Class 2 Flashcards
Impact of neglect on brain
Primary goal is survival, not development of cognition, socio-emotional and regulation.
Neocortex can’t develop after chronic adverse childhood events= clumsy, impulsive, attention seeking, agitated, irritable, difficulty learning, oppositional, tendency to move away when they’re supposed to stay close.
Interviewing a child
Engaging in play = see a lot about the attachment, frustration tolerance, ability to follow rules, memory, affect modulation, language. Content of play/ drawing: can reflect what’s going on (depression, abuse, trauma, anxiety), sitting at their level, describe the agenda. Family, teacher, GP, social worker. Not more than 45 min. Ask them to draw, describe worst + best events, 3 wishes, open ended question with multiple choice answers, rate feelings 1-/0. Past assessments.
Members, each person’s history, dynamics between each individual, genograms, ecomaps, physical interactions, nonverbal, where does everyone sit
Parents can describe: routine, agitation, lying, developmental milestones, medical history, family history, watch for parental bias
Kids: obsessions, sex, drug, what’s happening at school, mood, suicidal ideation, perceptual disturbances
complex trauma, child will present with
ODD, ADHD, agressivity, anxiety, behavioral issues, sleep diff, enuresis
reactive attachment disorder
common in kids of DYP, don’t show wide range of emotions, more sad, more withdrawn, big temper tantrums, don’t seek comfort from their primary caregivers, don’t demonstrate affection themselves
Prevalance ASD
1,64% 5M=1W 44% don’t have ID
Etiology of ASD
Neuro: changing total brain volume, disproportionate enlargement in temporal lobe white matter and increase in surface area of the temporal, frontal and parieto-occipital lobes, overall impairment in brain connectivity networks associated with attention, consciousness and self-awareness, greater amygdala hyperarousal, differences in face processing, differences in activation.
Physio: tuberous sclerosis, fragile x syndrome, maternal rubella, congenital hypothyroidism, phenylketonuria, neurofibromatosis, angelman syndrome, seizure disorder
Gen: hereditary
Perinatal: asthma/ allergies at pregnancy, advances maternal and paternal age, gestational bleeding, gestational db, first born, umbilical cord complications, birth trauma, fetal distress, low birth weight, congenital malformation, hyperbiliriumia, ABO blood group system/Rh incompatibility
Warning signs of ASD in a child under age three
Social skills:
doesn’t respond to name
avoids eye contact/ will look at facer instead of eyes
prefers playing alone to playing with others
doesn’t share with others, even with guidance
doesn’t understand how to take turns
isn’t interested in interacting or socializing with others
doesn’t like or avoids physical contact with others
isn’t interested or doesn’t know how to make friends
doesn’t make facial expressions or does make inappropriate expressions
can’t be easily soothed or comforted
has difficulty expressing or talking about feelings
has difficulty understanding other people’s feelings
never cries
doesn’t pretend play
Use their parents as a piece of furniture
Language and communication skills:
has delayed speech and language skills (falling behind peers)
repeats words or phrases over and over
doesn’t answer questions appropriately
repeats what others say
doesn’t point to people or objects or doesn’t respond to pointing
reverses pronouns (says “you” instead of “I”)
rarely or never uses gestures or body language (for example, waving)
talks in a flat or sing-song voice
doesn’t use pretend play (make believe)
doesn’t understand jokes, sarcasm, or teasing
Irregular behaviors:
performs repetitive motions (flaps hands, rocks back and forth, spins)
lines toys or other objects up in an organized fashion
gets upset, frustrated by small changes in daily routine
plays with toys the same way every time
has odd routines and gets upset when not allowed to carry them out (such as always wanting to close doors)
likes certain parts of objects (often wheels or spinning parts)
has obsessive interests
has hyperactivity or short attention span
refusal to eat certain textures/ certain of clothes
Other potential autism signs:
has impulsivity
has aggression
self-injures (punching, scratching themselves)
has persistent, severe temper tantrums
has irregular reaction to sounds, smells, tastes, looks, or feels
has irregular eating and sleeping habits
shows lack of fear or more fear than expected
Intellectual disability vs ASD
social skills on par with cognitive development
Communication disorder vs ASD
social skills are preserved
Comorbidities ASD
aggressivity, ADHD, anxiety, conduct disorder, epilepsy (30%), ARFID, sleep disturbances
Eval ASD
ADOS, multidisciplinary
1. Historical information
Early development and characteristics of development, pregnancy
Age and nature of onset
Medical and family history
2. Developmental and psychological assessment
Intellectual level and profile of learning
Communicative assessment (receptive and expressive language skills, use of nonverbal communication, pragmatic use of language)
Adaptive behavior (ability to generalize skills to real-world settings)
Occupational/physical therapy assessments as appropriate
3. Psychiatric examination
Nature of social relatedness (eye contact, attachment behaviors, reciprocity, insight)
Behavioral features (stereotypy/self-stimulation, resistance to change, unusual sensitivities to the environment)
Language/communication difficulties (echolalia, presence of communicative speech, etc.)
Play skills (nonfunctional use of play materials, symbolic play, and imagination)
4. Medical evaluations
Search for associated medical conditions, genetic abnormalities, presence of seizures EEG
With additional tests as needed
Hearing/vision test
Additional consultation (neurologic/pediatric/genetic) as indicated by history and current presentation
Examination (e.g., EEG, CT/MRI scan (neurological signs), chromosome analysis)
