Autism Lecture Flashcards
CDC stats on autism conservatively
1 in 44 children
4 times more common in boys than girls
Average age of diagnosis is between 4 and 5 years of age.
For children who are culturally and linguistically diverse diagnosis often comes later and after many more visits to professionals
Likely the same amount of boys and girls with autism but what is the difference that makes the stats different
Girls are being assessed differently. When boys don’t make eye contact, we see it as a red flag, if a girl does that then they are labeled shy. We see the genders differently.
What are the main indicators of autism diagnosis
not responding with adults, not making eye contact, not understanding social cues
DSM looks for what in ASD diagnosis
Persistent deficits in social communication and social interaction across multiple contexts
Restricted, repetitive patterns of behavior, interests or activities
The symptoms are present in the early developmental period and
Cause clinically significant impairment in social, occupational and other important areas of functioning
These disturbances are not better explained by intellectual disability or global developmental delay
ASD is what kind of diagnosis
diagnosis of exclusion
3 levels of severity with the diagnosis
mild, moderate or severe.
What are some symptoms of ASD but not necessarily in the DSM
Hyporesponsiveness, hyperresponsiveness, enhanced perception, hyporeactive, hyperreactivity, unusual interests in sensory aspects of the environment,
Why is early identification important?
What is the impact of early identification on the family?
To get proper support. Helps to initiate services that can start early. The more support we get the better the outcomes long term.
Initiation of services can begin early
Refer children with “red flag” behavior early
What is the impact of early identification on the family?
Late diagnosis associated with increased parental stress
Interventions before age 4 associated with improved skills
What is the impact on the family of an Autism diagnosis
- Access to care in early years.
- Higher stress levels
- Sibling relationships
89% of parents are the core case coordinator of their child’s care. 25% of those say they spend more than 10hrs per week coordinating care.
from one study. this leads to higher stress levels, financial stress and community isolation
sibling relationships of ASD children some reported -
more empathy
lonliness, not much parental attention, confusion of rules of how to act or not act since the ASD child could get away with. agression from ASD siblings and stress of taking over caregiver role.
What can we do as OTs to help families
collaborate with family throughout the intervention process to understand the families needs. We want to understand their strengths and give them the tools to problem solve.
What are barriers to an early diagnosis?
Dismissal by healthcare providers
Misconception that a reliable diagnosis is only done after age 2 or after the age of 3. We know that is not true but some professionals won’t screen a child early.
Autism diagnostic tools
Modified Checklist for Autism in Toddlers (M-CHAT)
Ages and Stages Questionnaire, 3rd edition (ASQ-3)
Social Communication Questionnaire (SCQ)
Autism Diagnostic Interview – Revised
Autism Diagnostic Observational Schedule-2
Childhood Autism Rating Scale 2nd edition (CARS-2)
Gilliam Autism Rating Scale, 3rd edition (GARS-3)
What is the impact accross a diagnosis dx
- Occupational Performance:
- Social Participation - delayed or limited due to communication issues.
- Play - may exhibit unusual visual, limited creativity, pretend play is limited. more solitary and functional play
- Sleep - difficulty falling and or staying asleep due to sensory processing needs.
- ADLs - Sensory processing makes ADLs hard. fine motor skills can be impacted.
- Education - sensory needs impacting participation in education. challenges in fine motor skills required
Autism Evaluation
Occupational Profile and Assessment of Occupational Performance
- May require alternative strategies
- Important questions to ask Families During an Evaluation
Standardized norm referenced assessments
- Adaptations
- Scoring is considered estimate of ability
Focus on function
- Strength and needs
Administration Modifications to make ASD kids comfortable
Allow child to become acclimated to room and therapist
Provide breaks during testing
Allow parental presence
Use motivators and rewards
Limit eye contact and words used
Provide additional processing time
Change order of items regarding preferred and nonpreferred tasks when appropriate
Does it mean to use a foundational approach during evaluation?
Individuals daily life patterns
Unique manifestation of core autism characteristics
Any challenges the individual experiences
Supports and barriers
Performance demands
Therapeutic relationship building
Families can experience stress navigating service delivery
The therapeutic relationship provides “a familiar, consistent, and predictable context for services and becomes a foundation on which evaluation and further service delivery is built” (Watling, 2018, pg. 106).
Humility and confidence in own ability
Knowing family is the expert on their child
What does it mean to presume competence?
If a child is’t verbal abilities it doesn’t mean that they can’t communicate.
Observations are key, it what specific areas are we observing?
During Play
Gross Motor Performance
Fine Motor Performance
Behavior and Self-Regulation
Possibly Classroom Performance
Choosing Wisely for ASD
Don’t provide interventions for autistic persons to reduce or eliminate “restricted and repetitive patterns of behavior, activities, or interests” without evaluating and understanding the meaning of the behavior to the person, as well as personal and environmental factors.
Occupational therapy practitioners should provide person-centered, strengths-based interventions, and advocate for autistic persons on individual and societal levels by providing information to promote inclusivity and belonging, and to decrease stigma. Actions that are considered “restricted and repetitive behaviors” by the DSM-5 (American Psychiatric Association, 2013) may serve as meaningful activities for self-regulation, communication, or self-expression. Attempting to change or extinguish these behaviors without direct request from the individual, without understanding and incorporating the underlying meanings, or substituting other actions to meet self-regulatory reasons for the behavior commonly results in camouflaging (e.g., masking or hiding behaviors), that can result in negative self-image, depression, and an increased risk of suicidality.
Why is “kids need to have quiet hands” harmful to ASD
They may have a need for moving their hands. We are stripping away and extinguising their behaviors without understanding their purpose.
Strategies for session with Autistic children
Improve engagement and interaction
– – Reduce Fear or Anxiety
Improve behavior and Task Completion
Improve Comfort
Improve Motor Skills/Praxis
Improve Play and Ideational Praxis
How can we make session more comfortable
incorporating sounds, colors objects, toys that they already like. Turn the work into play. Using visual cues or schedules can help the children with expectations. Know what the child’s preferences are. clear boundaries on what is acceptable. Give enough choice to allow the child to feel in control of the session.
Occupational Therapy- Sensory Integration (Ayres Sensory Integration)
Play based approach
Sensory Strategies
SI Intervention
How does Ayres Sensory integration help kids with autism
inclue sensory strategies into session or environment. modifying task or environment to improve childs comfort. Improves the Childs ability to interact with others. implemented by teachers or parents after session. like weighted vests after a shower and before sleeping.
long term sensory integration
often provided by a highly skilled therapist.
Applied Behavior Analysis (ABA)
Adult directed
Discrete trial training
Positive Behavioral Support (PBS)
OT - can use some of the skills of ABA, token economy or sticker charts in line with ABA approach.
What is the ABA theory?
learning occurs through a change in behavior brought about by external experiences. Can be brought about with reinforcers. Rewards desired behaviors while ignoring undesirable behaviors.
Cognitive Orientation to Daily Occupational Performance Approach (CO-OP)
*Focus is on learning new skills and generalization of skills
*Effective with high functioning ASD
*Cognitive behavioral and motivational theories
Goal , plan, Do, Check
what is this a part of?
Cognitive behavioral and motivational theories
What do you want to do
how will you do it
then they do it,
OT observes
collaborate how to do it and achieve the goal and then you check that it’s successful.
Developmental, Individual Differences, Relationship-Based Model (DIR)
Considers whole child
Parental implemented strategies
6 developmental stages: intimacy, engagement, two way communication, complex communical, emotional ideas, emotinal thinking.
OT strategies - playful blocking - getting into the childs world and then expand upon it. encouraging parent and child relationship
developed by Stanley Greenspan
Floortime
Family-centered
Naturalistic or play-based
Considered part of DIR model
Therapist will immitate the child. We watch how they play and then join in.Expand interaction between sensory, integration.
Interventions that include play
*Play interactions
*Play initiations
*Reciprocal pretend play - floor model
*Parent-child interaction within play
*Independence in play
What is video modeling used for
to allow ASD kids to gain a lot of skills and helps enhance and diversity their sense of play.
Sleep as an intervention
Sensory
- Proprioceptive
- Auditory
- Visual
- Tactile
- Vestibular
Behavioral - goal is for the child to self soothe - clear and consistent bedtime routine. Bedtime closer to a naturally established time.
Extinction programs
What is an extinction program
excuse me drill
parent will sing to child or rub back and then they will excuse themself and say I need to go and I’ll be right back. When they come back they praise the child for being good.
ADLs interventions that are common needs and good interentions
ADLs & IADLS
Cognitive
Behavioral
Sensory
