3. Early Years & Childhood

Question 1

Describe one challenge of early diagnosis of ASD.

Answer 1

All kids develop at very different rates, which is why it is so tricky. There is a range that is considered typical. If a child comes in with no speech at say 15 months, a good doctor will look at communication more broadly (eg. joint attention, pointing, comprehension of language, responding to their name) rather than just the lack of speech in itself.

Question 2

When do parents bring their child in for social services?

Answer 2

When an appropriate developmental goal at that stage in their lives are not met. Eg. speech concerns, social concerns (no friends), problems with learning, behavioral control (emotional regulation)

Question 3

What are the “normative” developmental goals at infancy to preschool stage? (3)

Answer 3

1) attachment to caregivers
2) language
3) differentiation of self from environment

Question 4

What are the “normative” developmental goals at middle childhood? (4)

Answer 4

1) Role-governed conduct (following rules of society in moral and prosocial domains. self-control and compliance)
2) school adjustment (attendance, appropriate conduct)
3) academic achievement (learning to read and do arithmetic)
4) getting along with peers (acceptance, making friends)

Question 5

Describe normative social development at 2 months to 12 months. (2,4,6-9,9-12)

Answer 5

2 months - reciprocal smiling, prefers face-like stimuli and speech-like sounds
4 months - spontaneous smiling. vocalizing
6-9 months - joint attention when wanting help, monitoring, expresses happy/sad emotions
9-12 months - follows point; gives objects to adult for help/action; points; stranger anxiety; solitary play

Question 6

Describe normative social development at 13 months to 24 months

Answer 6

13-18months - functional play, points for interest, shows empathy
18-24 months - pretend play with others, watch other children, parallel play

Question 7

Describe normative social development at 2-3 years. (4)

Answer 7

• imitate adults’ actions
• starts turn taking
• start to share
• imaginative play

Question 8

Describe normative social development at 4 years.

Answer 8

• has preferred friends; group play
• labels emotions in self
• understands and tries deception
• wants to please adults

Question 9

Describe normative social development at 5 years.

Answer 9

Has group of friends

Question 10

Describe normative social development at 6+ years.

Answer 10

• has best friend
• plays board games; group play
• increase understanding of social rules

Question 11

Why is ASD a neurodevelopmental disorder?

Answer 11

depending on age and developmental level, the presentations are different. certain behaviors are more important at certain developmental stages. during assessment, we still look at same domains but different presentations.

Question 12

As a clinical psychologist, if a parent tells you his/her child has little speech at a certain age, how should you check if the child has ASD?

Answer 12

can’t just look at speech alone but the overall behaviors. it’s not just about the number of words they have, but how they are used. if the words are not used socially and communicatively there could be an issue. see if they integrate non-verbal gestures, intonation, eye contact into their speech etc.

Question 13

Describe “normative” language/communication development at 2 months to 12 months.

Answer 13

2-5months - alert to sound, vocalizes when talked to, squeals, laughs out loud
6 months - start responding to name, babbles, listens to adult and vocalizes when adult stops
7-8 months - shakes head for no, looks towards familiar objects or sounds
9-12 months - orients well to name, first words, imitates sounds

Question 14

Describe “normative” language/communication development at 12 months to 24 months.

Answer 14

12-18 months - follows one step commands, 5-25 words, names objects, body parts, points, imitates sounds
18-24 months - two words combinations, 25-50 words, follows 2-step commands, refers to self by name

Question 15

Describe the “normative” language/communication development at 3 years old.

Answer 15

• groups objects
• uses 200+ words
• 3 word sentences
• uses pronouns and plurals

Question 16

Describe the “normative” language/communication development at 4 years old.

Answer 16

• uses adjectives (eg. big, small)
• follows 3-step commands
• tells stories
• uses “feeling” words

Question 17

Describe the “normative” language/communication development at 5 years.

Answer 17

• enjoys rhyming
• responds to why?
• retells story with beginning, middle, end

Question 18

Describe the “normative” language/communication development at 6 years.

Answer 18

• repeats sentences
• describes events in order
• 10,000+ vocabulary

Question 19

What are some reasons why diagnoses are not usually made til around 4 years old, even though ASD diagnosis at 2 years old is already quite reliable and stable over time? (6)

Answer 19

1) asian culture - kids tend to be more shy and not very social. western psychologists may overscore the kids on autism traits. social communication expectations are different.
2) haven’t gone to school until 4 years old, so behaviors haven’t manifested that clearly for professionals to tease it out. can’t say for sure if it’s autism or just speech and developmental delay
3) service problems. early intervention programmes tend to start around 4 years old. if you give a diagnosis but have little help to offer, it’s induces anxiety for the parent.
4) procedure for assessment takes a bit of time. usually need a series of meetings, interviews, observation, and specialist referral before confirmation of diagnosis.
5) presentation is very diverse and most don’t present all the symptoms at point of visit.
6) parents’ mindset - they may just interpret it as the child being naughty or disobedient. won’t entertain the possibility of autism. blaming the child. girls can be interpreted as shy, boys can be interpreted as being naughty.

Question 20

What is a problem with retrospective studies based on caregiver reports of autism traits in very young children?

Answer 20

people don’t really unpick early behaviors like pointing. (eg. when did your child first point?) parents rarely take note of such details.

Question 21

What are some efficient ways that we can track ASD symptoms prospectively at a very young age? (2)

Answer 21

• use existing universal screening systems. regular checkup at health screening done by nurses for signs of ASD.
• baby sibling studies

Question 22

Can we see ASD signs at 6 months?

Answer 22

Not really. Overt presentations emerge after 6 months, currently only observable from 12 months onwards. If they are there, we can’t spot them yet.

Question 23

What are some early ASD signs at 12-18 months pertaining to social interaction and communication?

Answer 23

1) little/no initiation of social interaction (eg. showing, pointing, initiation of joint attention)
2) response to social interaction (eg. limited gaze to faces, direct vocalisations, social smiling, social attentiveness to caregiver, response to name, imitation of sounds, words etc.)

Question 24

Give one example explaining why it is difficult to tease out the ASD signs at 12-24 months?

Answer 24

eg. intense preoccupation with things is part of being a kid! need to do things repetitively to learn! most kids are like that

Question 25

According to The Social Attention & Communication Study (SACs), what are the 5 early markers at 12 months?

Answer 25

1) pointing
2) eye contact
3) response to name
4) waving
5) imitation

Question 26

According to The Social Attention & Communication Study (SACs), what are the 5 early markers at 18 months?

Answer 26

1) pointing/follows point
2) eye contact
3) response to name
4) social smile
5) showing

Question 27

According to The Social Attention & Communication Study (SACs), what are the 5 early markers at 24 months?

Answer 27

1) pointing/follows point
2) eye contact
3) showing
4) waving
5) pretend play, follow simple commands, response to name

Question 28

According to the SACs, children who consistently fail the 5 items have a ___% chance of ASD diagnosis.

Answer 28

80

Question 29

In school-aged children, what are some symptoms of ASD pertaining to spoken language?

Answer 29

1) from limited use to repetitive, monotonous tone
2) stereotyped phrases
3) talking “at” others

Question 30

In school-aged children, what are some symptoms of ASD pertaining to social responses?

Answer 30

1) reduced greeting behaviors
2) reduced shared play/enjoyment
3) difficulties adapting (eg. overly formal)

Question 31

In social & emotional aspects, how may ASD present in developmentally more able children? (3)

Answer 31

• difficulties with friendships
• managing unstructured parts of the day
• working cooperatively

Question 32

In language and communication aspects, how may ASD present in developmentally more able children? (3)

Answer 32

• difficulties understanding jokes and sarcasm
• difficulties understanding social use of language
• difficulties understanding non-verbal cues (body language, facial expression, gestures)

Question 33

In terms of flexibility of thought (imagination), how may ASD present in developmentally more able children?

Answer 33

• coping with changes in routine
• empathy
• generalization

Question 34

What are 4 things you need to keep in mind when considering a diagnosis?

Answer 34

1) aims and goals of obtaining a diagnosis
2) how to maximize benefits of diagnosis
3) how to assess sensitively and respectfully
4) how to gather reliable and comprehensive information to aid in clinical decision making.

Question 35

In what ways should ASD assessments be comprehensive?

Answer 35

• across contexts
• multi-informant
• standardized measures + clinical interviews + observations + informants
• current or by history

Question 36

When conducting an ASD assessment what family/medical history must you ask?

Answer 36

• familial history of ASD and related conditions
• pregnancy history
• developmental milestones. when are parents first concerned and why.
• check for epilepsy and regression
• previous intervention history

Question 37

What are some common areas of assessment for ASD? (5)

Answer 37

1) developmental/intellectual functioning (look for ID)
2) adaptive functioning
(look for differences between intellectual functioning and independence)
3) language and speech
(assess pragmatics of language, more complex language)
4) play/imagination
5) communication (look for frequency, quality, reciprocity, methods used to communicate and integrate)

Question 38

Besides conducting assessments for ASD, what other related assessments should we conduct?

Answer 38

assessments for

• mental health (anxiety, mood)
• ADHD symptomatology
• behavioral concerns

Question 39

What are some challenges in identification and diagnosis in childhood?

Answer 39

• subtler presentations in cognitively non-impaired girls, or children who have learned to mask/camouflage
• may overlap with other conditions, so differential diagnosis is challenging

Question 40

Describe what are baby siblings studies about.

Answer 40

about tracking children who have siblings with autism and see if we can spot signs of autism before age 1. ultimate goal is to create an infant screen for the condition. research started out looking for behavioral markers only, but it was quite hard to spot, so they expanded to biological markers as well.

Question 41

What did baby siblings studies reveal about the nature of ASD?

Answer 41

revealed that ASD is a very complex, heterogeneous spectrum of conditions. unlikely we will find any single predictor for it, but we may one day discover a combination of prognostic indicators.

Question 42

From the baby siblings study, what are some neurobiological factors we have found for ASD?

Answer 42

• surplus of cerebrospinal fluid at 6 months of age

- different growth pattern in microstructure of nerve fibers that link various brain regimes between 6-12 months

Question 43

What are some limitations of the baby siblings approach?

Answer 43

1) autistic infants with siblings who are also autistic may be different from those without autistic siblings. different genetic load.
2) sample size issues. even though this population is more likely to develop autism than average, the condition is still rare.
3) unknown if th eunusual brain-development patterns is due to autism or as a result of other conditions that accompany autism like ADHD, intellectual delays etc.

Question 44

In terms of effective communication and sharing enjoyment, what early “flags”/markers are there?

Answer 44

• does not share enjoyment

- does not respond to others’ bid to share toy. overly focused on toy

Question 45

In terms of social connections, what early “flags”/markers are there?

Answer 45

• no response to name
• no response to others’ bids to share attention
• not socially engaged

Question 46

in terms of seeing social opportunity through play, what early “flags”/markers are there?

Answer 46

• does not engage with people during play

- no response to name