Autism Final Flashcards
DSM-5 Social Dysfunction is defined as
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
In Higher Functioning Individuals with ASD: Failure to:
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).
Studying Social Behavior ASD:
Early studies often based on parent report (i.e., Retrospective studies).
“…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.
Specific Social Processes in ASD
I. Gaze II. Interest in Social Speech III. Joint Attention IV. Imitation V. Play VI. Peer Relations
Gaze Typical Development
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
Gaze ASD
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%
Interest in Social Speech (Typical Development)
Preference for human voice
Particularly the mother’s
Can respond differentially to voice:
Tone
Pitch
Interest in Social Speech ASD
Lack of preference for speech sounds over other types of sounds
Atypical preverbal vocalizations
Restricted range of communicative behaviors
Particularly in regulation
Joint Attention (Typical Development)
Two or more individuals share a common focus on ONE entity Three components: Indicating Diexis Naming
Joint Attention ASD
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
Joint Attention and Vocab
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
Different forms of JA
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.”
Joint Attention and Fast Mapping
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.
Joint Attention and Fast Mapping ASD
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.
Imitation Typical Development
Leads to the development of critical social-communication skills Play Language Emotion sharing Social understanding
Preverbal Behaviors (Imitation)
Behaviors preceding production of words & phrases Gestures Noises Sounds Eye contact Babbling
Imitation ASD
Delays in Oral-facial imitation Actions with objects Deficits in reciprocal social play Peekaboo Patty-cake
Play TD
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
Play ASD
Lack of social engagement
Repetitive and stereotyped object manipulation
Nonfunctional use of objects
Immature capacity for play
Peer relations TD
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
Peer Relations ASD
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
Executive Function
Planning Inhibition of responses Flexibility Organized search Self-monitoring Use of working memory
Flexibility and Inhibition
Two EFs frequently linked
Shifting attention can be argued as requiring both EFs
Inhibition of previous stimuli
Flexibility in attention to new stimuli
ASD Behaviors and EF
Impulsive behavior Perseveration Deficits in planning and sequencing Disorganization Inflexibility Problems with multiple meanings Cookie Monster Writing A Letter to Santa
EF and Social Processes
Difficulty shifting attention between social vs. non-social stimuli
Performance on EF tasks correlated with joint attention in preschool age children with autism
Intervention and EF
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
Intervention and EF Problem
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
Stroop Task
list of colors not written in the color they are
Theory of Mind
Impaired understanding of the mental states & beliefs of others
Inferring beliefs, rather than emotions, about something
False Belief tasks
ASD behaviors and ToM
Difficulty with perspective taking Problems with empathy Breakdowns in conversation skills Comprehension deficits Difficulty with non-literal speech Cookie Monster & NPR interview
Implications for Treatment
Programs addressing perspective taking Pretend Play Dress up Puppet play Deixis Here/There This/that Mine/yours
Weak Central Coherance
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
Ambiguous figures
Cannot infer mental state verbs imply in context
Make inferences about social scripts
Basis of social communication b/c elaborate meaning
ASD behaviors WCC
Stimulus overselectivity Problems with word learning Difficulty drawing inferences Problems with category skills Difficulty reading facial expression Joint attention deficits Conversation deficits
Basic Functions of Challenging Behaviors
MEATS M – Medical E – Escape A – Attention T – Tangible S – Sensory
Common Behavioral Difficulties: Tolerating…
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
Social Behavior
They don’t understand the rules of: Social proximity Eye contact Gestures Posture Facial expressions Authoritative hierarchy
Social Communications %s
55% gestures, posture, stance
38% tone of voice
7 % words
Discrete Trial Instruction: ABA
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.
ABA
Discrete Trial Instruction
Incidental Teaching
Applied Verbal Behavior
Gross Motor Imitation
Sd: “Do this”
R: Child imitates action
Sr: Child receives reinforcer
Non-verbal Requesting
Sd: “What do you want”
R: child points
Sr: Child gets desired
item
ABA methods support individuals with ASD by:
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
Incidental Teaching
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
Incidental Teaching Example
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.
Using Incidental Teaching another example
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.
Challenges of Incidental Teaching in individuals with Autism
Low rates of initiations
Limited interests
Procedural Components of Incidental Teaching
Four Steps: Engineering the Environment Initiation Elaboration Result
Engineering the Environment IT
Set up situations that serve as communicative temptations
stand in student’s way:
student may initiate, or
can be prompted to say, “Excuse me”
The Initiation IT
Student “initiates” the teaching process by indicating an interest in an item or topic/action:
Gesturally
Verbally
Via some other response modality
Elaboration IT
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.
The Result (Reinforcement) IT
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
Other incidental teaching strategies
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
Benefits of using IT
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
FCT
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
Successful use of FCT involves 3 steps
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.
Step 1 FCT Step 1: Identifying the communicative and behavioral function
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
FCT Step 2: Selecting an appropriate alternative means of communicating
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”
FCT Implementing systematic instruction of the desired communicative behavior under relevant conditions
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.
FCT Scenario 2
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.
AVB
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
AVB Form
Structure (topography) of language or specific responses such as words, signs, or symbols
The HOW
AVB Function
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
Mand has occurred if:
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).
Manding Example
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.
Echoics
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.
Tacts
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.
Intraverbals
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.
Textual Responding
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
Autoclitics
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).
5 universal stages of grief
Denial & isolation Anger Bargaining Depression Acceptance
Common Challenges in Parenting a Child with ASD
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
Three General Principles when working with “Parents as partners”
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
Relationship building with parents
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.
Opening Interview food for thought
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
Questions to ask parents
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?
Incidence
The number of new cases diagnosed within a population, within a specific time frame
Prevalence
Total number of individuals with a given disorder.
Kanner’s Syndrome
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
According to DSM IV
diagnosed within for years of life by:
Impairments in social interaction
Impairments in communication
Presence of stereotyped behaviors, interests and activities
Diagnosis criteria
Child must show at least two of the following impairments in social interaction:
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
Child must show at least one of the following impairments in communication:
Diagnosis
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
Child must show at least one of the following restricted, repetitive and stereotyped patterns of behavior, interests and activities:
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
The following characteristics are seen in some individuals with autism, but not all:
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
How is PDD-NOS diagnosed?
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,
How is AS diagnosed
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
5 Major changes of DSM
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)
DSM-5 Change #2
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
DSM-5 Change #2 Deficits in social emotional reciprocity
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
DSM5 Change #2 Deficits in Non-Verbal Communication Used for Social Interactions
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
DSM5 change #2 Deficits in developing & maintaining relationships; appropriate to developmental level
Lack of perspective taking Difficulty adjusting behavior to social contexts Difficulty sharing imaginative play Difficulty in making friends Absence of interest in others
Level 3: “Requiring Very Substantial Support”
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.
Level 2: “Requiring Substantial Support
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.
Level 1: “Requiring Support
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.
DSM 5 change number 5
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
nonverbal
Up to 20% of individuals with autism may be nonverbal.
Up to 50% may not develop functional speech.
Often accompanied by Intellectual Disabilities.
Artic
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/
What is “Prototypicality
Categories are organized by Prototypes
The central member of this category being the most representative exemplar
house
word use in autism
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”)
syntax and morphology
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
Echolalia
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
Diectic Terms
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
Language Comprehension
Tightly linked Continuation of delays in comprehension Play skills correlated with: Receptive language level Social cognition
suprasegmentals production pattern may be:
Monotone
Singsong
Hyponasal
