Child and Adolescent Psych - Autism Spectrum Disorder Flashcards
What is ASD in general?
A neuropsychiatric disorder characterized by patterns of delay / alterations in development of social, communicative, and cognitive skills beginning in the first years of life
Why were all the different diagnoses clumped into the ASD with the DSM 5?
DSM criteria had been applied inconsistently, with poor differentiation between these disorders
Why is early intervention so important in autism? What aspects does the disorder affect?
It is a disorder of learning, which can slow development and start a snowball effect
Changes occur in: Social observation, imitation, and generalization of skills
When is autism typically diagnosed, and is it more common in boys or girls?
Typically diagnosed around age 4, more common in boys
-> symptoms typically noticed by 2nd year of life
What neurobiological abnormalities are known to be associated with ASD? One important environmental exposure?
Neurobiological - EEG abnormalities & seizure disorders
Environmental - Fetal exposure to valproate
What are the diagnostic features of ASD?
- Poor social interactions, social communication deficits
2. Repetitive / ritualized behaviors, and restricted interests.
Why might ASD symptoms not be seen until later in life?
Symptoms may not precipitate until the social demands exceed their capacities, or may be masked by coping techniques
What are two things which are commonly specified with ASD?
with or w/o accompanying intellectual impairment
with or w/o accompanying language impairment
-> without both of these is generally thought about as Asperger’s
What are the three levels of ASD severity?
Level 1 - least severe, requires some support. Will have decreased interest in social interactions and difficulties switching between activities, with poorer independence
Level 2 - requires substantial support, marked deficits, reduced or abnormal social responses, and repeated behaviors are obvious to casual observer
Level 3 - Most needy, very limited social interactions / social responses, restricted behavior interferes with functioning in all spheres
What does it mean when we say ASD may lack social-emotional reciprocity?
Failure of back & forth conversations, sharing of interests, and failure to initiate or respond to social interactions
What are two other social deficits ASD kids will have?
- Defects in nonverbal communication (i.e. poor eye contact, body language, facial expressions)
- Deficits in peer relationships - lack of interest in peers and lack of cooperative play
How can ASD social developmental deficits be seen in infancy?
Lack social smile, anticipatory posture (for being picked up), and failure to differentiate primary caregiver. May have poor attachment behavior.
How can ASD social developmental deficits be seen in childhood and adults?
Childhood - Difficult playing with peers due to awkward / inappropriate social behavior, cannot detect feelings of others
Adults - lack of relationships
How is language in autism often affected? What are idiosyncratic phrases
Stereotyped noises, Echolalia (repeat what people say), have difficulty putting meaningful senses together, may use a word once then not say it again
use of idiosyncratic phrases - i.e. will only speak lines out of a Disney movie they know
How is restricted, repetitive behavior characterized in ASD?
- Stereotyped / repetitive movements and in use of objects / speech - steorotypies
- Insistence on sameness, inflexibility / ritualized behavior - i.e. extreme distress at small changes
- Highly restricted, fixated interests which are abnormal in intensity / focus -> way too focused on one thing, possible savantism
- Hypo/hyper reactivity to environment
What is an example of hypo / hyper-reactivity to the environment?
Apparent indifference to pain / temp (wont even care if they bang their head)
Will have adverse response to specific sounds, or be fascinated by lights / movement
What are islets of precocity?
The rare areas where an ASD kid is very developmentally ahead of the curve -> savantism
What type of infection are ASD kids more susceptible to?
URIs, also GI symptoms
What are the good prognostic factors of ASD? Poor prognostic factor?
Good: Normal IQ and development of communicative language by age 5
Poor: Grand mal seizures
What is commonly confused for ASD? Are they reversible?
Global developmental delay / intellectual disability, and psychosocial deprivation
Psychosocial deprivation is reversible -> need to put in a good environment and they can recover
What are the treatment goals of ASD?
Increase socially acceptable & prosocial behavior
Decrease odd behavioral symptoms
Improve verbal / nonverbal communication
What are the typical avenues to accomplish the treatment goals of ASD?
Parental support & counseling
Language remediation for speech delay -> speech therapy
Educational interventions -> classroom changes
**Applied Behavior Analysis (ABA) ** -> teach them learning
OT/PT, and sensory integration therapy
What are the pharmacological treatments of ASD for?
Targeting specific symptoms / common comorbidities
If aggression -> Risperidone
SSRIs for comorbid depression / anxiety
Stimulants for comorbid ADHD
What are some general unpleasant associated features of ASD?
Instability of mood, hyperkinesis, aggression and tantrums, selfinjurious behavior, insomnia / eating problems, enuresis, intellectual / language disability
What is Asperger’s basically?
A subset of ASD, with no language or intellectual impairment, but clearly marked decrease in social interactions which can lead to teasing / bullying
What causes Rett syndrome and who gets it?
X-linked dominant MECP2 gene mutation -> homozygous lethal in males
MeCP2 gene = Methyl Cytosine-binding Protein 2 -> needed for brain development
-> cases are usually de novo, but some are rarely asymptomatic (not penetrant)
Seen in females only
What are the diagnostic features of Rett syndrome?
Encephalopathy beginning between 6 months and 2 years (normal development early)
Loss of purposeful hand movements, with stereotypic hand-wringing, ataxia, head circumference growth deceleration, loss of language skills
What is social (pragmatic) communication disorder?
Disorder of social / communication aspects without other features of ASD
-> difficulties in social use of verbal / nonverbal communication
What are the common manifestations of social or pragmatic communication disorder?
Deficits in using appropriate communication for context / listener needs. Cannot understand the implied meaning or multiple meanings of words and phrases very well.
Sometimes when things are said, you mean to imply many things “We are going to the store, remember it’s raining” -> need them to infer you need to put on your raincoat, etc. They have difficulty understanding whats not explicitly stated.
