Autism Spectrum Disorders

Question 1

What is the sensory integration approach?

Answer 1

Activates the vestibular/proprioceptive systems.
Engages vestibular/ocular coordination
Support playfulness
Triggers praxis

Question 2

What is the performance oriented approach?

Answer 2

Imbeds sensory processing into the routines of daily life.
Supports families
Builds capacity
Enhances child development
Support parent competence

Question 3

What is the epidemiology of ASD?

Answer 3

1 in 68 kids have it
Occurs in all racial, ethnic, socioeconomic groups
5 times more common among boys
Small % of kids who are born early or with low birth weight are at risk
Kids born to older parents are at higher risk

Question 4

T/F: ASD co-occurs with other developmental, psychiatric, neurologic, chromosomal, and genetic diagnoses?

Answer 4

True

Question 5

Why is there an increase in diagnosis of ASD?

Answer 5

Increased professional awareness
Increased public awareness
Access to services
Broader diagnostic criteria and better diagnostic instruments
Environmental toxins

Question 6

What are the changes from DSM-4 to DSM-5 when diagnosing autism?

Answer 6

Elimination of PDD umbrella diagnosis
Subcategories will be folded into broad term ASD
Transition from 3 domains of autism symptoms to 2 (social communication impairment and restricted interests/repetitive behaviors)
Changed from 6 of 12 deficits in social interaction, communication or repetitive behaviors to 3 deficits in social communication and at least 2 symptoms in restricted range of activities/repetitive behaviors

Question 7

What are the new diagnostic criteria?

Answer 7

3 deficits in social communication and at least two symptoms in restricted range of activities/repetitive behaviors: new symptom will be included- hyper or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment

Question 8

When are children diagnosed with ASD?

Answer 8

Between 4.5-5.5 years but for 51-91% of kids developmental concerns have been recorded before 3 years.
About 1/3 of parents of kids with an ASD noticed a problem before their child’s 1st bday and 80% saw differences by 24 months
Diagnosis of autism at age 2 can be reliable, valid, and stable

Question 9

What is the genetic risk for ASD?

Answer 9

Some claim 80-90% of genetic influence on autism phenotype
Not a single causal factor; not a single gene disorder
Co-occurring medical conditions associated with ASD: Fragile X, tuberous sclerosis, mitochondrial disorder
Unknown why strong male dominance
Not clearly understood
likely involves multiple genes

Question 10

What is assortative mating and the risk for ASD?

Answer 10

High “systemizers” (those that cannot cope with systems of high variance or change, such as the social world of other minds, appear change resistant) choose each other as mates and may pass on genetic risk for ASD to kids

Question 11

What are the environmental risks for ASD?

Answer 11

Maternal, paternal age
Ongoing research: prenatal environment, maternal obesity, pesticides, vitamin D, hazardous air pollutants, assisted reproductive technologies, medications given during pregnancy and childbirth, maternal infections, smoking, nutritional factors, maternal stress, and chemicals such as flame retardants, premature birth, low birth weight

Question 12

What are brain difference found in those with ASD?

Answer 12

Increased head circumference in children aged 12 months with ASD as compared to children with TD
Early brain overgrowth occurs prior to the first 2 years of life
Different neural responses to faces

Question 13

What are the strengths of ASD?

Answer 13

Often highly skilled in particular areas
Attention to detail
Tendency to be logical (helpful in decision making where emotions may interfere)
Usually visually processing (thinking in pictures or video)

Question 14

What are differences in social interaction and communication?

Answer 14

Social impairment is core and defining symptom of autism.

Babies are social from infancy and the lack of social skills is a critical finding and reason for concern at any age.

Question 15

What are ASD red flags?

Answer 15

No babbling or pointing by age 1
No single words by 16 months or two word phrases by age 2
No response to name
Loss of language or social skills
Poor eye contact or poor use of eye gaze
Excessive lining up of toys or objects
Lack of smiling or social responsiveness, lack of shared enjoyment
Lack of joint attention
Limited interaction
Lack of gestures to compensate for communication difficulties
“Sticky” attention

Question 16

What are absolute indicators for ASD?

Answer 16

No babbling by 12 months
No gesturing (pointing, waving bye) by 12 months
No single words by 16 months
No two word spontaneous phrases by 24 months
Loss of language or social skills at any age

Question 17

At 12 months children that go on to have a diagnosis with ASD often show?

Answer 17

Sleep difficulties
Eating difficulties
Play: differences in object exploration (lack of, unusual)

Question 18

What are some indicators in older kids>?

Answer 18

Communication/speech differences
Use of language differences
Reciprocal communication- give and take of conversations
Body language
Restricted interests/repetitive behaviors
Sensory differences

Question 19

How does motor relate to communication?

Answer 19

Locomotion leads to a changed exploration of the world.
When children are able to actively explore their environments, parent-child interactions change.
Caregivers may provide increased communication when children are mobile.
Children may show increased communication bids.
When we impact a young children’s motor skills, we offer them increased opportunities to explore and learn.
Emergence of new motor skills changes infants experience with objects and people in ways that are relevant for both general communicative development and the acquisition of language.

Question 20

What are motor differences in ASD?

Answer 20

Postural asymmetries
Gait: lack of heel toe pattern, lack of reciprocal arm movements, waddling gait compared with age matched infants
Differences in onset of rhythmic arm movements and babbling in siblings of kids already diagnosed with ASD.
Jitteriness and irritability or reduced motor activity, excessive stereotypical object play, excessive time looking at nearby objects within first year of life.
Toddlers: more atypical hand and finger movements and more stereotypical object play, such as excessive banging or preoccupation with spinning objects or with part of an object.

Question 21

What are motor stereotypes?

Answer 21

Rhythmic, repetitive, fixed, predictable but purposeless movements: rocking, arm flapping, finger flicking

Flapping hands, being fascinated with certain noises, showing interest in bright lights or moving objects, seeking various types of movement, spinning, excessively mouthing objects, and smelling objects

Question 22

What is SIRS and what happens as kids with ASD age?

Answer 22

SIRS= Sensory interests, repetitions, seeking behaviors

Children with ASD demonstrate increasingly complex repetitive behaviors as they age.

Question 23

What are the 4 sensory processing patterns?

Answer 23

Hyperresponsiveness: avoidance/sensitivities
Hyporesponsiveness: bystander
Enhanced perception: hyper aware/detail oriented
Sensory seeking: lots of sensory input

Question 24

What are characteristics of avoiders?

Answer 24

Easily overwhelmed by sensory input and try to get away from sensory experiences.
Crowds provide sound, touch input, visually messy place and sometimes various smells from perfume, soap, etc

Question 25

what are characteristics of sensors?

Answer 25

Notice every detail, such as texture, spices or temperature of food.
Only certain textures are acceptable.
A sensor can detect a different brand of popcorn, or a different spice.
Discerning ability can extend to fabrics, noises in a building, or parts of a musical score.
Sensors can be demanding about the precise way they want a meal, a room, or their clothing.

Question 26

What are characteristics of bystanders?

Answer 26

Miss sensory input that others notice
Not distracted by small inputs, and can concentrate even in busy places that might be challenging for others.
Might also miss sensory input such as someone calling their name; they may seem oblivious to inputs that others notice easily.

Question 27

What are characteristics of seekers?

Answer 27

Need a lot of sensory input, and they like having input so they try to get more.
People who hum, tap, jiggle their legs, touch things are all acting like seekers.
The regular experience is not enough for them so they find ways to make every experience more dense with sensory input.

Question 28

What are AAP screening guidelines?

Answer 28

All children receive autism specific screening at 18 and 24 months of age, in addition to broad developmental screening at 9, 18, 24 months.

Question 29

What is a screening tool?

Answer 29

A snapshot of children’s development.
May be either global development or autism specific.
Provides info regarding a child’s “risk” for autism or another developmental disability

Question 30

What are screening guidelines for global development and autism specific?

Answer 30

All children should be screened for developmental delays and disabilities during regular well child doctor visits: 9, 18, 24/30 months

All children should be screened specifically for ASD during well child doctor visits at 18 and 24 months

Question 31

when is additional screening needed for a child?

Answer 31

If they are at high risk for ASDs (eg having a sister or brother or other family member with an ASD) or if behaviors sometimes associated with ASDs are present.

Question 32

What are diagnostic tools?

Answer 32

Determines if child meets diagnostic criteria for autism.
Assessment attempts to gather info about the child, often parent report/behavioral, in order to measure the child’s symptoms of autism.
Part of a broader, multi-disciplinary assessment

Question 33

What is the MCAT-R?

Answer 33

Modified checklist for autism in toddlers
20 item yes/no parent response checklist
Follow up scripted interview for failed items reduces false positives
Tested on 16-30 month olds
Translated into multiple languages, used in many countries

Question 34

what are MCAT-R items?

Answer 34

If you point at something across the room, does your child look at it?
Have you ever wondered if your child might be deaf?
Does your child play pretend or make believe?
Does your child like climbing on things?
Does your child make unusual finger movements near his or her eyes?
Does your child point with one finger to ask for something or to get help?
Does your child point with one finger to show you something interesting?
Is your child interested in other children?
Does you child show you things by bringing them to you or holding them up for you to see?
Does your child respond to their name?
When you smile at them, do they smile back?
Does your child get upset my everyday noises?
Does your child walk?
Does your child look you in the eye?
Does you child try to copy what you do?
If you look at something does your child look around to see what you are looking at?
Does your child try to get you to watch him or her?
Does your child understand when you tell him or her to do something?
If something new happens does your child look at you to see how you feel about it?
Does your child like movement activities?

Question 35

How early can intervention make a difference?

Answer 35

Parent delivered intervention for 7-15 month olds helps kids show better developmental outcomes by age 3 years

Question 36

What is the evidence behind intervention in ASD?

Answer 36

Research supports positive, long term effects of EI on developmental trajectories of kids.

The question is no longer if EI is efficacious; instead research must focus on specific components of EI models that are effective in real world settings.

Efficacy of behavioral interventions persists throughout adulthood for individuals with ASD

Question 37

What are 6 key principles of coaching?

Answer 37

Authentic contexts
Family's interests and routines
Caregiver interaction and responsiveness
Observation
Modeling
Joint plans

Question 38

When planning an intervention what should we ask ourselves?

Answer 38

What routine do I want to try this in for the week? (breakfast? ride to school? dinner? bath time? etc.)
What do I hope that will happen as a result of this?
What do I expect to change?
How much time am I going to invest in trying this?
Does this strategy work for the family in everyday lives?
Is it fun?
Did you show caregiver how to do it?
Did you make the child interested in it?

Question 39

What are treatment ideas to work on social play?

Answer 39

Play face to face games without toys
Imitate my child’s actions and communications
Drawing infant attention to the parent’s face and voice
Increase affect

Question 40

What are treatment ideas to work on exploration?

Answer 40

Expand to show the next developmental step.

Change the environment in terms of availability and novelty of toys

Question 41

What are treatment ideas to work on joint activity?

Answer 41

Joint perseverative play (make it interactive)
Be more interesting than my child’s distractions
Keep my child for one or two more turns than usual
Model simple sequences of pretend play
If imitation occurs, label my child’s actions

Question 42

What are treatment strategies to help intentional communication?

Answer 42

Model “help” or “fix it”

Question 43

Who delivers the intervention in kids with ASD?

Answer 43

Parents