Autism Spectrum Disorder (ASD) Flashcards
DSM V described Autism to be a class of disorders with impairments related to (5):
- 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)
Social communication issues
• 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.)
Repetitive behaviors: Routines
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.
Repetitive behaviors: Atypical play
Atypical play- rub car on belly, so the play is repetitive, rigid, non experimental.
Repetitive behaviors: Stereotyped movements
Stereotyped movements like stemming occurs where the child is saying AHHH and clap ears to give him/herself a stimulus
Repetitive behaviors: Unusual response to sensory input
Extreme response to input
Language: Echolalia
When child repeat words, like someone’s laugh
Language: Prosody
Person does not have much rhythm, like robotic speech.
Language: Delay or regression
Regressive form- kid able to speak until the age of two, but now, the child cannot speak (RED FLAG)
Language: Nonverbal language, pragmatics
Unable to understand autism
Etiology of Autism: Genetics
– Recurrence rate for sibling 2-8%, 18%
– Twins (identical 36-95, fraternal 31)
Etiology of Autism: Brain structure: Macrocephaly, when it happens and stops, hows it measured
– Macrocephaly between 4 and 12 months and then normal growth rates
resume
- Measurement in head circumference
Etiology of Autism: Brains structure: When does white matter increase and decrease
– Greater white matter volume in cortex and cerebellum in early childhood
– Decreased cortical thickness, white matter connectivity, neurochemical
concentrations in adults
Etiology of Autism: Brain structure: Glia and mirror neuron impairment?
– Inflammation of glia
– Mirror neuron impairments? It is a fuzzy area so some research say yay and some say nay
Etiology of Autism: Prenatal/Perinatal
– Prematurity (means uterine environment is not compatible)
Etiology of Autism: Pregnancy spaced in what time frame?
Less than a year apart
Etiology of Autism: Teratogens
Valproic acid (leads to seizure)
Etiology of Autism: Vaccinations?
Falsified data from UK, no direct association with vaccine and autism as children are diagnosed with autism at the age they get vaxxed
Etiology of Autism: Maternal infections (3)
Rubella, CMV, Influenza
Etiology of Autism: Age of parents
Maternal >35, Paternal >40
Etiology of Autism: Co-morbidity with and what percent?
with other DD 83%
Female to male ratio and children ratio
- 4.5:1 male: female ratio
* Prevalence is 1 in 54 children
Reasons for increased prevalence in ASD (2)
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
Screening exams (2)
– Checklist for Autism in Toddlers (CHAT)
– Modified Checklist for Autism in Toddlers (M-CHAT)
Multidisciplinary assessment
– 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)
Associated Diagnoses
• 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
Treatment Approaches: Applied Behavioral Analysis and what are the cons?
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
Treatment Approaches: Behavioral interventions/plans and what is the con?
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.
Treatment Approaches: Video modeling and what is good about it?
Kids with autism do well with learning watching over a video
Treatment approaches: PECS
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)
Motor skill ability (standardized testing) (3)
– 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)
Prone, walking, and crawling motor skill development
DD develop maturity slowest, compared to AutNR (non aggressive) and Aut R (aggressive)
Supine motor skill development
Aut NR develop maturity slowest. Aut R develop fastest
Sitting motor skill development
Aut NR develop slowest, then DD, then Aut R.
Early motor indicators
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.
Proportion of time in lying and unsupported sitting and ASD
More time in those positions when person has high risk ASD
Physical fitness for child with ASD
- Decreased participation in physical activity
- More sedentary activities
- Increasing rates of obesity as compared to TD peers
- Fitness Assessment
Motor Deficits in ASD
- 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)
Sensory Processing Disorders: Sensory stimulus: Hyporesponsive/hyposensitive and how to treat
– 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
Sensory Processing Disorders: Sensory stimulus: Hyperresponsive/ hypersensitive
– 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)
Sensory Processing Disorders: Sensory stimulus: Fluctuating
mix of both hyper and hyporesponsive
Sensory Processing Disorders: Central processing: Sensory modulation disorder
– Difficulty with registration, arousal, self-regulation, attention, focus
and behavior/emotional response
• High or low set point
• Hyperreactive electrodermal reactivity to sensory challenge
protocol
Sensory Processing Disorders: Central processing: Dyspraxia
–Difficulty planning, organizing, sequencing motor skills
• Poor coordination
Sensory Processing Disorders: Central processing: Discrimination disorders
no notes on it lol
Sensory Processing Disorders: Output (5)
Executive Function Behavioral Emotional Motor Language
PT Intervention Considerations
• 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
Guiding Principles for Intervention
• 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)
