SHS 450 Exam

What is the DSM5

It is the tool used by clinical psychologists, physicians, and neurologists to diagnose autism.

What are the criteria of the DSM5

restrictive repetitive behavior, and social communication challenges

with the changes in criteria for DSM5 autism is now identified under ,

one category

With the changes in criteria for DSM5, individuals with autism are identified by

“level of support needed” relative to the ASD diagnosis

with changes in criteria for DSM5, the addition of “Social Pragmatic Communication Disorder” as its diagnostic category was added for

individuals with pragmatic disorders not meeting ASD
criteria (e.g., no RRBs, but meets social
impairment)

the shift in criteria to DSM-5 is that all
forms of ASD fall under

One diagnostic category.

Additional requirements for ASD diagnosis are ONSET, meaning

Symptoms must have been present since early development.

additional requirements for ASD The symptoms are not better accounted for due to

other factors (e.g., trauma, neglect, physiological condition such as stroke or TBI).

What are possible co-occurring conditions for ASD

ADHD, Speech sound disorder, language disorder

SPECIFIERS: (for ASD, 3)

a) with or without intellectual impairment
b) with or without accompanying language impairment
c) associated with a known medical or genetic condition or environmental factor

ASD Level 1

Difficulty initiating social interactions and clear examples of atypical or unsuccessful overtures of others

ASD Level 2

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of
social interaction with others; “markedly odd nonverbal communication.”

ASD Level 3

Severe deficits in verbal and non-verbal communication; limited initiation of social interactions, minimal response to social overtures of others

Breif history of BCBA (4 main points)

• BCBA Treatments for ASD: Lovaas, UCLA’s 40-hour-a-week model.

• EI Models: ABA at 25 hours/week + parent education shows positive results.

• National Standards Project (2009): In 276 studies, ABA has proven effective (ages 3-8).

• NPDC & National Standards (2015): 377 studies, ABA positive outcomes up to age 21.

EBP Interventions

27 EBP practices identified across developmental levels (NPDC, 2017).

Agreement in Meta-Analyses

NPDC & NAC meta-analyses identified EBP by age and intervention type (Sam et al., 2019).

Shift in Services Toward EBP

Focused intervention practices use specific procedures to improve skills in children with ASD (Odom, 2010).

WA State Standards for COEs

ABA diagnosis requires a multidisciplinary evaluation with both BCBA and SLP involved.

Collaborative Framework

Collaboration can involve contract-based services or an integrated team with SLP on-site in ABA programs.

Key Determinants of Positive Outcomes (Birth-5)

Routine speech exposure, visual supports, and focus on “readiness to learn” skills (imitation, joint attention, play).

Data Collection & Treatment

Monitor reinforcement, extinction, and fading cues to guide treatment decisions.

Family Involvement

Family education and parent coaching are crucial for ASD services.

Key Determinants for Language Development (Birth-5)

Pair auditory input with objects/symbols; focus on visual/auditory discrimination, repetition of verbal production, expanding to two-word utterances and questions.

Neural Underconnectivity in ASD

ASD linked to neural underconnectivity in auditory, motor, and visual circuits.

Neural Underconnectivity in ASD, Impact on Processing

Slower speed, reaction time, and integration of phonological, visual, and auditory inputs.

Neural Underconnectivity in ASD, Effects on Language

Decreased vocabulary recognition, trouble associating sounds with meaning, and motor planning difficulties.

What is Childhood Apraxia of Speech (CAS)?

A motor-based speech deficit characterized by decreased motor planning ability and insufficient innervation to the muscles required for speech production, often comorbid with ASD.

How does Central Auditory Processing Disorder (CAPD) affect speech?

CAPD involves difficulties in sequencing sounds to process them into meaning, which can occur without hearing loss. It hinders the ability to understand and discriminate subtle sound distinctions.

What percentage of children with hearing loss also exhibit another disability?

40% often including a dual diagnosis of ASD.

Why might a dual diagnosis of ASD and hearing loss be missed?

It can be overlooked due to the complexities of symptoms and presentations in children.

What are some medical factors that can influence speech acquisition?

Factors such as infections, illnesses, and poor nutrition can negatively impact speech development.

What is the purpose of assessing response to behavioral interventions during treatment?

To determine if data indicate improvement in both receptive and expressive communication skills.

What are examples of receptive communication skills that should be assessed?

Pointing, matching, and joint attention.

What might a plateau or decline in verbal speech indicate during treatment?

No sound approximation, no imitation of verbal speech, and difficulty with non-verbal motor skills (e.g., eating, blowing bubbles).

What role does the BCBA play when noticing patterns of behavioral performance?

identify patterns that may suggest more extensive underlying motor-based speech deficits and can refer the individual to an SLP or collaborate with one.

What might an underlying neurologic motor speech disorder or hearing loss affect?

Language acquisition and communication.

Why is collaboration between a BCBA and SLP important?

Collaboration is pivotal when motor-based speech deficits emerge, as they can hinder language acquisition.

What are the primary responsibilities of a BCBA in a collaborative scope of practice?

Leading data collection & analysis, supervising behavioral support personnel, decision-making on functional communication and adaptive skills, parent education and coaching, and developing reinforcement schedules and behavioral maintenance programs.

What are the main roles of an SLP in a collaborative scope of practice?

Assessing and diagnosing communication disorders, assessment for AAC (Augmentative and Alternative Communication), differential diagnosis of apraxia of speech vs. language-based deficits, development of complex language beyond functional communication, and direct treatment for social pragmatic needs and emerging literacy.

What is one of the responsibilities of both a BCBA and SLP in treatment?

Both are involved in data collection, parent training/support, decision-making, planning treatment, and developing goals related to functional communication.

What specific assessments might an SLP conduct related to ASD?

Screening for red flag characteristics of ASD and conducting diagnostic assessments.

How does a BCBA contribute to parent involvement in treatment?

By providing parent education and coaching, helping them understand and support behavior and communication goals.

What is the SLP's role in assessing communication needs

The SLP assesses for AAC, complex language acquisition, and provides direct treatment for social pragmatics and emerging literacy.

What does the form of a behavior refer to?

The form of the behavior refers to what the behavior looks like and is used for data collection.

What does the function of a behavior refer to

The function of the behavior refers to what the individual is gaining by performing the behavior, i.e., the reinforcers that follow and maintain the target behavior.

How is the function of behavior used in treatment?

It is used to inform and develop appropriate replacement skills for the individual.

What is the first step in teaching a replacement behavior?

Identifying the function of the current undesired behavior.

What does "functionally equivalent" mean in terms of replacement behavior?

The replacement behavior serves the same purpose or fulfills the same need as the undesired behavior.

What are practical skills in the context of adaptive behaviors?

Everyday skills that help individuals meet their basic needs and function effectively in their environment.

What are some examples of practical skills?

Self-help & self-care, communication, problem-solving, social skills, and leisure skills.

What is Lovaas' Discrete Trial Instruction (DTI)?

It is a structured teaching method involving repeated trials that target specific skills, commonly used for children with ASD.

How many hours per week did Lovaas' original model recommend for Discrete Trial Instruction?

40 hours per week

What skills are targeted in Lovaas' DTI model?

Speech and language, imitation, complex skills, pre-academic skills, and reduction of problem behaviors.

What is the outcome for children who underwent Lovaas' DTI in terms of IQ?

Mean IQ increased from 63 to a normal range for many children.

What impact did Lovaas' DTI have on special education placement?

Many children required less restrictive placements in special education.

What is a key principle of Lovaas' teaching method?

"We must teach the way the child can learn."

What is the 3-term contingency in ABA?

Antecedent, Behavior, Consequences

Antecedents:

What triggers the behavior

Behavior

the behavior itself (appropriate or inappropriate)

Consequences

Reinforcing or punishing outcomes that follow the behavior.

What is the goal of speech-language intervention for children with ASD?

To move the child from unconventional means of communication (e.g., kicking, screaming) to conventional means (e.g., gesture, sign, verbal speech, AAC), and eventually to language.

Conventional communication

Gestures, sign language, verbal speech, AAC.

Unconventional communication

Kicking, screaming, grabbing, pushing.

What are foundational prerequisite skills for social interaction and learning?

Joint attention, imitation, initiation, and turn-taking.

What factors should be considered during assessment for treatment planning?

The child's developmental level, cognitive ability, current communicative behaviors, and whom the child interacts with under what conditions.

What are the four major domains of the Communication Matrix

Refuse, Obtain, Social, Information.

what are the seven levels of the Communication Matrix

• Pre-Intentional Behavior

• Intentional Behavior

• Unconventional Communication

• Conventional Communication

• Concrete Symbols

• Abstract Symbols

• Language

Why is verbal speech by age 5 considered important in children with ASD?

"Useful" verbal speech by age 5 predicts better social and adaptive skills later in life.

How does cognitive ability impact responsiveness to treatment in ASD?

Cognitive ability, particularly intellectual disability, can affect treatment response, and it is important to watch for plateaus or regressions in response to treatment.

What is the focus of early developmental intervention in ASD?

Assessing prelinguistic nonverbal communication and social interaction skills, and supporting verbal communication or AAC for nonverbal/minimally verbal children.

What is the focus of treatment for adolescents with ASD?

Transitioning to adulthood, prevocational training, and improving communication skills for quality of life and daily living skills (ADLs).

Why is interdisciplinary assessment important in ASD intervention?

It supports diagnosis, efficient service delivery, differential diagnostics, and helps identify co-occurring disorders to plan effective interventions.

What are some risks for co-occurring disorders in ASD?

Epilepsy, gastrointestinal problems, sleep disturbances, psychiatric diagnoses, immunological conditions, and genetic conditions.

Positive Reinforcement (R+)

• Presentation of a stimulus that increases future behavior.

Negative Reinforcement (R-)

Removal of a stimulus that increases future behavior.

Positive Punishment (P+)

Presentation of a stimulus that decreases future behavior.

Negative Punishment

• Removal of a stimulus that decreases future behavior.

Extinction

Withholding reinforcement for a previously reinforced response, decreasing future behavior likelihood.

Unconditioned (Primary) reinforcer

Unlearned (e.g., food, water).

Conditioned (Secondary) reinforcer

Learned (e.g., praise, money).

Differential Reinforcement

Reinforcing a particular response while withholding reinforcement for other responses.

Stimulus Control

Increases behavior probability in the presence of a specific cue; decreases it with S delta or other variables.

Prompting

Supplemental stimuli used to evoke a response.

Reinforcement:

• Stimulus change (presentation/removal)

• Contingent upon a response

• Increases future likelihood of the response.

Punishment

• Stimulus change (presentation/removal)

• Contingent upon a response

• Decreases future likelihood of the response.

Extinction

1. Withholding reinforcement

2. For a previously reinforced response

3. Decreases future likelihood of the response.

Discrete Trial Instruction

• Instruction (sd) (antecedent)→ Response (behavior)→ (consequence) Reinforcement/Error correction.

• Includes wait time, response latency, and feedback intervals.

Adaptive Characteristics of ASD

• Difficulty with transitions and routines.

• Challenges with food textures and variety.

• Deficits in independent self-help skills (e.g., dressing, toileting).

Motor Characteristics of ASD

• Seeks sensory input via self-stimulation.

• May exhibit clumsiness or “toe-walking.”

• Difficulty with fine-motor skills (e.g., coloring, writing).

• Engages in repetitive motor tasks.

Cognitive Characteristics of ASD

• High-functioning individuals may have average to above-average IQ.

• Performance may exceed verbal ability (e.g., puzzles).

• Hyperlexia: can read but struggles with comprehension.

• Intense repetition needed for new learning.

Play Skills in ASD

• Preference for solitary play; may parallel play without interaction.

• Non-functional use of toys (e.g., spinning instead of rolling).

• Deficits in pretend play; may recite scripts instead of engaging.

Social Communication Characteristics

• Lack of social reciprocity and initiation.

• Difficulty with joint attention and asking questions.

• Delayed verbal speech; may echo phrases or songs.

• Requires visual cues to support communication.

Prerequisite Skills for AAC

• Joint attention, imitation, initiation of communication.

• Visual discrimination and association of objects with sounds.

Determining AAC Modalities

• Communicative behaviors needed: initiation, persistence.

• Cognitive skills: cause and effect, visual discrimination.

Preference Assessment for AAC

• Use paired stimuli to identify preferred items.

• Mark choices to determine highly desired reinforcers for interventions.

AAC Modalities

• Manual signs, graphic communication systems, PECS, speech-generating devices.

• AAC is considered “emerging” in evidence level; shows positive outcomes.

Practical Requirements for AAC Implementation

• System selection, acquisition, setup, and maintenance.

• Instructional strategies, training for families/professionals, ongoing support.

Key Components of AAC Intervention

• Selecting the AAC system and initial vocabulary.

• Identifying instructional strategies and training partners.

• Frequent monitoring and adaptation of the AAC system.