EXAM REVIEW: AUTISM SPECTRUM DISORDER ASD

Signs/Symptoms of ASD in Preschool-aged children

• delay or absence of spoken language

• difficulty reading expressions

• unusual eye contact; appear to stare through or past people

• sensory interests or avoidance

Signs/Symptoms of ASD in Preschool-aged children

• social deficits: lack of interest in other people, difficulty turn taking, poor initiation of play

• reduced / absent pretend play

• unusual motor behaviors: rocking, spinning, or tip-toe walking

• difficulties with change in routine

• abnormal interests / play behavior

Signs/Symptoms of ASD in School-Aged Children

• speech abnormalities: delays, repetitive speech, echolalia, other difficulties

• limited, sometimes very literal understanding of language

• impairments in nonverbal communication: limited use of eye contact, expression, gestures

• sensory interests / avoidance

Signs/Symptoms of ASD in School-Aged Children

• unusual interest / interests that are overly intense difficulty with unexpected changes in routine

• socialization difficulties: problems initiating or joining in with others in play or difficulty understanding social norms (personal space)

ASD CHARACTERIZED BY:

• deficits in social communication & interaction

• restricted, repetitive, stereotyped behavior & interests

primary symptoms of ASD in social interaction

• deficits in joint attention behavior

• poor eye contact

• poor processing of social stimuli

• difficulties with social subtleties

primary symptoms of ASD in communication

• mutism or echolalia & pronoun reversals

• poor pragmatics

primary symptoms of ASD in restricted behavior & interests

• repetitive movements

• insistence on sameness

• restricted, fixated interests

associated impairments in ASD

• sensory / perceptual ( over/under sensitivity or over selectivity

• intellectual performance ( higher IQ associated with better prognosis, performance scores better than verbal scores, splinter skills, savant skills )

• adaptive behavior deficits

joint attention

• one of the deficits in autism

• interactions, which usually develop after 6 months

• interactions involve preverbal gestures, such as pointing & eye contact that center the child’s and caregiver’s attention on object or situation, in order to share an experience

echolalia

person echoes back what another has said

pronoun reversal

• more common in autism; may persist into adulthood

• child may refer to others as I, me, and to self as he, she, the, you

hyperlexia

single-word reading is good but comprehension of what is read is problematic

splinter skills

abilities much higher than expected on the basis of their general intelligence

savant abilities

skills that are strikingly better than those seen in normally developing youth

theory of mind ToM

• Ability to infer mental states in others and in ones self

• meaning that we understand that mental states exist- that humans have desires, intentions, beliefs feelings- and that these mental states are connected to action

• thought of as the ability to read others’ minds, which guides our interaction with others

In typical development in theory of mind

• by age 3 to 4 yrs children have first order abilities, some understanding of peoples private mental states (pretend play)

• age 5 to 5 children have second order abilities, can think about another person’s thinking about a third person’s thoughts

central coherence

viewed as caring from strong to weak in the general population

weak in central coherence WCC

• individuals with autism; they tend to focus on parts of stimuli rather than on integrating information into wholes

• they seen the trees rather than the forest

executive dysfunction

• difficulties in initiating, sustaining, and shifting attention, planning and impulse control

• need for sameness

• tendency to perseverate

executive function

a set of cognitive processes that enable individuals to plan, focus attention, remember instructions, and manage multiple tasks successfully

primary features of ASD?

• social communication and interaction ( difficulty understanding social cues, engaging in reciprocal conversation)

• restricted, repetitive patterns of behavior, interests, or activities RRBS

repetitious behaviors

kicking and rocking in infancy and later preference for sameness

described as restricted, repetitive behavior

both younger and older youth with autism display odd behaviors, interests, and activities; occurring in high frequency

RRBS

• differ in autism; occurring in greater frequency and severity and persisting through late childhood

• especially common in younger children with autism and those with lower intelligence

second category of RRBs

• characterized as higher-order “insistence on sameness”

• children appear preoccupied with aspects of the environment

• seem obsessed w numbers, compulsively collect things

obsessive behaviors

more common in older children with ASD

why RRBs occur or maintained

• excessive arousal or anxiety plays a role

• perhaps some of the behaviors serve as self-stimulation that results from the child’s inability to engage the world in other ways

secondary features of ASD

• sensory/perceptual impairments

• intellectual disability / challenges in areas such as executive functioning, attention, memory, problem-solving

• impairments in adaptive functioning

• cognitive impairments (affects learning, social interactions n more)

motor impairments

• may represent the earliest signs abnormal development in ASD

• interfere w other aspects of developments, social interactions & physical activity

behaviorally, youth with ASD

a variety of maladaptive behaviors: aggression, uncooperativeness, withdrawal, self-injurious behaviors

second category of RRBs

• be overly absorbed in hobbies; adopt motor routines like rearranging objects, insist on following rituals for eating & going to bed

• minor changes in the environment; rearrangement of furniture or schedules can upset them

secondary features of ASD

• physical abnormalities (prominent forehead, atypical head size, high narrow palate, low set ears)

• impairments in motor development (poor balance, uncoordinated gait, impaired fine and gross motor skills, and motor awkwardness from infancy into adulthood)

• co-occurring disorders (anxiety, depression, ADHD, oppositional defiant behaviors)

executive dysfunction

• problems with cognitive flexibility and motor planning

• also seen in ADHD

Coexistence of ID with ASD creates

a varied clinical presentation of autism

prevalence of anxiety disorders

children with ASD is estimated to well above in the general population

ASD and anxiety

excessive sensitivity to stimuli is found in about half of the children with ASD, raising the possibility that oversensitivity might lead to some forms of anxiety like fear of loud noises.

regression / regressive patterns

far more common ASD that was once thought; declines in the child’s use of meaningful words, orienting to their names, or spontaneously imitating others & other behaviors

present between 6 to 12 months of age

• expansion of the cortical surface area of the brain

• predicted brain volume growth

• emergence of social communication impairments consistent with autism by age 2 yrs

IQs 70 or above

seem to do notably better, suggesting that this level is a good predictor of adult independent living

individuals with ASD show

• larger head size (macrocephaly) 9% with brain overgrowth

• brain size is small to normal at birth, atypical growth occurs as early as 6 months

• youth and adults indicate brain volume anomalies; cortical surface areas overgrowth in infants at high risk

educational opportunities

• included in the IDEA

• school districts are obliged to identify children with ASD, provide services from birth, include families in evaluation and intervention, deliver appropriate educational programs

inclusion in regular classrooms

puts children with ASD at risk for peer rejections and unfavorable social and emotional outcomes.