Exam 2- ASD

These flashcards cover key concepts, historical figures, and prevalent statistics related to Autism Spectrum Disorder.

What did Leo Kanner refer to his observations of patients in 1943 as?

Early Infantile Autism (classic Autism)

What are some symptoms/signs noted by Kanner for Autism?

Autistic aloneness, insistence on sameness, significant language problems.

What term did Hans Asperger coin in 1944 to describe symptoms?

Autistic Psychopathy.

What was a notable characteristic of individuals described by Asperger?

Difficulty interacting with others and preoccupation with specific topics (special interests).

Who founded the National Autistic Society in the UK?

Lorna Wing.

What was Lorna Wing's criticism of Kanner's criteria for autism?

She believed Kanner's criteria were too narrow and called for fewer essential criteria.

What did Wing agree with Asperger regarding the presentation of autism?

She agreed on a more diverse presentation of autism, leading to the term 'Asperger Syndrome' in 1976.

What is the prevalence of autism in North America according to the study mentioned?

1 in 54 children have autism.

How much more likely are boys than girls to receive a diagnosis of ASD?

Boys are at least four times more likely than girls.

What population do individuals diagnosed with ASD represent in the USA?

They are one of the largest minority groups.

When was Autism Spectrum Disorder (ASD) introduced into the DSM III?

ASD was introduced into the DSM III in 1980 and described as a 'pervasive developmental disorder.'

What terms did DSM 5 replace?

• High Functioning Autism

• Asperger’s Disorder

• PDD-NOS (pervasive developmental disorder)

Criterion #1: Persistent deficits in social communication and social interaction

• Deficits in social reciprocity

• Difficulty establishing, maintaining, and understanding relationships

• Limited nonverbal communication

Criterion #2: Restricted, repetitive behaviors or interests

• Stereotyped or repetitive motor movements, use of objects, or speech

• Insistence on sameness, inflexible adherence to routines

• Highly restricted, fixated interests that are abnormal in intensity or focus.

Specifiers: Severity of criteria 1 & 2

• Very substantial support (level 3)

• Substantial support (level 2)

• Support needed is minimal (level 1).

Specifiers

• Language impairment

• Medical condition (GI problems, sleep, seizures)

• Neurodevelopmental, psychological, or behavioral disorder

• Intellectual impairment

Co-morbities: Communication Disorder

• Pronoun reversal

• Abnormal prosody

• Difficulty with pragmatics

• Mutism

Co-morbities: Medical problems

• Gastrointestinal problems

• Sleep difficulties

• Seizures

Co-morbities: Neurodevelopmental, psychological, or behavioral disorders

• Attention-deficit/hyperactivity disorder

• Anxiety disorder

• Oppositional defiant disorder

Co-morbities: Intellectual developmental disorder

• 1/3 earn IQ scores <70

• ¼ earn IQ scores between 71-85

• 40% earn IQ scores >85

Etiology: Kanner proposed classic autism as a ___ disorder

Innate (genetic) disorder

Etiology: Kanner described parents as showing ___

Low social interest (they may have learned to adapt to their child’s preferences)

Etiology: Bettelheim (1967) claimed autism was caused by __

Maternal Aloofness (refrigerator mother (coldness, distance))

Etiology: Bettelheim claimed autism could be treated through ___

Psychoanalysis

Etiology: Andrew Wakefield wrote the ___

Lancet article in 2004'; it was retracted as “utterly false” after the 2010 trial.

Etiology: Wakefield’s 2004 investigation included:

• Thimerisol is not the culprit

• Conflicts of interest

• Abuse of children (did procedures on children who qualified for Autism)

• No IRB approval

Strong genetic basis: The Autism Genome Project

20% have known genetic mutation

Strong genetic basis: Twim studies confirm heritability of ASD

• Concordance rate of Monozygotic twins (80%)

• Concordance rate of Dizygotic twins (30%)

• Concordance rate of non-twin siblings (20%)

Prenatal Factors

• Age of parents

• Sex hormones

• Exposure to toxins

• Viruses/autoimmune disorders

Growth dysregulation hypothesis

Youths with ASD show:

• No significant difference in head circumference at birth.

• By 1 year, you see 1 standard deviation difference.

• No significant difference in late childhood.

• Rapid brain growth without significant pruning.

Brain chemistry

• Increased blood serotonin (5HG) levels (GI problems)

• Decreased brain serotonin levels (responsible for mood, sleep, appetite, cognition & sociability)

• prevents reuptake (SSRI-Prozak)

• If serotonin is increased in the nucleus accumbens, you can address typical social motivation deficits, repetitive behaviors, and emotional regulation difficulties.

Mind-blindness (Simon Baron-Cohen)

• controversial

• methodological limitations with tests

• false BeliefTasks failures

Not evidenced by all people diagnosed with ASD.

Not specific to individuals diagnosed with ASD (all with ASD would show it if true)

Early Identification

• American Academy of Pediatrics (AAP) recommends routine screenings between 18 and 36 months.

• Symptoms presentation (12-18 months) (outcome better if detectable)

• Challenges to early identification (so much variability in & about child)

Psychometrics: Multiple methods

• Interview

• Observation

• Norm-reference testing

• Informal data gathering

Psychometrics: Multiple informants

• Child

• Parent/guardians

• Professionals

ADI-R: Autism diagnostic interview

• 93-item structured interview

• Reciprocal social interactions (if you say hi to a child, they will say hi back)

• Language/communication

• Restricted/repetitive behaviors/interests

• Parent report

• Take 90-150 minutes

ADOS-2: Autism diagnostic observation

• Assesses

• social interaction

• communication

• play

• stereotypical/restricted behaviors

(Clinicians deliver social cues/presses to the child & notes how they respond (30-45 minutes)

Assessment Questionnaire (ASD)

• Social responsiveness scale, second edition (SRS-2)

• Childhood autism rating scale, second edition (CARS-2)

• Autism spectrum rating scale (ASRS)

• Modified checklist for autism in toddlers- revised with follow-up (M-CHAT-R/F)

Assessment: Norm-referenced tests

• Measures the ability to learn/adapt.

Difficult to administer:

• language impairment(s)

• aversion to sensory stimuli

• insistence on sameness

Assessment: Alternate tests

• Test pf non-verbal intelligence (TONI-4) (Shake or nod head/point)

• Raven’s standard progressive matrices (patterns, no verbal instructions (measures ability to learn)

Adaptive behavior scales

• measures the ability to meet basic personal & social responsibilities.

• Adaptive behaviors may lag behind IQ scores (Rain man)

Developmental course

ASD is NOT a degenerative disorder

• Symptoms are most pronounced early in development

• Development gains are expected over time

Good prognostic indicators

• language by age 5

• social interests (shared attention, imitation, pretend play)

• IQ >70

• early and intensive intervention

Functional independence may be possible

ASD medications

Minimize symptoms that interfere with the effectiveness of behavioral interventions (not first step)

Treat co-morbidities:

• at least 1 psychotropic medication (50%)

• 2 psychotropic medications (33%)

• 3+ psychotropic medications (20%)

Interventions a/limited empirical support (ASD)

• Holding therapy (well-intentioned)

• Facilitated communication

• Art/music therapy

• sensory integration therapy

• special diets (good for GI problems, not a treatment)

Behavioral interventions (ASD)

Goals

• address signs/symptoms

• maximizing independence

• alleviating family distress

Early intensive behavioral intervention (ASD)

• 40 hours/week; 1 on 1 interaction (designed to help child move forward)

• Focus on overt (anger/aggression) behaviors (focus on reinforcement)

• Use behavioral strategies (model, prompt, reinforcement)

Discrete Trail Training (by louaas)

• Therapist-directed in a lab/clinic setting

• Teach basic communication skills (eye contact, nodding, turning, etc)

• May not generalize (outside lab/clinic or @ school)

• Does not teach spontaneous social behaviors

• Impacts IQ scores (50% achieved scores above 85)

Pivotal response training (by Kogel)

• Child-directed in natural setting (parents are taught to use PRT in their homes)

• Use natural reinforcers and attempts (vs. success)

• Yields sustained improvements in social communication (learning new ways of interacting w/others)

TEACCH (by Shopler)

Structure the classroom to increase independence and success:

• Organized, predictable

• clear expectations

• minimize sensory bombardment

• include special interest (drawing, singing)

Teach techniques to parents (to support skills upon context)

Outcomes:

• Improved social communication

• reduced behavioral problems