11 11 Chpt 6 & Notes - Michelle Rozenman PDF

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Michelle Rozenman...

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Autism Spectrum Disorder ● Complex neurodevelopmental disorder characterized by abnormalities in social communication and unusual behaviors and interests Description and History ● Feral children who were isolated from human contact represent first reports of ASD ● Described in 1943 as more attention to objects than people, avoided eye contact, lacked social awareness, limited or no language, stereotyped motor activities, preservation of sameness ○ Early infantile autism (1943) DSM-5: Defining Features of ASD ● Must display symptoms in both domains of social communication and interaction & restricted, repetitive patterns of behavior, interests, or activities ●

Social communication and interaction (all three required) ○ Deficits in social-emotional reciprocity ○ Deficits in nonverbal communication behaviors used for social interaction ○ Deficits in developing, maintaining, and understanding relationships ● Restricted and repetitive behaviors (2 out of 4 required) ○ Stereotyped or repetitive motor movements, use of objects, or speech ○ Insistence on sameness ○ Highly restricted, fixated interests that are abnormal in intensity and focus ○ Hyperactivity or hypoactivity to sensory input ● Severity ratings ○ Level 1 = requiring support ○ Level 2 = requiring substantial support ○ Level 3 = requiring very substantial support ● Social communication and interaction were viewed as two different domains in DSM-IV ● DSM-5 included specifiers to indicate whether it is a medical or genetic condition, and modifiers to consider other conditions ASD across the Spectrum ● ASD is a spectrum disorder because the symptoms, abilities, and characteristics are expressed in many different combinations and degrees of severity ● Can also be impacted by level of intellectual ability, severity of language problems, and behavior changes with age Core Deficits of ASD Social Interaction and Communication Deficits ● Social interaction ○ Lack of monitoring of the social activities of others ○ Lack of social and emotional reciprocity ○ Unusual nonverbal behaviors ○ Lack of interest and/or difficulty relating to others ○ Failure to share enjoyment and interests with others ○ Joint attention: ability to coordinate attention to a social partner and an object or event of mutual interest ● Social communication deficits ○ Protoimperative gestures: gestures or vocalizations that are used to express needs ○ Protodeclarative gestures: gestures or vocalizations that direct the visual attention of other people to objects of shared interest ○ Instrumental gestures: get someone else to do something immediately ○ Expressive gestures: convey feelings ○ Pronoun reversal: repeating personal pronouns as heard without changing them to suit the situation ○ Impairment in pragmatics

Restricted and Repetitive Behaviors and Interests ● Characterized by high frequency, repetition in a fixed manner, and desire for sameness in environment ● Echolalia: parrot-like repetition of words ● Self-stimulatory behaviors: repetitive body movements or movements of objects ● Sensory overresponsivity: negative response to or avoidance of sensory stimuli Associated Characteristics of ASD Intellectual Deficits and Strengths ● 70% have co-occurring ID ○ 40% have severe to profound ID ○ 30% have mild to moderate ID ○ 30% have average intellectual ability or above ● Splinter skills/isles of ability: special talents in one domain ○ 25% display a special cognitive skill that is above average for the rest of the population ● Autistic savants: supernormal abilities in one domain ○ 5% of children Cognitive and Motivational Deficits ● Specific cognitive deficits in processing social-emotional information ○ Theory of mind: awareness of mental states in themselves ■ 15-60% of children demonstrate some knowledge of ToM ■ Most specific to children with ASD ● Also sometimes viewed in schizophrenia, ADHD, conduct problems ● General cognitive deficits in info processing, planning, and attention ○ Deficits in executive functions ○ Central coherence: strong tendency to interpret stimuli in a global way that takes broader context into account ● Social motivation impairments Medical Conditions and Physical Characteristics ● 25% experience seizures (associated with greater ID) ● 65% experience sleep disturbances ● 50% experience gastrointestinal symptoms Accompanying Disorders and Symptoms ● 90% have one co-occurring disorder, 50% have four or more ● Most common are ID, epilepsy, anxiety, ADHD, learning disabilities, conduct problems, mood disturbances, SIB Prevalence and Course of ASD ● 1 in 68 children have ASD

● Rise in prevalence is most likely caused by greater awareness, broadening concept and definition, changes in diagnostic criteria ● More common in boys ○ ID affects boys and girls equally ○ Extreme male brain theory of ASD: males show more systemizing and females show more empathizing, but ASD characteristics reflect systemizing dimensions Age at Onset ● 1-2 years ○ Current diagnoses between 18-36 months are accurate Course and Outcomes ● Symptoms fluctuate over time ● Long-term outcomes will be achieved by those who were diagnosed at a younger age Causes of ASD ● Biologically based neurodevelopmental disorder with multiple genetic and environmental risk factors Problems in Early Development ● Prenatal or neonatal complications have been identified with a small percentage of ASD ● Other risk factors: increased parent age, in vitro fertilization, maternal use of drugs, toxic chemicals during pregnancy ● Vaccinations do not cause autism (Wakefield) Genetic Influences ● Fragile X anomaly accounts for 2-3% of children with ASD ● Tuberous sclerosis ● 15-20% of siblings share ASD diagnosis ● 70-90% concordance for identical twins, near 0 rates for fraternal twins ● Many genes are causally implicated but don’t directly cause ASD Brain Abnormalities ● Impairments in verbal intelligence, orienting and selective attention, memory, pragmatic language, executive functions ASD as a Disorder of Risk and Adaptation ● Genetic and environmental factors → abnormalities in brain development → generalized disturbances in processes → disrupt critical input in early periods of sensitivity Treatment of ASD Overview ● Treatments focus on specific social, communication, behavioral, and cognitive deficits ○ Strategies for engaging children, decreasing disruptive behavior, teaching appropriate behavior, increasing functional communication, promoting cognitive

skills ● Building rapport → discrete trial training (step by step approach) or incidental training (naturally occurring opportunities) ● Operant speech training increases vocalization Early Intervention ● Early, intensive, low student-teacher ratio, high structure, family inclusion, peer interactions, generalization, ongoing assessment Medications ● Children receive antipsychotics, antidepressants, and stimulants...