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Pediatrics > Autism > Flashcards

Autism Flashcards

1
Q

Autism defined:

Generally evident when?

A
  • Before 3yrs of age
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2
Q

Autism defined:

A
  • Developmental disability sig. affecting verbal and non-verbal communication and social interaction, generally evident <3yrs of age, that adversely affects childs educational performance
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3
Q

Other Characteristics assocd w/ autism:

3:

A
  1. Repetitive activities and stereotyped mvmts
  2. Resistance to environ. change OR change in daily routines
  3. Unusual responses to sensory exp’s
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4
Q

Autism Spectrum Disorder “ASD”

Defined:

A
  • Term used to indicate behavior cond’s that exist on a continuum
  • Mildly→ severely involved
  • Social communication, social interaction, sensory integration are affected
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5
Q

3 areas affected w/ ASD:

A
  1. Social communication
  2. Social interaction
  3. Sensory integration
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6
Q

Genetic link found w/ ASD when?

A

1980s

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7
Q

ASD

Prevalence

*most important

A
  • FASTEST GROWING DEV. DISORDER
  • 1 in 44 children ID w/ ASD
  • Parents who have child w/ ASD have 2-18% chance having second affected
  • 10% ASD also IDd w/ DS, Fragile X, tuberous sclerosis, genetic/chromosomal disorders
  • 5x more common in bots
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8
Q

ASD

Prevalence

*Fastest growing develop. disorder

Contributing factors:

A
  • More likely to properly ID autistic vs intellec. disabled
  • Incd awareness/funding
  • More broad DX
  • Earlier diagnosis
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9
Q

ASD

Etiology

A
  • NO known single cause
  • Gen accepted→ abnorms in brain structure/function
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10
Q

ASD Risk Factors

Prenatal

A
  • Gene mutations, environ factors, adv. age either parent
  • DM, psychiatric drugs in mother
  • Infections→ rubella, CMV
  • Teratogenic causes
  • Prenatal stress
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11
Q

ASD Risk Factors

Perinatal

A
  • LBW
  • Hypoxi
  • Prematurity
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12
Q

Dx of ASD

Physicians use what?

A

Diagnostic and Statistical Manual (DSM) of Mental Disorders to det. whether person has ASD (DSM-5)

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13
Q

Dx of ASD according to DSM-5

A
  1. Dx called ASD
  2. No more sub-diagnoses
  3. New dx criteria arranged: 2 areas→
    1. Social communication/interaction**
    2. Restricted and repetitive behaviors**
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14
Q

2 areas of diagnostic criteria for ASD

A
  1. Social comm./interaction
  2. Restricted and repetitive behaviors
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15
Q

Clinically Diagnosing ASD

All following sx’s describing persistent deficits in social comm/interaction not acctd for by gen develop. delays, must be met:

MUST HAVE ALL OF THESE!!!

All of these are related to first area: Social communication/interaction

A
  1. Problems reciprocating emotions or social interaction
  2. Severe probs maintaining relationships
  3. Verbal/non-verbal communication probs
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16
Q

Clinically Diagnosing ASD

Two of the four sx’s related to restricted and repetitive behavior need to be present:

All of these are related to second area: Restricted and repetitive behavior

A
  1. Stereotyped or repetitive speech, motor mvmts or use of obj’s
  2. Excess adherence to routines, ritualized patterns of verbal or nonverbal behavior, OR excessive resistance to change
  3. Highly restricted interests that are abnorm in intensity or focus
  4. Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environ.
    1. not understanding environ.
    2. sensory feedback not working properly
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17
Q

Social Communication/Interaction Criteria

1.Problems reciprocating emotions or social interaction

Ex’s

A
  • diff holding conversations
  • unable to initiate interaction
  • probs w/ shared attn or sharing emos/interests
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18
Q

Social Communication/Interaction Criteria

2.Severe probs maint. relationships

Ex’s

A
  • lack interest in people
  • diff. w/ pretend
  • diff w/ age-approp social acts
  • probs adjust to diff social expects
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19
Q

Social Communication/Interaction Criteria

3.Verbal/Non-verbal communication probs

Ex’s

A
  • Abnormal eye contact, posture, facial express’s, tone of voice/gestures
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20
Q

ASD

Early warning signs

A

Lack eye contact, no resp to name, no interest in people, prefer not to be held*

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21
Q

ASD

More early warning signs:

A
  • Trouble adapt to changes, unusual rxns smell, sound, taste, feel
  • Unusual/repetitive way play w/ toys
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22
Q

ASD

More early warning signs w/ ages considered:

A
  • No babbling or gesturing by 12 mos
  • Inability to speak 1 word by 12-14mos
  • Regression in OR loss of lang or social skills********* BIG ONE!!!!
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23
Q

ASD Early Warning Signs

Studies show…

A
  • Parents notice dev. prob before 1st bday
  • Vison/hearing concerns more often reported 1st year
  • Diffs in Social, comm, fine motor skills evident from 6mos
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24
Q

Assoc’d Clinical Impairments:

BSF

A
  • Failure of lang/comm. dev., sensory processing, sensory abnorms-sensitivity
  • motor function, apraxia (motor planning)
  • control of voluntary mvmts→ clumsy/uncoord
  • restrictive repetitive behaviors
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25
Q

Assocd Clinical Impairs:

BSF cont’d

A
  • over-rxns, intellectual impairs, poor eye contact, eating disorders, sleep, SZ’s, GI impairs
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26
Q

Assocd Activity Limits/Participation Restricts:

A
  • Limtd gross motor skills, dec IND/safety, decd understanding rules,
  • Decd efficiency w/ functional mob, assist reqd to sit/attend school t/o day, diff w/ interpersonal relationships/social relationships
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27
Q

ASD video

A

slide 32*****

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28
Q

PTs play a role for children w/ ASD MOST OFTEN in regards to:

A

BSF issues that reduce safety during activity or dec participation

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29
Q

PTs play a role for ASD MOST often in regards to BSF issues that reduce safety during activity OR dec participation

SUCH AS:

A
  • Abnorm mm tone→ hypOtonia
  • Apraxia/motor planning
  • Gait impairs→ toe walking*** (very prevalent)
  • Balance defs
  • Gross motor delay
  • Atyp. motor performance→ motor imitation/coord
  • Sensorimotor integration
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30
Q

PT Exam for ASD

Hx → Important things to include:

A
  • Social interactions/activities, support system, dev. hx, phys/psycho/social function,
  • Behavioral habits, medical hx, chief complaints (family perceptions), functional status, meds
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31
Q

PT Exam for ASD

Systems Review

A
  • CV/Pulm→ BP, edema, HR, RR
  • Integ→ scarring, skin integ, coloring
  • MSK→ ROM, strength, symmetry, ht/wt
  • **NMSK→ Gross coord’d mvmts—- KNOW THIS ONE!
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32
Q

MOST COMMON MOTOR SX IN ASD

A

LOW MM TONE (HYPOTONIA)

51%

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33
Q

PT Exam for ASD

HypOtonia → MOST COMMON motor sx

A
  • LOW mm tone
    • Most common→ 51%
  • Improves over time w/ incd strength about jts
    • wont change it, but can improve thru strength
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34
Q

PT Exam for ASD

Apraxia (think Planning)

A
  • Motor planning disorder affects ability to carry out purposeful mvmts
  • Assess→ dexterity, coord, agility
    • coord. screen
    • motor impair test
    • video
  • *NOTE: improves over time
35
Q

PT Exam for ASD

Gait impairment

A
  • Intermittent toe-walking
    • reduced ankle mob. is rare
36
Q

Gait Assessment for ASD

Observation includes:

A
  • Balance, velocity control, symmetry, mvmts of UE/LE/trunk, wt transfer, foot placement, walking pattern***
37
Q

More on gait assessment for ASD

A
  • Video analysis, time-distance variables, functional amb
38
Q

ASD group shows sig impairment of motor control

Ex’s

A
  • Dysrhythmias, timed mvmts hands/feet, overflow of mvmts
39
Q

Balance Assessments for ASD

Sensory System

aka what would you use to assess?

A
  • Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB)
  • Tilt board tip
40
Q

Balance Assessments for ASD

Motor System

aka what would you use?

A
  • The Clinical Observations of Motor and Postural Skills (COMPS)
  • Side-reach
41
Q

Balance assessments of ASD

Biomechanical

aka what would you use?

A
  • Goni
  • MMT
42
Q

Balance Assessments for ASD

Developmental

aka what would you use?

A

PDMS-2, Mvmt-ABC, BOT-2

43
Q

Gross Motor Delay in ASD

Of note… literature shows:

A
  • Rate of motor dev slow in 2nd→3rd year
  • 50% children w/ ASDs show developmental regression bw 14-24mos
44
Q

50-100% school-aged children w/ ASD had sig motor delays compared to norms

A

**************

45
Q

Standardized Assessment of Mvmt Functions

-tests for infants/young children based on typ seq of motor skill acquisition

A
  • Harris Infant Neuromotor Test (HINT)
  • Test of Infant Motor Performance (TIMP)
  • Mvmt Assess of Infants (MAI)
  • Gross Motor Performance Measure (GMPM)
  • Alberta Infant Motor Scale (AIMS)
46
Q

Standardized Assess of Mmvt Functions

-Dev. tests for young children w/ items related to complex balance and coord→ SLS, hop, gallop, jumping

A
  • Mvmt-ABC
  • Bayley Scales of Infant Dev (BSID-2)
  • Peabody Developmental Motor Scales (PDMS-2)
  • Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
47
Q

PT Interventions for ASD

Motor/Mvmt Intervents:

A
  • Strength
  • Postural control/balance
  • Motor planning acts
  • aquatic/hippotx
48
Q

Pt Interventions for ASD

Strengthening acts:

A
  • Use PLAY!!!
    • push/pull heavy objs
    • jumping, crab walk, scooter board, wheelbarrow
49
Q

PT interventions for ASD

Postural control/Balance

A
  • Balance beams
  • SLS
  • Rocker board
  • Therapy ball—Conklin LOVES the ball!!!!
50
Q

PT Interventions for ASD

Motor Planning/Mvmt Activities

A
  • Obstacle course, Simon says, RL/GL, jumping, balloon toss, throw/catch, diff walks, running
51
Q

PT Interventions for ASD

Motor/Mvmt→ Aquatic Tx

Why?

A

Strengthening AND relaxation due to warmth, buoyancy, resistance and anti-gravity pos’ing

52
Q

PT Interventions for ASD

Motor/Mvmt

HippoTx

Why?

A
  • Rhythmical mvmts of horse directed to reduce limits in posture, balance, mobility
53
Q

Sensorimotor Integration

Sensory Processing defined:

A

The way the nervous system receives messages from senses and turns them into approp. adaptive responses

*Ex. hot outside=take off jacket

54
Q

Sensorimotor Integration for ASD

Includes:

A
  • Sensory processing
  • HypER/HypOsensitivity
  • Auditory, tactile, visual, gustatory, olfactory, proprio, vestib, enteroception
55
Q

Sensory Integration defined:

A

Neuro processes that collect/receive sensation from body and environment→ makes possible to use body effectively w/in environment

56
Q

Sensory Processing Disorder Defined:

A
  • Sensory signals do not get organized into approp responses→
    • Motor clumsy, behavior probs, anxiety/depression, school probs
57
Q

Sensorimotor Dysf Stats

A

90% ASD→ sensory abnorms

95% ASD→ sensory process impairs

58
Q

Sensory Process Dysf. Types

7:

A
  1. Tactile
  2. Vestib→ gravity
  3. Proprio→ force
  4. Auditory→ no dx hearing probs
  5. Oral input
  6. Olfactory
  7. Visual input→ no dx visual deficit
59
Q

Sensory Processing Dysf Types

Tactile Dysf

A
  • Hyper/Hyposensitivity to touch
    • tactile defensiveness OR under-responsive
  • Poor tactile perception and discrim.
60
Q

Sensory Processing Dysf Types

Vestibular dysf:

A
  • Hyper/Hyposensitivity to mvmt
    • Over/under-responsive
61
Q

Sensory Processing Dysf Types

Proprioceptive Dysf:

A
  • Sensory seeking behaviors
  • Diff w/ “Grading of mvmt”
62
Q

Sensory Processing Dysf Types

Auditory Dysf: no dx hearing problem

A
  • Hyper/Hyposensitivity to sounds
    • auditory defensiveness vs under-registers sounds
63
Q

Sensory Processing Dysf Types

Oral-Input Dysf

A
  • Hyper/Hyposensitivity
    • oral defensiveness vs under-registers
64
Q

Sensory Processing Dysf Types

Olfactory Dysf (smells)

A
  • Hyper/Hyposensitivity to smells
    • over/under responsive
65
Q

Sensory Processing Dysf Types

Visual Input dysf: no dx visual def.

A
  • Hypersensitive→ over-respond
  • HypOsensitivity to vis. input
    • under-responsive or diff w/ tracking, discrim, perception
66
Q

Sensory Processing Dysf Types

How do you know which dysf child has?

A
  • Sensory Processing Disorder Checklist→ S/S of dysf
  • Observe play, engagement preferred acts, interactions
67
Q

Intervention for ASD

Improve QoL and ability to participate in society

Themes linked to positive outcomes:

A
  • Indiv analysis that includes basis for behaviors and environmental influence on the behaviors
  • Family is central to program
  • Services are intensive and comprehensive
  • Facilitating active engagement of child= Essential*
68
Q

Potential Interventions for Sensorimotor Integration

4:

A
  1. Behavioral tx
    1. applied behavioral analysis, floor time
  2. Social skills intervents.
  3. *Sensory integration/sensory-based intervents
  4. *Motor/mvmt intervents
69
Q

Applied Behavior Analysis (ABA)

A

Techs/principles to bring about meaningful/positive change in behavior

  • focus on principles that explain how learning takes place
    • reinforcement
  • behavior followed by reward→ more likely to be repeated
70
Q

Applied Behavior Analysis (ABA)

what kind of techniques to use?

A

Techs to INC useful behaviors and reduce those that may cause harm or interfere w/ learning

71
Q

Floor time is a type of _______ therapy

A

Behavioral therapy****

72
Q

Floor Time

*IMPORTANT, KNOW IT!!!!!

A
  • From Developmental Individual-difference Relationship-based model (DIR)
  • Encourages parents to engage children literally @ their lvl→ getting on floor to play!!!
    • go into childs “world”
73
Q

Sensory Integration Therapy

Addresses what?

A

Sensory processing, motor/perceptual impairments

  • Assumes→ child over/under stimulated by environment
  • Aim→ improve ability of brain to process sensory info=== better function in daily acts
74
Q

Sensory Diet

A
  • Designed, personal act. plan provides sensory input needed to stay focused and organized t/o day
  • Ex. calming input for kids over-stim’d, arousing input for kids “sluggish” or too tired
  • Brushes, wt’d vests, mats, big hug, swings, music, massagers, etc…
75
Q

Sensory Integration Activities:

Tactile

A
  • Deep pressure/”Squishing”→ gym bal, “bear hug”
  • Firm massage, brushing, wtd vest/lycra undergarms
76
Q

Sensory Integration Activities:

Proprioception

A
  • Pushing→ heavy objs, grocery cart, scooter, wheelbarrows
  • Pulling→ Tug of War
  • Hand/Eye coord→ hitting swinging balls
  • Balance→ balance beams
  • Vestib/tactile→ run & crash
  • Tactile/motor planning→ crawl thru tunnels
77
Q

Sensory Integration Activities:

Vestibular

A
  • Swings, mvmt on balls, spin on chair (vis/balance)
  • Jumping, tumbling, rocking
78
Q

Sensory Integration Activities:

Auditory

A
  • Repetitive songs, quiet workspace, elim. chatter
  • Music→ classical, soothing
79
Q

Sensory Integration Activities:

Vision

A

Dim lights, avoid fluorescents, spinning

80
Q

Sensory Integration Activities:

Aerobic Acts:

*RAISE arousal lvl

A
  • RAISE arousal lvl
    • TM, cycling
81
Q

Sensory Integration Activities:

Tx Techniques:

A
  • Change acts freq→ stations
  • Routines and plan transitions
  • Vis. engaging toys→ provide sensory input
  • NON-overwhelming environ.
  • Create Reward system***
82
Q

Sensory Integration Activities:

Therapy tools to use!!!!

A

IDEAS****

83
Q

ASD: When to refer to OT→

A
  • Self-directed behavior
  • Limtd engagement
  • Cannot follow commands/1-2 step directs., despite visual and phys. cues
  • Unable to regulate or attend in PT environ.

******

Pediatrics (27 decks)

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