ASD Revision Flashcards
What is ASD?
Developmental Disorder
Impacts the way they communicate and relate to others
Not progressive but can be seen as changing through how they respond to changes in their life as they get older
What are the theories of potential causes of ASD?
Infection - in utero
Biological Theory - SSS brain damage as the cause, and co-morbidities are common
Genetic Causes - evidence of a familial link, as well as links to genetic conditions such as fragile X
Birth Damage - traumatic delivery/lack of oxygen
How do the RCSLT define the SLT role within ASD?
Contribute to diagnosis as a member of the MDT
To enable the client to make free choices, express their feelings, learn and increase their independence
Provide/facilitate an environment that maximises opportunities to develop rec/exp language skills
Educate and support family and educators to facilitate success of the child
What are key indicators of ASD?
- Deficits in social and communication skills
- Reciprocity in communication
- Difficulties in initiating communication
- Joint attention
- Language comprehension
Explain the dyad of impairment?
- Persistent deficits in social communication and social interaction across contexts
¡ deficits in social-emotional reciprocity, nonverbal communicative behaviours and/or the development, maintenance and understanding relationships - Restricted, repetitive patterns of behaviour, interests or activities
¡repetitive motor movements
¡use of objects or speech (hand flapping, lining up toys, echolalia)
¡inflexibility to routine change
¡restricted, fixated interests that are abnormal in intensity/focus
¡hyper or hypo reactivity to sensory input/environments
What is the potential impact on the family of a PwASD
- Loss
- Anger
- Guilt
- Managing behavioural difficulties
- Fear for the future
- Concerns over education
- Breakups/strain on relationships
- Impact on siblings
- Judgement from others
Why is early intervention important?
Howlin, 1997
Early intervention can minimise or avoid behavioural problems, and help children to develop their skills to their full potential
Pierce et al
Argues early intervention may have more chance of success because it is happening during a period of optimal brain plasticity, which decreases as the child gets older.
What is the best approach for a child with autism?
Jordan and Jones, 1999
There isn’t strong evidence that indicates one approach is best for a CwASD. There is a consensus for intensive, early intervention, that involves parents and includes direct teaching of skills.
Notes from Systematic Review of ASD Early Intervention
French and Kennedy, 2018
Only 12.5% of studies showed a low risk of bias
Direct or indirect teaching for ASD?
Wing, 1996
We know children with ASD are less likely to learn from observing and copying their peers, hence Jordan and Jones (1999) stating direct teaching is needed.
What are potential implications for therapy with an ASD diagnosis?
- May not respond to social reinforcement
- Lack of internal structures for self control and motivation
- Functioning in groups might be hard
- Difficulty understanding interpersonal messages
- Limited use of social language
- Difficulty with concept formation and abstract ideas
- Oversensitive to certain stimuli
- Poor sequential memory
- Preference for continuity and routine
- Limited spontaneity to behaviour
- Difficulty in generalising learning across contexts
What are some approaches for ASD therapy?
- PECS
- Social Stories
- Teacch
- Intensive interaction
- LEGO ® therapy
- Attention Autism
- Applied Behavioural Analysis
- Options (Son-rise programme)
What are Social Stories?
Help CwASD develop their social understanding and ability to stay safe
What are the pros of social stories?
- target a core difficulty of ASD - understanding social communication/social situations
- provide ‘rules’/guide
- can be self managed
- can increase confidence
- can reduce stress in situations they have ‘studied’
What are the cons of social stories?
- specific, targeted behaviour intervention - what is the carry over going to be like?
- the program is reliant on receptive ability
- require updating > reliance on trained staff, may be tricky with service or setting constraints
What is PECS?
Picture Exchange Communication System
Aims to teach functional communication so children can communicate their basic wants and needs. Teaches children to give adult a picture of a desired item in exhange for the item.
Teaches initiation of communication within a social context.
Starts basic at SWL, can be built up to include picture discrimination (what does/doesnt the child want) and sentence building.
Key paper: LT effects of PECS
Learn et al
2014
Claimed that PECS promoted LT enhancement of some specific social communication skills in CwASD - showed a significant improvement in social communication and cooperative play
What are the pros of PECS?
- teach turn-taking/2 way element of communication
- teaches initiation
- easily understood by the conversation partner, reducing likelihood of frustration and loss of motivation
- takes pressure off expressive skills
- quite a lot of case study, anecdotal evidence
- increases independence
- What Works Study states moderate evidence level
- some evidence suggests improves functional conversation (although not verbal)
What are the cons of PECS?
- Some perception it prevents development of speech (arguably doesn’t encourage it)
- Training is essential
- can be a long process for some children - requires commitment and continuity
- lacks studies with evidence of long term effects
- mixed outcomes, especially in language improvements
What is Attention Autism?
Devised by Gina Davies
Aims to develop social communication skills and thinking skills
Aims for 20 minutes participation to be achievable after 6 weeks
4 stages:
FOCUS - child must focus
SUSTAIN - attention lasts increasingly longer
SHIFT - child can shift attention - watch, turn take, watch
ALL WITH TRANSITION -
What is ABA?
Applied Behavioural Analysis
Developed from the principles of operant conditioning
Uses positive reinforcement, breaking down tasks, modelling and repetition
Intensive - 40hrs a week
What are the pros of ABA?
Success with some children
What are the cons of ABA?
- Aims to get all to mainstream education - not the goal for all families or appropriate for all
- Intensive
- Specific training needed, meaning may be subject to service constraints
What is Intensive Interaction?
Intervention that targets communication development through a developmental approach.
Aims to develop shared/joint attention, and for CwASD to enjoy being expressive and connected to their CP, and to increase socialising and using vocalisations meaningfully (including speech)
Increasing attention can enable the child to better engage in peer activities, learning and communication.
What are the pros of Intensive Interaction?
Adaptable - e.g. can adjust your proximity to the child to make them more comfortable, do it in an environment they’re happy and calm in
Works at their pace
Non-confrontational
Relatively short sessions - easier to fit in to busy lives of families/educators
Potentially wider benefits - improving relationships/rapport between CwASD and adults around them arguably improves their QoL for both them and the family member, for whom ASD can be an emotionally difficult diagnosis.
What are the cons of Intensive Interaction?
A systematic review on the literature of intensive interaction showed a lack of indication regarding training
Variety of study outcomes
What are some common comorbidities of ASD?
- Developmental disorders
- Anxiety
- Language Disorder
- ADHD
How can behaviour be managed?
- Reduce stress
- Try to consider their perspective
- There is a reason for their behaviour - its not ‘naughty’ - it is typically triggered by an external stimuli, rather than consciously controlled by the child.
- Avoid punishment
- Give positive instructions - tell the child what to do, not what not to do.
What are some strategies for behaviour management within education?
- Offer support within ‘free’, unstructured times - support staff or buddy schemes if appropriate
- Consider sensory disturbance across environments
- Give warnings of timings - clear starts and finish, announced clearly in advance
- Use visuals to support understanding - now and next boards, visual timetables, images on staff lanyards, objects of reference that represent activities, places or people
- Give frequent prompts
- Rules need to be clear, structured and consistent
- Teaching the child the concept of finish
