Autism Flashcards
Autism classification
A lifelong neurodevelopmental disorder
Autism is in DSM and
an aspect of self and identity
DSM 4 to 5
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
Autism meaning
Within oneself
Spectrum added to refer to
The fact that symptoms, abilities, characteristics are expressed in many combinations across many degrees of severity
ASD Diagnostic Criteria 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)
What do Criteria A symptoms reflect?
Not necessarily a lack of interest in other people
ASD Diagnostic Criteria B
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)
ASD other criteria
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
ASD evidence in earliest weeks of life
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
ASD evidence later in infancy
Reduced responsiveness to direct gaze
Reduced joint attention- shown though switching gaze between something interesting and another person or through pointing
ASD evidence in toddlers and preschoolers
Variations in pretend play- don’t engage at all or will engage in objects not with their intended purpose
ASD over time
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
ASD in adulthood
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
Stereotypies
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
Theory of Mind
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
Mindblindedness Theory
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
Sally-Anne Test
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
Unique deficit of ASD
Deficits in Theory of Mind are very specific to ASD, unlike other symptoms bc social difficulties can be part of other disorders
Emotion assessment in ASD
When assessing emotions, non-ASD look at eyes and mouth, ASD more variability
ASD and eye contact
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
Cognitive empathy-
Inferring another person’s emotions accurately
Empathic concern-
Responding to another’s emotions supportively
Affective empathy-
Feeling the same emotions as another person
ASD and empathy
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
Milton’s Double Empathy Problem
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
ASD + sex disparities
ASD 3-4x more common in males
Difference magnified in higher-functioning range, high-functioning people w ASD 10x as likely to be male
Systemizing
Drive to analyze, explore, classify, construct, evaluate systems and the rules that govern them
Empathizing
Drive to identify another person’s thoughts and emotions, respond to these appropriately
Gender + drives
Males more prone to systemizing, women to empathizing
Baron-Cohen’s Extreme Male Brain Theory
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
Two core diagnostic criteria of ASD
Difficulties with/impairments in social communication and social interactions
Restrictive, repetitive behaviors, interests, activities
ASD prevalence
2.5-2.8% in Western countries, lower in Middle East and Africa, prevalence has increased in recent years
History of ASD
Not clearly described until 20th century, as refined diagnosis, prevalence has shifted
Donald Triplett
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
Autism in DSM
First in DSM III in 1952, reflected first 11 children
Near misses
Children who resembled Kanner’s children but didn’t qualify for autism diagnosis
ASM in DSM IV
Added to catch near misses, 5 disorders to cover how people almost meet autism
Asperger’s
Core identical criteria for autism- what??
Tim Page’s memoir
Bullied, disliked being touched, repetitive interests, childhood rages
Why a single diagnosis?
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
Why clarify diagnostic criteria?
Better inter-rater reliability
Awareness that name of diagnosis could determine access to services (could only get if autistic disorder not Asperger’s)
Concerns with new taxonomy
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
Changes in how we conceptualize and study autism
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
Copy Number Variations
DNA mutations where some sections of a chromosome are repeated and others are not included
Can be inherited or spontaneous (de novo)
CNVs and ASD
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
CNVs and parental age
Higher prevalence of autism in children born to older parents
Age also associated w greater likelihood of CNVs esp paternal age
Treating ASD
Idiographic approach is esp important bc breadth of symptoms and severity
Only one core approach to treatment has strong empirical support- ABA
Applied Behavior Analysis
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
Behavior Analysis in ABA
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
Discrete trial learning - ABA
Breaks down large tasks into small, manageable ones
Completed request is positively rewarded
If not completed, child prompted and guided
Incidental Learning - ABA
Naturalistic, real-world
Can occur in breaks, outside therapy session etc
Guide them towards behavior
Pivotal Response Training
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)
Four Pivotal Areas of PRT
Motivation
Managing emotions
Initiation of speech and activity
Multiple cues (ability to absorb and respond to many different sources of information)
ABA goal
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
ABA history
Questionable + unethical
Electric shocks to shape behaviors
Tested theory on nonverbal foster children without people to advocate for them
Components of effective ABA treatment
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
