Chapter 14 Part 2: ASD and ADHD Flashcards
What is social (pragmatic) communication disorder
includes the diffiulties in social communication seen in ASD but without restricted, reptitive patterns of behaviour. aka PDDNOS
3 major characteristics of ASD
1) impairments in social communication and social interaction and difficulties maintaining relationships and adjusting behaviour to suit various social contexts.
2) restricted and repetitive patterns of behaviour, interests or activities
3) impairments are seen in childhood that interfere with normal functioning
the DSM5 follows the ___ model
medical model. The concept that diseases have physical causes that can be diagnosed, treated, and in most cases cured(or at least that is the presumed ultimate goal
What is neurodiversity
a concept where neurological differences are to be recognized and respected as any other human variation.
maybe ASD is just neurodiversity; range of differences in individual brain function and behavioural traits and other brain functions, regarded as part of normal variation in the human population.
3 fundamental principles of the neurodiversity paradigm
1) neurodiversity– the diversity of brains and minds– is a natural, healthy, and vulnerable form of human diversity
2) there is no “normal” or “right” style of human brain or human mind, any more htan there is one “normal” or “right” ethnicity, gender or culture
3) The social dynamics that manifest in regard to neurodiversity are similar to the social dynamics that manifest in regard to other forms of human diversity (e.g., diversity of race, culture, gender, or sexual orientation). These dynamics include the dynamics of social power relations –the dynamics of social inequality, privilege, and oppression –as well as the dynamics by which diversity, when embraced, acts as a source of creative potential within a group or society.”
neurodivergent
means having a brain that functions in ways that diverge significantly from the dominant societal standards of “normal
Specifiers for ASD
without or without intellectual impairment, language impairment, or if there are genetic/environmental factors.
in people with ASD/ASC, difference in social communication and social interaction may include:
–Challenges with pragmatic language
–Failure to develop age-appropriate social relationships
–Challenges with engaging in joint attention, social referencing, perspective-taking/theory of mind
–May be disinterested in social situations
–Display deficits in nonverbal communication
–Lack prosody of speech
–“Abnormalities in eye contact
in people with ASD/ASC, Restricted, repetitive patterns of behaviour, interests, or activities may include
Repetitive motor or vocal behaviours (previously referred to as self-stimulatory behaviour,or “stimming”)
–Stereotyped and ritualistic behaviours
–Complex rituals that if interrupted or prevented, may lead to severe frustration
–Difficulty with transitions, changes in routine, rigid thinking (concrete, black-and-white thinking), restricted eating patterns
–Sensory differences (hyper-or hypo-sensitivity)
3 levels of severity of ASD
1) requiring support
2) requiring substantial support
3) requiring very substantial support
there are lots of abberances to communication in people with ASD, but what three aspects MUST be present for someone to be diagnosed with ASD?
1) problems with social reciprocity
2) problem nonverbal communication (ie/ eye contact, gestures)
3) problems with maintaining social relationships
people with ASD have problems with ___ attention
joint attention: attention shared by two persons toward an object after one person has indicated interest in the object to the other person
people with ASD may repeat the speech of others, a patern known as ____
echolochalia
T/F rett’s syndrome and childhood disintegrative disorder is part of pervasive developmental disorders
true. autism, asperger disorder, and PDD-NOS are also part of pervasive developmental disorders
what problems with normal play do children with ASD have?
they do not have spontaenous imaginative or pretend play seen in children who are neurotypical
what is maintenance of sameness?
an intense preference for the status quo. people with ASD have an extreme maintenance of sameness and often get upset if routine is disrupted.
In higher functioning individuals, maintenance of sameness may take form in an obessive interest in certain very specific subjects (ex/ such as following airline schedules)
gender differences seen in ASD. How is this exacerbated? Why are there problems with this number?
male to female diagnostic prevalence of 4.5;1.
Estimates tend to vary by cognitive ability:
o As high as 10:1 male to female in more cognitively able individuals
o As low as 2:1 among individuals with intellectual disability
-Some suggestion though that current diagnostic criteria and processes are male biased.
o Ex/ if a little boy is shy and not engaging in play on the playground, he will be identified sooner. But if a girl is quiet and doesn’t play much, she is classified as a “sweet little girl,” and this antisocial/shy behavior is not linked
usually, ____ abilities and ___ ___ are reliable predictors of how children with ASD will fare later in life.
usually, LANGUAGE abilities and IQ SCORES are reliable predictors of how children with ASD will fare later in life.
link between gender identity and autism
There is growing evidence that a large proportion of autistic people identify outside the traditional male/female gender binary; transgender, non-binary, or other gender identity
People with autism “do not care” as much about social rules, but what that also in a way does makes them more authentic; if they are not being hindered by what peers expect them to be
Medical conditions that have been associated with ASD
1) rubella
2) hypsarrhthmia
3) tuberous sclerosis
4) cytomegalovirus
What neurological receptor dysregulation is associated with ASD
there is an association between ASD and oxytocin receptor gene, because oxytocin is shown to have a role in how we bond with others.
Some studies have shown that children with ASD have lower levels of oxytocin in their blood.
genetic influence of ASD
15-20% of siblings of individuals with ASD/ASC also meet criteria for ASD
Moderate genetic heritability
Majority of cases are result of action of many common genetic variants which together produce characteristics of autism; action of any given gene is very small
Minority of cases of ASD are connected to a rare genetic mutation; ex/ _____ most of these cases involve additional intellectual disability.
fragile X
prenatal environmental causes of ASD
1) exposure to valproate (anti-epileptic drug)
2) Birth complications such as reduced blood supply, reduced O2, or trauma to the infant
Weaker links to
o C- section
o Maternal obesity
o Maternal diabetes
there is a correlation between PATERNAL age and ASD. Why might this be?
due to de novo mutations. Suggests that mutations may occur in the sperm of fathers that influence the development of ASD
implications of amygdala and autism
people with ASD have less neurons in their amygdala in adults, but as children, they actually have larger amygdalas, may cause excessive anxiety and fear, perhaps contributing to their social withdrawal.
why may people with ASD have less neurons in their amygdala in adults?
because of the chronic release of stress hormone cortisol, damages the amygdala.
ASD comorbidities
1) intellectual disability
2) savant syndrome
3) language disorders
4) anxiety
5) feeding and eating disorders
6) self injurious behaviour
7) *GI symptoms
why may anxiety be comorbid with ASD?
may be relayed to a general construct of intolerance of uncertainty. Research evidence supports use of CBT to manage ASD-anxiety.
primary behavioural modification is focused on ___ ___ for children with ASD
early intervention.
what is applied behaviour analysis
derived largely from operant conditioning theory (behaviour modification)
–Rationale: intervene early in order to take advantage of greater neural plasticity to improve communication and social skills and prevent worsening of symptoms. Increases communication, socialization, living skills
Main psychosocial treatment for people with ASD
CBT for anxiety and mood problems, with a de-emphasis of the cognitive introspection methods, with a bigger focus on behavioural modification
Lovass (the psychiatrist) is a big proponent of using ___ ____ ___to help treat/support autism
applied behavioural analysis (ABA). Use of operant conditioning to modify behaviour. (like rewards and slapping**)
Used very harsh punishment to get rid of autistic behaviours. Lovass was criticized. He also started to apply this harsh punishment operant conditioning theory to young males that expressed sex-role deviancy (ie/ doing typically “non-male” activities). Essentially, this ABA is thought to be a type of “conversion therapy” of people who are autistic.
What is ABA linked to?
PTSD
naturalistic teaching strategies
psychosocial treatments to ASD that involve child-directed rather than adult-directed techniques. Brings therapy away from a classroom and into the home, school, and community.
general process of a natural teaching strategy
making an environment so that the child initiates an interest and this is used as a teaching opportunity
ex/ placing a favorite toy just out of reach, and then making the kid say “I want the trunk,” using the object of interest as a reinforcer.
alternative to teaching communication skills to children who have limited speech (like kids with ASD)
using Picture Exchange Communication Systems.
for children with ASD, most therapy consists of:
school education combined with special psychological supports for problems with communication and socialization. As children with ASD grow older, intervention focuses on efforts to integrate them into the community.
What is masking/passing
when autistic individuals hide their autistic traits in order to “fit in” and not cause discomfort in neurotypicals.
Neurodiversity with ASD
Neurodiversity
Using person-first language vs identity-first language.
- This is not universal preference. 60% of individuals prefer identity-first language; personal choice/preference. Some people with autism actually prefer to call them selves an “autistic person” possible shift.
High functioning and low functioning vs high and low support needs
o Support needs is more flexible, and can be specifically applied to different domains, different settings, and at different times (less of a global functioning implication)
o High functioning terminology implies that most ASD individuals are low functioning.
- Predisposes a loss of confidence in the individuals with ASD. Suggests that they will “never be normal.” Functionality terminology is problematic with both high and low terminology
- Masking/passing—when autistic individuals hide their autistic traits in order to “fit in” and not cause discomfort in neurotypicals.
Why may stimming be beneficial
Stimming is output in order to receive input without being overwhelmed
- Rocking, picking, doodling, even aroma therapy, self harmer
- May actually be beneficial ( not the self harm) to let them continue, as it is therapeutic.
