Chapter 5: a focus on autism spectrum

Revisiting adaptive functioning…why now with ID and ASD?

• work on conceptual, social and life/practical skills is a core part of programming both ID and ASD

• looking at skills applicable across neurodevelopmental challenges

• thinking of down syndrome moderate ID and ASD/ID

conceptual skills

• challenges in receptive language (difficulties understanding others)

• challenges in expressive language (difficulty expressing thought)

• understanding the values of money and their function

• self-directions (motivations, self-regualtory activities)

social skills

• interpersonal skills

• self-esteem

• responsibility

• following rules

practical skills

• eating, dressing, toileting

• taking medication

• daily functional living skills fall in this domain

case study

• Kali is having challenges in the social, conceptual, and practical domains. she has a difficult time knowing social rules, learning how to interact with others in social interactions, understanding the function of money and finally making her bed.

• which domains do each other these skills fall under?

• social rules

  • being able to understand social skills and rules

• function of money

  • conceptualization

• interacting with others

  • social

  • must be able to understand children and their needs

• making their bed

  • functional

  • sorting laundry, making bed

assessment of basic learning abilities

• imitation

  • considered one thing and the person is to follow you

• matching objects

• auditory discrimination

the ASD spectrum

• concerns happen when multiple challenges occur

• severe: restricted behaviours,lack of awareness, no initiation of conversation

• moderate: support for children, not as extensive as severe

• high functioning: previously known as asperger’s syndrome

brief history

• 1940s- Leo Kanner (early infantile autism) enlarged head circumference

• 50s- Bruno Bettelheim (psychoanalysis, refrigerator mothers)

• today…a neurodevelopmental disorder (exploring the genome)

today..speaking of cause of ASD

• very complex neurodevelopmental disorder with a biological basis

• considered a neurological disorder that is influenced by both environmental and genetic factors

• it spans the genome

introduction to core deficits and the spectrum

• core challenges of ASD

  • social communicative issues

  • restrictive repetitive behaviorus

• symptoms become increasingly noticeable around the age of 2-3 years of age

• rating of autism through levels 1-3

• 1 in 36 children have ASD

• increased prevalence-better tools with good psychometric properties

ASD more information

• autism is 4 to 5 times more likely in boys than girls

• it is estimated two thirds of individuals with ASD have a ID

Temple Gradin

• woman with autism

• frustrated that she could not talk

• importance of early intervention for children with ASD

• words gradually came to her

• was kicked out of school for being different

• thinks in pictures

area1: social and communication challenges

• looking across the spectrum there is a general difficulty in relating to others

• difficulty with social and emotional reciprocity

• can be limited shared enjoyment, joint attention and emotional expression

  • harder for people with autism to put themselves in others shoes

  • if you leave the child over time does the child look back and show enjoyment over parents showing parents things

  • seeing a cluster of symptoms

• assessed through observation and interview

• symptoms usually become apparent in toddler years

joint attention

• when you are talking and someone makes reference of something

• ex. taking about coffee and what you got you would automatically look at the cup you are talking about, shifting attention to the cip and then back to the individual. may not see this as much in kids with autism

rett syndrome

• rare genetic syndrome that develops within the first 18 months of life

• more prevalent in girls

• characterized by such symptoms as nearly constant repetitive hand movements, loss of acquired spoken language, gait abnormalities and partial or complete loss of acquired purposeful hand skills

ABA: behaviour intervention-Lovaas study

• project BEST-CASE: a model for developing an intensive early childhood intervention program for children with autism spectrum disorder. provent practice

• incidental training

• transfer and teaching in the natural environment

applied behaviour analysis

• the use of learning principles to address interfering behaviours and improve well-being is a key feature of ABA

• positive reinforcement, shaping and chaining are all features of ABA

• ex. brushing your teeth, comes with multiple steps and children with autism need extra help and guidance with these skills

• want to wokr with the children when they are young to develop these skills in order for easier way of keeping these skills throughout the child’s life

alternative communication

• often part of ABA program

• importance of collaboration

• SLP would prescribe the best measure to help the child, what device, vocal signals that work best for the child will be described here

• if the things that are prescribed for the individual are not what the child likes this will not reinforce these beahviour you are trying to teach so you need to ensure that child is responsive to the treatment

case: chris

• followed form age 4-7

• has few vocals given his age

• intensive work on his speech

• ,worked with a device with stickers and velcro

  • child would use this to say what he wanted

  • child must keep eye contact in order to get what they want

  • uses joint attention

• took a while to get to next stage

• got to a point at age 6 where he was not vocalizing but making sentences with an ipad

• from this he was able to imitate what was being said and learned how to speak

• now is fluently speaking

RRBs

• lower order

  • self injury, echolalia

• higher order

  • OCD-like, preoccupations

• continued talk of building on strengths and giving children and youth a voice

• incident training

• discrete-trial training video

Case 2: Don

• using CBT/behaviour therapy

• age 8

• use of learning principles

• high functioning (asperger’s syndrome)

• anxiety around loud sounds

  • anticipatory

  • breaking things down into small pieces/small changes in the environment

  • relaxation training

• fear of losing

• social communication

  • conversation skills

  • self-monitoring language (using ABA and CBT)

autism spectrum disorder

• a neurodevelopmental disorder involving impairments in the domains of social communication and the performance of restricted repetitive behaviours

echolalia

• repetitions of the same sounds over and over

tourettes disorder

• characterized by a combination of chronic motor and vocal tics and can include uncontrollable movements of the head and ittering of vocalizations that sound odd to others

According to the cognitive perspective, which of the following contribute to intermittent explosive disorder?

• harsh punishment as children

  correct

• faulty cognitions

  correct

• negative beliefs

pyromania

• People with this disorder deliberately set fires, feel tension and arousal before the act, are fascinated with fires, and derive pleasure when witnessing fires.

• The treatment for pyromania that shows the most promise is based on the cognitive behavioural model

conduct disorder

• An impulse-control disorder that involves repeated violations of the rights of others and society’s norms and laws.

anton, a 5 yr old boy with autism spectrum disorder is con sodered a musical prodigy. while showing little interests in social interaction and displaying a severe impairment in speech, he can play incredibly difficult piano pieces at a pro level from memory. anton is displaying

autistic savant syndrome

what is true of Rett syndrome

• the child begins to show neurological and cognitive impairments after 4 years of age

• it has some of the same symptoms as autism spectrum disorder

girls with ADHD tend to what their symptoms

• internalize

the following medications are used to treat tourette’s disorder

• SSRIs

• atypical antipsychotic agents