Chapter 6: Autism Spectrum Disorder

Question 1

Autisim

Answer 1

A complex neurodevelopmental disorder characterized by abnormalities in social communication and unusual behaviors and interests.

Question 2

ASD

Answer 2

Autism Spectrum Disorder

Question 3

What is ASD in terms of the DSM-5?

Answer 3

Characterised by significant and persistent deficits in social interaction and communication skills by restrictive patterns of interests and behaviours.

Question 4

ASD children exhibit preservation of sameness

Answer 4

anxious & obsessive insistence on the maintenance of sameness in daily routines & activities, which no one but the child may disrupt.

Question 5

Austim vs Intellectual disability

Answer 5

Both are characterised as Neurodevelopmental Disorders in the DSM-5

Question 6

ASD is defiend as a spectrum disorder

Answer 6

Its symptoms, abilities, and characteristics are expressed in many different combinations and in any degre of severity.
ASD is “All or Nothing’ phenomenon.

Question 7

What are the 2 symptoms domains of ASD?

Answer 7

1. Social communications and interaction
2. Restricted, repetitive patterns of behaviour, interests, or activities.

Question 8

What are the 5 domains for the diagnostic criteria for ASD in terms of the DSM-5?

Answer 8

A: Social communication and interaction
B: Restrictive and repetitive behaviours
C: Symptoms must be present in early developmental period
D: Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
E: These disturbances are not Intellectual Disability or global developmental delay

Question 9

Domain A: Social communication and interaction

Answer 9

All 3 required for ASD diagnosis

1. Deficits in social-emotional reciprocity - FAILURE of back and forth conversation, reduced sharing of interests, failure to respond to social interactions.
2. Deficits in nonverbal communication behaviour used for social interaction - Poorly integrated verbal and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships - Difficulty adjusting beahviour to social contexts, difficulty making friends.

Question 10

Domain B: Restrictive and repititive behaviours

Answer 10

AT LEAST 2 types are required for an ASD diagnosis

1. Stereotyped/repititive motor movements, use of objects, or speech - lining up toys or flipping objects.
2. Insistence of sameness, inflexible adherence to routines, ritualised patterns of verbal or nonverbal behaviour - extreme distress at small changes.
3. Highly restricted, fixated interests that are abnormal in intensity/focus - Strong attachment to unusual objects.
4. Hyperactivity or Hyporeactivity to sensory input or unusual interest in sensory aspects of the environment - Excessive smelling or touching of objects.

Question 11

What should people with a deficit in social communication be evaluated for?

Answer 11

If they have no other symptom of ASD, but only have a deficit in social communication. They should be evaluated for PRAGMATIC communication disorder.

Question 12

Specify if

Answer 12

• With/without accompanying intellectual impairment/language impairment - modifier
• Associated with a known medical or genetic condition/environmental factor
• Associated with another neurodevelopmental, mental, or behavioral disorder -modifier
• With catatonia [immobility]

Question 13

Specify severity

Answer 13

• Level 1 – Requiring support.
• Level 2 – Requiring substantial support.
• Level 3 – Requiring very substantial support.

Question 14

Children with ASD can be quite different from one another, we look at 3 factors

Answer 14

• Level of intellectual ability
• Severity of their language problems
• Behaviour changes with age

Question 15

CORE DEFICITS OF ASD:

Answer 15

A. Social interaction deficits
B. Social Communication deficits
C. Restricted and Repetitive behaviours & interests

Question 16

Social interaction deficits

Answer 16

o Children with ASD have profound difficulties in relating to other people
o A lack of monitoring of the social activities of others
o A lack of social and emotional reciprocity
o Unusual nonverbal behaviors such as using and processing atypical facial expressions, eye-to-eye
gaze, body postures, and gestures to regulate social interaction
o Impairments in JOINT ATTENTION: The ability to coordinate attention to a social partner and an object or event of mutual interest.

Question 17

Social communication deficits

Answer 17

• Display serious abnormalities in communication and language that appear early in their development and persist.
• One of the first signs of language impairment = inconsistent use of early preverbal communications (gestures & vocalizations)
• Children with ASD can use protoimperative gestures – gestures/vocalizations used to express needs.

*However, they will not protodeclarartive gestures - gestures/vocalisation ised to direct the visual attention of other people to objects of shared interest .
* Impairments in PRAGMATICS – the appropriate language in social & communicative contexts

Question 18

Restricted and repetitive behaviours & interests

Answer 18

• They are characterized by their high frequency, repetition in a fixed manner, and desire for sameness in the environment
• Some children may perform stereotyped body movement [such as rocking back and forth]
• A common type of repetitive speech – ECHOLALIA: parrot like repition of words immediately after hearing it.
• Perseverative speech – incessant talking of a topic or incessant questioning

Question 19

2 dimensions of restrictive repetitive behaviors in children with ASD

Answer 19

1. Repetitive sensory and motor behaviors
2. Insistence on sameness behaviors

Question 20

Self-stimulatory behaviors

Answer 20

repetitive body movements/movement of objects

Question 21

Associated characteristics of ASD:

Answer 21

1. Intellectual deficits and strengths
   - ID is common within children with ASD
   - Intellectual ability of children with ASD varies from Profound disability to Superior ability.

Question 22

AUTISTIC SAVANTS

Answer 22

Display super-normal abilities in calculation, memory, jigsaw puzzles, music or drawing

Question 23

Cognitive and motivational deficits

Answer 23

There are two types:

1. Specific cognitive deficits in processing social emotional information.
2. General cognitive deficits in information processing, planning and attention.

Question 24

TREATMENT OF ASD:

Answer 24

1. Minimise core problems of ASD
2. Maximise independence, and quality of life
3. Help child and family cope effectively with the problems

Question 25

Initial Stages

Answer 25

• Initial stages focus on building rapport and teaching learning-readiness skills
• Various procedures help the child feel comfortable being physically close to the therapist
• These readiness skills are taught using 2 approaches:
  1. Discrete trial training: step-by-step approach to presenting stimulus and requiring a specific response

2. Incidental training: strengthens behavior by capitalizing on naturally occurring opportunities

Question 26

Reducing disruptive behavior

Answer 26

• Tantrums, throwing objects, self-stimulation, aggression and self-injury
• How to eliminate disruptive behaviors? Rewarding competing behaviors, ignoring the bahavior,
  and mild forms of punishment.

Question 27

Teaching Appropriate Social Behaviours

Answer 27

Þ Priority in treatment of ASD.
Þ Involves teaching expression of emotions—facilitates reciprocity.
Þ Teaching social toy play; social pretend play; including others in activities.
Þ Social skills training—initiating and maintaining interactions; turn-taking; sharing. Þ Peer-focussed approaches

Question 28

Teaching appropriate communication skills

Answer 28

• Most effective when parents and clinician are actively involved
• Adding a speech-generating device (SGD; off-the-shelf tablet with communication software)
• Technology is being developed to help children with ASD in their communication

Operant speech training = step-by-step approach that first increases the child’s vocalizations and then teaches imitation of sounds and words, the meanings of words, labelling objects, making verbal requests, and expressing desires.

Question 29

Executive function intervention

Answer 29

Unstuck and On Target (UOT), uses cognitive-behavioral strategies to reduce insistence on sameness and to teach flexibility and planning.

Question 30

The most effective interventions for children with ASD include the following features (8)

Answer 30

1. Early: begin intervention as soon as ASD diagnosis is considered.
2. Intensive: Active engagement of child at least 25h a week, 12 months a year, in systematically planned, developmentally appropriate educational activities with specific objectives.
3. Low student-teacher ratio: Allow sufficient one on one time.
4. High structure: Use predictable routines, visual activity schedules.
5. Family inclusion: Include family component, with parent training as indicated.
6. Peer interactions: Promote opportunities for interaction with typically developing peers.
7. Generalisation: Teach child to apply learned skills in new settings and to maintain these skills.
8. Ongoing assessment: Monitor child’s progress and make adjustments to treatement as needed.