Autism Flashcards
Austistic dx in DSM-5
Persistent deficits in social communication and social interaction across multiple contexts
Restricted, repetitive patterns of behavior, interests or activities
The symptoms are present in the early developmental period and
- Cause clinically significant impairment in social, occupational and other important areas of functioning
These disturbances are not better explained by intellectual disability or global developmental delay
What type of dx is autism dx?
exclusionary dx
Severity Level 1
social comm - Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and reading social cues. May appear to have decreased interest in social interactions.
Restrictive, repetitive behavior -
Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities..
Level 2
Social Comm - Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. Has markedly odd nonverbal communication.
Restrictive, Rep, behavior - Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently.. Distress and/or difficulty changing focus or action.
May be non-verbal.
Level 3
social comm - Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others.
restrictive rep behavior - Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
Diagnosis Considerations
Co-occurring diagnoses may include:
Intellectual disability
ADHD
Anxiety, depression or other mood disorders
Epilepsy
GI issues
Sleep disturbances
DSM-5 definition of restricted and repetitive patterns
Defined in DSM-5 as”stereotyped patterns of speech or movement; insistence on sameness; abnormal, highly focused interests; and hypo- or hyperreactivity to sensory input or unusual sensory interests.
motor behavior in restricted and repetive patterns
Flapping, spinning, complex body movements, echoalia, hypo or hyper responsiveness to stimuli
insistence on sameness in restricted and repetitive patterns
- Lining up objects, using the same route, eating same foods, following set routine (especially if nonfunctional)
intense interests in restrictive and repetitive patterns
- Interests with abnormal focus, fixation on a particular topic
Motor and Praxis
- Motor delays may be inconsistent and occur in specific areas (locomotion, grasp, ball skills and balance) while others are intact.
- Differences in postural control- first seen in delayed head lad in pull-to-sit
- Gait differences- toe walking, wide based gait, atypical foot, hand and trunk positioning and movements; stiffness; greater stride variability; and difficulty walking a straight line.
- Reach and grasp tends have increased variability to occurs at a slower speed. Force and strength of grasp is also less than neurotypical individuals.
- Difficulty with imitation
- Dyspraxia
What does play look like for kids with autism
differences in types of functional and symbolic play
sensorimotor play is often a strength
less flexible play schemes
Sensory Features
- 69-94% of autistic individuals demonstrate sensory features.
- Manifest in 1 or more sensory systems
——Hyporesponsiveness
—–Hyper responsiveness
——Sensory Seeking
——Enhanced perception - Impact an individual’s adaptive behavior, activity participation and family routines
Middle childhood and autism
Social-emotional development
- Self and emotional awareness
- Emotional Intelligence
- Empathy
- Emotional self-regulation
- Social and friendship skills
Motor abilities
Participation in activities
Vulnerability
Complexities of the school environment
What type of evaluations would we want
strength based evaluations
What is a strength based evaluation?
Identifying skills, competencies and characteristics that promote an individual’s task accomplishment and skill development (Watling, 2018)
What is a foundational approach in evaluations for autism
Identifying individual’s personal skills, preferences, interests and strengths;
Unique manifestation of autism characteristics
Developmental status in foundational areas
throughout our evaluation we want to establish therapeutic relationship - how do we do this?
Showing respect to each individual, their strengths and preferences
Grading the pacing of performance demands
Assume competence
Family as the expert
How can we modify an assessment
Administration Modifications:
- Alternate phrasing to explain test items
- Adding gestural, physical or visual cues
- Modeling desired performance
Using visual schedule
- Grading the degree of structure offered
- Using positive reinforcement to motivate the student
- Incorporating a preferred toy or sensory item into the testing scenario
if you adapt a standardized assessment, what do you do?
in the comments section talk about how and why it was modified and what that means. include everything you do.
Data Driven Decision Making (DDDM)
Developed to address the need for outcome measures, systematically support decision making, target interventions and document outcomes.
Proximal outcomes-
hypothesized underlying factor
distal outcomes
Distal outcome- participation based outcomes (impact on ability to successfully participate in tasks, activities and outcomes)
Outcomes are the
effect or consequence of intervention.
Goal Attainment Scaling
Research supported for use with
Autistic children
data driven decision making
- Identify Participation Challenge
- Identify factors impacting participation (systematic Assessment)
- Synthesize assessment data and create hypothesis
- Develop and scale goals
- Identify Proximal and Distal outcome measures
- Set the stage for intervention
- Conduct Intervention
- Measure outcomes and revise hypothesis as needed.
Service delivery - Least Restrictive Environment
Best fit
Least Restrictive Environment
- OT will look at fit between the child, occupation (education) and environment
- Questions to ask include:
- What activities within the school day routines can the student perform independently and which activities require assistance?
- Are there changes to the instruction, curriculum, or environment that could help facilitate performance?
- Have least restrictive measures of providing services been tried? What level of success was experienced?
- Does existing data support providing services in the classroom or would removal of the student be a better option?
- What is the plan for moving services back to the classroom?
