Autism Spectrum Disorder (ASD)

Question 1

DSM V described Autism to be a class of disorders with impairments related to (5):

Answer 1

• Persistent deficits in social communication or interaction * (no eye contact)
• Restricted, repetitive patterns of behaviors, interests or activities*
• Symptoms must be present in early developmental period

• Symptoms cause clinically significant impairment in social, occupational
or other important area of function

• Disturbances not better explained by intellectual disability or global
developmental delay. (could be co-morbid)

Question 2

Social communication issues

Answer 2

• Difficulty reading and comprehending feelings, experiences
and motives of others

• Joint attention (normal toddler was like whoa and turns to mom when seeing a firetruck to try experience with her. Children with ASD do not draw others in their space.)

Question 3

Repetitive behaviors: Routines

Answer 3

ASD kids have rigidity to reliant of a daily routine. They need to know what happens first, second, and third. Otherwise they will be stressed and have a tantrum.

Question 4

Repetitive behaviors: Atypical play

Answer 4

Atypical play- rub car on belly, so the play is repetitive, rigid, non experimental.

Question 5

Repetitive behaviors: Stereotyped movements

Answer 5

Stereotyped movements like stemming occurs where the child is saying AHHH and clap ears to give him/herself a stimulus

Question 6

Repetitive behaviors: Unusual response to sensory input

Answer 6

Extreme response to input

Question 7

Language: Echolalia

Answer 7

When child repeat words, like someone’s laugh

Question 8

Language: Prosody

Answer 8

Person does not have much rhythm, like robotic speech.

Question 9

Language: Delay or regression

Answer 9

Regressive form- kid able to speak until the age of two, but now, the child cannot speak (RED FLAG)

Question 10

Language: Nonverbal language, pragmatics

Answer 10

Unable to understand autism

Question 11

Etiology of Autism: Genetics

Answer 11

– Recurrence rate for sibling 2-8%, 18%

– Twins (identical 36-95, fraternal 31)

Question 12

Etiology of Autism: Brain structure: Macrocephaly, when it happens and stops, hows it measured

Answer 12

– Macrocephaly between 4 and 12 months and then normal growth rates
resume
- Measurement in head circumference

Question 13

Etiology of Autism: Brains structure: When does white matter increase and decrease

Answer 13

– Greater white matter volume in cortex and cerebellum in early childhood
– Decreased cortical thickness, white matter connectivity, neurochemical
concentrations in adults

Question 14

Etiology of Autism: Brain structure: Glia and mirror neuron impairment?

Answer 14

– Inflammation of glia

– Mirror neuron impairments? It is a fuzzy area so some research say yay and some say nay

Question 15

Etiology of Autism: Prenatal/Perinatal

Answer 15

– Prematurity (means uterine environment is not compatible)

Question 16

Etiology of Autism: Pregnancy spaced in what time frame?

Answer 16

Less than a year apart

Question 17

Etiology of Autism: Teratogens

Answer 17

Valproic acid (leads to seizure)

Question 18

Etiology of Autism: Vaccinations?

Answer 18

Falsified data from UK, no direct association with vaccine and autism as children are diagnosed with autism at the age they get vaxxed

Question 19

Etiology of Autism: Maternal infections (3)

Answer 19

Rubella, CMV, Influenza

Question 20

Etiology of Autism: Age of parents

Answer 20

Maternal >35, Paternal >40

Question 21

Etiology of Autism: Co-morbidity with and what percent?

Answer 21

with other DD 83%

Question 22

Female to male ratio and children ratio

Answer 22

• 4.5:1 male: female ratio

* Prevalence is 1 in 54 children

Question 23

Reasons for increased prevalence in ASD (2)

Answer 23

Reclassification of diagnosis of people with ID are diagnosed with ASD (ppl less diagnosed with ID while more ppl diagnosed with ASD over time) and people delay having babies

Question 24

Screening exams (2)

Answer 24

– Checklist for Autism in Toddlers (CHAT)

– Modified Checklist for Autism in Toddlers (M-CHAT)

Question 25

Multidisciplinary assessment

Answer 25

– Language, motor, cognitive, hearing, social/emotional, adaptive (speech therapists would refer to hearing specialists) – Family history – Rule out other medical conditions – Autism Diagnostic Observation Schedule (ADOS) (done by psychologists)

Question 26

Associated Diagnoses

Answer 26

• ID (intellectual disability) • LD (learning disability) • Epilepsy • Tic disorders • Sleep disorders (can be caused by tonsils and ADHD results) • GI discomfort (constipation) • Psychiatric - mood disorders, ADHD, anxiety • Genetic disorders: TS, Fragile X syndrome, Chromosome 15 deletion (Prader-Willi** and Angelman syndromes), Down syndrome, others

Question 27

Treatment Approaches: Applied Behavioral Analysis and what are the cons?

Answer 27

Tell child, "look at me" then give child cookie. Problem is the child will only look at the therapists and some think this method is disrespectful

Question 28

Treatment Approaches: Behavioral interventions/plans and what is the con?

Answer 28

If child runs away, you have plan given by school system to treat child. The problem is you don't understand why child demonstrate this behavior.

Question 29

Treatment Approaches: Video modeling and what is good about it?

Answer 29

Kids with autism do well with learning watching over a video

Question 30

Treatment approaches: PECS

Answer 30

Picture exchange Communication Systems (help child gain autonomy and structure over their sessions, you show pictures and child picks the three. Then you have child remember the things in order. Like tell children that you want to do this thing first, second, and third so these children can understand the order of things)

Question 31

Motor skill ability (standardized testing) (3)

Answer 31

– MABC-2 (fine motor, balance, activity, ball playing skills) – TGMD-3 (locomotion, higher ball playing skills, hitting a bat, for higher level kids) – PDMS-2 (peabody)

Question 32

Prone, walking, and crawling motor skill development

Answer 32

DD develop maturity slowest, compared to AutNR (non aggressive) and Aut R (aggressive)

Question 33

Supine motor skill development

Answer 33

Aut NR develop maturity slowest. Aut R develop fastest

Question 34

Sitting motor skill development

Answer 34

Aut NR develop slowest, then DD, then Aut R.

Question 35

Early motor indicators

Answer 35

Head lag at 6 months, (grab supine baby by their arm and see if baby can use its flexors to help itself up.) If baby is showing head lag, just keep an eye on the baby, head lag is not a marker to diagnose child with ASD.

Question 36

Proportion of time in lying and unsupported sitting and ASD

Answer 36

More time in those positions when person has high risk ASD

Question 37

Physical fitness for child with ASD

Answer 37

* Decreased participation in physical activity * More sedentary activities * Increasing rates of obesity as compared to TD peers * Fitness Assessment

Question 38

Motor Deficits in ASD

Answer 38

* Hypotonia (low muscle tone, weak, not much upright postural alignment) * Dyspraxia (decrease coordination for more complex motor skills) * Toe Walking (GI discomfort, child do hyperextension by counteracting the acid from coming up)

Question 39

Sensory Processing Disorders: Sensory stimulus: Hyporesponsive/hyposensitive and how to treat

Answer 39

``` – Sensory seeking behavior – Touching, bumping, rocking – Poor safety awareness – High pain threshold – Tactile discrimination disorder – difficulty with skills requiring individuation or coordination • Blowing whistle • Riding bike • Holding up fingers to indicate age – May present as passive, decreased tone ``` Benefits from: unpredictable, fast vestibular or tactile input, loud complex auditory input

Question 40

Sensory Processing Disorders: Sensory stimulus: Hyperresponsive/ hypersensitive

Answer 40

``` – Avoidance behavior ("i dont want you to touch me, too much light, noise") – Emotionally charged behavior • Flight or fright – Aggression (when overloaded) – Large reaction for small event – May shut down from overload ``` • Benefits from: deep, predictable proprioceptive input, gentle auditory input, slow vestibular input (swing child side to side slowly to calm children down)

Question 41

Sensory Processing Disorders: Sensory stimulus: Fluctuating

Answer 41

mix of both hyper and hyporesponsive

Question 42

Sensory Processing Disorders: Central processing: Sensory modulation disorder

Answer 42

– Difficulty with registration, arousal, self-regulation, attention, focus and behavior/emotional response • High or low set point • Hyperreactive electrodermal reactivity to sensory challenge protocol

Question 43

Sensory Processing Disorders: Central processing: Dyspraxia

Answer 43

–Difficulty planning, organizing, sequencing motor skills | • Poor coordination

Question 44

Sensory Processing Disorders: Central processing: Discrimination disorders

Answer 44

no notes on it lol

Question 45

Sensory Processing Disorders: Output (5)

Answer 45

``` Executive Function Behavioral Emotional Motor Language ```

Question 46

PT Intervention Considerations

Answer 46

• Finding way to communicate/connect (proper tone) – Make inroads with sensory interventions! • Managing behaviors – see behavior as communication! • Functional strengthening (climbing, gait, ball playing) • Skill building for peer interaction, participation – Similar principles as with ID population • Exercise has broad impact (cardiovascular fitness is important!, keeps behaviors organized) • Musculoskeletal/Neuromuscular impairments

Question 47

Guiding Principles for Intervention

Answer 47

• Early Intervention • Family involvement • Structured/predictable environments (orderly routine) • Functional approach to behavior (atypical /socially unacceptable behaviors) • EVERY INPUT MATTERS – You Tell Me! (we can change the child's ASD trajectory, like the way they eat, sleep, we don't know how far we can push them)