Autism Spectrum Disorder

Question 1

Knowledge of deficits in social-emotional reciprocity. Deficits in Social-Emotional Reciprocity || Problems with Social Communication

Answer 1

• Social-Emotional Reciprocity (SER) is a person’s “ability to engage in social interactions between two or more people” (Schwartz et al., 2021)
• Social Communication:
  Basic Communication
  Expressing wants and needs in an effective manner, following instructions
• Conversational Language
  Commenting, asking and answering questions, participating in simple complex exchanges with other
• Complex Social Language
  Understanding humor, sarcasm, figures of speech, and non-literal language

Question 2

Knowledge of deficits in nonverbal communicative behaviors used for social interaction. Deficits in Nonverbal Communicative Behaviors Used for Social Interaction || Problems with Social Interactions

Answer 2

• Non-Vocal Gestures:
  Making and maintaining eye contact, facial expressions, understanding and using non-vocal social cues/body language
• Basic Social Behavior:
  Imitation, attending to others in the environment, seeking to share social experiences

Question 3

Knowledge of deficits in developing, maintaining, and understanding relationships. Deficits in Developing, Maintaining, and Understanding Relationships || Problems with Social Interactions

Answer 3

• Basic Social Interactions;

Reciprocating greetings, joining and maintaining play, making and sustaining peer relationships

Question 4

Knowledge of stereotyped or repetitive motor movements, use of objects, or speech. Stereotyped or Repetitive Motor Movements, Use of Objects, or Speech || Presence of Restrictive or Repetitive Behaviors/Interests

Answer 4

• Repetitive Motor Mannerisms/Interests
  Non-vocal behaviors such as body rocking, spinning, pacing, jumping, hand flapping, or peripheral gazing
• Repetitive Vocal Behaviors/Stereotypy:
  Humming, echolalia (repeating sound, words, phrases), other non-speech related vocal sounds

Question 5

Knowledge of insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior. Insistence on Sameness, Inflexible Adherence to Routines, or Ritualized Patterns of Verbal or Nonverbal Behavior || Presence of Restrictive or Repetitive Behaviors/Interests

Answer 5

• Object fixation and manipulation:
• Arranging items in lines or particular locations, hoarding, repetitive manipulation of objects in on-functional ways
• Extreme need for sameness and routines
• Rigid adherence to rules, schedules, routes, placement of items and roles

Question 6

Knowledge of highly restricted, fixated interests that are abnormal in intensity or focus. Highly Restricted, Fixated interests that are Abnormal in Intensity or Focus || Presence of Restrictive Behaviors/Interests

Answer 6

• Obsession with unusual topics of interest:
• Narrow interest in one or few ideas or themes, reluctance to shift from preferred interests
• Three Primary Areas Affected by ASD
• Problems with Social Communication
• Deficits in SER
• Problems with Social Interactions
• Deficits in nonverbal communication behaviors
• Deficits in developing and maintaining relationships
• Presence of Restrictive or Repetitive Behaviors/Interests
• Stereotyped or repetitive motor movements
• Insistence on sameness
• Highly restricted fixated interests

Question 7

Knowledge of hyper or hyreractivity to sensory or unusual interests in sensory aspects of environment. Hyper or Hypo-Reactivity to Sensory Input or Unusual Interests in Sensory Aspects of Environment

Answer 7

• HYPER-reactive to sensory input:
• The individual is more sensitive to what they experience though their senses
• Someone who is hyper-reactive to the sounds they hear when in a group or people is likely to be more overwhelmed and stressed by this experience as compared to most other people
• They might notice things more intensely, which may be a very unpleasant experience for them especially if they are not fond of the noises they are hearing
• HYPO-reactive to sensory input:
• The individual is likely to experience less sensitivity to things they experience through their senses
• Under-responsive to sensory input may not register or attend to certain stimuli in their environment
• In a group of people, they might not notice another person has started talking and they might unintentionally talk over other people in a loud voice

Question 8

Knowledge of levels of severity across social communication and restricted, repetitive behaviors

Answer 8

Three specifiers are used to refer to the amount of support needed in order to function

• Level 1: Requiring support
• Level 2: Requiring substantial support
• Level 3: Requiring very substantial support
• Level 1: 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 from others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.
• Level 2: Marked deficits in verbal and nonverbal social communication skills, social impairments apparent even with supports in place; limited initiation of social interactions; and reduced to abnormal responses to social overtures from others. For example, a person who speaks in simple sentences whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication. 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 3: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches. Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interferes with functioning in all spheres. Great distress/difficulty changing focus or action.

Question 9

Knowledge of research regarding treatment intensity

Answer 9

• Children with autism who began 37.6 hours per week of one-to-one ABA treatment or 31.3 hours per week of parent managed ABA treatment at a mean age of 36 months had significant pretest and posttest gains for IQ, language comprehension and ADI-R Social Skills and ADI-R Communication. Children receiving ABA gained an average of 25 IQ points and 48% achieved average post-treatment scores and were succeeding in regular education classrooms.
  (Sallows, G.O., & Graupner, T.D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal of Mental Retardation, 110, 417-438.)
• Children with autism who began 28 hours per week of one-to-one ABA treatment between 4-7 years of age scored significant higher as compared to the eclectic treatment group on intelligence, language, adaptive functioning, and maladaptive functioning and on two of the sub scales on the socio-emotional assessment. Children in the ABA group gained an average of 25 IQ points and 54% scored within the average range of both IQ and verbal IQ at follow-up.
  (Smith, T., Jahr, E., & Eldevik, S. (2007). Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7: A comparison controlled study. Behavior Modification, 31, 264-278.)

Question 10

Knowledge of early intensive behavioral intervention research. Early Intensive Behavioral Intervention Research

Answer 10

• All participants in the study were under the age of 4 and had a diagnosis of ASD.
• 3 groups depending on services at intake:
• 2 control groups of 21 children each received either 10 hours of ABA/week or no ABA treatment
• Experimental group consisted of 19 children receiving 40 hours of ABA/week:
• Home based ABA intervention using discrete trial teaching
• Individualized for each learner’s areas of needs
• Transitioned into typical preschool with 1:1 shadow aides
• Results: After 2+ years
• Experimental group - 9/19 (47%) attended “regular” education and scored within normal IQ range
• Control group - 2% attended “regular” education and scored within normal IQ range
  (Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.)
• Follow-up assessments from Lovaas’ 1987 study participants at a mean age of 11.5 years showed that children in the intensive group maintained gains and had higher scores for IQ, adaptive behavior, and personality than children in the control group
  (McEarchin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97, 3569-372.)

Question 11

Knowledge of foundational autism research. Foundational Autism Research

Answer 11

• The Study to Explore Early Development (SEED) is a multi-year study funded by CDC
• As of 2022, SEED is the largest study in the United States to help identify factors that may put children at risk for autism spectrum disorder (ASD) and other developmental disabilities
• The research goals for SEED include learning about:
• Physical and behavioral characteristics of children with ASD, children with other developmental disabilities, and children without other development delay or disability
• Health conditions among children with and without ASD
• Factors associated with a child’s risk for developing ASD
• Ages 2-5, children with ASD, children with other developmental disabilities, and children with typical development
• Many studies are still underway, while early study results are available and summarized at Seed Research

Question 12

Evidence-Based Interventions vs. Non-evidence-Based Interventions

Answer 12

• Evidence Based Practices - Practices or interventions used that have supporting research in effectiveness and are supported by peer reviewed journals
• Effects must be measurable
• Must show a cause-effect relationship with improved outcomes
• Studies can be replicated
• ABA is an evidence based practice
• Non-Evidence Based Practices - Practices or interventions that do not have supporting research in effectiveness and are not supported by peer reviewed journals
• Unmeasurable
• No relationships between variables shown
• No studies or experiments replicated?