal communication - abnormal eye contact, body language or lack of gestures

3. Deficits in developing, maintaining and understanding relationships - difficulties adjusting behavior in various social contexts

DSM Criteria for ASD - Restricted and Repetitive Behaviors (B)

Restricted and Repetitive behaviors that manifest as AT LEAST 2 of the following:

1. Stereotyped or repetitive motor movements, use of objects or speech (e.g., simple motor stereotypes, lining up toys, etc.)

2. Insistence on sameness, inflexible routines or ritualized patterns of verbal/nonverbal behavior

3. Highly restricted, fixated interests with abnormal intensities

DSM Criteria for ASD - Additional Diagnostic Requirements

(C) - Symptoms must be present in Early Developmental Period (these behaviors may not fully manifest until social demands EXCEED limited capacities or masked by learned strategies)

(D) - Symptoms cause significant impairment in social, occupational or other areas of functioning

(E) - Symptoms are not better explained by ID or global developmental delay (i.e., significant delay in 2+ domains of development)

Prevalence of ASD

1. CDC estimates ASD occurs in 1/68 births

   • Males-to-Females; 4:1

2. Intellectual Disability occurs in 31% of ASD cases (+25% of individuals in ""borderline” range)

3. Strong genetic component involved in the onset of ASD

Etiology of Autism (causes)

• Used to be mother blaming - “refrigerator mother” (mother’s described as ‘emotionally cold” and “uncaring”; cause of ASD)

  • In recent times, ASD is now attributed to biology

• Viruses, neurotransmitter and structural brain deficits

• Recent increase in incidence caused them to look at environmental causes

• Recent studies link older parent age, birth complications and pregnancies spaced <1 apart to increase risk of ASD

Are rates of autism really increasing?

1. Broader definitions + more acceptance of the disorder may lead to “increased” rates

2. Recategorization or “shifting” of people from ID to ASD category

3. While recent studies have observed environmental effects on onset of ASD, we must be skeptical of using these results on a broad scale

Potential difficulties that families may face when a member (more specifically, a child) has ASD

1. Communication difficulties (e.g., nonverbal, limited verbal skills)

2. Behavioral challenges

3. Social & Educational Integration

4. Transition to adulthood

5. Health & Mental health concerns (e.g., co-occurrences of conditions)

Microbiome and ASD

Microbiome (i.e., microorganisms that live within the body) has been seen to be a possible biological mechanism or explanation of ASD

ex. research in rodents link microbiome and ASD behaviors

Why is Early Identification important for people with ASD?

The earlier we identify autism, the earlier we can help children access services and the better their outcomes will be.

Identifying Autism (key, observable behaviors of those with ASD)

1. Avoiding eye contact

2. Having little interest in other children or caretakers

3. Limited display of language

4. Getting upset by minor changes in routine

5. KSADS - psychodiagnostic interviews

6. Autism Diagnostic Observation Schedule (ADOS)

7. Consultation

Do you think we’ll be able to diagnose children with autism solely using eye tracking technology (ETT)? If we can do it, should we? Why or why not?

ETT shows promise in helping diagnose ASD by tracking differences in gaze patterns (a sign of ASD). There are benefits and issues with this method:

• Pros

  1. Early detection - ETT could offer a more object indicator

  2. Non-invasive - this technology is unobtrusive, making it easier to use with children

• Cons

  1. Limited Scope - ASD involves more than social gaze issues. Focus on ETT results may overlook other behaviors

  2. Individual Differences - Not all children w/ ASD present the same way

  3. False Positives/Negatives - over-reliance on a single tool could lead to misdiagnosis!

Overall, diagnosing ASD requires a COMPREHENSIVE EVALUATION, needing multiple test and observation to determine an appropriate diagnosis.

How do we treat autism?

1. Gold standard treatment = Applied Behavior Analysis (ABA)

2. TEACCH - program that helps people with ASD learn and enhance their skills

3. Reciprocal Imitation Training - treatment that helps children with ASD learn to imitate others in social context

4. Physical, Speech and Occupational Therapy (i.e., academic)

ABC Model (Behavioral-modification strategy)

Antecedent, Behavior, and Consequence

Antecedent - the event, action or circumstance that happens BEFORE the behavior. It can either trigger/be the root cause of the behavior

Behavior - the observable/measurable action that occurs

Consequence - the action, response or event that happens AFTER the behavior

Reinforcement vs Punishment Consequence (in ABC model)

Reinforcement - strengthens the Behavior

Punishment - decreased the Behavior

Antecedents (ABC Model)

Many parents don’t think to prompt for specific behaviors that they seek from their children. However, prompting can be an effect intervention strategy, especially since they can easily be changed.

Visual Schedules are 1 way to increase structure and prompt specific behaviors by specifically telling a child what to expect.

FOUR Types of Consequences

Reinforcement - INCREASE behavior

• Positive - adding something desirable to increase the likelihood of a behavior

  ex. child earns a sticker for completing homework. The sticker serves as a reward, increasing chance the child completing their homework

• Negative - removing an averse stimulus to increase the likelihood of a behavior

  ex. a buzzing noise is removed when the child behaves appropriately. The removal of the sound makes the child more likely to behave well.

Punishment - DECREASE behavior

• Positive - Adding something unpleasant to decrease the likelihood of a behavior

  ex. bed-wetting alarm sounds to wake up the child when they wet the bed. The addition of the alarm is a punishment and aids to decrease the negative behavior

• Negative - removing something desirable to decrease the likelihood of a behavior

  ex. a child loses their favorite toy when they misbehave. The removal serves as a punishment, and reduces chance of misbehavior

Which consequence type is most used within ASD treatment, and why is it seen as more effective than the latter?

Reinforcement (more specifically positive ref.)

• P.reinforcement focuses on encouraging desired behaviors by rewarding them. This method builds a positive association with learning and behavior change.

  • Punishment is not used as it can increase stress/anxiety, may cause confusion and frustration, and reinforces negative before and consequences, never giving the child a chance to learn positive behaviors.

Susie is playing a game on the computer when her mother tells her that it is time for her to turn it off so she can start her homework. Susie falls to the floor, screaming and kicking. In an attempt to stop Susie from waking up her baby sister from her nap, Susie's mother tells her that she can have a few more minutes on the computer.

Use the ABC model to breakdown Susie’s reaction

Antecedent — Susie’s mother tells her to stop playing the game and to start her homework

Behavior — Susie falls to the floor, screaming and kicking (indicating she doesn’t want to stop playing her game

Consequence — In order to avoid waking the baby, Susie’s mother allows her to have a few more minutes on the computer

Susie is playing a game on the computer when her mother tells her that it is time for her to turn it off so she can start her homework. Susie falls to the floor, screaming and kicking. In an attempt to stop Susie from waking up her baby sister from her nap, Susie's mother tells her that she can have a few more minutes on the computer.

Based on the following behavior, does Susie’s mother’s response reinforce or mitigate her daughter’s behavior (possible function of the consequence)?

REINFORCEMENT

The consequence of Susie’s tantrum reinforces the behavior. By giving in and allowing more time on the computer, the mother unintentionally teaches Susie that tantrums are effective in getting what she wants, which may increase the likelihood of this negative behavior in the future

What are the benefits of using visuals to induce positive behaviors in children with ASD?

Visual Supports - pictures, symbols or written words used to communicate expectations or routines

• Benefits

  • Reduces anxiety by clarifying tasks.

  • Helps children with ASD understand schedules, social cues, and transitions (ease them into change)

  • Encourages independence by offering clear, structured guidance