PBL Case 4: Autism

what is AUTISM characterized by

1. marked abnormalities in social interactions + communication

2. presence of stereotypes + unusual interests

when do SYMPTOMS of AUTISM emerge

prior to 3 years of age

what 2 DOMAINS do the SYMPTOMS of AUTISM emerge prior to 3 years of age

1. social communication development

2. imaginative play

what are 4 ETIOLOGIC FACTORS associated with AUTISM

1. premature birth

2. infants born to older parents

3. infants exposed to prescription medication (valproic acid + thalidomide) during gestation

4. genetics (family history)

are BOYS/GIRLS 4x more likely to have AUTISM

boys

what are 4 SOCIAL + COMMUNICATION DEFICITS associated with AUTISM

1. difficulty with verbal + nonverbal communication

2. limited use of gestures, facial expressions or eye contact

3. impaired understanding of social cues

4. difficulty in forming relationships (limited interest in peer interaction)

what are 4 RESTRICTED + REPETITIVE BEHAVIORS (Restricted, Repetitive Patterns of Behavior, Interests or Activities) associated with AUTISM

1. engaging in repetitive movements (hand-flapping, rocking)

2. insistence on sameness or routines (eating foods in a particular order)

3. intense focus on specific topics or interests (memorizing facts about a specific subject)

4. sensory sensitivities (overreaction to sounds, lights, textures)

what are 3 HALLMARK SIGNS associated AUTISM

1. failure to develop peer relationships

2. lack of spontaneous sharing on interests + enjoyment

3. lack of social/emotional reciprocity

what are 3 NONVERBAL BEHAVIORS during SOCIAL INTERACTIONS associated with AUTISM

1. eye gaze (not eye contact)

2. lack of facial expressions

3. lack of body postures + gestures

what are 4 COMMUNICATION IMPAIRMENTS associated with AUTISM

1. delay or lack of spoken language

2. impaired ability to initiate or sustain a conversation with order

3. use of repetitive or idiosyncratic language

4. lack of spontaneous pretend play

what are 3 RESTRICTED REPETITIVE + STEREOTYPED BEHAVIORS associated with AUTISM

1. inflexible adherence to routines + rituals

2. stereotyped + repetitive motor mannerisms

3. persistent preoccupation with parts of objets

what are 5 MOTOR IMPAIRMENTS/MOTOR DELAYS associated with AUTISM

1. gross motor coordination

2. fine motor coordination

3. motor stereotypes

4. postural

5. imitation + praxis

what are 3 GROSS MOTOR COORDINATION IMPAIRMENTS in SCHOOL-AGED CHILDREN + ADULTS with ASDs

1. poor upper + lower limb coordination impairments

2. bilateral coordination impairments

3. visuomotor coordination impairments

what GROSS MOTOR DELAYS are present in the FIRST YEAR of LIFE in TODDLERS + PRESCHOOLERS with ASDs

gross motor delays in supine, prone + sitting skills

what GROSS MOTOR DELAYS are present in the SECOND YEAR of LIFE in TODDLERS + PRESCHOOLERS with ASDs

delayed onset of walking

what is a FINE MOTOR COORDINATION IMPAIRMENT in SCHOOL-AGED CHILDREN + ADULTS with ASDs

poor fine motor coordination (performance on manual dexterity tasks - Purdue pegboard task)

what is the FINE MOTOR DELAY is associated with INFANTS at RISK for ASD

reaching + grasping delay

when do FINE MOTOR DELAYS persist

in 2nd + 3rd years of life

what is MOTRO STEREOTYPIES common in

older children + adults with ASDs

what MOTOR STEREOTYPIES may appear in 1st year of life

repetitive banging of objects or unusual sensory exploration

when do MOTOR STEREOTYPES most often emerge

2nd year of life

what is affected in CHILDREN + ADULTS with ASDs

feed-forward + feedback control of posture

what PERSISTS in adults with ASDs

deficient postural control

what POSTURAL DELAYS are present in INFANTS at risk of ASDs + TODDLERS and PRESCHOOLERS with ASDs

postural delays in rolling + sitting

what POSTURE is present in INFANTS who later developed ASDs

unusual postures held for brief to long periods in infants

regarding IMPAIRMENTS in SCHOOL-AGED CHILDREN + ADULTS with ASDs, what are IMITATION IMPAIRMENTS present during

postural, gestural + oral imitation

regarding IMPAIRMENTS in SCHOOL-AGED CHILDREN + ADULTS with ASDs, when is PERFORMANCE of COMPLEX MOVEMENT SEQUENCES poor

during imitation on verbal command + during tool use

what are 3 BRAIN DEVELOPMENT STAGES associated with AUTISM

1. overgrowth in infancy + early childhood

2. slowing + arrest of growth in later childhood

3. degeneration of preadolescence + adulthood

what is EARLY BRAIN OVERGROWTH in ASD followed by

a phase of growth arrest during development/degeneration

what is the HEAD CIRCUMFERENCE of a 1-2 year old child who develops autism later

head circumference significantly greater than a typical developing child

what does HEAD SIZE near normal at BIRTH indicate

brain overgrowth may occur in first 2 years of life

what 3 BRAIN STRUCTURES does the BRAIN OVERGROWTH PERIOD affect

1. frontal lobes

2. temporal lobes

3. amygdala

when does BRAIN OVERGROWTH continue into

early childhood

what does LACK of LONG-RANGE CONNECTIVITY within BRAIN lead to

poor integration of:

1. sensorimotor

2. social communication

3. cognitive functions

regarding the NEUROPATHOLOGY of AUTISM, what is there an OVER-CONNECTIVITY in

short-range neuronal fibers

regarding the NEUROPATHOLOGY of AUTISM, what is there an UNDER-CONNECTIVITY in

long-range neuronal fibers

what are 3 BRAIN CHANGES associated with AUTISM

1. cerebellum

2. limbic system

3. cortex

what are 2 GOLD STANDARD OUTCOME MEASURES for DIAGNOSING AUTISM

1. Autism Observation Schedule (ADOS)

2. Autism Diagnostic Interview-Revised (ADI-R)

what is the AUTISM OBSERVATION SCHEDULE (ADOS)

is a 45 minute to 1 hour standardized qualitative assessment that evaluates a child's social reciprocity, nonverbal + verbal communication as well as stereotypical behaviors + interests using various play-based activities with an adult tests

what is the AGE RANGE of the AUTISM OBSERVATION SCHEDULE (ADOS)

12 months to adulthood

what are the 3 DOMAINS of the AUTISM OBSERVATION SCHEDULE (ADOS)

1. social

2. communication

3. repetitive behaviors

what is the AUTISM DIAGNOSTIC INTERVIEW-REVISED (ADI-R)

is a structured interview where parents/caregivers are asked a set of questions about their child's early + current behaviors + development

what does the information gathered from the AUTISM DIAGNOSTIC INTERVIEW-REVISED (ADI-R) help a clinician determine

if a child meets the criteria for an ASD diagnosis

what are the 3 KEY DOMAINS of the AUTISM DIAGNOSTIC INTERVIEW-REVISED (ADI-R)

1. language/communication

2. reciprocal social interactions

3. restricted, repetitive + behaviors/interets

what are 7 ASSESSMENT CATEGORIES utilized in the DIAGNOSIS + EVALUATION of AUTISM

1. cognitive assessments

2. sensory-perceptual assessments

3. motor assessments

4. developmental screening

5. developmental assessments

6. praxis + imitation assessments

7. functional assessments

what is 1 MOTOR ASSESSMENT utilized in the EVALUATION + DIAGNOSIS of AUTISM

peabody developmental motor scale

what is 1 DEVELOPMENTAL SCREENING TOOL utilized in the DIAGNOSIS + EXAMINATION of AUTISM

Modified Checklist for Autism in Toddlers (MCHAT)

what is the PURPOSE of the MODIFIED CHECKLIST for AUTISM in TODDLERS (MCHAT)

for early detection of ASD in toddlers (16-30 months)

how does the MODIFIED CHECKLIST for AUTISM in TODDLERS (MCHAT) work

parents answer a series of questions about their child's behavior (social interactions, communication + play)

what is 1 SINGLE-DOMAIN DEVELOPMENTAL ASSESSMENT TOOL utilized in the DIAGNOSIS + EXAMINATION of AUTISM

Vineland Adaptive Behavior Scale (VABS)

what does the VINELAND ADAPTIVE BEHAVIOR SCALE (VABS) measure

adaptive functioning in areas of communication, daily living skills + socialization

what are 3 OTHER OUTCOME MEASURES used in the DIAGNOSIS + EXAMINATION of AUTISM

1. Childhood Autism Rating Scale (CARS)

2. Aberrant Behaviors Checklist (ABC)

3. Social Responsiveness Scale (SRS)

what is the purpose of the CHILDHOOD AUTISM RATING SCALE (CARS)

to rate severity of autism based on observation of behavior

how does the CHILDHOOD AUTISM RATING SCALE (CARS) work

clinicians observe child's behavior in various settings + rate severity in areas of social behavior, communication + stereotypical behaviors

what is the CHILDHOOD AUTISM RATING SCALE (CARS) used for

determining severity of autism + tracking progress over time

what is the purpose of the ABERRANT BEHAVIORS CHECKLIST (ABC)

to assess irritability, lethargy, stereotypic behaviors + social withdrawal

what is the purpose of the SOCIAL RESPONSIVENESS SCALE (SRS)

to assess severity of social impairment in children + adolescents with ASD

how does the SOCIAL RESPONSIVENESS SCALE (SRS) work

questionnaire is completed by parent/teacher rating child's social responsiveness + interactions in various situations

what is the SOCIAL RESPONSIVENESS SCALE (SRS) used for

assessing social functioning + monitoring changes over time

what are 4 SOCIAL + COMMUNICATION DEVELOPMENTAL DEFICITS associated with AUTISM

1. delayed speech or language skills (nonverbal communication)

2. limited or absent social referencing (looking at others for cues on how to react)

3. delayed or absent joint attention (sharing focus with others, pointing, showing)

4. difficulty in pretend play (may not engage in imaginative play)

what is the SENSORY DEVELOPMENTAL DEFICIT associated with AUTISM

sensory processing issues (overreacting to certain textures/sounds)

what are 7 COMPLICATIONS associated with AUTISM

1. intellectual disability

2. language impairment

3. behavioral issues

4. sleep disorders/disturbances

5. anxiety + depression

6. epilepsy

7. gastrointestinal issues (constipation/diarrhea)

what LANGUAGE IMPAIRMENTS is linked to AUTISM

delays or deficits in speech + language development

what are 4 BEHAVIORAL ISSUES linked to AUTISM

1. aggression

2. self-injury behaviors

3. tantrums

4. difficulties with transitions/changes in routine

what are 5 COMORBIDITIES associated with AUTISM

1. ADHD

2. intellectual disabilities

3. anxiety disorders

4. sleep disorders

5. seizures

what are 3 ANXIETY DISORDERS linked with AUTISM

1. social anxiety

2. generalized anxiety disorder

3. obsessive-compulsive disorder

what are 3 SLEEP DISORDERS linked with AUTISM

1. difficulty falling asleep

2. staying asleep

3. having irregular sleep patterns

when are LANGUAGE DELAYS present in AUTISM

2-3 years of age

how would PT INTERVENTION DIFFER in HOME-BASED SETTING vs OUTPATIENT SETTING

Home-Based Setting:

1. utilizes patient's own home -> patient familiar with environment = patient more comfortable + relaxed

2. patient less overwhelmed

3. therapist can incorporate child's favorite toys + activities

4. encourages active participation from family members

Outpatient Setting:

1. access to specialized tools + sensory environments that aren't often available at home

2. offers a highly structured + controlled setting

3. creates opportunities for patients to interact with peers

what are 5 COMMON MEDICATIONS used to manage behaviors in AUTISTIC CHILDREN

1. antipsychotics

2. SSRIs

3. stimulants

4. anticonvulsants

5. melatonin

what 2 ANTIPSYCHOTICS are FDA APPROVED MEDICATIONS for treating irritability in children with ASD

1. risperidone

2. aripiprazole

what is the purpose of ANTIPSYCHOTICS in the treatment of AUTISM

to manage irritability, aggression, self-injurious behaviors + tantrums

what are 2 COMMON SSRIs used for the treatment of AUTISM

1. fluxoetine

2. sertraline

what is the purpose of SSRIs in the treatment of AUTISM

to manage anxiety + repetitive/obsessive behaviors

what is 1 COMMON STIMULANT used in the treatment of AUTISM

methylphenidate

what is the purpose of STIMULANTS in the treatment of AUTISM

to improve attention + reduce hyperactivity

what is the purpose of ANTICONVULSANTS in the treatment of AUTISM

to treat + manage epilepsy + seizure activity

what is the purpose of MELATONIN in the treatment of AUTISM

to help with sleep disturbances

what are 2 MAIN REASONS for an AUTISTIC PATIENT is FEARFUL of CLIMBING + JUMPING on a TRAMPOLINE

1. gravitational insecurity

2. sensory processing issues

how does GRAVITATIONAL INSECURITY + SENSORY PROCESSING ISSUES result in an AUTISTIC PATIENT being FEARFUL of CLIMBING + JUMPING on a TRAMPOLINE

autistic patient maybe overly sensitive to certain physical sensations/have difficulty integrating sensory input = fear/discomfort when engaging in activities that involve balance, movement or unfamiliar sensations

what are 4 INTERVENTIONS that could be implemented to improve FEARFULNESS of CLIMBING + JUMPING on a TRAMPOLINE

1. sensory integration therapy

2. gradual exposure

3. proprioceptive activities

4. behavioral support

what does SENSORY INTEGRATION THERAPY involve

structured activities to gradually desensitize patient to physical activities (climbing + jumping)

what is the GUIDELINE for SENSORY INTEGRATION THERAPY

OTs start slow with less challenging tasks + increase difficulty as patient becomes more comfortable

what is the purpose of PROPRIOCEPTIVE ACTIVITIES

help patient to better understand + manage their body's movement + positioning

what is the goal of PROPRIOCEPTIVE ACTIVITIES

reduce fear + build confidence in activities (climbing + jumping)

what are 3 EXAMPLES of PROPRIOCEPTIVE ACTIVITIES for addressing FEAR of JUMPING on a TRAMPOLINE

1. seated bouncing activities

- bouncing on a Swiss therapy ball

- trampoline seated bouncing

2. standing trampoline activities

- side to side weight shifting on trampoline (use handrails for support if needed)

- musical statues on trampoline (patient bounces on tramp when music is playing + freeze when music stops

3. slowly implement jumping on trampoline

- small jumping on trampoline using handrail

what are 2 EXAMPLES of PROPRIOCEPTIVE ACTIVITIES for addressing FEAR of CLIMBING

1. floor + mat activities

- animal walks (leap frog, crab walks + bear walks)

- obstacle courses

2. controlled climbing on low surfaces

- crawling up a ramp or over stacked cushions

- crawling through tunnels

what is the purpose of BEHAVIORAL SUPPORT

reinforces small successes + providing reassurance during challenges activities

what is the goal of BEHAVIORAL SUPPORT*

help patient feel more secure + reduce their fear overtime

what are 7 TYPES of THERAPIES beneficial for an AUTISTIC PATIENT

1. speech therapy

2. physical therapy

3. occupational therapy

4. applied behavior analysis (behavioral therapy)

5. psychiatric support

6. family support

7. functional nutrition

what is the purpose of SPEECH THERAPY

to improve communication + use of alternative methods (PECS)

what are 3 PURPOSES of PHYSICAL THERAPY

1. addressing gait issues

2. addressing calf pain

3. improving balance + coordination

what does OCCUPATIONAL THERAPY focus on (3)

1. sensory integration

2. fine motor skills

3. managing transitions

what are 3 PURPOSES of APPLIED BEHAVIOR ANALYSIS (BEHAVIORAL THERAPY)

1. address aggressive behaviors

2. improve flexibility with routines

3. breaking down skills (step by step approaches)

what does FUNCTIONAL NUTRITION focus on

on a whole-food diet rich in fruits, vegetables, lean proteins + health fats while potentially incorporating specific dietary strategies (GFCG: gluten-free casein-free or ketogenic diet) to manage symptoms

what is the CAUSE of TOE WALKING with AUTISM

sensory difference + motor challenges

what are 3 ASSOCIATED FACTORS of TOE WALKING with AUTISM

1. sensory processing

2. motor control

3. vestibular system

why is SENSORY PROCESSING an associated factor of TOE WALKING with AUTISM

patient may be seeking/avoiding certain sensory input by walking on their toes

why is MOTOR CONTROL an associated factor of TOE WALKING with AUTISM

differences in muscle tone or balance can make toe walking feel more comfortable or natural

why is the VESTIBULAR SYSTEM an associated factor of TOE WALKING with AUTISM

impairments in vestibular system can affect balance + spatial awareness making toe walking a compensatory mechanism