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Autism > Autism Final > Flashcards

Autism Final Flashcards

1
Q

DSM-5 Social Dysfunction is defined as

A

Deficits in social-emotional reciprocity
Deficits in nonverbal communication used for social interaction
Deficits in developing and maintaining relationships
-understanding emotions of others, nv comm, gestures, intrapersonal space, develop/maintain relationships

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2
Q

In Higher Functioning Individuals with ASD: Failure to:

A

Establish joint frame of reference (e.g., in conversation).
Take in social norms or listener’s feelings into account (e.g., “you have a mole on your face).
Maintain broad interests (e.g., “do you know about prime numbers?”).
Use nonverbal cues (e.g., reading/demonstrating body language).

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3
Q

Studying Social Behavior ASD:

Early studies often based on parent report (i.e., Retrospective studies).

A

“…Often concern the child’s development in the first year of life” (Rogers, 2004).
Development may be normal, then shifts between 18 months – 3 years of age.

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4
Q

Specific Social Processes in ASD

A 
I. Gaze
II. Interest in Social Speech
III. Joint Attention
IV. Imitation
V. Play
VI. Peer Relations
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5
Q

Gaze Typical Development

A

First month of life:
Preferential attention to human faces
Orienting toward parents
Two months:
Preferentially scan eye region of the face
Four months:
Discriminate the direction of an interactive partner’s gaze

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6
Q

Gaze ASD

A

Fail to establish pattern of mutual gaze.
Inattention to/disinterest in human face.
Do not disengage when in presence of competing stimuli.
“Less likely to use gaze to augment other sources of information about ambiguous interactions.”
90%

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7
Q

Interest in Social Speech (Typical Development)

A

Preference for human voice
Particularly the mother’s

Can respond differentially to voice:
Tone
Pitch

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8
Q

Interest in Social Speech ASD

A

Lack of preference for speech sounds over other types of sounds
Atypical preverbal vocalizations
Restricted range of communicative behaviors
Particularly in regulation

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9
Q

Joint Attention (Typical Development)

A 
Two or more individuals share a common focus on ONE entity
Three components:
Indicating
Diexis
Naming
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10
Q

Joint Attention ASD

A

Don’t orient to certain speech sounds(e.g., mother’s voice)
Deficits in referential looking
Deficits in declarative pointing & showing
Deficits in looking where others point
IJA is more profoundly impacted than RJA
IJA demands both attention AND social cognition
Improvements of IJA are indicators of overall social improvements

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11
Q

Joint Attention and Vocab

A

Strongly linked to communication

Joint attention is an integral part of vocabulary development

As language learners, we look at what we say
And we look at what others look at

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12
Q

Different forms of JA

A

Initiating Joint Attention (IJA)
“Infants’ use of gestures and eye contact to direct others’ attention to objects, to events, and to themselves.”
Function: to show or spontaneously seek to share interests with others.

Responding to Joint Attention (RJA)
“Responses to the bids of others or spontaneous initiations.”

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13
Q

Joint Attention and Fast Mapping

A

Children w TLD learn meaning of new words incidentally and experientially
automatically fast map new labels for referents
Newly acquired words are further categorized and associated w other words
Predominantly occurs through joint attention experiences.

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14
Q

Joint Attention and Fast Mapping ASD

A

Children w ASD may fast map words with incorrect referents
If a child w ASD is not engaging in joint attention bids, mapping of referents will inevitably be incorrect.
Superimposed w rigidity characteristic of ASD, these atypical referent-label relationships may be maintained over a lifespan, negatively impacting lexical organization.

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15
Q

Imitation Typical Development

A 
Leads to the development of critical social-communication skills
Play
Language
Emotion sharing
Social understanding
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16
Q

Preverbal Behaviors (Imitation)

A 
Behaviors preceding production of words & phrases
Gestures
Noises
Sounds
Eye contact
Babbling
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17
Q

Imitation ASD

A 
Delays in
Oral-facial imitation
Actions with objects
Deficits in reciprocal social play 
Peekaboo
Patty-cake
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18
Q

Play TD

A 
At first (prior to first year):
Manipulation of objects
Mouthing
Visually regard
Later (around first year)
Combining objects in play
Toward end of second year
Symbolic play
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19
Q

Play ASD

A

Lack of social engagement
Repetitive and stereotyped object manipulation
Nonfunctional use of objects
Immature capacity for play

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20
Q

Peer relations TD

A 
Early (Prior to age two), peer relations require: 
managing joint attention
regulating emotions
inhibiting impulses
imitating another child’s actions
understanding cause-effect
developing language skills
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21
Q

Peer Relations ASD

A

Limited interest in social interaction
Reduced initiation of social contact
Prefer to be left alone
Failure to engage in social interchange with peers
Cooperative play is usually absent
Over time, become more passive or odd in interaction style.
Respond less other to approaches of others
More likely to approach adults than children
Difficulty taking another person’s point of view into account
Difficulty defining components of friendship and loneliness
Difficulty with social conventions

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22
Q

Executive Function

A 
Planning
Inhibition of responses
Flexibility
Organized search
Self-monitoring
Use of working memory
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23
Q

Flexibility and Inhibition

A

Two EFs frequently linked
Shifting attention can be argued as requiring both EFs
Inhibition of previous stimuli
Flexibility in attention to new stimuli

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24
Q

ASD Behaviors and EF

A 
Impulsive behavior
Perseveration
Deficits in planning and sequencing
Disorganization
Inflexibility
Problems with multiple meanings
Cookie Monster Writing A Letter to Santa
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25
Q

EF and Social Processes

A

Difficulty shifting attention between social vs. non-social stimuli
Performance on EF tasks correlated with joint attention in preschool age children with autism

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26
Q

Intervention and EF

A 
No real research examining EF intervention with ASD
Main focus has been with TBI and stroke
Cognitive remediation 
Focus on specific cognitive components
Memory
Attention
Motivation
Language
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27
Q

Intervention and EF Problem

A

Most cognitive EF training programs are based on the assumption that skills were there and then damaged

In ASD, these skills may have never developed

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28
Q

Stroop Task

A

list of colors not written in the color they are

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29
Q

Theory of Mind

A

Impaired understanding of the mental states & beliefs of others
Inferring beliefs, rather than emotions, about something

False Belief tasks

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30
Q

ASD behaviors and ToM

A 
Difficulty with perspective taking
Problems with empathy
Breakdowns in conversation skills
Comprehension deficits
Difficulty with non-literal speech
Cookie Monster & NPR interview
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31
Q

Implications for Treatment

A 
Programs addressing perspective taking
Pretend Play
Dress up
Puppet play
Deixis
Here/There
This/that
Mine/yours
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32
Q

Weak Central Coherance

A

Processing incoming information,to formulate the main idea or “gist”

Global processing is possible for this population, though not preferred in open ended scenarios

Sometimes considered a “cognitive style” rather than a true deficit

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33
Q

Ambiguous figures

A

Cannot infer mental state verbs imply in context
Make inferences about social scripts
Basis of social communication b/c elaborate meaning

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34
Q

ASD behaviors WCC

A 
Stimulus overselectivity
Problems with word learning
Difficulty drawing inferences
Problems with category skills
Difficulty reading facial expression
Joint attention deficits
Conversation deficits
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35
Q

Basic Functions of Challenging Behaviors

A 
MEATS
M – Medical
E – Escape
A – Attention
T – Tangible
S – Sensory
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36
Q

Common Behavioral Difficulties: Tolerating…

A

Tolerating Transitions
From one task to another
From one location to another
Changes in schedule/routine

Tolerating Mistakes
Accidentally ripping paper
Perceived mistakes in writing or drawings

Confusion

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37
Q

Social Behavior

A 
They don’t understand the rules of: 
Social proximity
Eye contact
Gestures
Posture
Facial expressions
Authoritative hierarchy
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38
Q

Social Communications %s

A

55% gestures, posture, stance
38% tone of voice
7 % words

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39
Q

Discrete Trial Instruction: ABA

A

A structured opportunity for a learner to practice a new skill
Provides learner with repeated opportunities to practice
Components:
Discriminative stimulus
(Prompt)
Response
Consequence
(Inter-trial interval)
effective teaching procedure in teaching a variety of skills to individuals with autism.

NOTE: this teaching procedure needs to be used in combination with other interventions such as incidental teaching.

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40
Q

ABA

A

Discrete Trial Instruction
Incidental Teaching
Applied Verbal Behavior

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41
Q

Gross Motor Imitation

A

Sd: “Do this”

R: Child imitates action

Sr: Child receives reinforcer

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42
Q

Non-verbal Requesting

A

Sd: “What do you want”

R: child points

Sr: Child gets desired
item

43
Q

ABA methods support individuals with ASD by:

A

Increasing desired behaviors
Readiness skills, Sitting, Listening, Responding
Teaching new skills:adaptive skills, communication skills, play/social skills
To maintain behaviors : self control, self monitoring procedures, generalization
To reduce interfering behaviors : Self injury, Stereotypy, Perseverations

44
Q

Incidental Teaching

A

Interaction between an adult and child that occurs in a natural situation

Used to give the child an opportunity to practice a skill.
Begins when the child initiates for interaction with the adult
Used to increase communication
Waiting for the individual to initiate conversation about a topic
responding in ways that encourage more language

45
Q

Incidental Teaching Example

A

Child requests “want car.”
Clinician might then ask the child whether he wants the blue car or the red one.
Child would then receive the car if she/he demonstrated more elaborate language by asking for the red one.

46
Q

Using Incidental Teaching another example

A

A three year-old girl climbs on a shelf and attempts to reach for the cookie jar while saying, “cookie”. Her father places his hand over the cookie jar and tells his daughter, “Say, I want cookie.” The child repeats this statement and the father immediately gives her a cookie.

47
Q

Challenges of Incidental Teaching in individuals with Autism

A

Low rates of initiations

Limited interests

48
Q

Procedural Components of Incidental Teaching

A 
Four Steps:
Engineering the Environment
Initiation
Elaboration	
Result
49
Q

Engineering the Environment IT

A

Set up situations that serve as communicative temptations
stand in student’s way:
student may initiate, or
can be prompted to say, “Excuse me”

50
Q

The Initiation IT

A

Student “initiates” the teaching process by indicating an interest in an item or topic/action:
Gesturally
Verbally
Via some other response modality

51
Q

Elaboration IT

A

Clinician will prompt an elaboration related to the student’s topic of interest.

Clinician will provide eye contact and contingent smiling or some other facial gesture conveying interest and expectation.

In other cases an actual prompt is needed.

52
Q

The Result (Reinforcement) IT

A

Student’s access of item/topic of interest

Reinforcer may be:
access to a desired item
access to an action or activity
access to information
access to social attention
53
Q

Other incidental teaching strategies

A

Make a loud noise
Ask about the location of a missing person or item
Solicit compliments; e.g., “I painted this picture” or “This is a new shirt”
Solicit inquiries; e.g., “I have something cool in my pocket”
Have multiple people take turns making comments about a meal or activity

54
Q

Benefits of using IT

A

Exposure to naturally occurring and contrived opportunities to use language
Exposure to naturally occurring consequences
Maintenance of skills over time
Generalization
Specifically target communication and social initiations
Can be applied within a broad range of activities
car trips, getting dressed, bath time, meals

55
Q

FCT

A

Functional Communication Training (FCT) is a proactive approach to reduce problem behaviors
Involves two components:
identifying the reason for a behavior
teaching an appropriate communication skill to serve the same purpose as the behavior itself

56
Q

Successful use of FCT involves 3 steps

A

Identifying the communicative function of a given behavior
Selecting an appropriate alternative means of communicating
Implementing systematic instruction of the desired communicative behavior under relevant conditions.

57
Q

Step 1 FCT Step 1: Identifying the communicative and behavioral function

A

Originally thought to be delayed echolalia + OCD

After a thorough FBA, determined to be function of attention.

ANDY REALLY JUST WANTED TO TALK ABOUT SWIMMING

58
Q

FCT Step 2: Selecting an appropriate alternative means of communicating

A 
Modeled Verbal phrases (3-5 words in length)
Examples: 	
“I like swimming”
“swimming is fun”
Reciprocated phrases with Andy
Examples (spoken by staff member): 
“I like swimming too!”
“I swim at the beach”
59
Q

FCT Implementing systematic instruction of the desired communicative behavior under relevant conditions

A

SLP in-serviced dayhab staff on modeling short phrases when “babbling” behavior was observed
Psychologist wrote this intervention into Andy’s behavior plan as a reactive strategy.
Team meeting occurred with all staff to discuss function of behavior and intervention strategies.

60
Q

FCT Scenario 2

A 
Escape from demands 
after a verbal demand is presented, frustration during a task, during an activity such household chores
Uses scripts at home and in Day hab
Examples:
I need space
I need help
I don’t understand
It’s too hard
I need a break
I don’t want to do that.
Materials were developed and placed in Mark’s daily agenda
Reviewed script with Mark across environments.
61
Q

AVB

A

A complex theory of communicative behavior based on the basic science of behavior and Skinner’s considerable knowledge of English literature.
Skinner’s use of the term “verbal” refers to both vocal and non-vocal functions of communication

62
Q

AVB Form

A

Structure (topography) of language or specific responses such as words, signs, or symbols

The HOW

63
Q

AVB Function

A

The effects of the behavior.
A child may emit the vocal/sign/symbol “milk.”
We need to know the function of this form for the child.
It is the function that determined Skinner’s (1957) elementary verbal operants.
The WHY

64
Q

Mand has occurred if:

A

a result of certain deprivation or aversive conditions,

2) is preceded by a non-vocal antecedent, and
3) specifies a particular reinforcer (operant function is that of a pure mand).

65
Q

Manding Example

A

A child says, “juice, “ (form) when he or she is thirsty (deprivation) and the delivery of juice is the reinforcer for that instance of verbal behavior (function), a mand has occurred.

The child may mand “juice” in the presence or absence of a container of juice for consumption.
Typically, clinicians teach first instances in the presence of the object, and then fade the presence of the object.

66
Q

Echoics

A

vocal verbal behavior that has point-to-point correspondence with a vocal verbal model.

Example:
If a parent says, “cookie,” and a child echoes the parent by saying, “cookie,” echoic behavior occurred.

67
Q

Tacts

A

Verbal operants involving a nonverbal antecedent, the tacted stimulus that is present, and a generalized reinforcer, such as praise or affirmation from an adult.
Example:
If a child says “juice” in the presence of juice and the reinforcer consists of a parent responding, “Yes, that is juice,” the utterance functions as a tact operant.

68
Q

Intraverbals

A

In an instance when someone says, “How are you?” and an individual responds, “Fine.”

The parts of the initial spoken behavior do not correspond topographically with the spoken response.

In still another case recitation of a poem or the alphabet can be incidences of intraverbal behavior.

69
Q

Textual Responding

A

A visual or tactile verbal stimulus [print, or Braille] that controls auditory patterns of verbal behavior [such that] a vocal response is under the control of a non-auditory verbal stimulus
reading a menu
reading text from print
interpreting Braille

70
Q

Autoclitics

A

consist of verbal behavior that modifies, qualifies, affirms, identifies possession, negates, or specifies functions for the primary verbal operants.

Example:
a child may mand the big cookie or bigger cookie, or tact the blue bird
(identifying the blue one as opposed those that are not blue).

71
Q

5 universal stages of grief

A 
Denial & isolation
Anger
Bargaining
Depression
Acceptance
72
Q

Common Challenges in Parenting a Child with ASD

A 
Dx Confusion
Uneven/Unusual Course of development
“Can’t” versus “Won’t”
Atypical Social Communication
Typical Physical Appearance
Behavior in Public
Broader Phenotype
Professional Relationships
Fads in Tx
Empirically Supported Tx
73
Q

Three General Principles when working with “Parents as partners”

A

Investment in genuine collaboration
Building parent-professional rapport

Explain/observer parent-child relationship
Describe patterns of behavior

Individualize intervention
Meet the needs of the family

74
Q

Relationship building with parents

A

Determine role of the family members
Assess whether the family shares same values and assumptions as clinician
culturally educationally & otherwise
Collaborate with family to create a plan that merges clinical determinations with family values.

75
Q

Opening Interview food for thought

A

Purposes:
To learn more about client’s communication
To answer questions and provide reassurance/support to family & client
Open ended questions are preferable
Opportunity for respondent to express concerns

76
Q

Questions to ask parents

A

In your own words, tell me what you think your child’s difficulties are?
OR, “Tell me why you are here today?”
What does your child enjoy; What will she work for?

77
Q

Incidence

A

The number of new cases diagnosed within a population, within a specific time frame

78
Q

Prevalence

A

Total number of individuals with a given disorder.

79
Q

Kanner’s Syndrome

A 
Characteristics of the children that Kanner described included:
Delay in speech acquisition
Immediate and delayed echolalia
Pronoun reversal
Repetitive/stereotyped play activities
Compulsive demand for sameness
Lack of imagination
Normal physical appearance
Abnormalities in infancy
80
Q

According to DSM IV

A

diagnosed within for years of life by:
Impairments in social interaction
Impairments in communication
Presence of stereotyped behaviors, interests and activities

81
Q

Diagnosis criteria

Child must show at least two of the following impairments in social interaction:

A

Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

b) Failure to develop peer relationships appropriate to developmental level

A lack of spontaneous seeking to share enjoyment, interests or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

d) Lack of social or emotional reciprocity

82
Q

Child must show at least one of the following impairments in communication:
Diagnosis

A

Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternate modes of communication such as gesture or mime)

b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
Stereotyped and repetitive use of language or idiosyncratic language

d) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

83
Q

Child must show at least one of the following restricted, repetitive and stereotyped patterns of behavior, interests and activities:

A

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, non-functional routines or rituals
Stereotyped and repetitive motor mannerisms (e.g., hand flapping or twisting, or complex whole body movements)

d) Persistent preoccupation with parts of objects

84
Q

The following characteristics are seen in some individuals with autism, but not all:

A

Cognitive skills falling in the range of intellectual disability
Particular strengths in learning style (e.g., better than average visual-spatial skills)
Exceptional cognitive abilities in one particular area (e.g., mathematics, computers)
Abnormal sensory reactions
Abnormalities in eating, drinking, toilet training and sleeping
Self injurious behavior
Aggressive behavior
Tantrum behavior
Seizure disorders

85
Q

How is PDD-NOS diagnosed?

A

Often this diagnosis (Dx) is given as a lesser Dx to autism
May be given for young children and later changed to autism
A Dx of intensity
Severe and pervasive impairment in the development of reciprocal social interaction
Associated with impairment in either verbal and nonverbal communication skills
Or with the presence of stereotyped behavior, interests, and activities,

86
Q

How is AS diagnosed

A

Controversy about this diagnostic category
May be considered HFA (High Functioning Autism) rather than a separate category.
No general delay in language
e.g., single words used by age 2 years, communicative phrases used by age 3 years.
No delay in cognitive development or in the development of age-appropriate self-help skills, or adaptive behavior

87
Q

5 Major changes of DSM

A

Elimination of subcategories (now all ASD)
Three domains (social, communication, behavioral) collapsed into two (social communication & restricted/repetitive interests)
Symptoms can either be present or in past history
Additional evaluation of known genetic cause (e.g., fragile X, Rett’s), level of language & ID, and presence of medical conditions.
New disorder (Social Communication Disorder)

88
Q

DSM-5 Change #2

A

Persistent deficits in social communication and social interaction across contexts; not accounted for by general developmental delays; and manifest by 3 of 3 symptoms.
Deficits in social emotional reciprocity
Deficits in Non-verbal communication used for social interactions
Deficits in developing & maintaining relationships; appropriate to developmental level
Stereotyped or repetitive speech, motor movements or use of objects
Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change
Highly restricted, fixated interests that are abnormal in intensity or focus
Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

89
Q

DSM-5 Change #2 Deficits in social emotional reciprocity

A

Abnormal social approach
Failure of normal back & forth conversation
Reduced sharing of interest
Reduced sharing of affect
Lack of initiation for social interaction
Poor social imitation

90
Q

DSM5 Change #2 Deficits in Non-Verbal Communication Used for Social Interactions

A

Impairments in social use of eye contact
Impairment in use and understanding of body postures
Impairment in use and understanding of gestures
Abnormal volume, pitch, prosody or volume
Lack of coordinated nonverbal and verbal communication

91
Q

DSM5 change #2 Deficits in developing & maintaining relationships; appropriate to developmental level

A 
Lack of perspective taking
Difficulty adjusting behavior to social contexts 
Difficulty sharing imaginative play
Difficulty in making friends
Absence of interest in others
92
Q

Level 3: “Requiring Very Substantial Support”

A

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.
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.

93
Q

Level 2: “Requiring Substantial Support

A

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.
Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.

94
Q

Level 1: “Requiring Support

A

Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. My appear to have decreased interest in social interactions.
-Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

95
Q

DSM 5 change number 5

A

Deficits in using communication for social purposes, such as greeting & sharing information in a manner that is appropriate for the social context
Impaired ability to change communication to match context or needs of the listener

96
Q

nonverbal

A

Up to 20% of individuals with autism may be nonverbal.
Up to 50% may not develop functional speech.
Often accompanied by Intellectual Disabilities.

97
Q

Artic

A

Articulation has been reported to be normal (Kjelgaard & Tager-Flusberg, 2001; Dunn, Gomes, & Sebastian, 1996; Pierce & Bertolucci, 1977)
However, it’s development has been found to be somewhat slower (Bartak, Rutter, & Cox, 1975)
1/3 of individuals with (high functioning) autism have residual distortion errors into adulthood (Shriberg et al., 2001)
/r/, /l/, /s/

98
Q

What is “Prototypicality

A

Categories are organized by Prototypes
The central member of this category being the most representative exemplar
house

99
Q

word use in autism

A

Semantic groupings similar to TLDs to categorize & retrieve words (Dunn & Bates, 2005)
Fail to use semantic knowledge in order to retrieval or organize information (Tager Flusberg, 1991)
Hardly use mental state terms (e.g., know, think, remember, pretend) (Frith, 1998)
Use of metaphorical language (e.g.., “cuts & bluesers”)

100
Q

syntax and morphology

A

Generally follows similar developmental trajectory (Tager-Flusberg et al., 1990)
Eventually reaches a plateau in some individuals with ASD (Paul & Cohen, 1984)
Narrower range of constructions (Scarborough et al., 1991)
Ask fewer questions

101
Q

Echolalia

A 
Delayed vs. Immediate
Originally thought to be nonfunctional 
		(Lovaas, 1987)
Now thought to have several functions 
		(Prizant & Rubin, 1999)
Turn taking, Requesting, Rehearsal to aid in processing, Commenting in a given context

Most prevalent early on & declines over course of development

102
Q

Diectic Terms

A

Codes shifting reference between speaker and listener
Pronoun reversals
Those most linguistically advanced eventually stop making these errors
Originally attributed to echolalia
Also attributed to difficulty with marking reference

103
Q

Language Comprehension

A 
Tightly linked
Continuation of delays in comprehension 
Play skills correlated with:
Receptive language level 
Social cognition
104
Q

suprasegmentals production pattern may be:

A

Monotone
Singsong
Hyponasal

Autism (1 decks)

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