412 ASD

Question 1

core features of autism

Answer 1

• impairment in communication
• impairment in social interaction
• repetitive patterns of behaviour and interests

Question 2

impairment in communication

Answer 2

• about 50% of kids with ASD do not develop useful language
• echolalia, perseverative speech, deficits in pragmatics (not taking into account context)

Question 3

impairment in social interaction

Answer 3

• social imitation
• joint attention
• expressive nonverbal behaviour (communicating what you want, how you’re feeling - pointing)
• reciprocity
• social ‘mind’ (not thinking about people as possibilities for interaction, not interpreting the social nature of things or seeing the world as social)
• theory of mind

Question 4

Theory of Mind

Answer 4

• knowing that other people have mental states (desires, beliefs, intentions) that guide their behaviour
• ASD have trouble taking others’ perspectives
• assessed via False Belief tasks (Sally/Anne)
• typical children reach this developmental milestone by age 4 (about 20% of kids with autism have reached it by then)

Question 5

repetitive patterns of behaviour and interests

Answer 5

• self-stimulation (stereotyped, patterned, repetitive bx usually involving one or more senses)
• intense, narrow interests (could be related to selective attention - filtering out social information in favour of these interests)
• rigid routines (disruptions are even more upsetting that for typical kids)
• preoccupation with parts of objects (only playing with the wheels of a car)

Question 6

self-stim theories

Answer 6

• craving for stimulation that excites nervous system = reinforcement
• blocking out/controlling unwanted stimulation from an overstimulating environment = calms down = reinforcement

Question 7

preoccupation with parts of objects

Answer 7

• focus on parts of things when attending to social information (watching movies with eye tracking)
• typical kids focus on faces to receive social information, kids with ASD don’t look at faces (only at parts of the faces or in the periphery
• this avoidance of social information compounds over time = less social input = not developing skills to interact with your social world

Question 8

autism as categorical vs. dimensional

Answer 8

• once viewed as a classic categorical disorder
• now, it’s a spectrum: range of IQs, severity of symptoms, language abilities
• family members tend to have autistic traits without meeting full criteria

Question 9

DSM-IV autism diagnoses

Answer 9

• autistic disorder: social interaction + repetitive/restrictive interests + language deficits
• asperger’s: social interaction + repetitive/restrictive interests
• pervasive developmental delay, not otherwise specified (PDD-NOS): residual category

Question 10

changes in DSM-5 autism diagnosis

Answer 10

• combining all previous diagnoses into one spectrum
• criteria for DSM-IV were being applied differently across clinics
• groups weren’t significantly different from each other - they all met criteria for the new ASD

Question 11

Autism Diagnostic Observation Schedule (ADOS)

Answer 11

• semi-structured observation for assessment
• tester engaging the person in tasks while rating their behaviour (like capacity for joint attention, reciprocity, etc.)
• looking for unusual behaviours - the more are present, the more likely ASD is
• has version for younger kids, teens, adults

Question 12

Autism Diagnostic Interview (ADI-R)

Answer 12

• often paired with ADOS for assessment
• interviews with parents/caregivers
• trying to triangulate behaviour and get a more accurate diagnosis

Question 13

prevalence of autism

Answer 13

• 1-1.5%
• prevalence increasing over time (better identification and broader definitions?)
• prevalent cross-culturally and at all income levels but large variation in diagnostic practices
• 4:1 male to female ratio which increases to 10:1 for milder forms of autism

Question 14

course of autism

Answer 14

• there could be symptoms before, but not reliably diagnosed before age 2-3
• may be differences starting from birth
• some lose developmental milestones that they previously achieved
• usually lifelong (but variability in trajectories)
• strong predictors of positive prognoses are better language skills and higher IQ (better social, academic, occupational achievement)

Question 15

efforts toward early identification

Answer 15

• eye tracking to see what toddlers are looking at (with autism = focus on geometric figures rather than social images)
• brain enlargement (cortical surface expansion between 6-12 months predicts autism diagnosis)

Question 16

ASD comorbidity

Answer 16

• 70% also have IDD, 40% are severe-profound
• 25% have splinter skills
• 5% have isolated and remarkable talents (savant syndrome - difference in degree from splinter skills)
• epilepsy
• ADHD, conduct problems, anxiety, depression

Question 17

splinter skills

Answer 17

above average for the population and compared to yourself in other areas

Question 18

environmental etiological factors in ASD

Answer 18

• toxin hypotheses: exposure of toxins as a causal factor
• birth complications are a strong predictor (anoxia)
• maternal factors like obesity, diabetes moderately associated
• low in vitamin D, heavy metal exposure like mercury and lead (not necessarily causal, just an association)

Question 19

vaccine hypothesis of ASD

Answer 19

• anecdotal evidence about kids starting to show autism symptoms around when they get their vaccines (esp. MMR)
• worry about thimerosal and mercury
• Wakefield: normal development + MMR = behavioural and GI problems (caused media outcry which increased rates of measles and mumps, but the paper was retracted and Wakefield fired)
• later research not able to find any links between MMR/thimerosal/any vaccine and autism

Question 20

heritability of autism

Answer 20

• 15-20% of siblings of people with autism also have autism
• 70-90% concordance rates in Mz twins
• 83% heritability estimate

Question 21

molecular genetics of autism

Answer 21

• many possible areas on different chromosomes
• complex genetic disorder
• expression of ASD genes may depend on environmental factors during fetal brain development (epigenetics, etc.)

Question 22

etiology of ASD: brain development

Answer 22

• not clear if causal
• differences in structure (frontal lobe, cerebellum, medial temporal, limbic)
• differences in function (decreased activation of mirror neurons especially in social situations, altered activation of facial recognition area like when viewing mother vs. stranger)
• structural and functional differences in the amygdala

Question 23

fad treatments for autism

Answer 23

• vitamin supplements for B6, magnesium, etc,
• gluten-free or secretin diets
• secretin produced in the intestine, used to treat ulcers, but evidence shows it isn’t effective
• anecdotal evidence for anything doesn’t mean it actually works

Question 24

psychotropic meds for ASD

Answer 24

• used to treat co-occurring problems, not core features of autism
• SSRIs for anxiety/OCD/depression
• stimulants for ADHD
• antipsychotics for aggression
• work just as well as in typical kids, but be extra careful monitoring them in kids with ASD

Question 25

oxytocin for ASD

Answer 25

• neuropeptide hormone involved in social bonding and social behaviours
• studies showed improvements in social interactions for kids taking intranasal oxytocin (ToM, eye contact, social connection)
• small samples so far, but promising
• animal studies warn of potential long-term effects to be cautious of

Question 26

treatment strategies for ASD

Answer 26

• decreasing disruptive behaviours
• appropriate social behaviour
• improving functional, spontaneous social communication
• cognitive skills
• adaptive skills to increase responsibility and independence

Question 27

Applied Behaviour Analysis (ABA) for ASD

Answer 27

(1) discrete trial training (structured behavioural approach) for behaviours that aren’t already present
- prompt the behaviour + reinforce the desired behaviour
- shaping: reinforce approximations/attempts of desired behaviour (every effort toward the behaviour)
(2) reinforce naturally occurring behaviour
- use of language, initiating conversation = reinforce = more likely to repeat that

Question 28

Developmental Social Pragmatic (DSP) models of treatment for ASD

Answer 28

• targeting joint attention to improve social communication and interaction by being responsive to the child
• promoting any type of communication (verbal or nonverbal) that the child initiates
• pragmatic: just trying to communicate any way you can
• building on what the child is doing

Question 29

two best established treatments for ASD

Answer 29

• individual, comprehensive ABA
• teacher-implemented, focused ABA + DSP

Question 30

individual comprehensive ABA for ASD

Answer 30

• intensive (20-40hrs/week) for 2-3 years
• start prior to 5 yrs
• communication, social skills, behaviour management, pre-academic skills (teaching skills that will help you in school)
• small studies show improvements in IQ and adaptive behaviour
• gains could be achieved with 6-28 hrs/weeks

Question 31

teacher-implemented focused ABA + DSP

Answer 31

• delivered in a classroom, less intensive than individual
• reinforcing communication + ABA
• associated with greater joint engagement in play activities with caregivers and teachers

Question 32

Yu et al. meta-analysis

Answer 32

• broad: any ABA-type treatment (wide range of duration and dosage)
• no impacts on receptive language, adaptive behaviour, daily living skills, IQ, restricted/repetitive bx, motor, cognition
• saw good effects on socialization, communication, expressive language
• not general improvements, but still positive

Question 33

Eckes et al. meta-analysis

Answer 33

• only including comprehensive ABA (early childhood, 20-40hrs/week, personalized, promoting several skills at once, using multiple methods, one-on-one + group activities, requires parents)
• good effects on intellectual functioning and adaptive behaviour
• no improvements in language abilities, symptom severity, parental stress
• language abilities may act as a moderator (greater receptive/expressive language at baseline = bigger intellectual gains)

Question 34

controversy around ABA

Answer 34

• historical use of harsh punishment to reduce unwanted behaviours (like self-stim which isn’t harmful to anyone even if it is atypical)
• dosage of intervention is way too intense
• people with autism not being consulted about ABA implementation (is the intervention what is best for them, who advocates for kids and which behaviours should be reinforced or extinguished)