3/21 & 4/2-Language Impairments 3

Question 1

Is ASD (autism spectrum disorder) on the PDD (pervasive Developmental disorder) continuum?

Answer 1

Yes-Autism is at the more severe end of it and PDD-NOS (pervasive developmental disorder-not otherwise specified is at the milder end of the PDD spectrum.

Question 2

In practice, what does a diagnosis of autism equate with?

Answer 2

a more severe form of PDD

Question 3

In practice, when will a diagnosis of PDD or another disorder be given?

Answer 3

• a less severe form of PDD is present
• it may be labeled as Asperger’s syndrome or mislabeled as an LD or ADHD
• others may be labeled hyperlexic and have some characteristics of ASD
• Some present very much like LD and the milder forms are sometimes diagnosed as such, rather than ASD

Question 4

According to the American Psychiatric Association (2000) and the Autism Society of America what elements does a diagnosis of ASD contain?

Answer 4

• impairments in social interaction
• severely limited behavior, interest, and activity repertoire
• onset prior to 30 months
• disturbances in developmental rates and sequences in motor, social-adaptive, and cognitive skills
• disturbances in responses to sensory stimuli (hyper and/or hypo- in hearing, vision, touch, motor, smell, taste, combined with self stimulation behaviors) (“stimming”)
• disturbances in speech and language, cognition, and nonverbal communication, including mutism, echolalia, and difficulty with abstract terms.
• disturbances in capacity to appropriately relate to people, events, and objects
• lack of social behaviors, affection, and social play** (hallmark!)

Question 5

In who is ASD more likely to occur in? and what is the ratio?

Answer 5

• males
• 1 in 54 boys are likely to be affected according to the center for disease control
• up 23% since ‘06
• up 78% since 2002

Question 6

Has there been an explosion in diagnosis of ASD in the last few years?

Answer 6

YES!

Question 7

ASD affects what ratio of children?

Answer 7

1 in every 88

Question 8

TRUE OR FALSE: Is ASD a diverse group?

Answer 8

true

Question 9

In terms of IQ, what are the statistics for children with ASD?

Answer 9

• 1/2 have IQ below 50
• 1/4 have IQ 50-70
• 1/4 have IQ 70+

Question 10

When is ASD rarely diagnosed?

Answer 10

Before 18 months

Question 11

What are some indications of ASD around 18 months?

Answer 11

• lethargic
• prefer solitude
• make few demands OR highly irritable w/ sleeping problems and intense crying

Question 12

What are some indications of ASD from ages 18-36 months?

Answer 12

• tantrums
• repetitive movements
• ritualized play
• extreme reactions to stimuli
• lack of pretend and social play
• joint attention and communication difficulties including lack of gestures

Question 13

In a % of cases, what do parents report about their ASD child prior to 24 months?

Answer 13

parents report typical development before 24 months, particularly with girls

Question 14

True or false: with ASD sometimes self-injurious behaviors develop

Answer 14

true

Question 15

With Children with ASD does development grow consistently and smoothly?

Answer 15

no, it seems to involve spurts and plateaus

Question 16

What is PDD-NOS and what are some of it’s characteristics?

Answer 16

• a milder form of ASD
• difficulty with social behavior
• poor eye contact
• poor use of gestures and facial expressions
• may have disordered grammar and exhibit echolalia
• Communication, ADL, social skills, IQ, and language acquisition falls between ASD and Aspergers

Question 17

What are some characteristics of Asperger’s Syndrome (AS)?

Answer 17

• Less severe than ASD
• Cognitive language and self-help skills not disordered
• subtle language impairments with little delay
• social interaction difficulties, restricted interests, repetitive behaviors
• when compared to children with HFA (high functioning autism) these children have high verbal IQ and low nonverbal or performance IQ (the opposite of HFA)
• despite this there is an overlap between HFA and AS
• may have decreased organizational sills, yet be perfectionist
• can concentrate deeply
• difficulty transitioning between activities

Question 18

What do you know in terms of language for children with Asperger’s Syndrome?

Answer 18

• verbosity
• pedantic speaking style
• decreased social pragmatics in social and conversational settings
• intense interest in limited topics

Question 19

Is Hyperlexia on the ASD spectrum?

Answer 19

yes

Question 20

What information can you give of Hyperlexia?

Answer 20

• 7:1 boys to girls
• spontaneous ability to read, frequently by 2.5-3yrs.
• little reading comprehension however
• intense preoccupation with letters and words
• extensive word recognition/decoding by age 5
• language and cognitive disorders in reasoning and perceiving relationships
• Delayed language
• difficulty with connected language in all modalities
• difficulty integrating language with context to make meaning

Question 21

What are the general language characteristics of ASD?

Answer 21

• 1st red flag is often communication problem (failure to begin gestures or talking, no interest in others, lack of verbal responses)
• poor social interaction, language, communication skills
• articulation is not usually a concern, but speech can be robot-like/wooden–lacks prosody/rhythm
• 25% may have typical language but 25-60% remain nonspeaking–AAC may help some
• many demonstrate immediate or delayed echolalia-most go through at least one period of this

Question 22

What does ASD look like?

Answer 22

• PRAGMATICS
• DECREASED JOINT ATTENTION
• difficulty initiating and maintaining conversations
• limited overall communication functions
• difficulty matching language form and context
• MAY PERSEVERATE AND/OR BRING UP INAPPROPRIATE TOPICS
• IMMEDIATE AND DELAYED ECHOLALIA
• routinized utterances
• few gestures, misinterprets gestures
• overuse of question form
• asocial, solitary monologues
• speaker listener roles not well developed
• poor eye contact–seems to use peripheral vision

Question 23

In terms of ASD, what is the “theory of mind”?

Answer 23

• the ability to recognize that others have beliefs, desires, intentions, emotions, and knowledge that are different from one’s own
• directly related to pragmatics
• deficits often exist in this area for PDD/ASD

Question 24

In terms of ASD and what it looks like, What does semantics look like?

Answer 24

• Word finding problems
• underlying meaning of words is not used as a memory aid
• inappropriate answers to questions

Question 25

In terms of ASD and what it looks like, What does syntax/morphology look like?

Answer 25

• pronoun use and verb endings are affected
• superficial, structured sentences, with little attention to meaning
• overly dependent on word order

Question 26

In terms of ASD and what it looks like, What does phonology look like?

Answer 26

• often disordered, but variable within the child
• developmental order is same as TD
• this is the least affected aspect of language in many cases

Question 27

In terms of ASD and what it looks like, What does comprehension look like?

Answer 27

overall impaired. most noticeable during conversations

Question 28

What are the possible BIOLOGICAL causal factors of ASD?

Answer 28

Evidence points to this

• 65% have abnormal brain patterns
• incidence correlations found between autism and prenatal complications, fragile X syndrome, Ritt Syndrome, and family history of ASD
• often accompanied by mental retardation & seizures
• studies have found high levels of seratonin- a neurotransmitter, abnormal cerebellum development, multifocal brain disorders, neural subcortical impairment, etc.
• some studies have suggested a multiple gene genetic link

Question 29

What are the possible SOCIAL ENVIRONMENTAL causal factors of ASD?

Answer 29

• early studies blamed parents
• there is no basis for this and subsequent studies have found that these parents frequently interact with their children @ appropriate language levels

Question 30

What are the possible PROCESSING causal factors of ASD?

Answer 30

• difficulty analyzing and integrating information; fixate on one aspect of incoming stimuli (attention)
• this impacts the ability to discriminate
• overall processing is “gestalt” and chunks are stored and reproduced identically (organization)
• input never seems to get taken in as a whole and analyzed into its parts-these children frequently repeat agrammatical sentences and don’t correct them.
• very little of the world makes sense to these children. they overload quickly
• storage of these gestalts may overload memory
• can’t organize information on the basis of relationships between stimuli because whole chunks are stored
• huge problems transferring or generalizing learned information from one context to another

Question 31

What is the big take away for PDD/ASD?

Answer 31

• PDD is heterogeneous and varies in terms of severity
• early intervention is critical. early identification is critical at times
• it is difficult to diagnose before 2 years in most cases
• we are often first point of contact-referral is key!
• while we don’t diagnose alone, we are a critical part of the evaluative team, which varies by worksite

Question 32

What kind of professionals would autism team members include?

Answer 32

• psychologists
• SLPs
• nurses
• educators/special educators
• developmental pediatricians
• child neurologists
• cognitive psychologists

Question 33

What does the American Academy of Neurology and Child neurologists list as the red flag milestones for ASD?

Answer 33

• no babbling by 12 months
• no gestures by 12 months
• no single words by 16 months
• no two-word spontaneous speech by 24 months
• loss of language or social skills at any age
• (many would add joint attention deficits and symbolic communication deficits)