Autism Spectrum Disorder (ASD) Flashcards
Language matters
- the autism community has expressed a preference for identity first language = autistic person vs person with autism
- with a new diagnosis, Dr. Zimmerman still uses “child with autism” = especially because some families may mourn of their children when found out they are autistic as they had future plans for their children
- high support needs/low support needs vs. severely autistic/mildly autistic
Chris Ulmer - Special Books by Special Kids Videos
- Ellie = a high schooler with autism, anxiety, and ADHD
- Gabe = a nonverbal teenager with autism
Diagnostic and Statistics Manual-4 (DSM-4)
- 5 separate diagnoses
- autistic disorder
- Asperger disorder (Asperger syndrome)
- Pervasive developmental disorder - not otherwise specified (PDD-NOS)
- Childhood disintegration disorder
- Rett disorder
DSM-5 Diagnostic Criteria
Persistent deficits in all areas of social communication and interaction across multiple settings:
- deficits in social-emotional reciprocity = cannot communicate back and forth verbally or socially in the same way
- deficits in nonverbal communicative behaviors used for social interaction = facial expression, hand gestures, body language
- deficits in developing, maintaining, and understanding relationships
Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
- stereotyped or repetitive motor movements, use of objects or speech = sometimes called stimming (ex: flapping hands, rocking back and forth, and bouncing)
- insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior = flexibility is not a strength
- 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 environment = they hear sound and movements and navigate them differently
Importance of DSM-5 Diagnostic Criteria
- must be present in the early developmental period (may not fully manifest until social demands exceed limited capacities or may be masked by learned strategies)
- symptoms cause clinical impairment in social, occupational, or other important areas of current functioning = doesn’t happen in just one setting, we see it across multiple settings
- disturbances not better explained by intellectual developmental disorder or global developmental delay
- intellectual disability and autism spectrum disorder frequently co-occur
- social communication must be below what is expected for general developmental level
Severity levels diagram (slide 10)
Level 3:
- very substantial support
- significant deficits in verbal and nonverbal social communication
- limited initiation of social interactions
- extreme difficulty coping with change; great distress changing focus or action
- restricted behaviors interfere with functioning in all spheres
Level 2:
- substantial support
- marked deficits in verbal/nonverbal deficits
- social impairment even with supports in place
- difficulty coping with change
- restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer
Level 1:
- without supports, deficits in social communication
- may appear to have decreased interest
- inflexibility of behavior
- problems or organization and planning decrease independence
Data and statistics
- about 1 in 36 children in the U.S. has a diagnosis of autism (increased from 1 in 44)
- boys are 4 times more likely than girls to be diagnosed
- can be detected as early as 18 months, by age 2 diagnosis can be considered reliable
- developmental regression affects around 1 in 5 children, occurs between ages 1 and 3
- impacts all racial, ethnic, and socioeconomic groups
- most recent studies indicate a new pattern of ASD identification = percentage of 8 year olds diagnosed with ASD was higher among Black, Hispanic, and Asian/Pacific Islander compared to White children
- reported prevalence varies by location
Associated challenges (not tested on this)
- anxiety deficit hyperactivity disorder
- anxiety disorders
- depression
- over half have chronic sleep issues
- chronic gastrointestinal issues
- food selectivity
- sensory processing disorder
- epilepsy
- schizophrenia
- intellectual disability
- nonverbal
- nearly half of individuals with autism wander or bolt from safety (elopement)
- drowning as leading cause of death for children with autism
No single defined cause of ASD
- having a sibling with ASD
- having certain genetic condition, such as Fragile X
- experiencing complications at birth
- being born to older parents
- rafters differ in various areas of the U.S.
Economic cost
- on average, estimated cost of $60,000 per year through childhood = special services and loss of wages
- cost of care for Americans with autism reached $268 billion in 2015
- majority of costs are for adult services
- medical costs for children and adolescents with autism is 4.1 to 6.2 times greater than children without autism
Autism in girls
- better functional behaviors than boys
- better at masking well into adulthood
- more engaged and talkative
- engage more in pretend play
- looks like they are blending into the playground
- more likely to play with younger children or alone
- better basic nonverbal skills than boys = ask about their experience of eye contact
- fewer and more subtle repetitive behaviors
- less likely to have behaviors problems = more likely to have perfectionism
- tend towards typical interests at an intense level
- must understand their inner experience
Autism screening
*autism center
- learn the signs, act early, developmental tracker
- Academy of Pediatrics (AAP) recommends developmental and behavior screenings at ages 9, 18, and 30 months old
* the brain grows the fastest when it’s young, has the most neural plasticity
- children screened specifically for ASD at ages 19 and 24 months
Red flags
- not respond to name by 9 months of age
- does not show facial expression such as happy, sad, and angry by 9 months = flat effect
- uses few or no gestures by 12 months (waving good-bye)
- not point at objects to show interest by 12 months
- does not share interests by 15 months
- does not notice when others are hurt or upset by 24 months
- does not play pretend by 24 months
- lines up toys or objects, becomes upset if moved
- echolalia
- plays with toys the same way each time
- upset by minor changes
- must follow certain routines
- flaps hands, rocks body, spins itself
- unusual reactions to sound, smell, taste, look, and feel
*you have to have strong understanding of typical development in order to understand if something is delayed or abnormal
Impact on sleep
- difficulty falling asleep
- difficulty staying asleep and waking up early
- over 50% have chronic sleep problems
Impact on eating
- difficulties with eating, food textures, and limitations in food because of textures, sensory, and motor
- problems with eating leads to GI issues
Impact on social participation
- difficulty with imitation
- difficulty with communication
- sharing similar interests/forming friendships
Impact on play
- preoccupation with objects
- unusual use of objects
- unusual visual exploration
- preoccupation with object features
- limited flexibility and creativity in use of object
- repetitive use of objects
Impact on activities of daily living (ADLs)
- delayed self-care performance particularly with feeding and toileting
- affects children with autism and many programs require them to be toilet-trained
Impact on education
- accomodations reaffirmed to educational program
Sensory differences (underlying differences which impact occupations)
- hypersensitivity/hyposensitivity = poor auditory filtering
- sensory seeking
- overreactions to sounds, touch, tastes, and smells
- atypical visual exploration of objects
- differences in eye contact
- lack of response to their name
- excessive mouthing of objects
- social touch aversions
Gross motor (underlying differences which impact occupations)
- posture
- gait and balance
- lack of heel-toe gait and toe walking
- coordination/praxis
- difficulties with initiation, sequencing and timing of actions
- poor use of two or more body parts
- difficulties in developmental positions/early sequential movement pattern
Fine motor (underlying differences which impact occupations)
- decreased isolated finger movements
- poor in-hand manipulation; slow manual dexterity
- little difference in skills between preferred/nonpreferred hand
Oral motor (underlying differences which impact occupations)
- poor oral control for sucking, chewing, blowing
- poor breath support for speech
- poor coordination in breath support for eating, drinking, swallowing, and conversing
Ocular-motor (underlying differences which impact occupations)
- decreased use of eyes for guidance of body or hands in action
Cognition (underlying differences which impact occupations)
- differences in ideation (creating new ideas)
- executive function
- visually modeling
Family impact
- considerable health care needs and behavioral characteristics of ASD have substantial impact on family
- access to care/coordinating care
- financial issues
- significant child-rearing needs restricting family lifestyle
- social isolation
Safety (other considerations for support)
- harmful behaviors, elopement
- assist family in managing escape/harmful behaviors
- problems solving
- activity analysis
- use of technology
Coping and self-efficacy of family
- coping strategies
- assist in effective decision making
- respite care
- local resources
- empower parents
Support across the lifespan
- early intervention (0-3)
- school age (3-21)
- transition to adulthood (individuals with disabilities have federal support until age 21; a huge area that OTs have tons of expertise)
- support in adulthood
The concept of neurodiversity
- refers to variation in the human brain regarding sociability, learning, attention, mood, and other mental functions
- How much should a child or adult be expected to change?
- How do we use strengths-based approach? (to be able to facilitate growth)
- How is autism reflected in the media?
*when you have parents that are in denial, you want to slowly and carefully introduce strengths-based approach
Representations of autism
- Sesame Street character named Julia
- Newest autistic character on Thomas and friends
- Carl the collector on PBS Kids
