Autism Flashcards
Current concept of autism
1.Behavioral disorder/syndrome (currently viewed as such)
Currently seen as behavioural disorder/syndrome
2. Multiple etiologies: genetic and environmental
3. Lifelong disorder
a ) Different appearance (e.g., peer interactions change throughout life)
Most parents know by the age of 2 that there is something wrong with children with autism
Babies with autism go stiff when picked up, whereas other babies usually mould to the body when picked up
This is the earliest symptom
The earlier the intervention, the better the outcomes
b) Importance of early diagnosis
earlier you intervene, the better the outcomes
c) Need for sustained support
Average person with Asperger’s usually has a high IQ and is high-functioning (has family and job)
People with autism have much more difficulty with everyday functioning (e.g. toilet training)
4. Selective or greater impairment in social interaction
What changes were made from the DSM-4 to the DSM-5
Deleted the term pervasive developmental disorder
Deleted Retts disorder (although you can add the specifier of genetic/biological influences)
Deleted aspergers disorder
Deletion of childhood disintegrative disorder
Retts Disorder
Not in the DSM5 Normal development up until 6-18 months Deceleration of head growth loss of hand skills Loss of social engagement Poorly coordinated
Child disintegrative disorder
The essential feature of CDD is a marked regression in multiple areas of functioning following a period of at least 2 years of apparently normal development
B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
(1) expressive or receptive language
(2) social skills or adaptive behaviour
(3) bowel or bladder control
(4) play
(5) motor skills
C. Abnormalities of functioning in at least two of the following areas:
qualitative impairment in social interaction
qualitative impairments in communication
restricted, repetitive, and stereotyped patterns of behaviour
This latter point is the major reason it was put in the category of Pervasive Developmental Disorders
More common in males
Autism spectrum disorder diagnostic criteria
Currently, or by history, must meet criteria A, B, C, and D
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays (rule out intellectual disability), and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communicative behaviors used for social interaction
Big problem – do they understand all the nonverbal components of communication
3. Deficits in developing and maintaining relationships
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects
E.g. collecting strange items that wouldn’t normally be of interest, e.g. sticks or pebbles
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change
3. Highly restricted, fixated interests that are abnormal in intensity or focus
E.g. Adam did an assessment on a child with Asperger’s, they asked Adam what kind of vacuum cleaner he owned
He loved vacuum cleaners, had an IQ of 60
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment;
Loud sounds/bright lights cause physical pain
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities
D. Symptoms together limit and impair everyday functioning.
Adam: human beings are amazingly unaware of their own behaviours
ASD associated features
Cognitive profile usually uneven
Receptive language is below that o expressive language (can tell you what they want but not hear what you’e saying)
Behavioural symptom: hyperactivity, short attention span, impulsivity, aggression, self-injury, tempter tantrums
Odd responses to sensory stimuli (high threshold for pain, oversensitiviy to sound of touch
Abnormalities in eating and sleeping
Abnormalities of mood or affect
Lack of fear in response to real dangers, and excessive fear in response to harmless objects
Self-injury; head banging
ASD prevalence
2-20 per 1000 (1960’s) and 1 in 150 today (prevalance is increasing)
5 fold increase in diagnosis in the past 10 years
ASD aetiology
Responsible for 60-91% concordance Often a parent will have asd 4x more likely in males than females Biological: Deficits in theory of mind
ASD outcomes
16% make good adjustment and live independently (usually with a higher IQ and speech before age of 6 years)
16% working but need support
23% not working and living in sheltered setting
45% poor outcome- complete supported environment with minimal/if any assisted work i.e. group home
ASD treatment
Early interention
Should ahve an Individual plan (IP) for education, designed to fit needs and strengths (often work to improve the strengths rather than the weaknesses)
Program needs to be at least 20 hours per week, over 2 years (if in a group, no more than 4 people)
Died (avoid dairy, chocholate, whole grains and wheat- no empirical support)
Autism specific content
Teach joint attention skills
Play
Imitation skills
Augmentative communication i.e. picture systems, gestures and signs
Social interactions
Daily living skills (toileting, eating ect)
manage sensory issues (low sound, quite place)
Generalisation of learning strategies (teach them to learn)
Applied Behaviour Analysis (ABA)
Focus on Communication and socialisation
Shaping and discrimination training (reward based)
Sign language, augmented communication
brief periods of one-on-one instruction, during which a teacher cues a behaviour, prompts the appropriate response, and provides reinforcement to the child
Shaping and discrimination training (rewards based)
ASD Drugs
Haloperidol: reduces behavioural abnormalities but high rate of adverse side-effects
Secretin: gastrointestinal peptide hormone that influences pancreatic juices
Epilum: anticonvulsant- improves mood and subsequent behaviour
Serotonin: Too much – Fenfluramine reduce levels (modest gains in behaviour, social adjustment and attention. Too little – Venlafaxine to inhibit reuptake (improve across range of behaviour). Use is controversial, movement to ban use in children.
Aspergers disorder DSM
Good cognitive/language skills
Motor problems
Circumscribed interests
+ Family Hx (esp. fathers)
Verbal IQ scores are higher than performance IQ scores
I) Qualitative impairment in social interaction, as manifested by at least two of the following:
(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)
(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.
(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.”
How is aspergers different to autism?
Like very high functioning autism but…
There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behaviour (other than in social interaction), and curiosity about the environment in childhood.
Average or above average IQ
Later onset than autism (or at least recognised later)
Becomes more apparent in school context
Adults typically have problems with empathy and modulation of social interaction
Duration - lifelong
