Autism (Fall 2024) Final Exam

What is ASD

a neurodevelopmental disorder characterized by social communication problems, and social interaction problems in the presence of restrictive and repetitive behavior issues

Who introduced the disorder of autism:

Leo Kanner 1943

In 2014 the estimated ASD prevalence was:

In 2016 the national survey of children's health estimated by parent report ASD to be:

- 16.8 per 1,000 (about 1 in 59 children 8 years or younger with that diagnosis)

- 1 in 40 (children ages 3-17)

Is ASD higher in males or females? By what percent?

Higher in males

Boys- 26 percent, of every 1,000 cases

Girls - 6.6 in 1,000

ASD is higher in white children by what %

7%

- what percent higher with children of hispanic background

- Asian specific population prevalence of ASD is:

- 22% (14/1000)

- 13.5 per 1,000

what are the key deficits included in the DSM-5

1. Impaired social communication

2. Restrictive and repetitive interests, activities, and behaviors

3. Personal social communication challenges has negative impact on life

4. Onset of symptoms that occur in early childhood

5. Behaviors they show cant be accounted for/explained by intellectual disability

what are some characteristics of autism?

- Impaired Social Communication

- Restrictive and Repetitive interests, activities, and behaviors

- Onset of symptoms that occur in early childhood

- Behaviors they show can't be accounted for/explained by - - - intellectual disability

- Obsessiveness

- Stereotypic behavior (repetitive, motor movements or behaviors, run cars over and over, bounce ball over and over)

- Ecolalia

- Purposeful relationship to objects (can relate to truck or teddy bear, but not to people)

- Isolation (designed to be alone and does the same routine)

- Lack of effective interaction, awareness of contact with people

- lack of joint attention, eye contact, deficits in social reciprocity

explain level 1 of autism:

requires support:

Talking about social communication and interest in behavior:

- noticeable deficits in verbal and non verbal communication

- difficulty initiating social interaction

- trouble with responses to/from other people

- reduced interest in social interaction (they are okay by themselves)

- resist being redirected or interrupted

- doesn't want things changed and behavior will interfere with functioning

explain level 2 of autism:

substantial support

- Marked deficits in verbal and non verbal communication and social communication

- Limited initiation in social interaction - won't walk up and say hi

- abnormal response to outsiders interacting with them

- behaviors are pretty apparent to others

- behavior interfere with functioning, some distress (cant stack - blocks anymore, toy is taken away-breaking pattern)

- difficult to redirect from those fixated responses

explain level 3 of autism:

very substantiation support

- Pretty severe deficits in verbal, non verbal, and social communication

- No initiation of social interaction

- minimal to no response to social interaction/social bids from others

- behaviors definitely interfere with functioning

- significant distress when rituals are broken

- very difficult to redirect from fixated interests

Explain the genetic connection for autism:

- Genetic research: Autism traits are extremely heritable among siblings of individuals with ASD and monozygotic or dizygotic twins. Up to 19% prevalence for siblings of individuals diagnosed with ASD spontaneous mutations occur during prenatal development or before conceptions

- Researchers largely agree that ASD is the result of hereditable genetic differences and/or mutations. For example, ASD is most likely linked to genetic differences associated with the X chromosome (Chakrabarti & Fombonne, 2005). People with a medical diagnosis of autism may also be more likely to have a younger sibling with an autism diagnosis (Ozonoff et al., 2011)

- variations in a gene play a role in an individuals risk of developing autism

Understand what the Human Genome Study shows about ASD, specifically Chromosome 5, 7, 11, 15, and 16:

when you break it down, we have been able to isolate 4-6 genes that seem to play a role. (5 chromosomes)

What do these chromosomes point out the importance of:

the importance of prenatal vitamins in women when pregnant.

explain chromosome 5:

genes that are involved in the development of brain circulation during very early years

explain chromosome 7:

we know that it causes some biological differences in males and females, noted differences in biological differences in males more than females.

explain chromosome 11:

group of genes involved in communication between neurons between brain development.

explain chromosome 15:

duplication on part of chromosome associating with intellectual impairment

explain chromosome 16:

small deletion associated with autism, that deletion is responsible for cell to cell signaling and interaction.

what are the Environmental risk theories of ASD?

Explain some:

toxins, vaccines, thimerosal, paternal age, maternal use of antidepressants.

- More research is needed to fully understand potential environmental factors, including specific exposures and gene-environment interactions

- 40 or over have a 6x greater chance of having a child with autism

- Maternal use of antidepressants increases chance of ASD

- Toxins are present in the environment

- Vaccines do not seem to be a cause of ASD

what are the core features of ASD:

- Social communication

- Language impairments

- Sometimes relative cognitive skill (some are really smart)

- Behavioral and emotional challenges

explain cognitive and intellectual deficits

- According to ASHA, individuals with ASD may exhibit cognitive and intellectual deficits in areas like complex social reasoning, abstract thinking, executive functioning, theory of mind, difficulty with flexible thinking, challenges in understanding non-verbal cues, and interpreting social situations, which can manifest as difficulties with communication, learning, and adapting to new environments; however , the severity of these deficits can vary greatly between individuals on the autism spectrum.

- Autism is a separate diagnosis from an intellectual disorder, it co-occurs (can or cannot co-occur) and doesn't let communication mask or not mask a cognitive or intellectual disorder.

examples of communication deficits

deficits with:

- joint attention

- social reciprocity

- social cognition

- nonverbal communication (gestures, facial expressions, eye contact)

- not able to understand body language

- proxemics

Be able to talk about sensory integration disorder or dysfunction.

- It is one of the comorbid medical conditions in autism spectrum disorder.

- highly prevalent in individuals with autism spectrum disorder (ASD)

- a condition where the brain doesn't properly process sensory information

- These children may overreact or under-react to sensory input

- these children may exhibit behaviors such as rocking, spinning, hand-flapping, or covering their eyes or ears

explain self regulation and motor deficits with autism

self regualtion:

- the child can strategize in terms of independently shifting their own arousal, controlling regulation); in teenagers sometimes self regulation can be difficult

- Strategies they use to self regulate themselves like chewing on a blanket or putting their head on a dryer to feel warmth (hand clapping).

motor deficits:

may experience delays in gross motor skills like walking and and crawling, as well as fine motor difficulties like manipulating objects or writing (clumsy, uncoordinated)

what is executive dysfunction?

they have a lack of or limited flexibility, poor problem solving skills, poor planning and organization- desk and bedrooms are a mess, need help organizing desk and papers, lack of inhibition (going up to someone and asking an inappropriate question)

What are the roles and responsibilities of the SLP.

SLPs play a central role in the screening, assessment, diagnosis, and treatment of persons with autism spectrum disorder (ASD). The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research

- Improve social communication

- Work on language, speech, pragmatics

- Helping social communication partners

- Functional communication

- Assessing and treating feeding challenges

- Refer to other professionals

- Educate other professionals on the communication or feeding needs

- Provide parent education

- We do NOT make diagnosis of autism (we are instrumental), but we make clinical diagnosis of significant speech, language, pragmatic, sensory problems

How do you determine eligibility for SLP services

- a comprehensive assessment is conducted to evaluate their communication skills, including both verbal and nonverbal aspects, and assess whether their impairments significantly affect their educational performance

- Based on assessment results and the need for special education services

- In the school, it is based on the definition provided in the IDEA: nature of the social communication challenges in individuals with ASD supports the decision-making process to determine eligibility for language services in the schools

explain the seven Steps in an SLP assessment for someone with ASD characteristics

1. Intake: looking at any medical, education, IFSP etc.. information. Anything available thats been done prior to the assessment. See lots of birth stuff: weight, etc.. sometimes there is a psych to read

2. Chart review: going through all this information you have found. Look for the information that will help you in the diagnosis. Helps with a master plan

3. Team pre conference: Important because family and every party is on board, you can compare information from different standpoints so people aren't repeating themselves over and over. Important that the team talks together. Up to you to reach out

4. Assessment: every team member does one. They can be done with 2 or 3 people at the same time sometimes. Helps with not being repetitive. Saves time. Should always be a team post conference

5. Team post conference: early intervention does a job with this to discuss plans etc.. can be on paper, in person etc..

6. Feedback to the family: explanation of results and plans

7. Referrals if needed: psych, physician, medication of some sort. Outside referrals.

what are the steps in screening for ASD

typically include:

- norm-referenced parent and teacher report measures;

- competency-based tools, such as interviews and observations; and

- hearing screening to rule out hearing loss as a contributing factor to communication and behavior difficulties.

Screening procedures evaluate the main characteristics that differentiate ASD from other developmental disorders, including difficulties in what?

- eye gaze,

- orienting to one's name,

- pointing to or showing objects of interest,

- pretend play,

- imitation,

- nonverbal communication,

- language development.

Explain the ADOS:

- The Autism Diagnostic Observation Schedule (ADOS) is a standardized assessment tool used to diagnose autism spectrum disorders (ASD) in children and adults:

- Training for ADOS is needed, it consists of 4 modules (toddlers, speaking in single words, speaking in phrases, module for fluent speakers), it is play based, and it is used to observe behaviors of interest

What ASD Social Communication warning sign characteristics do you see for 9-12 months?

- avoids or does not keep eye contact

- little or no babbling

- no gesturing

- little or no back and fourth sharing of sounds/communication exchange

- does not respond to name or show facial expressions by 9 months

- no simple interactive games like patty cake by 12 months

- Lack of social smile

- Limited gestures

What ASD Social Communication warning sign characteristics do you see for 18 months?

- does not point to show you something interesting

- Lack of shared joy

- Lack of response to name

- Minimum pointing or gesturing

- Unusual prosody to speech

- Lack of appropriate gaze

- Lack of shared interest

What ASD Social Communication warning sign characteristics do you see for 24 months?

- does not notice when others are hurt or upset

- very few or no meaningful, two-word phrases

- may get echolalia responses but not intentional meanings (not expressing wants and needs)

- Lack of responsiveness

- Lack of shared enjoyment

- Abnormal eye contact

- Unusual visual interests

- Unusual play in objects

What is the CARS-2

- The Childhood Autism Rating Scale, Second Edition (CARS-2) is a clinical assessment that helps identify autism and determine its severity in children ages 2 and up

- Easy to use tool that helps distinguish between developmentally disabled children who are not autistic, giving quantifiable ratings based on direct behavior observation

- examine change over time

- object use and imitation of play actions

What is the Gilliam Autism Rating Scale?

The Gilliam Autism Rating Scale (GARS) is a tool used to identify and assess autism spectrum disorder (ASD) in individuals between the ages of 3 and 22:

what are two intervention goals (2 for autism and 2 for selective mutism)

Autism goals:

The client will engage in parallel play with others.

Client will engage in joint attention.

Selective mutism:

Answer questions in a large group at school

Answer questions to a familiar family member

What is the goal hierarchy for social pragmatics (for selective mutism)

- Develop a list of talking scenarios/gradual communication goals

- Have client rate level of comfort with talking situations

- Place these ranked situations into a hierarchy

What is ABA?

(Applied Behavioral Analysis)

- ABA therapy is typically only used for Autism Spectrum Disorder, and tx is not linear, you will have good and bad days

ABA aims to increase positive behaviors and decrease negative behaviors. It can help people develop new skills, improve their focus, and reduce challenging behaviors.

utilizes principles of learning theory to bring about meaningful and positive change in behavior. ABA techniques have been developed for individuals with autism to help build a variety of skills (communication, social skills, self control, self monitoring) and help generalize these skills to other situations. These techniques can be used in structured and every day settings and in one-on-one group instruction

intervention is customized based the the persons needs, interests, and family situation

often used in intensive, early intervention (below 4 years of age)

What is DTT?

Discrete Trial Training (DTT) is a structured teaching method used in Applied Behavior Analysis (ABA) to help children learn new skills

a one-to-one instructional approach utilizing behavioral methods to teach skills in small, incremental steps in a systematic, controlled fashion. The teaching opportunity is a discrete trial with a clearly identified antecedent and consequence (e.g., reinforcement in the form of praise or tangible rewards) for desired behaviors. DTT is most often used for skills that learners are not initiating on their own, have a clear, correct procedure, and can be taught in a one-to-one setting

What is AAC?

(augmentative and alternative communication)

- involves supplementing or replacing natural speech and/or writing with aided (e.g., Picture Exchange Communication System [PECS], line drawings, Blissymbols, speech

generating devices, and tangible objects)

and/or unaided (e.g., manual signs, gestures, and

finger spelling) symbols.

Whereas aided symbols require some type of transmission device,

production of unaided symbols only requires body movements.

What is PECS?

(Picture exchange system)

- low-tech intervention program for individuals with ASD and other developmental disabilities

- intended to shape a child's expressive communication abilities using prompting and reinforcement strategies.

- PECS is a specific approach with specific implementation parameters.

- PECS is based on applied behavior analysis.

- PECS training consists of six progressive instructional phases.

What role does interprofessional practice in ASD?

Interdisciplinary collaboration and family involvement are essential in assessing and identifying autism. The speech-language pathologist (SLP) is a key member of an interdisciplinary team that includes the child's pediatrician, a pediatric neurologist, a psychologist, and a developmental pediatrician. Several available algorithms and tools are available to help physicians develop a strategy for early identification of children with autism spectrum disorder

How many domains of development are there?

6

how many areas are in the ASD assessment process?

7

Developmental pediatrics includes what areas?

- physical

- social

- emotional

- and cognitive growth

What is an excellent parent interview tool?

vineland

What might diagnostic testing include?

- looking at everything in social communication a child needs

- must have 2-3 restrictive/repetitive behaviors

- everything we do is subjective and dynamic

- get as much info as possible about the child and what they can do

Comparing IQs and language scores to determine eligibility for speech/language intervention is based on assumption that language functioning cannot surpass cognitive levels is called what?

Is it acceptable?

cognitive referencing

this is not an acceptable practice

what is the key to the Childs success

the parent

what age does a baby hold a bottle with both hands in normal development?

4.5 months

What are the major components of neural control in swallowing

- afferent sensory fibers and cerebral/midbrain and cerebellar fibers

- paired swallowing center in brainstem

- efferent motor fibers

how is the Accessory cranial nerve tested

tested bedside by turning supine infants head to one side and determine if the infant attempts to bring head to midline

what are the stages of a swallow

1. oral prep

2. oral phase

3. pharyngeal phase

4. esophageal stage

what is the normal age for discontinuation of the of the bottle?

18-24 months

the oral cavity of the newborn is totally filled by what

tongue

a child is able to orally manage, for the first time, a cookie, what what age?

12 months

laryngeal penetration is a benign normal process in an infant due to:

immaturity in swallow mechanism

rooting in newborns is present by _________ and diminished by ________.

32 weeks gestation

3 months

what % of down syndrome that has cardiac anomalies?

40-50%

an adult sallows how many times a day?

600

a normal developing child can drink through a straw at what expected age?

18-24 months

the larynx and hyoid cartilage are higher in the neck and closer to the base of the what?

epliglottic

children with ASD have breakdowns in the intestinal wall that allows for _______ to enter the blood stream.

protein