5. ASD Flashcards
behavioural features of ASD often present
before 3YO
co-occuring conditions
language and learning difficutlies
medical conditions
anxiety, depression, ADHD
neurodiversity affirming perspective
views brain-based and behavioural differences in autistic people as reflective of natural human variation
Cognitive mechanisms
weak central coherence/local processing bias: impairments in ability to integrate material into context, explains stregnths and cognitive deficits
theory of mind: representing and reasoning about other’s minds to understand and predict others behaviours; addresses social/language impairments
executive functioning: impairments in planning, changing set, flexibility of thought; addresses non social aspects
central coherence
focusing on details rather than big picture
unable to filter out unwanted informaiton
explains strengths- good rote learning, local processing bias
explains challenges-difficulty with comprehension or understanding a theme due to having a stregnth in local processing, alongside a deficit in global processing
ASD assessment
General developmental assessment
language
social development
ASD screening
medical review, SLP, adaptive behaviour, audiological assessment, vision assessment
Vineland 3
9 core and 4 optional subdomains
core domains: communication, daily living skills, socialisation, motor skills, maladaptive behaviour. limited measures of motor skills and maladaptive behaviour
consistent with AAIDD and DSM-V crieria for IDD
most common
ABAS-III
11 skill areas in 3 domains: conceptual, social, practical
consistent with AAIDD and DSM-V criteria for IDD
less widely used
Scales of independent behaviour revised (SIB-R)
14 subscales, 4 clusters: motor skills, personal living skills, social interaction and communication skills, community living skills and problem behaviour skills
adaptive and maladaptive behaviour
ASD screening tools
M-CHAT (16-30MO)
DBC-ASA (4-18YO)
SCQ >4YO
SRS .2.5Y
ASSQ 6-17 YO
CAST 4-11 YO
ASAS 5-18 YO
AQ-10 16YO+
When to screen adults for ASD
one or more of:
- persistent difficulties in social interaction, social communication or stereotypic behaviours/resistance to change/restricted interests
AND
one or more of:
- problems in obtaining or sustaining employment or education, difficulty intiiating or sustaining social relationship, previoous/current contact with metnal health or learning disability services, history of NDC or MI
When to screen infants for ASD
current diagnostic tools designed for children >24 MO and diagnosis tends to be more stable from 2-3YO
Characteristics of ASD may be evident from 12-18MO
Who can diagnose for NDIS access
MDT
lead medical practitioner (paed, psychiatrist, med prac with 6 y experience)
clin psych/neuropsych/ed and dev psych
assessed using DSM-V-TR diagnostic criteria as level 2 or 3
Who can diagnose for Qld education
EAP verification form
EAP or diagnostic report/letter signed by a registered paediatrician, psychiatrist, neurologist or psychologist with a practice endorsement in clinical, education and developmental or neuropsychology
Who can diagnose for disability pension
clinical psych only ok
best practice assessment
more comprehensive and using tools validated by research (clinical interview using ADI-R and direct assessment using ADOS-2), but not required for diagnosis by Australian guidelines
additional assessment: LSP, dev assessment, assessment of MH, informants across settings
social skill questionnaires
SRS
SSRS
VABS, ABAS (social skill section of adaptive measures)
social communication questionnaires
CCC-2
CCAdults
repetitive behaviours/interests questionnaires
sensory profile
repetitive behaviour questionnaire
repetitive behaviour scale revised
adult repetitive behaviours questionnaire - 2
direct assessment
gold standard ADOS-2
Creates structured enviornment where ASD behaviours can be observed
30-60min
module chosen based on language level/age
disadvantages direct assessment
ADOS-2 may miss those with higher verbal abilities or who have learned tasks (pretend play), can instead observe in real world setting or elicit these behaviours
Diagnosis tools for adults without IDD
AAA, AQ, EQ
ADI-R
ADOS-2
ASDI
RAADS-R
Diagnosis tools for adults with IDD
ADOS-2 but use with caution if minimally verbal activities are designed for children and not age appropriate
ADI-R
adult assessment- enquire about…
core ASD symptoms- childhood and continuing into adulthood
early developmental history where possible
behavioural problems
funcitoning at home, school, work
past/current physical/mental conditions
other NDC
hyper and/or hypo sensitivities, attention to detail
condcut direct observations of core autism signs and symptoms especially in social situations
information regarding social interaction and/or communication domain
receptive language
expressive language
social comm
information regarding repetitive behaviour
sensory motor assessment
behaviour assessment
mental health assessment
neurological assessment
ASD levels of intervention
comprehensive treatment models
focused intervention practices (FIP)
Comprehensive treatment models
longer term packages of practices designed to address multiple domains over an extended period
e.g. TEACCH
FIP
Short term practices designed to address a specific learning area
picture exchange communication system (PECS), reinforcement, prompting
Antecedent based intervention (ABI)
arranging events preceding interfering behaviour, designed to reduce behaviour
CBI
instruction or management or control of congitive processes leading to changes in overt behaviours
differential reinforcement of alternative, incompatible or other behaviour (DRA/I/O)
rienforcement when engaged in a sipecific desired behaviour other than the inappropriate behaviour (DRA)
Learner engaged in behaviour physically impossible to do while showing inappropriate behaviour (DRI)
when learner not engaged in interfering behaviour (DRO)
discrete trial teaching
one teacher and one student/client teaching appropriate behaviour or skills
massed trials
each trial: teacher instruction, client response, carefully planned consequence, pause prior to presenting next instruction
exercise (ECE)
increase in physical exertion to reduce problem or increase appropriate behaviour
extinction (EXT)
Withdrawal or removal of reinforcers of interfering behaviour to reduce occurrence of that behaviour
sometimes single intervention, but often in combination with functional behaviour assessment, functional communciation training and differential reinforcement
FBA- functional behaviour assessment
systematic collection of information to identify functional contingencies supporting behaviour
functional communication training (FCT)
replacement of interfering behaviour that has a communication function with more appropriate communication that accomplishes the same function
usually includes FBA, DRA and/or EF
modelling
demonstrating desired target behaviour with modelling
naturalistic intervention (NI)
intervention in natural setting or routine
parent implemented intervention (PII)
parents deliver intervention in home or community through structured parent training program
peer mediated instruction and intervention (PMII)
PEERS INTERACT AND HELP LEARN SOCIAL AND BEHAVIOUR SKILLS
Picture exchange communication system (PECS)
initially taught to five picture of desired item to partner in exchange for desired item
six phases: How to communciate, distance and persistence, picture discrimination, sentence structure, responsive requesting and commenting
pivotal response training (PRT)
learning variables llike motivation and self initiation guide intervention practices to build on learner initiative
prompting, reinforcement, response interruption/redirection (RIR), scripting
prompting in target behaviour or skill
increasing occurrence of behaviour
comment or distracter when interfering behaviour occurs to divert attention away from interfering behaviour to reduce it
verbal or written descruption to model learning
self management
learner discriminated between appropriate and inappropriate behaviours, monitor, record and reward
social narratives
describe social situation in detail,
social skills training
instructions on basic concepts, role playing or practice, feedback
structured play group
clearly defined theme and role by adult leading play with specifically selected typically developing peers, prompting and scaffolding as needed to support performance
task analysis
activity divided into manageable steps to assess and teach skills
reinforcement, modelling, time delay facilitate this
technology aided instruction and intervention
technology central feature for acquisition of goal
social skill intervention
determine target behaviour
collect baseline data
operationally define goal
select content of sessions, instructional strategies, incorporate items or activities that are rewarding for the individuals
social story checklist
- Does the story answer the relevant “wh” questions?
- Is it written in the 1st person (as if the child is describing the
event?) - Does the story have a positive tone?
- Does it adhere to the ratio (0-1 directive, and 2-5 descriptive,
perspective, affirmative, or co-operative)? - Is the story literally accurate? Can it be interpreted literally
without altering the intended meaning? - Is the vocabulary/language appropriate to my child?
- What visual supports do I need to add to enhance
understanding? - Has the child’s interests been incorporated if possible?
- Overall, does the story have a patient and reassuring quality?
