Autism and PT

Question 1

Autism Spectrum Disorder Diagnosis

Answer 1

Detailed in the DSM-V

1.) impairment in social communication/interaction
*Deficits in social-emotional reciprocity
*Deficits in nonverbal communication
*Difficulty with relationships

2.) restricted, repetitive behaviors
*Stereotyped behaviors
*Inflexibility with routines
*Restricted interests
*Sensory hyper- or hyporeactivity

CLASSIFICATION: LEVEL I (SUPPORT), LEVEL 2 (MOD SUPPORT), LEVEL 3 (SUBSTANTIAL SUPPORT)

Question 2

Modified checklist for Autism in Toddlers-Revised-when is this tested/what age?

Answer 2

16-30 months

recommended at well-baby check ups at 18-24 months

Question 3

Epidemiology

Answer 3

1 in 150(2000) —> 1 in 44 (2018)

4x more common in boys than girls

Avg age of diagnosis is 3-4

All social, economic, and racial groups

NOT related to parenting

Not caused by MMR vaccine

44% have average or above average IQ

*the identification rates of ASD differ between races, likely due to differences in healthcare access

Question 4

Why is there an increase in prevalence of ASD?

Answer 4

-improved/different diagnostic practices

-public awareness increased

-actual increases about 1/3 that can’t be explained by above

POTENTIAL CAUSES
-likely genetic
-viral infections, meds, or pregnancy complications
-possible air pollutions exposure
-may be higher risk with older parents and babies born before 26 weeks gestation

Question 5

Pathophysiology of ASD

Answer 5

-synapses do not undergo normal pruning during childhood and adolescence
–> Overabundance of synapses in children with Autism

-cerebral morphology differences –> in volume and geometry

brains of individuals with ASD are larger earlier, level off –> overgrowth mostly in the temporal lobe before age 2

Question 6

Co-morbid conditions

Answer 6

ADHD

DCD

OCD

Mood disorder

Anxiety disorder

psychosis

*85% have comorbidities

Question 7

Related characteristics associated with ASD

Answer 7

eating disorders and obesity

sleep problems

seizures

GI disorders –> gut flora and fauna and relation to sensory processing

macrocephaly

sensory processing and modulation

Question 8

Motor impairments ASD

Answer 8

-low muscle tone

-early difficulty with head control

-early asymmetries in use of arms

-toe walking

-clumsiness

-decrease in gross and fine motor

Question 9

Medical management ASD

Answer 9

-no specific medication for Autism

-management of related medical conditions and/or symptoms
-often genetic testing
-referrals to rehab team members

PROGNOSIS
-children DO NOT outgrow autism
-depends on the level of support needed and access to supports
-ppl with LEVEL I support may be employed and participate in typical activities

Question 10

ADOS- Autism diagnostic observation schedule - completed by psychologists

Answer 10

Semi-structured assessment of communication, social interaction, and play (or imaginative use of materials) for individuals suspected of having autism

4 modules–> child to adult

-GOLD STANDARD TEST along with clinical judgment and observation

Interventions used by psychologists:ABA therapy and Early start Denver Model

Question 11

Motor Development in ASD

Answer 11

Delays in gross and fine motor skills

Deficit in gestures and motor imitation

Decreased postural control and stability (high frequency of toe-walking)

Decreased motor planning and praxis

**only 31.6% of those with ASD are receiving PT

Question 12

Outcome measure tests for ASD

Answer 12

MABC-2
-The MABC-2 is designed to identify and describe impairments in motor performance of children and adolescents 3 through 16 years of age. The Performance Test and the Checklist have been standardized using a larger, more representative normative sample
-appropriate for home and school

BOT-2
-4-21 years of age
-assesses fine and gross motor proficiency, with subtests that focus on stability, mobility, strength, coordination, and object manipulation

Question 13

Are there greater motor delays in children with ASD with internalizing or externalizing behaviors?

Answer 13

internalizing

Question 14

Implications for treatment

Answer 14

-cognitive strategies for activity similar to DCD with appropriate cognition

-consider OT collab for sensory strategies

-activities to improve imitation and motor planning

-intervention for postural control, motor skills, fitness

Question 15

Key points for effective intervention

Answer 15

early intervention

family involvement

individualized programming

systematic intervention- promotion of meaningful skills and collecting data to track change over time

structured/predictable environments

functional approach to behavior - teach new skills to address a challenging behavior

Question 16

Motor learning and ASD

Answer 16

discrete trials

reinforcement

repetitive practice across different settings

visual supports: video prompting, pictures

task-specific training

external vs. internal focus of attention (BOTH GOOD)

-blocked and distributive practice (BOTH GOOD)

**delayed feedback helpful

Question 17

Exercise may help with other aspects of function

Answer 17

“Results demonstrated that exercise interventions consisting individually of jogging, horseback riding, martial arts, swimming or yoga/dance can result in improvements to numerous behavioral outcomes including stereotypic behaviors, social-emotional functioning, cognition and attention.”

EX:
-AQUATIC THERAPY: increase eye contact, vocalization

-HIPPOTHERAPY: -increased social skills

Question 18

Three-tiered intervention model

Answer 18

LEVEL 1 ON BOTTOM
-strong foundations in bottom levels reduce need for greater labor induced interventions in level III
-building positive relationships, a supportive enviro, and optimal health

LEVEL 2
-building social and communicative competencies inconsistent with problem
-motor activities incorporated into language intervention

LEVEL 3
-individualized intensive interventions
-when challenging behaviors have become obstacles to learning