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Term 5 Psych > Autism > Flashcards

Autism Flashcards

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1
Q

DSM-5 Diagnostic Criteria

Neurodevelopmental disorder characterized by

A

persistent deficits in social communication and social interaction

and restricted, repetitive patterns of behavior, interests, or activities

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2
Q

DSM-5 Diagnostic Criteria

Symptoms must be present in

A

the early developmental period

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3
Q

DSM-5 Diagnostic Criteria

Symptoms cause clinically significant impairments in

A

social, occupational or other important areas of current functioning

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4
Q

DSM-5 Diagnostic Criteria

Not better explained by

A

intellectual disability or global developmental delay

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5
Q

“Autism” comes from the Greek word

A

“autos” meaning “self”

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6
Q

Eugen Bleuler

A

1911

a Swiss psychiatrist used the term to describe some of the symptoms of schizophrenia

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7
Q

Leo Kanner

A

1943
a psychiatrist at Johns Hopkins University described 11 children, who happened to come from families of highly educated parents

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8
Q

Bruno Bettleheim

A

‘40s-’70s
A psychiatrist at U of Chicago
Promoted the idea of the “refrigerator mother”
Compared parents to Nazi guards

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9
Q

AUTISM SPECTRUM DISORDER and the DSM

A

DSM-I 1952
Childhood schizophrenia

DSM-II 1968
Childhood schizophrenia

DSM-III 1980
Infantile autism with 6 characteristics

DSM-III-R 1987
16 symptoms in 3 categories—two from A, 1 from B, 1 from C

DSM-IV 1994 and TR
Several subtypes, including PPD, NOS and Asperger’s

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10
Q

Social-emotional reciprocity

A

Abnormal social approach

Failure of normal back and forth conversation

Reduced sharing of interests, emotions or affect

Failure to initiate or respond to social interactions

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11
Q

Nonverbal communication behaviors

A

Abnormal eye contact

Abnormal body language

Deficits in understanding of or use of gestures

Total lack of facial expressions and nonverbal communication

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12
Q

Developing, maintaining and understanding relationships

A

Difficulties adjusting behavior to match social expectations

Difficulties in making friends

Deficits in imaginative play
Lack of interest in peers

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13
Q

Stereotyped or repetitive motor movements, use of objects or speech

A

Simple motor stereotypies (hand flapping, finger flipping)

Lining up toys

Flipping objects

Echolalia (immediate and delayed)

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14
Q

Insistence on sameness

A

Extreme distress at small changes

Difficulties with transitions

Rigid thinking patterns

Ritual behaviors

Insistence on specific routines (route to school, same menu daily)

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15
Q

Highly restricted, fixated interests that are abnormal in intensity or focus

A

Strong attachment to specific and unusual items

Excessively circumscribed or perseverative interest

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16
Q

Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment

A

Indifference to pain or temperature

Excessive interest in smell, taste, feel or sight of objects

Adverse response to specific sounds, textures or other sensory experiences

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17
Q

Modifying Specifiers: DSM-5

A

With or without accompanying intellectual impairment

With or without accompanying language impairment

Associated with a known medical or genetic condition or environmental factor

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18
Q

What are the known medical or genetic conditions or environmental factors?

A

Rett syndrome, Fragile X syndrome, Down syndrome, Epilepsy, fetal alcohol syndrome, very low birth weight, in utero exposure to tobacco

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19
Q

More Modifying Specifiers: DSM-5

A

Associated with another neurodevelopmental, mental, or behavioral disorder such as:

ADHD, developmental coordination disorder; disruptive behavior, impulse-control or conduct disorders; anxiety, depression, bipolar disorder; tics or Tourette’s disorder; self-injury, feeding disorder, elimination disorder or sleep disorder

20
Q

Even More Modifying Specifiers: DSM-5

A

With catatonia

Dominated by three or more of the following: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms stereotypy, agitation, grimacing, echolalia and echopraxia

21
Q

Severity Level 3

A

Requiring very substantial support

22
Q

Severity Level 2

A

Requiring substantial support

23
Q

Severity Level 1

A

Requiring support

24
Q

Prevalence

A

Data was collected from health and special education records of 8-year-old children in 11 locations in the US during 2010

1 in 68 children were identified as having ASD
1 in 42 boys; 5 X more common in boys
1 in 189 girls

25
Q

Prevalence by race

A

1 in 63 Whites
1 in 81 Blacks
1 in 81 Asians/Pacific Islanders
1 in 93 Hispanics

26
Q

Prevalence over time (aka the Autism Epidemic) in the US

A 
2000			1 in 150
2004			1 in 125
2006			1 in 110
2008			1 in 88
2010			1 in 68
Studies in Asia, Europe, North America			1 in 100
Study in South Korea
				1 in 38
27
Q

Clinical Diagnosis

A

Sometimes may be detected as early as 18 months or younger, BUT USUALLY, can be detected by 24 months by an experienced clinician

1/3 to ½ of parents recognize a problem by 12 months

80-90 % recognize a problem by 24 months

Some children appear to develop normally until 18-24 months, and then regress

28
Q

Red Flags

A 
No response to name by 12 mo.
No pointing for interest by 14 mo.
No pretend play by 18 mo.
Avoiding eye contact
Preferring to be alone
Difficulty understanding feelings
Delayed speech and language
Echolalia
Getting upset by minor changes
Obsessive interests
Flapping, rocking, spinning….
Unusual reactions to sound, smell, taste, feel or look
29
Q

Typical infants

A

Make good eye contact
Imitate words and actions
Use simple gestures
Show interest in social games, such as peek-a-boo and pat-a-cake

30
Q

Joint Attention

A

Demonstrated at 9-12 months by typical children

First, catch the child’s attention by calling the child’s name

Then, draw the child’s attention to a distant object

The child should turn his/her head, following your gaze

31
Q

In the primary care clinician’s office

A

Developmental surveillance

Developmental screening

Autism-specific screening

32
Q

Developmental surveillance

A

At every visit

Process of recognizing who is at risk for delay

33
Q

Developmental screening

A

Use of a standardized tool to aid in identifying a developmental disorder

Routinely at 9, 18 and 30 months (AAP guideline)

34
Q

Autism-specific screening

A

Routinely at 18 and 24 months

Evidence-based process supports the use of the M-CHAT, now available in a revised form: M-CHAT-R/F (Modified Checklist for Autism in Toddlers-Revised with Follow-up)

35
Q

Diagnostic Tools

A

Gold Standard

Rating Scales

36
Q

Gold Standard

A

ADI and ADOS

Direct, semi-structured observation/interaction with the child, focusing on the core symptoms of the disorder

37
Q

Rating Scales

A

CARS, GARS, SCQ

Completed by parents and teachers

Screening vs diagnosis

38
Q

Additional Developmental Assessments

A

Speech, Language and Communication

Intellectual Functioning

Adaptive Behavior

Fine Motor

Sensory Sensitivity

39
Q

Medical Assessment

A

Formal audiologic evaluation

Lead screening (pica)

Wood’s lamp examination (tuberous sclerosis)

Dysmorphology evaluation

Genetic testing

Metabolic testing

EEG/MRI

40
Q

Treatment

A

Educational Intervention

Behavioral Therapies

Medications

41
Q

Educational Intervention

A

ASD is a qualifying condition under the Individuals with Disabilities Education Act (IDEA)

Public Law 99-457 (IDEA, 2007) covers early intervention programs from birth through two.

Section 504 of the Rehabilitation Act of 1973 (Rehabilitation Act, 2007) prohibits discrimination against students with disabilities in their education, vocational education, post-secondary education, employment, etc.

Physician role—advocate and support

42
Q

What is the IDEA?

A

A federal law that guarantees a “free and appropriate public education” to all children with disabilities from 3-21 years old.

43
Q

Behavioral Therapies

A

Applied Behavior Analysis (ABA)

The Early Start Denver Model (ESDM)

Pivotal Response Therapy (PRT)

Verbal Behavior Therapy

Floortime

Relationship Development Intervention (RDI)

Training and Education of Autistic and Related Communication Handicapped Children (TEACCH)

Social Communication/

Emotional Regulation/ Transactional Support (SCERTS)

44
Q

Medication

A

Target symptom oriented

No agents address core features

Associated conditions

45
Q

What are the associated conditions?

A

ADHD
Disruptive behavior
Anxiety

46
Q

Risk Factors

Genetic

A

36-95 % of identical twins are concordant for an ASD

Up to 31 % of fraternal twins are concordant for an ASD

Risk to subsequent child is 2-18 %

If two siblings have ASD, subsequent risk is 35-50 %

10 % of people with ASD have specific genetic or chromosomal conditions, such as Fragile X, tuberous sclerosis

Calculated heritability of ASD = 90 %

47
Q

Risk Factors

A

Older parents

Either mother and father
Premature or VLBW babies are at a slightly increased risk

Term 5 Psych (20 decks)

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