LD&A Final

What is Autism Spectrum Disorder?

A neurodevelopmental disorder characterized by challenges with social skills, repetitive behaviors, interests, or activities

When does ASD likely present?

At birth, and symptoms unfold over time

At what age to the symptoms of ASD become apparent?

Between the ages 1 and 3

What are the aspects of an autism diagnosis given the DSM-5?

deficits in:

-social-emotional reciprocacy

-nonverbal communicative behaviors used in social interaction

-developing and maintaining relationships appropriate to a developmental level

What is the current prevalence in autism?

1 in 31

What are general trends in the prevalence of autism?

-1966: 4 in 10,000

-2002: 1 in 150

-2025: 1 in 31

What factors have increased the prevalence of autism?

-genetic and environmental factors

-increased awareness and understanding of autism

-expanded diagnostic criteria

-improved screening and diagnostic tools/capabilities

-increased focus on getting children into services

How early in life can Autism be diagnosed?

As early as 18-24 months

When are most children diagnosed with Autism?

4 or 5 years old

Is diagnosing autism within the scope of practice for an SLP?

It depends, when there is no appropriate team available, an SLP who has been trained in the clinical criteria for autism and who is experienced in the diagnosis of developmental disorders, may be qualified to diagnose

-interdisciplinary collaboration is important

-some states restrict this from the scope of an SLP

What is ADOS?

Autism Diagnostic Observation Schedule

What does ADOS do?

Observes a child's communication and social interaction skills through play-based activities

Should ADOS be used alone to diagnose autism?

No, it is the gold standard for an autism diagnosis, but it should be used in conjunction with other assessment tools

Is there a biomarker for ASD

No

What are risk factors or potential causes of autism?

-genetic factors

-environmental factors

-neurobiological factors

What are genetic risk factors?

-4 times more common in boys, however we suspect girls are under-identified

-siblings of autistic children have a 20% chance of being autistic, which is about 7x higher than the rate of children with no autistic children

-autism is thought to be about 80% inheritable

What are environmental risk factors?

-children with older parents

-prenatal adverse events, such as: premature birth, gestational diabetes, hypertension

-exposure to environmental factors like air pollution

What are neurobiological risk factors?

-excess brain fluid in infancy

-macrocephaly: impacts about 20% of individuals with autism

-functional connectivity: results in inefficent processing of cognitive info

Why do people believe that MMR vaccine cause autism?

because, study's show an increase in autism diagnosis after getting vaccines, but correlation not causation

-age

-timeline of noticeable signs and age of vaccination

What are cultural/linguistic variables that contribute to the fact that children from minority families may not revieve diagnosis/services until later than average

-parental response, interpretation, and acceptance of ASD are different among cultures

-some may think disabilities are something that is kept in the family

-underrepresentation in minorities

What are early signs of autism?

-hard to get baby to look at you

-baby rarely shares enjoyment with you

-baby rarely shares their interests with you

-baby rarely responds to their name

-limited use of gestures and sounds

-unusual ways of moving fingers, hands, or body

-unusual reactions to dounds, sights, or textures

What does it mean to say "look for a combination of features"?

early signs are a combination of:

-lack of typical social communication milestones

and

-presence of unusual behaviors, repetitive behaviors, & restricted interactions

What are language features tha may be observed with autism

-jargon

-neologisms

-pronoun reversal

-overly formal speech

-atypical prosody

-literal language

-hyperlexia

-difficulty maintaining converations

What is the behavioral approach?

-targets are selected based on the needs of the family and skills of the child, not following a developmental sequence

-the first evidence-based interventions for individuals with autism were behavioral interventions

-language is a human behavior that can be taught

What is the developmental approach?

-benchmarks are based on typical language development

-following the child's interests and motivation is key, and learning is done within meaningful activities & events

-focus on teaching spontaneous social communication, with a blend of structure and flexibility

What does ABA stand for?

Applied Behavior Analysis

What does DTT stand for?

Discrete Trial Training

Are DTT and ABA the same thing?

No

What is ABA?

-understanding of how changes in the environment affect human behavior

-covers an umbrella of empirically based practiced that are built on operant learning procedures

-often time inaccurately equated with DTT

What is DTT?

-known for bing unnatural and overly structured

-if goals are taught in isolation, this should be only for very brief time with real life generalization and maintenance being important outcomes

-not compatible with acceptance of neurodiversity

-natural environment teaching is preferred over DTT

What are NDBI's?

Combination between developmental and behavioral approaches

Why did the field shift away from behaviorally based interventions?

Had some success, but sometimes lead to:

-child failure to generalize newly learned skills across multiple environments and people

-the presence of escape/avoidance challenging behaviors

-lack of spontaneity

-overdependence on prompts

Researches were driven to expand and improve interventions

What are some components that are common to all NDBI models?

-individualized treatment goals

-child initiated teaching episodes

-environmental arrangement

-natural reinforcement to enhance motiv.

-use of prompt and prompt fading

-balanced turns within social play routines

- modeling

-broadening attentional focus

-adult imitation of child's language, play, or involvement

What are the three steps of active engagement for young children with autism?

Step 1: coming together

Step 2: keeping together

Step 3: staying together

What is step 1 of active engagement?

Coming together

-is the child well regulated?

-engaged in a productive role in the activity

-socially connected and noticing the caregiver

What is step 2 of active engagement?

Keeping together

-is the child looking toward the caregiver often?

-responding when asked for their attention to do something?

-using gestures, sounds, or words to communicate

What is step 3 of active engagement?

Staying together

-is the child being flexible?

-generating new ideas

What are the 3 transactional supports for promoting active engagement?

1. Shared agenda

2. Social reciprocacy

3. Better skills

What is step 1 of transactional support for promoting active engagement?

Shared agenda

- a motivating activity includes interesting materials and is developmentally sensible

-a productive role lets child know exactly what is coming next and helps them get ready for change

-positioning supports interaction when it's on a child's level and face to face

-follow child's focus means talking about what the child is paying attention to

What is step 2 of transactional support for promoting active engagement?

Social reciprocacy

-promote child initiation by pausing during interaction and waiting for directed communication

-balance turns so that there is no more than 1 1/2 parent turns per child turn

-natural reinforcers such as requested objects, help, comfort, or shared enjoyment being naturally rewarded communication

-clear message to ensure comprehension have expectation for child to listen and act on the language heard

What is step 3 of transactional support for promoting active engagement?

Better skills

-model language, play, and interaction so that the child knows what they could say or do

-extend the activity, roles, and transitions to build on play, interaction, and connectedness

-adjust expectations and demands by offering more support when needed and measuring expectations when things are going well

-balance interaction and independence so that your child can be active and flexible whether alone or in small group

gestalt language processing theory: should we work to extinguish echoloalia in autism clients?

No, echolalia is a form of communication

What age range, MLU, and browns stage encompass the developing language stage?

Age range: 3 - 5

Browns stage: 2 - 5

MLU range: 2 - 5

What are the main features of language development that occur during the developing language stage?

-expressive vocab larger than 50 words

-from combining words to creating sentences

-on the way to acquiring all basic sentence structures of the language

-play with peers in developing

What are the principles of family-centered assessment at the developing language stage?

-parents are an important source of info

-help the family feel confident that the team has a true sense of who the child's

-addresses the families anxieties and concerns

-respect their pov and priorities

What are purposes of screening in the developing language stage?

-determines whether a child's lang skills are significantly different from peers

-use direct, standardized instruments

-should be short and psychometrically sound

-gathering info from family to gauge child's level of risk

What are purposes of standardized assessments in the developing language stage?

-gives more info than screening

-indicates whether the child is significantly different than the tests normed sample

What are purposes of criterion-referenced assessments in the developing language stage?

-watch for evidence of word finding concerns, consider nouns, question words, attributes, and verbs

-can use developmental milestones as criteria

-never too early to look for difficulties

What are early signs of word finding in preschool?

-child cannot quickly name items responded to correctly on the receptive test

-circumlocutions (using many words when fewer would do)

-overly general, non-specific labels

-may respond to phonetic or semantic cues for retrieval

What kind of milestones and skills for conversational skills are expected in the developing language stage?

-new topics introduced

-topics initiated that are appropriate to the context

-topic maintenance - how many turns

-discourse management interrupting or failing to take turns

How many turns should a 3 yo take?

3

How many turns should a 5 yo take?

5

What kind of milestones and skills for peer relationships and play are expected at 1 - 2 yo?

-sensorimotor play

-functional play

-symbolic play

What kind of milestones and skills for peer relationships and play are expected at 2 - 3 yo?

-solitary play

-parallel play

-simple social play

What kind of milestones and skills for peer relationships and play are expected at 3 - 5 yo?

-acting out pretend

-play schemes w/ peers

What is the importance of peer play?

They come at much earlier points in development than we might have thought

-experiences in the first 2 or 3 years of life have implications for children's acceptance by their classmates in preschool and their later school years

What kind of milestones and skills for narrative development are expected at 3 yo?

sequence stories

-"i ate a hamburger, mommy threw the ball"

What kind of milestones and skills for narrative development are expected at 4 yo?

primitive narratives

-"find a frog, he sees a frog, he fell, and the frog hopped, and he catched the frog, then he went away"

What kind of milestones and skills for narrative development are expected at 5 yo?

time based chain narratives

-"mommy took me to the zoo, there was a lion, her made a noise, there was a monkey, and i got some popcorn, and we drove home"

What is the theoretical foundation of Hanen?

To enable parents to transform their daily interactions with young children to build children's best possible lifelong social, lang, and literacy skills

What are the three program objectives of "it takes 2 to talk"?

1. parent education

2. early language intervention

3. social support

What is the objective of parent education?

teaching parents about the essential basic concepts of communication and aspects of communication

What is the objective of early language development?

-parents learn to apply strategies across intervention so that it becomes a normal part of interaction

-SLP's help to coach parent on intervention techniques

What is the objective of social support?

formal and informal support from the child family and community

What are the 5 characteristics of child-directed speech per the Hanen center?

1. shorter, less complete utterances

2. fewer utterances

3. slower speech, exaggerated intonation

4. Frequent repetition

5. Warm and enthusiastic responses

How does child-directed speech suport communication development?

-promoting attention to language

-highlighting linguistic and prosodic features of utterances

-fostering extended parent-child interactions

What are the 4 stages of communicator characateristics?

1. discoverer

2. communicator

3. first word user

4. combiner

What is the discoverer stage?

pre-intentional communication

What is the communicator stage?

intentional communication

-using combination of looks, gestures, and/or sounds

What is the first word user stage?

using single spoken or signed words

-intentional communication

What is the combiner stage?

using 2 + spoken or signed word combinations

-intentional communication

Who are early communicators?

children or adults who are not yet intentional communicators

What is the profile of an early communicator?

-rely on gestures and partner interpretations for most messages

-can speak some words on their own but need others to cue and prompt

-rely on cues and familiar situation

-missing the more complex forms of communication

What is the aided language model/stimulation

method by which an adult pairs spoken words with a point to visual representation of the word

-highlights key words or symbols to support comprehension

-aim to use during at least 80% of the AAC users ongoing daily activities

-model a variety of vocab and communicative functions

What are 3 signals?

-reinforce/maintain

-increase/expand

-decrease/decrease challenging behavior

What is the reinforce/maintain signal?

if the client shifts shoulders forward and pauses, you interpret that as them being ready to get out of the chair, touch their shoulders and say "you told me out!"

What is the increase/expand signal?

if the client reaches toward an object but doesn't look at the partner, they want object so place it object near face so that the individual looks and reaches toward you

What is the decrease signal?

if the child makes a low gg sounds while looking at a task, interpret that as them getting upset. say "I think you want to be all done" and push the object away

What are 4 areas to assess?

1. communicative frequency, form, and function

2. receptive language

3. play and/or functional object use

4. emergent literacy

What is focused language stimulation?

focus on a small number of functional, relevant vocab words and repeat across contexts

-child creates stronger representation and memory store for those words

What type of communicator has expected responsiveness and expected alertness?

Active communicator

What type of communicator has low responsiveness and low alertness?

Inactive communicator

What type of communicator has expected responsiveness and low alertness?

Passive conversationalist

What type of communicator has low responsiveness and expected alertness?

Verbal noncommunicator