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Neuropsych Board Prep > Autism Spectrum Disorders > Flashcards

Autism Spectrum Disorders Flashcards

1
Q

What is the difference between the DSM-IV and DSM-5 classification of ASD?

A

In the DSM-IV the category includes Autistic Disorder, pervasive developmental disorder not otherwise specified, Asperger’s disease, childhood disintegrative disorder, and Rett’s disorder

In the DSM-5 the disorders are collapsed into a single diagnostic category of Autism Spectrum Disorders

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2
Q

What are the two main characteristics of ASDs?

A

1) Deficits in communication and socialization

2) The presence of restricted and repetitive behaviors

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3
Q

What are three deficits in social communication and social interaction as defined in the DSM-V?

A

1) Impaired social-emotional reciprocity
2) Deficits in non-verbal communicative behaviors
3) Deficits in developing, maintaining, and understanding relationships

*Must have all of the following to meet criteria for ASD in the DSM-5

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4
Q

What are the four features of restricted and repetitive behaviors and interests as defined by the DSM-5?

A

1) Stereotyped or repetitive motor movements, use of objects, or speech
2) Inflexible, ritualized behavior
3) Fixated interests
4) Hyper- or hypo-reactivity to sensory input

*Must have 2 of the 4 to meet criteria

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5
Q

How are the symptoms of ASD rated in the DSM-5?

A

With a severity dimension rated from Level 1 (requiring support) to Level 2 (requiring substantial support) to Level 3 (requiring very substantial support)

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6
Q

What is PDD-NOS (as defined by DSM-IV)?

A

Individual presents with a deficit in social relatedness, along with either a deficit in communication OR the presence of restricted and repetitive behaviors

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7
Q

What is Asperger’s Disorder (as defined by DSM_IV)?

A

Presence of impaired social ability AND restricted and repetitive behaviors in the absnece of a language delay or significant impairment in adaptive functioning

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8
Q

What is Rett’s Disorder (as defined by DSM-IV)?

A
  • Genetic disorder that occurs primarily in females
  • Associated with the MeCP2 gene
  • Early development until age 6-18 months followed by deterioration in motor and social skills
  • Marked by a loss of purposeful hand movements that are replaced by repetitive hand mannerisms
  • Accompanied by progressive cerebral atrophy
  • Regression–>plateau (months to years)–>slow growth of skills
  • Outcome: nonambulatory and severe cognitive deficits
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9
Q

What is Childhood Disintegrative Disorder (as defined by DSM-IV)?

A
  • Marked by periods of typical development followed by loss of social and communicative skills after 2 years of normal development
  • After regression, children have features of ASD
  • Many never develop language and have severe ID, repetitive behaviors, and aggression
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10
Q

In the DSM-5, what diagnosis would children with social communication deficits but no repetitive behaviors or interests qualify for?

A

Social (Pragmatic) Communication Disorder

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11
Q

Why does autism have an unclear anatomical basis?

A
  • It has an unclear anatomical basis d/t heterogeneity of clinical presentation & high rates of comorbidity
  • Thought to originate on a biological level (i.e., genes, proteins, and molecules) and across hierarchy of levels of integration (e.g., tissues, brain regions, etc.)
  • Feedback from the environment shapes the phenotypic expression of the core symptoms
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12
Q

What suggests that ASDs are highly determined by genetics?

A

High concordance rates in MZ twins and low concordance rates in DZ twins

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13
Q

What is the most replicated biological findings in ASDs?

A
  • Brain size is often larger in younger subjects
  • It is often normal or small at birth, then a growth spurt btw. 6 and 24 months followed by slowed growth over time
  • Corpus collosum is typically undersized
  • Perfusion within the brain is lower
  • Diffusion tensor imaging shows a reduction in fiber integrity
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14
Q

What has research into the neurochemical basis of autism demonstrated?

A
  • Monoamines may have an influence on systems that are commonly impaired in autism such as mood, arousal, and attention
  • Hyperserotonemia in the blood was the earliest biological finding in autism
  • GABA and glutamate show decreased activation
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15
Q

Describe a neuropsychological theory of ASDs.

A
  • Individuals with ASDs are thought to have impairment of higher level cognitive skills that underlie goal-oriented behavior in executive functioning
  • This contributes to impairments in memory, planning, inhibition, flexibility, and self-monitoring
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16
Q

What is a “weak central coherence?”

A
  • Individuals process featural and local elements of stimuli at the expense of global meaning
  • Contributes to difficulty integrating information from the environment into a meaningful whole
  • Very common in individuals with ASDs
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17
Q

Describe social motivation theory and ASDs.

A
  • Social motivation theory suggests that individuals with ASDs have a decreased level of motivation to orient to social stimuli
  • This derails normal developmental pathways of social and comminication skills
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18
Q

What are the main risk factors for autism?

A
  • Genetic polymorphisms influenced by environmental contributions
  • Some research implicates genes controlling synaptic functioning
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19
Q

What are the incidence and prevalence rates of ASD?

A
  • Incidence= 1 in 110 individuals
  • Prevalence= 6.7 per 1000 children or about 1 in 88
  • Prevalence rates have increased over time and unknown if this is due to increased occurrence, improved diagnostic criteria, increased awareness, or relaxed diagnostic practice
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20
Q

Does ASD occur more commonly in males or females?

A
  • Males with a gender ratio of 4:1
  • Varies based on IQ: females with ASD have lower nonverbal and verbal IQs
  • Male to female ratio approaches 2:1 in those w/ ASD and mod to severe ID
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21
Q

What are the most common comorbidities associated with ASDs?

A
  • ID (40-69%)
  • Anxiety disorders (7-84%)
  • Depression (4-58%)
  • Tic disorders (6%)
  • Seizure disorders (11-39%)
  • ADHD (55%)
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22
Q

What are some measures used to assist with diagnostic evaluation?

A
  • Autism Diagnostic Interview-Revised: parent interview
  • Autism Diagnostic Observation Schedule: direct observation of behavioral sample through reciprocal play and social routines
  • Modified Checklist for Autism in Toddlers: 23-item screen completed by parent or caregiver
  • Childhood Autism Rating Scale: behavior rating scale a clinician rates
23
Q

At what age can ASDs be reliably diagnosed?

A

-18 to 24 months but some children show signs as young as 6 months

24
Q

What are some behaviors that children between the age of 6 to 12 months who later receive an ASD diagnosis will exhibit?

A

-Delayed vocal sound production, decreased babbling, reduced pointing, atypical eye contact, lack of social smiling, failure to respond to name, emotional flatness, disengagement of visual attention, diminished interest in social interaction, repetitive hand and finger mannerisms

25
Q

What are additional symptoms children with ASD will experience during their second year of life?

A
  • Delayed speech
  • Limited use of nonverbal communication
  • Lack of interest in peers
  • Limited imitation of others
  • Low rates of joint attentin
  • Restricted range of functional play
  • Greater frequency and duration of repetitive hand and finer mannerisms
26
Q

Between 20-47% of children with ASDs exhibit few symptoms until a loss of language and/or socialization skills at what age?

A

15-24 months

27
Q

What are symptoms of ASDs during the 3rd, 4th, and 5th years?

A
  • Communicative ability improves with time but language contains other abnormalities such as echolalia, unusual prosody, and poor reciprocal communication
  • Nonverbal communication continues to be impaired
28
Q

What is middle childhood like for children with ASDs?

A
  • Children may gain daily living skills
  • May become more aware of societal rules
  • Abnormalities in verbal and nonverbal communication and socialization skills remain
  • Small minority (5-20%) can lose all symptoms and function WNL (typically if had early intervention)
29
Q

Described adolescence for individuals with ASDs.

A
  • 11-39% suffer from seizures w/ ID
  • May also have behavioral difficulties, including self-injurious behaviors
  • May have increased communicative and social skills
30
Q

What is known about ASD symptomatology during adulthood?

A
  • 50% have poor outcome & require residential assistance, have few friends, and no employment
  • Many can be employed for at least several hours each week
31
Q

What are the four stages of Rett’s Disorder?

A

1) First stage: head growth deceleration, reduced interest in play, atypical hand mannerisms, deterioration in communicative ability, unusual eye contact
2) Second stage: classic symptoms of autism, dementia, and deteriorating motor abilities
3) Third stage: sx of ASD diminish & cog gains are made. Motor skills continue to decline and seizure onset is common
4) Fourth stage: motor abilities continue to deteriorate

32
Q

What are some common rule-outs for ASD?

A

Landau-Kleffner’s syndrome, fragile X syndrome, Heller’s syndrome, and Klinefelter’s syndrome.

33
Q

What are the typical intellectual profiles of those with autism versus Asperger’s?

A
  • Those with autism typically have strengths in nonverbal compared to verbal domains
  • Those with Asperger’s typically have strengths in verbal domains and higher IQs than those with autism
34
Q

What findings would you expect on tests of attention and processing speed for someone with autism?

A
  • Attentional abilities: variable; may have heightened attention to personally salient stimuli
  • Processing speed: likely to be impaired with verbal tasks but may be unimpaired with nonverbal tasks
35
Q

What findings would you expect on tests of language for someone with autism?

A
  • Low levels of language as toddlers and at preschool
  • Relative strengths in phonology/articulation, grammar, and single word receptive and expressive vocabulary
  • Semantics, higher-level output, prosody, comprehension, and pragmatic use may be impaired
36
Q

What findings would you expect on tests of visuospatial abilities for someone with autism?

A
  • A subset of those with ASDs have enhanced visual perceptual processing abilities
  • Many display deficits in face processing and face recognition
37
Q

What findings would you expect on tests of memory for someone with autism?

A
  • Memory for social information and autobiographical information is poor
  • Recognition and factual memory is typically preserved
  • Some may have a strong episodic memory of supranormal memory capacity for topics of interest
38
Q

What findings would you expect on tests of executive functions for someone with autism?

A
  • Deficits in this domain are common

- Problems with planning, shifting attention, monitoring performance, and cognitive flexibility

39
Q

What findings would you expect on tests of sensorimotor functions for someone with autism?

A
  • Impairment in fine, gross, basic, and complex motor skills involving planning and execution are common
  • Assessing motor skills without requiring imitation is important due to deficits in imitation skills
  • Tendency to experience overstimulation
40
Q

What findings would you expect on tests of emotion, personality, and social behavior for someone with autism?

A
  • Social impairment is a core deficit
  • Poor quality of reciprocal and social interaction
  • Social overtures may be unusual in quality
  • Limited empathic ability is common
41
Q

What findings would you expect on tests of adaptive behavior/skills for someone with autism?

A
  • Highly variable profile

- Most pronounced deficits are in socialization and communication domains

42
Q

What findings would you expect on tests of engagement for someone with autism?

A
  • May have difficulty understanding the nature of the testing, staying on task, paying attention, and answering questions in a relevant way
  • Social anxiety may affect performance
  • Ample time to complete tasks may be required due to tendency to perseverate
43
Q

When does early intervention need to occur to have the greatest likelihood for success?

A

Prior to age 5 with the optimal age being between two and three

44
Q

What two aspects of applied behavioral analysis are most effective in treating children with ASDs?

A
  • Task analysis and contingent reinforcement to help guide preferred behaviors and teach skills in a stepwise fashion
  • This can improve sustained attention and help with basic skills
45
Q

How do you utilize findings from intelligence tests and adaptive functioning to inform treatment in those with ASDs?

A
  • IQ often exceeds measures of adaptive functioning
  • Should focus on developing preacademic and basic self-help skills
  • In adolescence and those with lower IQs, vocational placement and career planning should be completed
46
Q

How do language skills inform treatment in those with ASDs?

A
  • Early language skills are a strong predictor of outcome
  • Speech and language should focus on semantic and grammatical skill acquisition, as well as functional communication
  • Semantics and pragmatic language skills should be targeted
  • Can consider using a picture exchange communication system or sign language
47
Q

What are additional treatments that can be considered for those with ASDs?

A
  • Social cognition: learning eye contact, imitation, requesting, and reciprocal interactions
  • Occupational therapy to target sensorimotor impairment
  • Desensitization to aversive stimuli
  • Relaxation and cognitive strategies
  • Functional assessment of repetitive behavior and extinguishing rewards
  • Cognitive-behavioral therapy
  • Medication for depression, anxiety, sleep problems, and irritability/aggression
48
Q

What medication has been approved by the FDA to treat children with ASDs who present with irritability, aggression, and self-injurious behaviors?

A

-SSRIs

49
Q

What is echolalia?

A
  • Repetition of sounds, words, phrases, or several sentences

- Observed in typical development btw agesof 12-30 months but generally fades

50
Q

What is idisosyncratic speech?

A

The use of words in an inappropriate way to form meaningful but unusual phrases

51
Q

What is a picture exchange communication system?

A

An augmentive communication system to aid children who have difficulties with spoken language

52
Q

What are restricted and repetitive behaviors?

A
  • Stereotypic motor behaviors, ritualistic behaviors, and insistence of sameness behaviors
  • Most often noticed during the second year of life and increases during the first 5 years
53
Q

What areself-injurious behaviors?

A
  • Behaviors that inflict injury on the individual

- They are most commonly observed in individuals with moderate to profound levels of ID

Neuropsych Board Prep (32 decks)

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