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Neuro Rehab 1 > ASD > Flashcards

ASD Flashcards

1
Q

what is the DSM-V key criteria to be dx w ASD

A
  1. impaired social communication skills
  2. restricted, repetitive behaviors
    - sx present in early childhood
    - everyday functioning impaired/limited d/t sx
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2
Q

what is the CDC’s definition of ASD

A

group of developmental disabilities that can cause significant social, communication, and behavioral challenges

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3
Q

what dictates where on the spectrum of autism someone is (3)

A
  1. degree of support required
  2. under what conditions individual may have issues w social communication and other sx of ASD
  3. qualifiers that accompany dx (ex: ID, language deficits)
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4
Q

how and why do individuals w ASD benefit from motor interventions

A

benefit both motor and socially

motor issues related to praxis and motor planning
- progress motor skills -> social growth to play with other kids
- frank motor skills

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5
Q

what is the prevalence of ASD

A

inc and don’t know why
- most common pedi developmental disorder
- more commonly dx in males than females

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6
Q

what is the etiology of ASD

A

genetic vulnerability w environmental trigger
- ASD is heterogenous which makes research into causation difficult

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7
Q

what are 6 environmental factors to the etiology of ASD

A
  1. mother taking valproic acid (for epilepsy, BPD) while pregnant
  2. advanced age paternal > maternal
  3. prenatal exposures
  4. extreme psychosocial conditions
  5. air pollutants
  6. heavy metals
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8
Q

what is a debunked environmental trigger

A

vaccines (esp MMR)

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9
Q

what medications a mom might be on that can inc ASD risk of child

A

valproic acid - epilepsy, BPD
SSRIs - inconsistent evidence

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10
Q

what role does a father with an advanced age play as an environmental trigger

A

de novo mutations
d/t cumulated inc risk of mutations in spermatogenesis across lifespan of father

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11
Q

thoughts on prenatal exposures being an environmental trigger

A

suggested, not definitive in its effect on the fetal environment

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12
Q

what are 5 prenatal exposures that may be environmental triggers

A

maternal obesity
DM
HTN
maternal infection -> immune response
high fetal sex steroid exposure

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13
Q

describe how a maternal infection may be an environmental trigger as prenatal exposure

A

immune response to infection passing thru placenta, inflammatory response could have impact on developing neuro processes in fetus
- low grade neuro inflammation

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14
Q

describe extreme psychosocial conditions as an environmental factor

A

institutionalization w low levels of stim & care can lead to autistic-like characteristics
- initial presentation of ASD, but amenable to treatment

extreme maternal stress as well

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15
Q

describe air pollutants as an environmental factor and what the evidence is

A

neuroinflammation and oxidative stress - relative to developing fetus

modest evidence

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16
Q

what heavy metals are environmental factors

A

toxic exposure to lead
- mercury esp

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17
Q

what are 3 predisposing genetic factors

A
  1. inc risk w some inherited conditions
  2. chromosomal abnormalities
  3. inc risk if sibling/twin has ASD
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18
Q

what inherited conditions is there an inc risk of ASD in (3)

A

fragile X
Rett syndrome
tuberosclerosis complex

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19
Q

what is an example of chromosomal abnormalities that may be seen as a genetic factor to ASD

A

dup15q syndrome

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20
Q

what evidence is there of family/twins as predisposing genetic factor

A

if older sib w ASD, 20% will be dx w ASD also
inc risk of ASD in identical twins (greater than fraternal)

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21
Q

what is the incidence of genetic causation noted in ASD

A

majority of cases will have no identifiable genetic cause

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22
Q

what 3 structures were different when seen in an ASD brain when autopsied

A

limbic system
cerebellum
cerebral cortex (inconsistent findings)

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23
Q

how is a clinical dx made

A

thru clinical observation and behaviors

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24
Q

what differences are seen in the limbic system in ASD

A

smaller and more dense amygdala and hippocampus vs neurotypical brains

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25
Q

what differences are seen in cerebellum in ASD

A

dec size and dec # of Perkinje cells in some patients

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26
Q

what differences were seen in the cerebral cortex in ASD (while findings were inconsistent)

A

disorganized
subtle cortical dysgenesis
- inferior frontal gyrus pars opicularis (part of Broca’s area)
- prefrontal and temporal cortex
- inc microglia infiltration and activation

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27
Q

what did a fMRI show in an ASD brain

A

alternate pathways of motor cortex activation, excitatory/inhibitory neurotransmission

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28
Q

where are mirror neurons located and what is their role in a neurotypical brain? what role can MNs play when combined w limbic system?

A

located in pars opicularis

active when performing goal-directed actions and when observing others doing same action
- perhaps neural mechanism for automatically understanding others’ intentions and actions

MNs + limbic system = mediate empathy and social connection

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29
Q

what is the theoretical causation of autism based off the anatomical differences in the brain

A

in ASD level of activation of MNs is different than in TD

altered MNs + limbic system can also explain why ASD kids seem to lack empathy and social engagement

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30
Q

where is the pars opicularis and what is it supplied by

A

frontal lobe
- near broca’s area
MCA

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31
Q

how do social skills present in ASD (6)

A
  1. impaired social reciprocity
  2. poor shared attention
  3. avoidance of eye contact (not always)
  4. seem indifferent/aloof, preference to be alone
  5. attached to parents (not show in typical ways)
  6. limited empathy
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32
Q

how does limited empathy present in social skills (2)

A
  1. affects ability to predict/understand other’s actions
  2. unable to read social cues
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33
Q

how can poor shared attention manifest in ASD

A

difficulty w give and take interactions

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34
Q

what is a classic early sign of ASD social skills

A

avoidance of eye contact

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35
Q

why don’t ASD babies/children show attachment to parents in typical ways

A

lack of social reciprocity

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36
Q

what are 5 communication presentations of ASD

A
  1. varied deficits
  2. may present w unusual use of language
  3. impaired conversation
  4. missed cues, body language, tone, ability to understand idioms
  5. inc awareness of difficulties w age -> anxiety/depression
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37
Q

how does communication present in varied deficits

A

non verbal, non vocal, to fully verabal
may coo, babble early and then stop
delayed development

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38
Q

echolalia

A

just words, not meaning

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39
Q

what does it mean that ASD could present w unusual use of language

A

unable to combine into meaningful sentences
echolalia

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40
Q

how can conversation be impaired in ASD

A

unable to initiate or sustain
monologue on favorite topics
- fixation you can’t break
- directs conversation
- not in age appropriate way

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41
Q

what are 3 ways behavior can present in ASD

A
  1. odd repetitive motions (“stereotypies”)
  2. persistent, intense preoccupation
  3. desire absolute routine
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42
Q

how can stereotypies present

A

range
- from finger flapping to self injurious behaviors

ex: tapping fingers, clapping, flapping

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43
Q

how can persistent, intense preoccupation behavior present in ASD

A

line up objects but not to “play with”
- numbers, science, trains, vacuums

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44
Q

how can excitement play into behavior presentations

A

as get more excited -> pitch of vocalization goes up, inc speed of stereotypies

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45
Q

what is the significance of ASD desiring an absolute routine

A

need routine to predict
surprise = panic/anxiety

helpful to start w routine when first working w ASD, but w effective intervention, improvements are possible

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46
Q

what are the 3 broad areas of motor dysfunction

A

postural control
visual-motor
bilateral coordination

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47
Q

what is the relationship of motor impairment to ASD

A

not a co-existing separate dx
- part of ASD picture

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48
Q

what are postural control deficits seen in ASD

A

reactive
anticipatory

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49
Q

how is ambulation present in ASD

A

often delayed onset

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50
Q

how are gross motor and fine motor skills impact

A

early delays

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51
Q

what are gait patterns seen in ASD (4)

A

(varied):
toe walking
ataxic like
shuffling
normal

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52
Q

is toe walking addressed and how

A

might resolve on its own
usually needs intervention
- behavior (normalize heel touching ground)
- passive stretching
- strengthening

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53
Q

what are gait differences NOT caused by

A

anatomical changes - dec ROM or hypertonia

may develop reduced ms length and weakness secondarily

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54
Q

DCD and ASD in their presentation

A

DCD = motor issues alone
ASD = include similar impairments/limitations

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55
Q

what are 6 specific motor impairments present w ASD

A
  1. postural control deficits
  2. gross motor/fine motor coordination and development
  3. ambulation onset
  4. gait patterns varied
  5. imitation and praxis
  6. dec endurance and physical activity levels
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56
Q

how does impaired fine and gross motor coordination present in ASD

A

UE/LE
(B)
visuomotor

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57
Q

what is praxis

A

motor planning - figuring out what to do and how to do it
- including fine motor ADLs

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58
Q

when can imitation and praxis impairments be identified

A

as early as 2yo

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59
Q

what is the impact of motor presentations of ASD that should be considered

A

consider inc complexity of skills as child ages
- requires inc motor planning, motor imitation

60
Q

what are clinical sensory presentation in ASD (3)

A

disordered sensory integration
- issues w sensory modulation
- connection w dyspraxia

61
Q

describe how issues of sensory modulation can present in ASD

A

difficulty regulating and organizing self in response to sensory input (think ANS)

possibilities = varied (running “hot or cold”)
- hypo-responsive
- hyper-responsive
- most exhibit range from hypo to hyper

62
Q

what greater impact does sensory modulation have

A

alertness level
- by filtering out what is important and what isn’t help to figure out what to focus on

63
Q

how is disordered sensory integration seen in ASD connected to dyspraxia

A

using body, relating to some objects in environment, organizing own behavior

64
Q

what other health conditions can present w ASD (6)

A

epilepsy
GI disorders
sleep disruption
feeding/eating
mental health
premature death

65
Q

when is epilepsy even more commonly seen in ASD

A

if person has both ASD and ID

66
Q

what are classic sx of epilepsy in ASD (2)

A

staring spells
ms stiffening/jerking of limbs

67
Q

what are more subtle sx of epilepsy in ASD (3)

A
  1. sleep disturbances/sleepiness
  2. unexplained marked irritation/aggression
  3. regression in development
68
Q

what is a red flag to watch for when working w someone w both ASD and epilepsy

A

status epilepticus

69
Q

what are sx of GI disorders in ASD (4)

A
  1. freq abd pain
  2. painful stooling
  3. diarrhea
  4. constipation
70
Q

what GI dx are associated w ASD (3)

A

ulcerative colitis
food allergies
- lactose
- celiac dz
GERD

71
Q

what are chronic GI issues related to in ASD

A

inc severity of behavioral sx (esp nonverbal)
- often d/t inc discomfort

72
Q

how common is sleep disorders in ASD

A

50% have chronic sleep issues

73
Q

what sx of sleep disorders are present in aSD

A

difficulty falling asleep, remaining asleep

chronic issues connected w behaviors

74
Q

how does sleep disorders in ASD impact their support system

A

affects parents/primary givers
- chronic stress associated w poor sleepers, concern ab wandering

75
Q

what are 3 potential causes of sleep disorders in ASD

A
  1. genetic mutations regulating circadian rhythm
  2. seizures
  3. anxiety disorder and other behavioral issues
76
Q

what can a feeding disorder be attributed to in ASD

A

high selectivity/restrictions (textures, brands, colors, flavor) and/or disruptive behavior

77
Q

what eating disorders are seen in ASD (3)

A

pica
chronic overeating & obesity
anorexia, bulimia

78
Q

what is seen ab the incidence of obesity in ASD

A

higher incidence than in general population

79
Q

what are 5 mental health disorders seen in ASD

A

ADHD
anxiety
depression
schizophrenia
bipolar disorder

80
Q

what are considerations of depression in ASD

A

inc rates w age and w inc intellectual capacity (more aware of differences)

can be difficult to tease out non-verbal, not able to describe

81
Q

what characteristics of growing up w ASD can contribute to developing anxiety and/or depression

A

difficulty navigating social situations
being unreadable to others
not recognized for strengths
difficulty engaging w others

82
Q

what tests/measures involved in differential dx of ASD (2)

A

genetic testing
neurological eval

83
Q

what differential dx should be r/o to dx ASD (5)

A

fragile X syndrome (chromosomal)
tuberous sclerosis
CNS infection
metabolic disorder
rett syndrome

84
Q

when to sx present in ASD

A

<30mo

85
Q

what is the problem w the current dx process for ASD

A

dx not made early enough
- most dz >4yo vs parents noticing <12mo

need early identification for early intervention

86
Q

what are 3 observations often identified by parents before dx w ASD

A

“Different”
unresponsive (emotionally)
atypical pattern of development

87
Q

what are 4 chief early dx signs of ASD

A

social isolation - and content
- not engaging w same age peers

lack of eye contact
poor language capacity
absence of empathy (seemingly)

88
Q

who dx ASD

A

ideally a mulitdisciplinary team w ASD experience and skill

89
Q

how can PT contribute to the ASD dx process

A

contribute to early identification
- motor impairments

90
Q

what is the layout of the PT exam for a child w dx or suspected ASD

A

adapted to child’s behavior, communication, & sensory modulation needs
- carryover of behavioral approaches

91
Q

what are 3 influences on performance during your PT exam for ASD

A

attention
anxiety
cog & ability to follow directions

92
Q

what are strategies to begin direct exam of ASD or suspected ASD (3)

A
  1. time to warm up to strangers
  2. communication (method?)
  3. behavior, interaction, play skills (what they gravitate toward)
93
Q

what 4 things should be asked in parent interview in PT exam for ASD

A

concerns
goals**
effective/ineffective interaction strategies
prior intervention

94
Q

what 4 points do you want to know from hx of someone w ASD

A
  1. age of dx
  2. meds, other treatments (alternative)
  3. diet (ie any restrictions, gluten, lactose, etc.)
  4. developmental milestone achievement (more important if younger)
95
Q

what setting should observations be in for ASD

A

natural environments where they are comfortable

96
Q

what are 3 things to observe in their natural environment for ASD

A
  1. age-appropriate functional skills
  2. socially embedded motor skills
  3. spontaneous play
97
Q

what about age-appropriate functional skills do we want to observe in ASD (4)

A

stairs
uneven terrain
fundamental skills
movement speed

98
Q

what about socially-embedded motor skills do we want to observe in ASD (3)

A

imitation
- playing catch
- hopscotch
- patty cake

99
Q

what about spontaneous play do we want to observe in ASD

A

lay various items out
- see what they gravitate toward
- how they coordinate body in space

100
Q

what about communication in ASD do we want to observe

A

preferred mode

101
Q

what about social skills in ASD do we want to observe (2)

A

take turns
spontaneous in 1:1 & group

102
Q

what about cognition in ASD do we want to observe (4)

A

attention
arousal
multi-step directions
problem solving

103
Q

what about sensory skills in ASD do we want to observe (3)

A

sensory preferences & ANS regulation and modulation
- how aroused are they in environment

104
Q

what about behavior in ASD do we want to observe (4)

A

repetitive behaviors
routines
aggression
self-injurious

105
Q

what are 3 types of tests and measures used in ASD

A
  1. questionnaires - parent report
  2. norm-referenced activity development measures
  3. activity overall functional skills measures
106
Q

what questionnaire is also appropriate to use in ASD for parent report

A

DCD questionnaire
- compare performance to that of DCD to determine severity of movement/coordination issues

107
Q

what are 5 norm referenced activity development measures/tests in ASD

A
  1. MABC
  2. Test of Gross Motor Dev
  3. PDMS-2
  4. BOT-2
  5. AIMS
108
Q

what are 2 measures to assess overall functional skills

A

school functional assessment (SFA)
PEDI

109
Q

describe the school functional assessment (SFA) used in ASD

A

used to monitor non-academic skills in elementary school such as:
- moving b/w classrooms
- negotiating lunchroom
- accessing school bus

tests participation also

110
Q

age range for the PEDI-CAT

A

0-21yo

111
Q

what populations is the PEDI-CAT valid/reliable for

A

multiple clinical dx
international populations

112
Q

what domains of ICF does the PEDI cover

A

activity (3 domains)
participation (via RCAT)

113
Q

what does the PEDI-CAT measure

A

functional skills in 3 domains:
- daily activities
- mobility
- social/cognitive

114
Q

how does the RCAT subset of PEDI measure participation

A

assesses responsibility domain
- how much responsibility does child take vs parent

115
Q

describe type of scores from PEDI-CAT

A

normative and scaled scores

116
Q

what are the goals of PT intervention in ASD (3)

A
  1. prioritize based on highest area of need of child & family
  2. age-appropriate skills for full participation
  3. improve coordination, postural control for functional movement
117
Q

how is direct PT intervention implemented for ASD (4)

A

highly individualized
within context (home, school)
apply motor learning strategy
carryover of behavioral/social interventions

118
Q

when are PT interventions most effective for ASD

A

when in context that they are having difficulty

119
Q

what are 4 global/educational PT interventions for ASD

A
  1. ABA
  2. DIR (floor time)
  3. PECS
  4. TEACCH
120
Q

what are 2 interventions that both PT and OT work to implement in ASD

A

sensory integration
motor learning

121
Q

describe what the PT intervention ABA is (per utilization in ASD)

A

Applied Behavioral Analysis
1:1, intensive, individualized
based on operant conditions
- positive reinforcement of desired behaviors
- rewards and punishments

122
Q

describe what DIR or “floor time” is as a PT intervention for ASD

A

Developmental, Individual differences, Relationship based

positive reinforcement thru natural context of interaction
- based on social interaction
- shape spontaneous interactions

focus: emotional and development of relationships; sensory
- integration of cognition w social, emotional, motor , communication

123
Q

PECS and TEACCH as PT interventions w ASD

A

PECS - picture communication system
- not limited to ASD

TEACCH - capitalize on strengths and unique qualities of individuals
- structured support for social communication
- visual and/or written info to supplement verbal communication
- specific to autism

124
Q

what is sensory integration therapy as utilized with ASD (3)

A

to address sensory needs
modulation issues

habituation, sensory uptraining to enhance adaptive responses

125
Q

what is the benefit to utilizing sensory uptraining in sensory integration therapy in ASD

A

can help w postural control

126
Q

what is a tool of sensory integration therapy depending on child’s level of arousal

A

sensory breaks
- either calm down
- or ramp sympathetic systme back up

127
Q

what does the evidence support the application of to address primary motor impairments, activity limitations, and participation restrictions in ASD

A

motor learning principles

128
Q

how can motor learning principles be applied to ASD

A

simple tasks - learn by doing
- engage in regular routine practice

complex tasks
- explicit instruction
- part-whole practice
- feedback
- visual modeling
- hand over hand
- K of R w reward

129
Q

what are 2 methods that apply motor learning to PT interventions of ASD

A

structured movement interventions
creative movement interventions

130
Q

describe what structured movement interventions for ASD are

A

physical fitness
- 2-3x/wk, 10-16wks
- mod to vig, 30-60min

type: aquatic, treadmill, cycling, adapted PE, therabands

131
Q

what were 3 benefits to the use of structured movement interventions in ASD

A

improved attendence
academics
dec stereotypies

132
Q

who is structured movement interventions geared more for

A

“average” kid w ASD

133
Q

what are 6 ex of creative motor interventions

A

rhythm (music, dance)
yoga
horseback riding
tech based (wii)
martial arts
outdoor play

134
Q

what is the purpose of creative motor interventions (3)

A

integrate multiple systems: social, motor, cognitive, behavioral

whole-body, multi-limb coordination

promote functional motor skills, creative exploration, free play

taking turns in a small group

135
Q

what are 7 key strategies to PT management of ASD

A
  1. structure environment
  2. instructions for activity
  3. modeling/feedback
  4. repetition
  5. active engagement
  6. progression
  7. reinforcement/rewards
136
Q

what ab the environment can PT structure when managing ASD

A

space
rules sheet/schedule
follow routine
- introduce small changes
- learn to accept small changes
- develop spontaneity
transitions
- time to phase from activity to leaving

137
Q

how can PT manage instructions for activities in ASD

A

verbal
gestures/sign
picture schedules

138
Q

what are the positives and negatives to utilizing a group approach to PT in ASD

A

positive:
- learn social monitoring
- may dec anxiety

negative
- too distracting

139
Q

how can PT promote repetition in treating ASD and why is this important

A

w/i session and across sessions
use caregivers for carryover

promotes generalization
- in one or multiple environments

140
Q

how can active engagement be utilized in PT for ASD

A

allow for spontaneous activities/movement
- encourage child to direct activities as much as possible

allow them time to problem solve
- only prompt 2nd trial (or more prn)

141
Q

what is the balance to strike w progression in PT in ASD

A

“just right” - allows for success

don’t want to be too frustrated by failure, create safe space that allows for success

142
Q

how can reinforcement and rewards be utilized in PT for ASD

A

verbal/gesture (high 5)
breaks from activity to do what they want
symbolic = stickers

stay consistent w overall program

143
Q

outside of direct interventions, how can PT be involved in the POC for ASD (2)

A

consultation/education
recreation

144
Q

how can PT be used to consult/educate in ASD

A

HEP/fitness programs
sensory-motor breaks w/i class or home (ex: bouncing)

145
Q

what should PT consider of recreation in ASD POC (3)

A

safety
interests
environmental stim

146
Q

what are ex of PT suggested recreation in ASD POC

A

yoga
music/dance
horseback riding
swimming

Neuro Rehab 1 (27 decks)

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