Chapter 16 - Autism Spectrum Disorders

Question 1

Autism Spectrum Disorder

Answer 1

• significantly impaired behavior or functioning in multiple areas of development that are disproportionate to their age:
  
  • social interactions, behavior/flexibility of behavior, verbal and nonverbal behavior, interests
• typically noticed at very young age

Question 2

What are the two categories of symptoms of ASD?

Answer 2

• social interactions and communication
• repetitive activities and restricted interests; addition of sensory criteria (sensitivity to certain stimuli)

Question 3

Social interactions and communication (category 1 of symptoms of ASD)

Answer 3

• inability to relate to, to be interested in, or enter into social interactions
• deficits in nonverbal communication like showing inappropriate facial gestures
• disconnection w/ others, apathetic, aloof
• difficulty developing and maintaining relationships

Question 4

What is language like in pts with ASD?

Answer 4

• literal and concrete - pragmatic
• difficulty learning language
• ranges from rudimentary to nonverbal
• comprehension is difficult

Question 5

Restrictive/Repetitive Behaviors

Answer 5

• restricted, repetitive patterns of behavior, interests, or activities as follows:
  
  • stereotyped or repetitive speech, motor movements (flapping hands, rocking, pigeon-toed), use of objects
  • excessive adherence to routine (everything has to be the same, difference can cause anxiety or rage)
  • highly restricted and abnormally intense, fixated interests
  • hypo or hyper reactivity to sensory input or unusual sensory interests
  • not interested in imaginative/symbolic play

Question 6

Epidemiology of ASD

Answer 6

• occurs in 4-5 out of 10,000
• more common in males

Question 7

Etiology of ASD

Answer 7

• perinatal complications/abnormalities in brain development
• gene/environment interaction (~20 genes involved)
• correlated with immune and gastrointestinal symptoms

Question 8

Some children with ASD may show a 25-50% increase in ______.

Answer 8

serotonin

Question 9

Along with the increase in serotonin, what are the other neuropsychological pathogeneses of ASD?

Answer 9

• greater head circumference due to having two growth spurts after being born with smaller head
• atypical white to gray matter ratios
• structural and functional abnormalities of the cerebellum contribute to attentional difficulties
• volumetric reductions in limbic system
• hypofrontality

Question 10

Neuropsychological Assessment

Answer 10

• children show deficits on several cognitive domains including:
  
  • language
  • memory
  • executive functions (difficulty determining meaning of literal or hypothetical language, reasoning/abstract thinking, can’t determine whole from its parts)
  • deficiency in academic performance

Question 11

Executive functioning in ASD

Answer 11

• poor complex planning and mental shifting performance
• “stuck in set” perseveration (inability to let go of step 1 to move onto step 2; only able to sort by color in WCS, not number or shape)
• impairment in executive planning
• tested via Wisconsin card sort

Question 12

Social cognition in ASD

Answer 12

• impairment in facial perception, social orientation, joint attention (sharing activities or conversation), imitation, and TOM
• prefer objects over humans

Question 13

Theory of Mind (TOM)

Answer 13

• capacity to understand other people by ascribing to mental states of others
• predicting other’s responses
• knowledge that others beliefs, desires, intentions, emotions and thoughts may be different from one’s own
• empathy

Question 14

Developmental course of ASD

Answer 14

• generally detected before the age of three
• tend to be better with visuospatial tasks

Question 15

Toddler and preschool years (developmental course of ASD)

Answer 15

• onset of speech and lang. delayed
• exhibit echolalia and reversed pronouns

Question 16

Elementary age (developmental course of ASD)

Answer 16

• developmentally delayed exhibiting unusual behavior patterns
• struggle developing long-lasting friendships

Question 17

Adolescence (developmental course of ASD)

Answer 17

• continue to exhibit deficits in one or more cog domains
• some teens regress
• 80% do not go on to work

Question 18

Tx of ASD

Answer 18

• behavior modification (targeting a specific behavior and rewarding it) - best option!
• speech/lang therapy
• MAYBE pharmacological (antipsychotics if engaging in severe self harming behaviors)