Lang Disorders Final: ASD & Selective Mutism

What is ASD

- Spectrum of manifestations
- Broad, pervasive developmental impact
- Inconsistent and variable, though persistent

How has the criteria for the diagnosis of ASD changed with the latest edition of the
DSM, the DSM-V?

Old Criteria (DSM-IV):
- Includes several sub-diagnostic labels under the ASD umbrella, including:
- Autistic Disorder (AD), Pervasive Developmental Disorder (PDD-NOS), Asperger's Disorder (AD), Childhood Disintegrative Disorder, Rett Syndrome

Current Criteria (DSM-V):
- Must meet all 3 persistent deficits in social communication/interactions across contexts, not accounted for general developmental delay
- Restricted, repetitive patterns of behavior, interests, or activities. At least 2.
- Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
- Symptoms together limit and impair everyday functioning
- Severity based on 3 levels

What is the difference between ASD and Social Communication Disorder?

ASD:
- Requires both social communication deficits and excessive ritualistic behaviors

Social Communication Disorder:
- Only requires the social communication piece
- Deficits in communicating socially appropriately based on context
- Impairment in changing communication to match context or listener needs
- Difficulty following rules for conversation and storytelling (turn taking, communication repair, verbal/nonverbal signals to regulate interaction)
- Difficulties understanding implicit statements (e.g., inferences) and nonliteral or ambiguous language (e.g., idioms, humor, metaphors, multiple meanings based on context)

Be able to identify exemplars of jargon, echolalia, and stereotyped vocalizations seen in
ASD.

Jargon:
- Strings vowels together when babbling (“ah,” “eh,” “oh”)
- Jabbering with “m,” “b”

Echolalia:
- Meaningless repetitions of others' words

Stereotyped vocalizations:
- Makes a lot of different sounds like “mamamama” and “bababababa”

Describe the variability in language skills observed in ASD?

Some children with ASD are incredibly high functioning, and may even be in the upper percentile, whereas others present with severe learning disability. A spectrum disorder.

What domain of language is
always affected (has deficits) in children with ASD?

Pragmatics

What is most predictive of the longterm language skills of children with ASD?

Language skills by age 6 are predictive of long-term prognosis. Long-term outcomes are impacted by intellectual functioning

What is the common screening measure used to screen children for ASD?

M-CHAT:
- PCP screening for ASD at 18 and 24-30 months
- GenDev screening at 9, 19, 24-30 months

What is the
gold standard diagnostic measure used to assist in the diagnosis of ASD?

ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition)
- Developmental level of 12 months through adulthood
- Semi-structured, standardized assessment that evaluates communication, social interaction, and play
- Flexible administration based on child's interests and activity levels

Most children with ASD have hypersensitive or hyposensitive sensory functioning. How
do these differ?

Hypersensitive (high) or Hyposensitive (low) functioning with:
- Sounds, lights, smells,
textures
- Pain threshold
- Difficulty processing more than one sense at a time
(e.g., not being able to understand spoken language
while looking at someone’s face)
- Confused or overwhelmed by sensory stimuli
- Challenges with body awareness or separating
different types of sensations

What is selective mutism?

A complex social anxiety disorder, characterized by a child's inability to speak and communicate effectively in certain social settings but the ability to speak and communicate effectively in other settings

How does selective mutism differ from extreme shyness?

Shyness:
- A normal personality trait and is a voluntary tendency to withdraw from people, especially those unfamiliar to them.

SM:
- Involuntary and they do not adapt well to social situations
- Limited academic and occupational achievement and require treatment to overcome their symptoms and functional at an adaptable level

What happens when selective mutism progresses (and becomes progressive mutism)?

Progressive Mutism is selective mutism that progresses to apply to all speaking situations

If a child is not talking at all in any environment with any person, can they have selective
mutism?

A child who is not speaking in any situation cannot have selective mutism, it is progressive mutism