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Developmental Psychopathology > Autism > Flashcards

Autism Flashcards

1
Q

Autism classification

A

A lifelong neurodevelopmental disorder

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2
Q

Autism is in DSM and

A

an aspect of self and identity

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3
Q

DSM 4 to 5

A

In 4, 5 Autism spectrum disorders
In 5, Rett’s Disorder moved out because genetic component; Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorders not otherwise specified, and Childhood Disintegrative Disorder were collapsed into Autism Spectrum Disorder- commonalities so strong and reliability so weak

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4
Q

Autism meaning

A

Within oneself

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5
Q

Spectrum added to refer to

A

The fact that symptoms, abilities, characteristics are expressed in many combinations across many degrees of severity

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6
Q

ASD Diagnostic Criteria A

A

One core:
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history:
- Deficits in social-emotional reciprocity (ie abnormal social approach, failure to initiate or respond to social interactions)
- Deficits in nonverbal communicative behaviors used for social interaction (ie abnormalities in eye contact)
- Deficits in developing, maintaining, and understanding relationships (ie absence of interest in peers)

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7
Q

What do Criteria A symptoms reflect?

A

Not necessarily a lack of interest in other people

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8
Q

ASD Diagnostic Criteria B

A

Another core:
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
- Stereotyped or repetitive motor movements, use of objects, or speech (a stereotypy is a repeated action) (ie echolalia- repeating words someone has said) (these are seen in p much all kids when very young but less common as older)
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
- Highly restricted, fixated interest that are abnormal in intensity or focus
- Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (ie overreactive to things or apparent indifference to temperature)

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9
Q

ASD other criteria

A

Symptoms present in early developmental period but may not become fully manifest until social demands exceed limited capacities or masked by learned strategies (mostly diagnosed in preschool or early elementary)
Impairment in functioning
Not better explained by an intellectual disability

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10
Q

ASD evidence in earliest weeks of life

A

In infancy, crying is communication
As early as one month old, kids who are later diagnosed with ASD have cries that sound different (prospective longitudinal study)- louder, more distressed, more screaming, variations in pitch, sound wave frequency, amount of breath exhaled between cried make cries difficult to decode for parents
Could be bc of sensory sensitivity

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11
Q

ASD evidence later in infancy

A

Reduced responsiveness to direct gaze
Reduced joint attention- shown though switching gaze between something interesting and another person or through pointing

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12
Q

ASD evidence in toddlers and preschoolers

A

Variations in pretend play- don’t engage at all or will engage in objects not with their intended purpose

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13
Q

ASD over time

A

In early-middle childhood, tend to see symptoms of autism decrease (maybe bc of interventions ramping up), pubertal deterioration- tough transition to adolescence as social pressures intensify, see comorbid depression + anxiety + eating disorders can emerge

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14
Q

ASD in adulthood

A

20%- content, autonomous, fulfilled lives
30%- some difficulties by good social, educational, occupational functioning
50%- unable to live independently
Adults report being better able to understand social expectations and social responsiveness, but not change in stereotypies and repetitive behaviors

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15
Q

Stereotypies

A

Meaningful and functional, a way to self-calm, buffer against overstimulation, express emotions
People can learn to suppress stereotypies but comes at a cost- takes away effective ways of managing information
Stigma - Kids report being mocked by others, parent report that other people’s negative reactions make them reluctant to bring them to public places, adults report they are treated as though dangerous or childish

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16
Q

Theory of Mind

A

Awareness of mental states in self and others, understanding that others have beliefs, desires, intentions that are different from own, by age 4 children can comprehend what others might know or think, older people w ASD struggle with this

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17
Q

Mindblindedness Theory

A

Children w autism fail to develop capacity to mindread in the same way others do, can learn and know things about the social world but don’t intuitively understand them

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18
Q

Sally-Anne Test

A

Test of mindreading, unique to autism to struggle, children (even Down’s Syndrome) get it right by age 4 or 5, older autistic people can’t, can learn the answer but don’t get why
COME BACK

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19
Q

Unique deficit of ASD

A

Deficits in Theory of Mind are very specific to ASD, unlike other symptoms bc social difficulties can be part of other disorders

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20
Q

Emotion assessment in ASD

A

When assessing emotions, non-ASD look at eyes and mouth, ASD more variability

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21
Q

ASD and eye contact

A

ASD people report eye contact is effortful, exhausting, frightening, not helpful- hard to determine emotion looking at eyes, but stigmatized for this, doesn’t indicate lack of empathy

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22
Q

Cognitive empathy-

A

Inferring another person’s emotions accurately

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23
Q

Empathic concern-

A

Responding to another’s emotions supportively

24
Q

Affective empathy-

A

Feeling the same emotions as another person

25
Q

ASD and empathy

A

Cognitive empathy and empathic concern are difficult for people with ASD, but affective empathy is better
When watching others experience pain or something upsetting, fMRI studies show that people with ASD have strong activation (maybe stronger than others) in own insula- region of brain that processes pain

26
Q

Milton’s Double Empathy Problem

A

Hypothesis: mutual misunderstanding bw people who have autism and people who don’t
Not just that people w ASD have trouble mindreading people who don’t, but bidirectional difficulty in understanding e/o bc of different communication styles and life experiences
Empirical support: People w/o autism are much better at reading emotions/mental states of people w/o autism than people w autism

27
Q

ASD + sex disparities

A

ASD 3-4x more common in males
Difference magnified in higher-functioning range, high-functioning people w ASD 10x as likely to be male

28
Q

Systemizing

A

Drive to analyze, explore, classify, construct, evaluate systems and the rules that govern them

29
Q

Empathizing

A

Drive to identify another person’s thoughts and emotions, respond to these appropriately

30
Q

Gender + drives

A

Males more prone to systemizing, women to empathizing

31
Q

Baron-Cohen’s Extreme Male Brain Theory

A

Autistic brain is an extreme male brain, leads to fixations on things, people w ASD score very highly on tests of systemizing, hypothesis that ASD caused by excessive exposure to fetal testosterone and other androgens- studies of pregnant mothers show higher levels of testosterone associated w more autistic traits in kids 6-10 yrs, figured out problem but not yet how to employ strengths

32
Q

Two core diagnostic criteria of ASD

A

Difficulties with/impairments in social communication and social interactions
Restrictive, repetitive behaviors, interests, activities

33
Q

ASD prevalence

A

2.5-2.8% in Western countries, lower in Middle East and Africa, prevalence has increased in recent years

34
Q

History of ASD

A

Not clearly described until 20th century, as refined diagnosis, prevalence has shifted

35
Q

Donald Triplett

A

First person diagnosed with autism, placed in institution- but didn’t change, his brother didn’t show same qualities, inspired Kanner in 1943 to describe 11 children who had difficulty relating to other people and a strong preference for sameness

36
Q

Autism in DSM

A

First in DSM III in 1952, reflected first 11 children

37
Q

Near misses

A

Children who resembled Kanner’s children but didn’t qualify for autism diagnosis

38
Q

ASM in DSM IV

A

Added to catch near misses, 5 disorders to cover how people almost meet autism

39
Q

Asperger’s

A

Core identical criteria for autism- what??

40
Q

Tim Page’s memoir

A

Bullied, disliked being touched, repetitive interests, childhood rages

41
Q

Why a single diagnosis?

A

No consistent differences between individuals diagnosed with mild autism and those with Asperger’s or other near miss diagnoses
Not reliable diagnosis- should be agreed upon and easy to differentiate across people, this wasn’t- people changing diagnoses all the time based on time in life
No agreement among practitioners- diff practitioners diagnosing same person with different diagnosis- bad validity

42
Q

Why clarify diagnostic criteria?

A

Better inter-rater reliability
Awareness that name of diagnosis could determine access to services (could only get if autistic disorder not Asperger’s)

43
Q

Concerns with new taxonomy

A

Stigma- autistic disorder “worse” in terms of how treated/viewed in word or prognosis
Erodes trust
Asperger’s was an identity and community, linked to genius and creativity, brought comfort

44
Q

Changes in how we conceptualize and study autism

A

Narrow to wide description of symptoms- no longer classic Kanner child but all different manifestations, no longer only study language but study communication more broadly
Rare to common- researchers now think ASD is underdiagnosed, esp for females (if diagnosed more severe symptoms, idea aof masking)
Childhood to lifespan- at first a disorder of early childhood (Kanner) and now we think about it as not just childhood
Discrete to dimensional- characteristics of ASD can and do exist in people who are not diagnosed with ASD, stereotypies in people w/o ASD, same w pronoun reversals, etc, spectrum is off the spectrum, expected signs of development in many cases, not categorical binary distinctions
One to many- we don’t understand etiology, not a single cause

45
Q

Copy Number Variations

A

DNA mutations where some sections of a chromosome are repeated and others are not included
Can be inherited or spontaneous (de novo)

46
Q

CNVs and ASD

A

High CNVs in 30% of ASD cases
In families with just one child w ASD, only that child shows CNVs
More CNVs-more severe symptoms of autism
CNVs associated w these symptoms are in regions of chromosomes that facilitate communication across different parts of the brain, transmission of neural signals

47
Q

CNVs and parental age

A

Higher prevalence of autism in children born to older parents
Age also associated w greater likelihood of CNVs esp paternal age

48
Q

Treating ASD

A

Idiographic approach is esp important bc breadth of symptoms and severity
Only one core approach to treatment has strong empirical support- ABA

49
Q

Applied Behavior Analysis

A

Based on principles of operant conditioning to shape behavior
Begins with intensive relationships and rapport building
2-3 hour sessions, 35-40 hrs/week
Short period of structured time devoted to task, free time for child, breaks every hour
Starts at home individually, goes to small group setting at school; as treatment progresses 1:1 therapist goes to school with child and then small group setting at school w parent training for home, 1:1 as needed

50
Q

Behavior Analysis in ABA

A

Observation of child’s environment to determine what triggers undesirable behaviors, effective reinforcers, what makes desirable behavior more likely
Removal of triggers/antecedents to difficult situations, implementation of rewards

51
Q

Discrete trial learning - ABA

A

Breaks down large tasks into small, manageable ones
Completed request is positively rewarded
If not completed, child prompted and guided

52
Q

Incidental Learning - ABA

A

Naturalistic, real-world
Can occur in breaks, outside therapy session etc
Guide them towards behavior

53
Q

Pivotal Response Training

A

Update to ABA
Main difference- more child-guided, child determines what to do, topics, toys
More expansive in rewards and reinforcements- rewards attempts to complete tasks not just completed ones
Rewards more sensical, in-session rewards match out-of session results (say cup and get a drink rather than say cup and get a sticker)

54
Q

Four Pivotal Areas of PRT

A

Motivation
Managing emotions
Initiation of speech and activity
Multiple cues (ability to absorb and respond to many different sources of information)

55
Q

ABA goal

A

Make people w ASD indistinguishable from peers
People have negative experiences
It achieves goals but comes at high cost
People believe goal is misguided
Most narratives come from more mild autism
Goal should be to change social environment and expectations to be more respective of differences across people

56
Q

ABA history

A

Questionable + unethical
Electric shocks to shape behaviors
Tested theory on nonverbal foster children without people to advocate for them

57
Q

Components of effective ABA treatment

A

Early- begin intervention as soon as diagnosis is discussed
Intensive- active engagement of child in at least 25 hours a week, 12 months a year, in systematically planned, developmentally appropriate educational activities with specific, individualized goals
High structure- use of predictable routines, visual activity schedules, clear physical boundaries, minimal distractions
Family inclusion- parent training in ABA
Ongoing assessment- monitor child’s progress and update goals

Developmental Psychopathology (10 decks)

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