Autism Spectrum Disorder & Sensory Integration

What are some environmental risk factors for austism?

• Exposure to harmful pathogens in utero

• Advanced maternal age

What sex more commonly develops autism?

• Males (4:1)

Describe the etiology/pathology of autism

An under-connectivity in the brain that leads to a decrease in communication between brain regions and cortical changes that results in impairments

Describe some common characteristics of someone who has level 1 autism

• Require support

• Decreased interest in social interactions

• Atypical response to social overtures of others

Describe some common characteristics of someone who has level 2 autism

• Require substantial support

• Have marked deficits in verbal and non-verbal social skills

• Have difficulty and distress when changing focus

Describe some common characteristics of someone who has level 3 autism

• Require very substantial support

• Severe deficits, impairments in functioning

• Limited social initiation, minimal response to social interactions

The following describes an individual with what level of autism? An individual is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others falls, and whose attempts to make friends are odd and typically unsuccessful

Lvl 1

The following describes an individual with what level of autism? A person who speaks in simple sentences, whose interaction is limited to narrow special interests, and has markedly odd nonverbal communication

Lvl 2

The following describes an individual with what level of autism? An individual who speaks a few words of intelligible speech and rarely initiates interaction and when they do, they make unusual approaches to meet needs only and respond to only very direct social approaches

Lvl 3

What are the diagnostic criteria for ASD?

• Persistent deficits in social communication and social interactions Atypical response across multiple contexts, as manifested by the following, currently, or by history

• Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently, or by history

• Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies later in life)

• Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

• Disturbances are not better explained by intellectual disability

What are the 3 categories of symptoms kids with autism face?

• Social reciprocity

• Communication intent

• Repetitive behaviors

What are co-occurring conditions that are associated with ASD?

• ADHD

• Communication disorder

• Motor planning disorders or dyspraxia

• Obesity

• Psychiatric disorders

• Sensory processing disorders

• Toe walking

• Intellectual disability

• Epilepsy

What are two types of ASD? Describe them

• Social communication/interactions

  • Difficulty with maintaining and establishing back and forth interactions

  • Maintaining relationships

  • Communicating non-verbally

• Restrictive and repetitive behaviors

  • 2 of 4 following behaviors

    • Stereotyped, repetitive speech, movements, or objective play

    • Adherence to routines or rituals

    • Abnormal interests

    • Hypo/hyperreactive to sensory input or unusual interest in sensory input

What are some red flags you might see in a child/infant that would indicate they may have ASD?

• Not responding to name by 12 months

• Not pointing at objects to show interest by 14 months

• Not playing “pretend” games by 18 months

• Stimming (hand flapping, body rocking, spinning)

• Avoid eye contact and wants to be alone

What are some S/S of ASD?

• Difficulty understanding other’s feelings or talking about their own

• Delayed speech and language skills

• Echolalia

• Non-functional/appropriate play

• Obsessive interests

• Short attention span

• Unusual eating and sleeping habits

• Lack of fear or excessive fear

• Hyperactivity

• Impulsivity

• Aggression

• Short attention span

Early signs of ASD appear at what age?

18 months

Siblings of children dx with ASD have distinct patterns of behavior that may predict the dx of ASD at ___ months

36 months

What body structures/impairments would you assess when evaluating a child with ASD?

• Strength

• Endurance

• Balance/coordination

What are some interventions strategies when working with a child with ASD?

• Structuring the environment

• Instructions

• Prompting/modeling/feedback

• Repetition

• Active engagement

• Progression

• Reinforcement/rewards

Describe what replacement skills are

When you have a child focus on what you want them to do and not the target/problem behavior

Describe the Developmental Individual-differences and relationship (DIR) model

The whole idea is built around meeting a kid at their developmental lvl and building on their strengths. The goal is to help kids expand their “circles of communication” so, PTs engage kids in activities the kiddo likes and follows their lead

What behavioral interactive is only response based?

Applied behavioral analysis (ABA)

What is sensory integration disorder?

The chronic, inefficient processing of information received through the senses that impacts educational, social, and emotional development and leads to significant disruptions in everyday life

What are the treatment goals when working with a kiddo with sensory integration disorder?

• Offer “just right challenges” that tap into natural “inner drive”

• Parent education regarding sensory diet

• Include cognitive/thinking strategies to be individualized for age, lvl, and responsiveness

What are some of the S/S of sensory processing disorder?

• Dislike people touching their hair

• Hate being tickled or cuddled

• Picky eater that resist new food and textures

• Unaware of normal touch and pain, feel things as too soft or too hard

• Chew on everything

• Have poor gross motor skills like running or riding a back

• Poor fine motor skills like handwriting and cutting

• Trouble focusing and concentrating

• Overly sensitive to loud sounds

What are some signs of the sensory processing disorder, sensory modulation?

• Over responsive

  • Resists haircuts/nail trimming

  • Bothered by sticky or strong scents

  • Picky eater

  • Upset by transitions

• Under responsive

  • Doesn’t cry with minor injuries

  • Likes sedentary activities

  • Unaware of surroundings

  • Passive and/or withdrawn

  • Doesn’t seem to react to stimuli

What is the challenge for kiddos with the sensory processing disorder, sensory modulation?

Turning input into controlled behaviors that match the nature and intensity of the input

What are the challenges for those with the sensory processing disorder, sensory seeking?

They seek out input that is often socially unacceptable

What are some S/S of the sensory processing disorder, sensory seeking?

• Restless and fidgety

• Rocks while seated

• Strong preference for swings/spins

• Constantly touching objects

• Licks/sucks on non-food items

• Difficult to calm

What are the challenges for a child who has the sensory processing disorder, sensory motor disorder?

Trouble with stabilizing their body, moving, or planning a series of movement to react functionally

What are the S/S of the sensory processing disorder, sensory motor disorder?

• Slow for milestones

• Clumsy

• Bumps into people

• Need support for multi-step assignments

• Messy/sloppy eating

What is the challenge for those with the sensory processing disorder, sensory discriminative disorder?

Trouble finding similarities and differences between sensations

What are the S/S of the sensory processing disorder, sensory discriminative disorder?

• Needs to watch hands to do fine motor tasks

• Force modulation challenges

• Over/under shoot targets

• Struggles in distracting environments

What is the difference between bribery and positive reinforcement?

• Bribery is when ya give a kid something to stop a behavior problem

• Positive reinforcement is when ya give a kid something for doing the replacement/learned skill

What are some tips for using positive reinforcement with a kiddo?

• Be specific with desired behavior

• Initially, give immediately for connection and association to occur

• Pair tangible with social praise

• 50% rule for time between reinforcement

• Limit access to reinforcers at other times in the day

• Progress to delayed gratification

What are some common pitfalls when positive reinforcement is frequently used?

• Reinforcers lose power

• Not given frequently enough

• Expect too much from kiddo