ASD

Question 1

what is ASD?

Answer 1

a neurodevelopmental disorder defined by sig diffs in 2 areas:
- social communication/ social interaction
- restricted and repetitive behaviors/interests/ activities (RRBs)

*need sympts in both domains for diagnosis

Question 2

social communication/ social interaction

Answer 2

may be indiff to physical contact, make little/no eye contact, infrequent gestures, limited facial expressions used, isolated and unimaginative play
- may not respond to others’ emotions, uninterested in making friends
- tendency to focus on parts of faces rather than face as a whole
- may not imitate others (in neurotypical this is the norm)

Question 3

restricted and repetitive behaviours/activities

Answer 3

repetitive movements (hand flapping) and use of objs, insistence on sameness (lining toys up specifically) and if disrupted, provokes extreme distress; narrow interests
- echolalia: repeat words back
- extreme responses to sensory input (sounds like a vacuum, textures for clothing, smells)

Question 4

DSM criteria

Answer 4

persistent deficits in social communication and social interaction across multiple contexts
- 2+ markers of RRBs
- symptoms present from early childhood; specific symptoms/characteristics are noted using specifiers (if assoc w/ medical/genetic condition) and modifiers (if there is also intellectual disability)

Question 5

early atypical autism spectrum disorder

Answer 5

intended to identify children 9-36 months who do not meet diagnostic criteria for ASD but have sig symptoms and impairment

Question 6

associated characteristics

Answer 6

cognitive
language
motor
behavioural
physical/health

Question 7

assoc characteristics: cognitive

Answer 7

30-40% have intellectual disability; diffs in exec functions common (struggle w/ planning/ organization, problem solving)
- central coherence: refers to tendency of humans to interpret stimuli in a global way and takes broader context into account (ppl w/ autism don’t really do this, they process in small pieces rather than look at whole picture)

Question 8

assoc characteristics: language

Answer 8

35-40% do not develop communicative speech; lang may be marked by echolalia, pronoun reversal, unusual information (putting emphasis in diff places can make it hard to understand speech)

Question 9

assoc characteristics: motor

Answer 9

50-80% have difficulties w/ gross motor skills (doing up buttons, holding pencil), fine motor skills, or co-ordination or balance

Question 10

assoc characteristics: behavioral

Answer 10

about 30% show self-injurious behs (more likely w/ comorbid intellectual disability)
- head banging, excessive skin scratching or rubbing

Question 11

assoc characteristics: physical/health

Answer 11

probs w/ sleep (frequent awakenings) and/or eating (can lead to high rate of gastric probs, stomach pain, nausea), about 25% develop seizures (more likely later in adolescence or young adulthood)

Question 12

prevalence rates

Answer 12

2-3% of children in general pop; Canada 2019: 2%; Global 2022: 1%
- higher estimates now because there is a lot more awareness of symptoms, broader diagnostic criteria, and better detection

Question 13

sex differences

Answer 13

more common among boys (4:1)
- core symptoms are the same; girls may show fewer RRBs and higher scores on lang skills and social motivation
- girls appear to be diagnosed at lower rates and diagnosed later in life

Question 14

when do symptoms emerge, and what is avg age at diagnosis?

Answer 14

symptoms emerge during first 1-2 yrs of life; reliable detection at 12-18 mos, reliable diagnosis by 24 mos (used to be 36mos)
- avg age at diagnosis: 4yrs
- symptoms may show up b/t 6-12mos of life, prefer unusual objs, looking at diff angles, squinting a lot

Question 15

symptom pattern over childhood

Answer 15

• preschool: classic symptom pattern
• school age: more responsive socially, but odd behs and self-stimulation/injury more common
• adolescence: symptoms continue, hyperactivity and self-injury may worsen, some make dev. gains, others don’t

Question 16

symptom pattern in adulthood

Answer 16

symptoms, associated characteristics may improve, but diagnostic stability is high, ASD is lifelong condition

Question 17

Simonoff et al. (2020) changes from 12-23yrs

Answer 17

youth followed from 12-23yrs: ASD symptoms remained the same, IQ increased (by 7+ points, huge inc), linked to higher language level in childhood

Question 18

etiology

Answer 18

a biologically based neurodev disorder that involves genetic and enviro factors

Question 19

bio factors

Answer 19

• family, twin, gene studies show sig heritability (up to .80), likely involving single and multiple gene mutations
• larger brain volume, specific structural abnormalities (frontal, amyg, cerebellum), dec blood flow in some regions (frontal, temporal), disrupted connectivity among brain regions, inc white and grey matter

Question 20

enviro factors

Answer 20

gene expression is affected by enviro factors before, during, and/or after fetal brain dev (older parental age, meds, drug exposure, low birth weight

Question 21

early interventions are used to…

Answer 21

reduce/minimize impact of core diffs, maximize independence and quality of life, help the person and fam manage diagnosis

Question 22

best early intervention

Answer 22

highly structured skills-oriented strategies have shown the most success
- esp when tailored to child
- provide educ and support to fam
- some children also given antipsychotic meds to help reduce challenging behs
- maximize child’s independence and QOL

Question 23

best intervention features include

Answer 23

• early
• intensive
• low student-to-teacher ratio
• high structure
• fam inclusion
• peer interactions
• generalization
• ongoing assessment

Question 24

3 things we have learned from prospective longitudinal studies of infant siblings of children who have been diagnosed with ASD

Answer 24

1) recurrence risk of ASD in infant siblings = up to 20% (10X higher than prevalence of ASD)

2) many behavioral markers emerge around 12 months (sometimes earlier); social abilities before 12 months do not rule out development of ASD

3) high risk siblings who do not develop ASD by 36 months may have other dev challenges (cog/lang delay)

Question 25

identify any 4 myths that persist about autistic individuals

Answer 25

• children “grow out” of autism (it is lifelong)
• they don’t have emotions (they are just not expressed as expected)
• caused by vaccinations
• they are all geniuses in science fields (many w/ avg intelligence, and in other fields; about 10% are extraordinary)