Ab Psych: Autism Spectrum Disorder

  • In previous DSM - Autism had multiple specific diagnostic categories

    • DSM-5: Asperger’s, autistic, pervasive developmental, and not otherwise specified (NOS) disorders were removed and instead autism was put under an umbrella term with all the different domains on a spectrum.

  • 3 Levels on the Spectrum: High-Functioning (Level 1), Autism (Level 2), and Severe Autism (Level 3)

  • Symptoms usually present by around age 2, but development isn’t linear, some children show symptoms earlier and some show later

Early markers →

  • Lack of interest in social interactions
  • Developmental regression in social behaviors or use of language
  • Odd play pattens
  • Unusual communication patterns

DSM Criteria for Autism Spectrum Disorder →

  • Criterion A: Persistent deficits in social communication and interaction across multiple contexts
    • Deficits in social response (nodding when someone is talking, cues to show you are listening)
    • Deficits in developing, maintaining, and understanding relationships
  • Criterion B: Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following -
    • Stereotyped or repetitive motor movements, use of objects, or speech (lining up toys, flipping objects)
    • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
    • Highly restricted, fixated interests that are abnormal in intensity or focus
    • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
  • Criterion C, D, E: Symptoms must be present in the early developmental period (but may not become fully manifested until social demands exceed limited capacities, or may be masked by learned strategies later in life)
    • Significant impairment caused
    • These disturbances are not better explained by intellectual disability or global developmental delay
    • Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level

Prevalence of ASD →

  • More often in males than in females
  • Often comorbid with: Intellectual impairment, Language disorders, Mental health disorders, ADHD

Diagnostic Tools to Test for ASD →

  • Theory of Mind - a test to assess one’s understanding of how other people’s minds work
  • Tasks to measure affect recognition and expressive/receptive language
  • Also often includes other domains: Attention/executive functioning, Memory, Achievement
  • ADOS: Autism Diagnostic Observation Schedule - not necessarily required to make a diagnosis, and other than ADOS more is required for full diagnosis
    • Direct observation assessment – looking at behaviors (primarily social skills/communication and restricted/repetitive behaviors)
    • 4 Modules: 1. Non-verbal, 2. Minimal verbal skills, 3. Verbally fluent and capable of playing, 4. Verbally fluent and beyond the age of playing with toys
    • Child works through standardized scenario (e.g., asked to complete a block project without enough blocks. The examiner has the remainder of the blocks. How does the child deal with this social situation?)
  • Autism Diagnostic Interview – Revised (ADI-R): Done with parents. Assesses - Qualities of reciprocal social interaction, Communication and language, Restricted/repetitive interests and behaviors

Treatments for ASD →

  • Behavior and communication approaches
    • Applied Behavior Analysis (ABA)
    • Assistive Technology
    • Speech Therapy/Physical Therapy/Occupational Therapy
    • DIR/Floortime
    • Social Skills Training
    • Social Story - writing out a story to develop an idea of routine
  • Dietary approaches
    • Minimal (if any) empirical support
  • Medication
    • Can help with certain aspects of functioning, and often certain comorbidities
  • Complementary and Alternative Medicine (CAM)
    • Not empirically supported