Exam 1 Flashcards
Who coined the term autism?
Kanner - 1943 > the first time “autism” was clinically used
-he recognized it as a spectrum, and as a product of development
-Autism = greek word meaning “inward self/ social withdrawal
-he came up with fridge mom but didn’t popularize it
What did Asperger (1944) compare autism to? What was his term for autism?
Childhood schizophrenia
-identified many of the diagnostic criteria as today
-called it autistic psychopathy
What did Bender (1953) do with autism?
radical invasive experimental treatments
-same diagnosis as schizophrenia
-used LSD, frontal luchotomy, and electrotherapy as treatment
-identified that its not due to poor childhood upbringing
What’s one thing about Bettheim (50s/60s)?
Believed autism had psychogenic origin, and the idea of fridge moms were the cause
-popularized fridge moms, didn’t make it up
-wasnt even a trained psychologist lol just released a book
What did Rimland (1964) believe about autism?
-That psychogenic/fridge moms weren’t the cause
-That autism was related to brain differences in the reticular formation - purely neurological causes
-too biological, not environmental enough
What did Wing (1979) differentiate autism from?
Differentiated autism from intellectual differences
-referred to it as a triad of impairment
-social communication differences
-behavioural differences
-autism continuum of strengths and differences - not a disorder
In the DSM I and II (1952/1968) consider autism as a diagnosis?
Nope - considered the same thing as childhood schizophrenia
What about the DSM III (1980)?
-added under developmental disorders
-focused on infant severe forms of autism:
lack of responsiveness, environment,
specified no hallucinations or delusions.
- must show symptoms before 30 months
What did the DSM III-R (1988) do with Autism diagnosis?
-Named Autistic Disorder, listed under PDD (pervasive developmental disorder)
-expanded criteria - must have 2 differences in each domain
What did the DSM IV-TR (1994, 2003) do?
-put autism in PDD category
-Aspergers, autism, rets , pervasive developmental disorder
-made criteria more specific
Tell me about the DSM-5 (2013)
Autism now referred to as Autism Spectrum Disorder (ASD)
Give me a brief description of the evolution of CAUSES of ASD
-Autism is not schizophrenia (Kolvin, 1971 + Rutter, 1972)
-Autism has a neurodevelopmental basis (1970, Hermelin/O’Connor + 1979, Rutter)
-Genetic basis of autism and twin studies (like showing diff inheritance rates, proving genetic cause) (1977, Folstien/Rutter + 1995, Bailey)
-Cognitive basis of autism (exec. disfunc. + over attention to detail) (1985, Baron-Cohen + 1989, Frith + 1991, Ozonoff)
Explain the points of evolution of TREATMENT of ASD (1950s, 1960s, 1960/70s, 1970/80s, 1990s+)
-1950s: Leucotomies, ECT and LSD - treatments for schizophrenia used for ASD
-1960s: Behavioural approaches - pos. rein., proof of env. impact, tactic of removing them from stimulation env., Lovaas (1965) claimed he could get rid of ASD lol
-1960s/1970s: Psychoanalytic approaches and the “Parentectomy” (remove child from “refrigerator parent”)
-1970s/1980s: Pharmacological studies: tried vitamins (didn’t work obvi), tried psychotics (helped but didn’t fully work), tried SSRIs (helped but didn’t work)
-1990s+: other intervention approaches
What is a refrigerator mother? Talk about the movie we watched
(said there will be broad q’s about movies + discussion after on exam)
-Moms blamed for children being autistic; told they were too cold, child rejected them
-child could only be autistic if white, upper middle class, and parents educated (ppl of colour would not be diagnosed)
-Isolation technique
-BUT REALLY: moms/parents were the experts on their children - this was ignored
What is the Isolation technique in relation to refiderator moms?
Isolate child from fam, remove all tools, lock them in a room… idk then hope they chill?
Are rates of autism today increasing?
yes (but see next card)
Why are rates of autism increasing?
Environmental factors:
-toxins, chemicals, hormones were being exposed to that weren’t there before
-later pregnancies
BUT see next card
Why may it seem like autism is increasing?
-better diagnostic criteria
-increased representation of autism
-increased diagnoses rather then more autism?
-recognition of wider spectrum
*environment is still contributing tho
What countries worldwide have been studied on ASD and therefore are comparable?
Canada, US, England, France, Finland, Iceland, Asia
*don’t have as much info on developing countries, so not comparable
Are the reports of “clusters” of ASD in some areas factual?
Not researched, only speculated by popular media so probably not true
Why is ASD political? Diagnosis:
-is it a disorder of just neurodivergent?
-ASD is the only diagnosis that requires a specific tool to diagnose (like compared to anxiety, which has many measures/tools)
Why is ASD political?
Terminology:
-DSM-5 removed different categories
-person first vs identity first > varying opinions on this
Why is ASD political?
Treatment:
-to treat or not?
-what works best?
-focus on early intervention or later?
Why is ASD political?
Advocacy and Supports:
-can get funding in Canada since 2003 for treatment of ASD, but not other diagnoses - this is controversial
What is the DSM definition of a “mental disorder”?
Clinically significant disturbance in an individuals cognition, emotion regulation or behaviour that reflects a dysfunction is psychological, biological, or developmental processes, underlying mental function
-associated with significant distress/disability
-not primarily conflicts between individual and society
Why do we make diagnoses? The good:
-access to support + resources
-validation/ understanding
-professionals can communicate clearly
-creates a common understanding for research
-guide treatment
-loose predictions of what person may go through/ how they might turn out
Why do we make diagnoses?
The bad:
-restrictive labeling
-negative self-perception
-negative perception of others
-hard to immigrate to some countries
-discrimination
-can become a self-fulfilling prophecy
-early diagnosis can lock in assumptions abt person
-pigeon holeing (educational lack)
-diagnostic overshadowing - everything is blamed on diagnosis
-inaccurate diagnoses
-need diagnosis to get help
What is a Categorical Approach to diagnosis?
(see slide 31 for visual)
DSM = categorical (but moving towards dimensional)
-problematic, but easier bc humans like to categorize
-assumes clear criteria
-assumes different diagnoses have diff causes
-hard to prove diagnoses are separate
-comorbidities
-understanding thresholds
-ppl have same label but often will look different
What is a Dimensional Approach to diagnosis?
-more of a spectrum
-quantified attributes
-more room for nature/nurture
-don’t have to recognize cause
-can have some differences - more flexible
-but harder to communicate about
Does Autism overlap with other conditions?
Yaaa
-repetitive behaviours + interests
-sensory needs
-social deficits
-communication deficits
-cognitive issues
-medical issues
-psychiatric issues (depression, anxiety, adhd, depression, OCD etc)
-NVLD?
-Genetic issues
What category was ASD listed under in the DSM IV (4)? What other diagnoses were in this category?
Listed under PDD
-ASD, Retts syndrome, Aspergers disorder, CDD (childhood disintegrative disorder), PDD, NOS
What were the 3 core criteria (triad of impairment) for ASD listed in the DSM IV (4)
- Qualitative impairments in social interaction
- Qualitative impairments in communication
- Restricted/repetitive behaviours and/or interests
What did they change about the PDD category in the DSM V (5)?
They removed all the other diagnoses listed under PDD in the DSM V (5), and made it one thing - Just ASD
-moved it to be more semi-dimensional (rather than categorical)
-so now its ASD with specifiers (mild, mod, severe with…)
*also changed PDD NOS diagnosis to SPLD (social pragmatic language disorder)
What did they do to the triad of impairment/ 3 core criteria when they moved from DSM IV to DSM V?
They collapsed the 3 into 2 categories, because the first 2 (impairments in social and communication) are too interrelated
-in the second category, they modified it to say “restricted/unusual interests and/or repetitive/stereotyped behaviours, restricted behaviours and sensory typicalities” - specifically mentioned sensory bc more problematic
-also added significant degree of functional impairment Severity Specifiers to second category
** see slide 36 if confused
What is the difference between the DSM IV and V when it comes to comorbidity diagnoses?
DSM IV TR made it so certain conditions couldn’t be diagnosed in the presence of ASD (ADHD, selective mutism, sep.anxiety, GAD)
-DSM V allows for diagnosis of comorbid conditions if meet symptoms thresholds (if meets full criteria, then diagnose)
Does the DSM-V TR have a more restrictive diagnosis for ASD? What specifically did they change?
**Go look at slide 38
Yes
-changed phrasing in section A from “the following” to “all of the following”, so now you must meet ALL of the following criteria rather than some
What does research tell us about the change from DSM IV to DSM V
that there are clinical and research implications
What is a core symptom of ASD?
Social dysfunction
Qualitative impairments in social-communication are characterized by differences in…..?
-social emotional reciprocity
-nonverbal communication
-Developing and maintaining relationships
What was Rutter the first person to differentiate ______ in autism from other _______
Social differences, intellectual disabilities
What is a cardinal symptom of autism? (cardinal means sign of symptom that might indicate a diagnosis)
Atypical social reciprocity
What does atypical social reciprocity look like?
-unable to recognize social overtures in others
-unable to correctly interpret social overtures
-unable to respond appropriately to social overtures
-not having the motivation to respond to social overtures
* on a scale from mild to severe
(A social overture is when a child or starts a conversation or asks a question to somebody else)
What is affective empathy? Do autistic people struggle with this?
Affective empathy is the
ability to emotionally resonate with someone - share that persons feelings.
Autistic folks struggle with cognitive empathy, but
not affective empathy.
What is cognitive empathy?
Cognitive empathy is related to the theory of mind - put yourself in someone else’s shoes and share their perspective.
-Autistic ppl struggle with this
Explain social differences in ASD and how they vary according to stage of development (infancy, childhood, adulthood)
Infancy: Imitation and joint attention
Childhood: social play and friendships
Adulthood: intimate and work relationships, friendships
What are 3 social differences/characteristics at age 0-3?
-smiles and shows pleasure to social interaction; comported by familiar adult
-responds positively to touch
-quiet when picked up; listens to voices
What are 5 social differences/characteristics at age 3-6?
-cries when upset and seeks comfort
-shows excitement by waving arms and legs
-smils at self in mirror; smiles and laughs
-enjoys looking at other babies
-pays attention to won name
What are 4 social differences/characteristics at age 6-9?
-plays peek a boo; shows several clear emotions
-responds to you when you talk to her
-starts to understand different emotions (frowns, angry tone)
-comforted by familiar people and anxious around strangers
What are 4 social differences/characteristics at age 9-12
-happy to see parent or self in mirror; differentiates stranger from family (cries when parent leaves)
-gives affection and love
-follows simple commands; turns to look when you call her name
-imitates some of your actions
early social behaviours are the precursor for more complex later behaviours
- early social milestones you need to hit to develop more complex
- sort of like a developmental cascade model.
- moms of autstic children dont smile as much at their children (because their children isnt smiling at them). but this can shape how the child develops
What is the difference between autistic kids and typically developing kids when it comes to “eye gaze”/eye contact?
-Typically developing new borns have a preference for faces. They are wired to
want to engage with faces.
-Autistic children there is less attracted to eye contact. They may miss social ques related to looking at others in regard to their motivational state.
* can be stressful for kids with autism
What is the definition of eye gaze? (I think)
Capacity and motivation to look at and sustain eye contact with others
What is imitation?
Mechanism through which infants share experiences with their caregivers around
objects of interest. Important for developing complex play
How do autistic children struggle with imitation
Autistic children have more difficulty with copying others. -do better when they are coached to do it (they do less of it naturally in their interactions).
-have some differences in reciprocal social play (peekaboo / patty cake). These
kinds of early social games are misunderstood / not enjoyed.
What is predictive of later communication difficulties (shows up as an infant)?
Joint attention
What is joint attention
Preverbal social communication skill that involves sharing with another person the experience of a third object or event
What are 2 forms of joint attention?
1) initiation of joint attention (kid points to obejct of interest)
2) response to joint attetnion. (parent looks at something, and child follows their gaze)
How do they study joint attention (in a child)
-retrospectively and prospectively
-look back at family videos, and looking at what the child is doing with respect to joint attention
-prospective - look at joint attention at that time, and follow up.
What are 4 types of early play?
- solitary object exploration (3-5 months)
- functional play (13-15 months)
- parent - infant play (has 4 types, listed in diff slide, 3-12 months)
- group play
What are 2 types of solitary object exploration?
- exploritory play - look at object, put in mouth, look again, inspecting
- non exploritory - banging, sensory process, kids with autism use this more.
Explain exploratory play
look at object, put in mouth, look again, inspecting
Explain non-exploratory play
banging, sensory process, kids with autism use this more
-odd patterns of looking
at object, looking at
parts of object opposed
to whole. non-exploritory
manipulation of toys.
What is the definition of early play?
Very complex activity, imagination, social skills, motor skills, forms basis for helping to develop both social and communication skills.
What are the 4 types of parent - infant play?
-face-face (3 months)
-social games (6-12 months)
-object mediated dyadic play (6-12 months)
-person directed play (10-12 months)
Explain face-face play
face to face play with others. look at them, smile, coo.. parents response is supposed to be exaggerated. child responds back. earliest form of turn taking.
*autistic children are less likely to respond.
Explain social games and object mediated dyadic play
-Playing with another person with an object.
-give object to parents / others to play with.
-shared enjoyment with dyad. -less likely to use gestures to get someone to play.
-more focused on object
Explain person directed play
Chasing, clowning around, meant to elicit response from caregivers.
-Differences with autism.
What do autistic children struggle with with group play?
Harder to be reciprocal, cant take other roles in game.
- group play is difficult.
Go look at slide about Javon in clinical features - social and talk about it
do it
___ social function can be predicted from ____ social deficits
later, early
Do early social deficits predict later social deficits?
yes
individuals with _____ cognitive ability are ____ likely to improve (social deficits)
lower, less
do environmental factors influence outcome? (social deficits)
yep
does variability in outcome. increase over time (social deficits)
yes ma’am
What is the developmental cascade model? (rogers et. al., 1991)
A “developmental cascade model” refers to a framework in developmental psychology that describes how early life experiences and interactions can have cumulative effects across different developmental domains, leading to cascading consequences for later behaviors and outcomes, essentially illustrating how one developmental factor can influence another, creating a chain reaction throughout development.
Slide 51 has a study, go look at it - points about it below
-the older they get, there is less social difficulties.
-there is a lot of variability within individuals.
-in general, 4-5 years scores are higher
-more social interactions with other kids at this age reveals more difficulty.
See slide 52, 53, 54 - 53 has a case Vignette (clinical features social lecture)
:)
Are social differences limited to ASD
nope, also applies to ADHD, anxiety depression, trauma etc.
-qualitative differences in social function specific to ASD
See slide 56 for another case vignette (clinical features, social)
rip
What are the three core language symptoms of ASD
-social emotional reciprocity
-nonverbal communication
-developing and maintaining relationships
What did Kanner and Asperger say about language as a symptom of ASD
Language was not initially a core criteria, but it was described
What did the DSM-III say about language as a symptom of ASD
-gross deficits in language development
-use atypically
-echolalia
-metaphorical language
-pronoun confusion
What did the DSM-IIIR say about language as a symptom of ASD
-no communication
-typical lack of imaginative play
-voice may sound atypical
-irrelevant statements
-pronoun confusion
What did the DSM IV say about language as a symptom of ASD
-only need one difference in communication
-lack of play
-lack of normal use of language
What does the DSM V say about language as a symptom of ASD
-combined verbal and social criteria
-have to have differences in all categories
What is phonology?
Sounds you can distinguish from each other:
“c” “t” “b”
In the DSM 5, you need atleast 2 of these for Repetitive behaviours
- Stereotyped / repetative motor movements (now includes speech)
- Insistence on sameness / inflexibility / rituals
- Fixed interests
- Sensory atypicalities
In the DSM eVoLuTiOn… when did they start saying that you needed to have 2 of repetitive behaviours instead of 1?
DSM 4 = 2 behaviours
DSM 3 TR – they started listing behaviours but you only needed 1 of them
What are morphemes?
Smallest meaning unit in a language
“walk” —-> “walked” = band morpheme
What is a syntax?
When you link morphemes together to create a sentence
According to Factor analytic studies (what? lol) what are the three different categories of repetitive behaviours?
- Repetative sensory motor behaviours ( lower order sensory category)
— stimming, hand flapping, spinning. - Insistence on sameness (higher orders sensory category)
—- things must not change - distinct interests / preoccupations / attachments factor (circumscribed / unusual interests)
– attracted to unusual things likeowl pellets.
– thought to be the most discriminate of autism (less seen in other dx)
– this is more recent
What are semantics?
Our ability to understand word meanings and how it fits together
What are pragmatics?
How we use language to communicate with others
-social aspects of language
-requires ability to take perspective of others
-words, non-verbal behaviours, facial expression, gestures, tone
What is procity?
How we use our voice in pragmatics: tone, volume, the sound of a persons voice and how that is use to convey meaning
Go to slide 60 - has some charts we don’t have to have memorized, but prob good to look at
I dare youuu
What are 4 moderating factors that make repetative behaviours more or less severe?
1) Age
2) Family Factors
3) behavioural temperament
4) intellectual ability (NVIQ)/ genetic disorder
What is the def. of non-verbal aspects of language?
Capacity to express ourselves using facial expressions, gestures, emotions.. important for both conveying our own message and understanding others.
How is age a moderating factor of the severity of repetitive behaviours?
kids usually get refered when they are 2/3 years old..
repetitive behaviours at this age is what gets them the most referred for ASD assessment (along with language)
repetitive behaviours are more common when younger..
you see fixed interests when older.
What is a gesture?
Simple: movement with meaning
Or: Using visible body actions to communicate a message either instead of speech or in conjunction with speech (hand, face, body)
how is family factors a moderating factor of the severity of repetitive behaviours?
family factors influence the severity
parents / siblings get involved in the behaviours.. try to accommodate them so there are no outbursts.
how is behaviour/ temparment a moderating factor of the severity of repetitive behaviours?
kids who are more moody / irritable / act out can have MORE severe repetitive behaviours, and outbursts when they cant satisfy
What are two kinds of nonverbal aspects of language?
-gestures and pointing
-facial/emotional expression
What are instrumental gestures?
Gestures that are used to deliberately convey a message. e.g., pointing at
something. have a goal, purpose of gesturing is to achieve goal
How is intellectual ability (NVIQ) / genetic disorder a moderating factor of the severity of repetitive behaviours?
- some component of repetative behviours has a genetic component..
e..g, fragile X kids have hand biting behaviours that you are less likely to see in other forms of autism.
When do stereotyped behaviours peak?
do they decrease over time?
what do they turn into?
they are the most obvious around 4/5 years old.
they decrease over time / get a little bit suppressed in the school system..
they often turn into circumscribed interests.
= kids focus on one topic. (one very special interest)
What are descriptive gestures?
Using our hands to give additional meaning to something
-Illustrating with hands
What are conventional gestures?
Conventional movements that are socially connected with our society
-socially understood by those around us. waving, middle finger, etc.
What are infant gestures tied to?
current and future language use
______ gestures are typically earliest form of _______ communications
conventional, infant
Okay now we’re talking hypotheses.. buckle up.
What are 4 different hypotheses for why people with ASD engage in repetitive behaviours?
(will make cards for each one after)
p.s. apparently none of these hypothesis’ are satisfactory
1) Self-stimulatory nature of RB’s (self-calming)
2) secondary consequence of social-cognitive deficits
3) Executive functioning problems
4) atypical attention processing.
Why are gestures important?
They are present early in infancy, develop in a sequence, and develop in tandem with language
(and remember they’re tied to current and future language use)
What three gestures are relevant to autism assessments?
Instrumental
descriptive
conventional
What are the 4 stages of gesture development?
Weird Penises Ejaculate Glue hehehheh
- Working gestures (9-14m)
- Preliminary social/conventional gestures (9-14m)
- Enacted or representational gestures (10-15m)
- Gesture + speech combinations (18m)
there are 2 hypotheses under “Self-stimulatory nature of repetitive behaviours (self-calming)”
What are they?
1) Perceptual reinforcement hypothesis
- proposes that behaviours cause positive perceptions in their environment.
-Environment is stimulating, which is positively reinforcing
- they like the perceptions that their behaviours create
2) sensorimotor integration hypothesis
- Sensory differences - not as good at it
- more reliant on getting kinesthetic (physical) feedback from the environment
- not well supported
So basically the first one is talking how they are positively reinforcing their own repetitive behaviours (behaviour is self rewarding)
Second one is they dont get sensory input from the world so they essentially create it for themselves
What does the working gestures stage involve (9-14m)?
Showing, giving, reaching
What does the preliminary social/conventional gestures stage involve (9-14m)?
-Performatives: wave bye-bye, shake head no etc.
-Developing understanding of conventional gestures
What does the enacted or representational gestures stage involve (10-15m)?
-begin with symbolic play (initially with toys)
-include pretending to drink out of a cup
What does the gesture + speech combinations stage of gestures involve?
use of gestures to compliment spoken info
“ the car was this big!”
What are two types of pointing?
-protodeclarative pointing
-protoimparative pointing
What is protodeclarative pointing?
When infant or child points spontaneously to draw someone else’s attention to something they are interested in
-linked to joint attention.
Tell me about the ‘Secondary consequences of social-cognitive deficits’ hypothesis of RB’s
allows them to avoid social situations.
can engage in self-stimulation opposed to socializing.
repetitive behaviour reduces anxiety
but research shows ASD people engage in people less? idk what that means
What is protoimparative pointing?
-autistic kids are better at this one bc no social aspect
-pointing to request an object, not share interest
-looking at person not required
Tell me about the executive functioning problems hypothesis of RB’s
- difficulty inhibiting behaviours
- cant suppress behaviours because of executive dysfunction
- difficulty generating novel patterns of behaviour so more often engage in repetitive behaviours.
What differences do autistic ppl have with gestures?
-imitation of gestures (gestures are learned through imitation)
-spontaneous production of gestures (mostly just do when asked)
-significantly fewer gestures used
-gesture use less advanced
-fewer spontaneous expressive gestures (less conventional gestures, the ones that are socially rooted, may look atypical if they are present)
Tell me about Atypical attention processing hypothesis of RB’s
people iwth autsim cant disengage from certain kinds of stimuli.. more focused on stimuli and that leads to repetitive kinds of beahviorus
How do repetitive behaviours in OCD/TS differ from repetitive behaviours in ASD?
in OCD/TS
- repetitive behaviours are to reduce anxiety
- but person becomes distressed that RB occupies so much time.
In ASD
- behaviour is rewarding and has a positive effect
How might playing with toys differ with kids with ASD?
- fixated on partiular part of toy
e.g., only the wheel/gears
—– They might enjoy the sensory properties of the part. - Instead of playing with toys they like to line them up.
—- lining them up in the same way every time
—- distressing if you interfere
—– don’t get some of the same learning experiences out of toys (like exploration and integration of toy)
—– lost opportunity for communication and social interaction with toys.
What is spontaneous use of gesture and imitation strongly
associated with in ASD?
Language development and severity of ASD symptoms
What are some common stereotyped behaviours?
- flapping arms
- twirling fingers infront of eyes
- unusual postures
- prancing on toes
- rocking doesn’t count (unless they flap while rocking)
- BUT there is no one type of repetitive behaviour that is characteristic of autism
What is facial expression and emotion sharing good for?
-important for sharing emotions and conveying meaning
-regulates social interaction
What are some other diagnosis that we see RBs
- terrets
- ADHD (bounding foot)
- OCD
How are RB’s in autism different than other dxs?
repetative behaviours of autism are more compex..
- they are not associated with stress
- they are often associated with enjoyment
- happen over different contexts
- consistent across time
Is sameness/ resistance to change fairly predictive or common of an autism diagnosis?
yessssss
but its also common in normal development (kids 2-4 like things the same.)
autism is more severe and lasts for longer
Autism interest have 2 categories.. what are they?
1) interest in unusual objects
2) restricted interests: more than a ‘hobby’
what are some interests in unusual objects a person with ASD might have?
owl pellets, vacuum motors, dandelion heads.. etc
what are 2 presentations of ASD restricted interests (more than a hobby)
- accumulation and cataloguing of objects
- accumulation of facts about a specific topic.
what is it called when a restricted interest (one that is more than a hobby) is normal in quality, but are stronger than you would expect for the persons age?
autistic fixation
How do restricted interests impact an ASD person’s life?
- tend to be all encompassing
- tend not to be shared as much socially
- they might tell you about the interest, but not to bond or get your thoughts
- disruptive for family activities (they have to work very hard to accommodate the interest).
Treating severe special interests is controversial… when are some times when this might be appropriate?
- cant engage in life
- severe injury from engaging in interest
might ask major changes from DSM 4 - DSM 5 broadly.
i dont know them. but that is what she said and I don’t want to lose
What id the 2 part process for facial expression and emotion sharing
-Imitation: imitating others expressions
-Discrimination learning: learning through experience with facial expressions go with situations
When were sensory atypicalities first noted as an autism symptom?
what version of the DSM did they appear as an ‘associated feature’
what version of the DSM were they officially apart of the diagnostic criteria
— what category?
- noted since Kanner’s description in 1943.
(he talked about sensory fascination) - DSM 4 as an associated feature
- DSM5 as part of the diagnostic criteria
— category 2
Infants can produce and understand a range of facilities expressions, but become more refined in producing and discriminating facial expressions with age
that’s it
Why add sensory atypicalities to the DSM5 diagnostic criteria?
- its one of the most troublesome symptoms that people with autism experience
- while its not specific to autism, we are starting to do more research on sensory profile that are specific to austism and there are differences.
What are some examples of sensory atypicalities in autism?
- auditory
(loud noises / pencils scratching / chewing/ desks moving / breathing too loud) - touch / tactile
(bothered by clothes / seams not lined up/ clothing being scratchy…. bothered by any sort of water droplet touching them (rain, sweat, shower), need for pressure (hyposensative and need to feel sensation – weighted blanket / vest…
——– kids can act out or cause behavioural issues if they are hyposenative (girl in tree). - smells (strong smells / or inappropriate smelling)
- somatosensory
- taste.
-vestibular systems
What are 5 patterns of sensory atypicality?
- hypo-responsiveness
- hyper-responsiveness
- sensory interest / repititions/ sensory seeking behaviours
- enhanced perception
- atypical sensory responses
What do facial expressions look like in toddlers and very young children with ASD?
-less showing of positive affect
-positive facial expressions in random self-absorbed acts more than in social acts
-less likely to elicit laughter or join in others laughter, or coordinate smiles with eye contact
-vocal expressions of emotion are idiosyncratic
-more flat/neutral or atypical facial expressions
is hyposensative OR hypersensativeity more specific to autism?
hyposensativity
what is hypo-responsiveness?
under sensitive to sensations… not getting enough sensory input, and seeking it out…
lack of typical response to pain (self injurious)
lack of responsiveness to temperature (not aware hot / cold)
not orienting to sounds
What do facial expressions look like in school age/adolescence with ASD?
-less able to make appropriate facial expressions spontaneously or when asked to imitate
-less expression of empathy in the face
-difficulty interpreting facial expressions and in recognizing emotions
what is hyper-responsiveness?
exaggerated response to sudden noises
e.g., kids who cant use public washroom because of loud noises.. no blender or vacuum
What are two ways communication/language may look like in ppl with ASD?
-defecits and delays
-excess
-often is characterized by a lack of certain aspects of communication - but also by excesses (unusual ways of
communicating [using language/ interacting])
what are some examples of sensory intersts / repititions / sensory seeking behaviours
(patterns of sensory atypicality)
- sense of being stuck on a particular sensation, not being able to draw away.
e.g., staring at lights / fan / licking other people/ putting things in their mouth / smelling everything / sense of fascination and needing input from that sensation
How do we initially see communication differences being represented in infants and toddlers with ASD?
-lack of joint attention/gestures (lack there of), and facial expressions
-some delays in language milestones
what is enhanced perception?
(patterns of sensory atypicality)
being aware of a specific element of a sensation more than the general population
what are some atypical sensory responses?
- specific fears / anxieties
e.g., fear of O Canada.
fear of glasses.
How does OT assessment (idk) help kids reduce their distress around sensory issues?
- helps understand what their sensory needs are (what they are over / under sensitive to)
- then you can get a better idea what is bothering them (cause of anxiety, irritability, outbursts, restricted diet and clothing, unable to participate in certain settings [cant eat because people are chewing]).
- if there is irritability and anxiety, we want to see if there is a sensory issue that is bothering them beneath it.
What are three patterns of differences of communication development in infants and toddlers with ASD?
- late to start, but when they meet milestones, language has rapid growth
- never fully catch up, never have rapid spurt, improving but slowly.
- language regression, seemed to be developing language at expected ages
and then have a loss of language skills (see this in a minority of kids with
autism, about 20% for true language loss). occurs around 2 years old
Do most infants and toddlers on the spectrum have some early language impairment?
yep
What percentage of infants and toddlers have language regression in their 2nd year?
minority (15-40%)
What is language development associated with in infants and toddlers with ASD?
Early symbolic and social communication skills (joint attention, imitation, gesture, play)
infants and toddlers can have _______ language impairments
pragmatic
What is delayed language in infants and toddlers often associated with?
cognitive delay
What is associated with communication development in preschool kids with ASD?
- Articulation (clarity of speech) OK, but atypicality in aspects of phonology
- Don’t have specific impairments in grammar, but may have atypiclities
(pronomial reversal) - Good lexical knowledge, except for mental-state words
- Emerging and persistent difficulties with reciprocal conversation
What is savantism?
special skills that go beyond what people are usually able to do..
an innate splinter skill that goes beyond what is typical.
e.g., a 4 year old boy who taught himself to speak 5 different languages with a perfect accent.
Or
reading Warren Peace at the get of 2 (haven’t been taught to read).
(different than developing expertise in something because you hyperfocused too close to the sun).
Most school age kids with ASD show growth in communication development BUT:
Even with growth, subtle impairments in semantics and pragmatics
What are 6 impairments in semantics and pragmatics that school age kids with ASD may show?
- Overly literal/concrete
- Conversational skills (more difficulty with monitoring the listener (bored / intered), less turn taking in conversation)
- Narrative Production (how the persons voice sounds, odd pacing, inflect at unusual times, speaking with accents. difference in how language sounds. Metaphors and idioms are less understood)
- Nonverbal communication (not facing people when speaking, less conversational reciprocity questions)
- Phonology (vocal tone/inflection/pacing)
- Aspects of language comprehension (inferential vs literal)
What percentage of the ASD populism have Savantism?
15%
can see it in music, verbal skills, language, art..
What is special skills, talents, savant skills associated with?
high IQ
what are special skills, talents, splinter skills, and savant skills NOT associated iwth?
more severe repetitive behaviours
What does communication in adolescence/adults with ASD look like?
-most have functional language
-pragmatic language probs and literal styles persist
Is special skills/ talents / savantism / ect associated with milder or more severe ASD symptoms (across all three domains)?
they are associated with milder ASD across all three domains
+
better cognitive and adaptive functioning.
What is the range of variability in language in ppl with ASD? (three categories)
Severe: no functional language (more seen in folks with intellectual disabilities with autism)
Med: language acquired at a slower and lower rate
Mild: normal language except pragmatics (fully normal. nothing unusual about their language except how they
use it socially, coordinating words with gestures issues)
Are special skills ect more common in males or females with ASD?
males ew.
has local processing OR broader processing been proposed as a contributing factor of special skills / savantism / etc?
local processing.
- however, research does not consistently show a strong correlation with local bias although skilled individuals have capacity for focused attention.
(I don’t know what this means)
Is savantism associated with genetic syndromes?
yes
- Prader Willi syndrome
- Williams syndrome
What is the single most important predictor of whether someone will have more severe or milder autism?
At age 4, their language and intellectual abilities
Go look at slide 78 there’s a study
ugh
How do repetitive behaviours look different in females?
- less protoypical red flags
- wider range of differences? ``
What does repetitive speech and echolalia look like in ASD?
-Repeating something you have heard on TV in a non-social way (buz light year away!)
-Echolalia: repeating something that someone else just said. specific to autism, don’t see in other diagnosis.
Give a basic overview of how the diathesis stress model of disease works
Genetic factors + prenatal and postnatal factors
—->
Brain vulnerability
—> +
Environmental stressors + Developmental Maturation Processes
=
Disorder
What do monologues look like for ASD ppl?
-commenting on your own behaviour
-giving a running commentary on what you are doing
-not copying, but saying random phrases that a
person uses over and over again.
In human words..
diathesis stress model
someone born with a genetic risk, who may have been exposed to factors in the prenatal environment when their mama was pregnant.
the genetic risk creates vulnerability in the brain
interacts with the environment and the environment reacts with them in a developmental cascade model.. meaning that based on how you are wired you will get unique results from environment interactions
phenotypically it can look white differently based n how all these factors combine
What are neologisms and what do they look like in ppl with ASD?
neologisms = made up words
-consistently using a word that is not a real word to refer to something (that other people other than family would not understand). (pencil = flake)
What would pragmatic differences look like for ppl with ASD?
-How to join a group, how to start a conversation
-may leave a conversation mid way through
-may be fixated topics in conversation
What are two approaches to study genetics in autism?
- linkage studies
- twin studies
- family studies - Molecular Genetics Studies
What other things can cause language impairment besides ASD?
brain injury, aphasia, language disorders, ADHD, social anxiety disorder
Tell me a little bit about linkage studies
- looking within families
- looking at relationship between parents and children
- or sibling relationships
- particular focus on twins
- looking at inheritance rates in the family
What is the difference between ASD language impairment and pragmatic language disorder?
ASD: characterized by social pragmatic interferences, and other differences in communication
Pragmatic language disorder: describes someone who has the language features of autism, almost exactly the same…. but do not have the repetitive interests
tell me about molecular genetics studies
- examining the genetic code on a fine grain level.
- looking at the DNA and seeing how it looks different in ASD
- became a thing in the 2000’s
Concordance = both people have the trait.
What is the concordance rate of ASD in monozygotic vs. dizygotic twins?
MZ = 80%
DZ = 3-6%
(this means its not a single gene effect)
Heritability = the estimation of the proportion of how much a trait is heritable
What is the ASD heritability estimate in MZ twins?
90%
What are the three purposes of family studies?
to see if:
- autism is familial?
- In families, can we identify homogenous subgroups?
- Can we identify a broader autism phenotype?
Is autism familial?
do that shit run in the family?
ya
rates of ASD in families is about double the general public
In families, can we identify homogenous subgroups?
(asking if symptoms cluster in a similar way within families)
yes.
there is a link in social, fixed interest, non verbal, and communicative domains that are similar in families.
traits pop off in families
e.g., a dad who closed off entire floor of the home to build a lego world.
Can we identify a broader autism phenotype?
Family member who has ASD
other members don’t, but have some similar traits and behaviours.
e.g., symptoms in just one domain..
________________________________
In family studies, the broader autism phenotype refers to traits similar to those seen in ASD that appear in family members, even though they don’t meet the full criteria for an ASD diagnosis.
Helps identify subtle traits or patterns that may contribute to a family’s genetic predisposition to ASD.
Provides insight into potential homogeneous subgroups within families that share these traits but may not have a formal diagnosis.
What are 3 ways we can identify a broader autism phenotype in family studies?
- clusters of specific ASD’s
– ( in families - certain ASD traits appear across multiple members) - Clusters of individuals with subclinical ASD’s
– (individuals individuals exhibit ASD behaviour, without diagnosis) - Dimensions of ASD symptoms
– see if subtle signs are present in relatives without dx.
What are 4 different Dimensions of ASD symptoms that are measured in family studies
–> in order to identify a broader autism phenotype
- Social function
- Communication
- Behaviour and interest
- cognitive style (theory of mind, social coherence)
Relatives with individuals with ASD are at greater risk for comorbid psychiatric disorders..
name
- Anxiety + mood disorders
- Schizophrenia (less risk)
- OCD (true genetic link)
- Also ADHD
studies have shown there may be an underlying genetic link with parents who have OCD traits… there is an association between OCD traits in parents and repetitive behaviours that we see in children
ya
What is looking at ‘Causal Loci’ in ASD?
- Molecular Genetic Studies
In the context of molecular genetics, causal loci refer to specific genetic locations or mutations linked to the development of autism.
- DNA carries code that makes cells make proteins
- each chromosome is made up of genes
- LOCI refers to a specific location on a gene.
- genetic mutations are identified by molecular genetics.
- laying out a person’s chromosomes and looking at genes.
- started doing this in 2007
What are 3 ways to assess ‘Causal loci’ in ASD?
- Medical genetic conditions
- Copy number variations
- Novel point mutations
What are Medical gene conditions?
disorders caused by abnormalities in genes or chromosomes
If you have specific genetic disorders, there is a greater probability you have autism
- most genetic syndromes that cause autism is the more severe kind of autsim
Genetic Conditions Linked to Autism:
Tuberous Sclerosis
Angelman Syndrome
22q13 Deletion Syndrome (associated with long arms)
Fragile X Syndrome:
One of the more common genetic causes of autism, associated with intellectual disability and specific behaviors (e.g., hand-biting, social anxiety).
About 33% of individuals with Fragile X meet the criteria for autism, showing a specific phenotype.
Other Syndromes:
Rett Syndrome: A single-gene cause for autistic behaviours, though it was removed from the first edition of the DSM for autism.
Genetic Features: Some genetic conditions have known mutations that strongly suggest a genetic cause for autism, such as Fragile X, Angelman Syndrome, and Cri-du-Chat.
probably don’t have to know but I wrote it all down
What are copy number variations?
- CNVs are differences in the number of copies of specific DNA segments, either extra copies or missing copies.
- CNVs are common in autism and contribute to genetic diversity.
- Excessive repeats (e.g., 200 copies of a sequence like “CGA” instead of 20) are linked to autism.
- CNVs can be spontaneous or inherited, often from parents who don’t show autism symptoms.
- Genetic contribution: CNVs can affect how neurons communicate, supporting a genetic link to autism.
What are Novel Point mutations?
Novel point mutations are random changes in a single point of DNA, often occurring during DNA replication. These mutations are typically spontaneous but can also be triggered by mutagens like X-rays, chemicals, or extreme heat.
Specific point mutations have been identified in individuals with autism.
Unlike CNVs, point mutations affect a single gene and do not involve duplications or deletions.
These mutations can occur spontaneously or be influenced by environmental factors (e.g., older parental age, exposure to mutagens).
Is the one genetic cause for ASD?
not one gene
different features of ASD may be associated with different genes.
What maternal and paternal age starts posing risks for prenatal factors?
Maternal age 35+
Paternal Age 40+
you get more spontaneous mutations in you’re genes when you get older.
What are some maternal lifestyle factors that can influence ASD?
- if momma has another baby again with 18 months (availability of nutrients)
- Maternal Nutrition ( Folate + B vitamins, Omega 3)
— folate = baby brain development
— omega 3 = lower ASD
— Vit D = lower vit D levels = higher risk of autism… concieving in the winter associated with autism.. vit d? - substance exposure
is alchohol assoicated with autism?
no ma’am
are cigarettes assoicated with autism?
in theory
- mom smokes = less oxygen to baby brain
- it might increase, but studies did not control for other factors that might be associated with smoking
What are some viral infections that are maybe associated with ASD?
- rubella
- cytomegalovirus
- flu and fever
What are some medications that might be associated with ASD?
- Thalidomide (50/60s heinous birth defects)
- Valproate (seisure meds)
- Maternal Vaccines? (nope.. more risk if momma gets the flu while pregnant)
- Antidepressants? (slightly higher risk for first trimester - might also be the physical effects of depression)
Are fertility treatments associated with higher risk ASD?
maybe
early studies showed higher risk
didnt control for factors like maternal age
What are 3 pregnancy related factors associated with ASD?
- Preterm Birth
- Fetal Growth Restriction
- Obstetric sub-optimality
How is pre-term birth associated with ASD?
- low birth weight is associated with cognitive and behavioural difficulties
- Gestational age (age at which baby is born at - which is unrelated to birth weight) = higher risk for autism
— premature birth = autism
How are fetal growth restrictions associated with ASD?
- babies who are small for their gestational age increase risk autism
What are a fuck ton of factors that ‘obsteric sub optimality’ contribute to autism?
Obstetric suboptimality refers to conditions or circumstances during pregnancy or childbirth that are less than ideal and may increase the risk of complications for both the mother and the baby.
- multiple births
- gestational diabets
- gestational bleeding
- obesity
- infections during pregnancy
- material hypertension / toxemia
- delivery (cesarean delivery, neonatal complications)
Environmental agents and neurotoxity
What is Acute Toxicity?
agent causes illness / death
Environmental Agents and neurotoxicity
what is Devtal toxicity?
agent has imact on developing NS below levels that kill or lead to severe illness
What are 2 main environmental contributors of autism?
1) pollutants
2) pesticides
(most at risk when you are a featus because that is when most of brain development occurs)
what are some different pollutants that contribute to ASD
- air pollution (confounded by SES)
- persistent organic pollutants (disrupts endocrine system)
—- polybrominated diphenyl ethers
——— disturbs maternal thyroid functioning
—- PCB’s - Non-persistent Organic pollutants (disrupts endocrine system)
—- BPA’s
—- Pthalates (cosmetic products and vinyl flooring)
What are some pesticides associated with ASD
- organophosphates
- organochlorines
concieved in winter? AUTISM.
might be vit d, seasonal nutrition?
Do vaccines cause autism?
- MMR vaccine
- Thimersol: ethyl mercury vs methyl mercury
idk no answer
When is the most critical periods for developing autism?
first trimester
How do kids with ASD play differently?
- parallel play = playing beside someone instead of with them
- less imaginative play - more building legos or walking around perimeter of room
- social misunderstandings
- social isolation (either want friendship but have a hard time, or don’t give a fuck)
- social clumsiness (not following social rules)
-ideosyncratic play (mya have dialogues on things that aren’t of interest to other kids like vacuum motors) - socially naieve or not street smart (not understanding they are being teased / being drama queens)
Diagnostic criteria: Social and emotional reciprocal play
e.g., (case study)
- doesnt engage in imaginative play
- looks away, growls, shakes first and grimaces
- play is repetitive
- expressions are flat
- when friend was hurt he laughed
- wont play in group
Catecory 2: Non verbal communication..
some examples
- does not make eye contact
- doesn’t wave hello or goodbye
- expressions are flat
- semi smile
Criteria 3: developing, understanding, and maintaining relationships
- play beside children rather than with them
- doesn’t initiate play
- ## one friend who is older and 10
DSM-V TR
What is category A?
Persistent deficits in social comunication and social interaction across multiple settings as manifested by ALL of the following, currently or by history
–> categories next
Category A - DSM 5 - TR
= Persistent deficits in social communication and social interaction cross multiple settings as manifested by all of the following, currently or by history
list 3
- Deficits in social-emotinoal reciprocity
- Deficits in nonverbal communicative behaviours
- Deficits in developing, maintaining and understanding relationships.
What is Diagnostic category B - DSM 5 - TR
Restricted, repetitive patterns of behaviour, interest or activities as manifested by at least two of the following, currently or by history
In Category B of the DSM 5 TR:
= Restricted repetitive patterns of behaviour, interests or activities as manifested by at least two of the following:
list 3
- stereotyped / repetitive motor movements, use of objects or speech
- insistence on sameness/ routines / ritualized patterns of behaviour
- highly restricted / fixated interests abnormal in intensity or focus.
What is Level 1 specifier
(Requiring Support)
Social Communication:
- without supports in place, deficits in social communication cause noticiable impairments
- difficulty initiating social interactions and clear examples of atypical or unsuccessful responses to social overtures of others
- may appear to be decreased interest in social interactions.
e.g., person who is able to speak in full sentences and engage in communication.. but reciprocal conversation with others fails - attempts to make friends are odd and typically unsuccessfully
Restricted repetitive behaviours:
- inflexibility of behaviours causes significant interference with functioning in one or more contexts.
- difficulty switching between activities,
- problems of organization and planning hamper independence.
Level 2 Specifier:
(Requiring Substantial Support)
Social Communication:
- marked deficits in verbal and non verbal social communication skills
- social impairments apparent even with supports in place
- limited initiations of social interactions.
- reduced or abnormal responses to social overtures from others
e.g., a person who speaks simple sentences who s interactions is limited to special intersts who has markedly odd, non verbal communicaiton
Restricted Repetative Behaviours:
- inflexibility of behaviour
- difficulty coping with chagne or other restricted / repetative behaivours
- appear frequently enough to be obvious to the casual observer.
- interfere with functioning in a variety of contexts… distress or difficulty changing focus or action.
Level 3
(Requiring very substantial support)
Social communication:
- severe defictis in verbal / non verbal social communication skills
- severe imparements in functioning. very limited initation of social interactions.
- minimal response to social overtures from others..
e.g., person with few words of intelligible speech who rarely initiates interaction and when he or she does, makes unusal approaches to meet needs only. responds only very direct social approaches.
Restricted Repetative Behaviours:
- inflexibility of behaviour
- extreme difficulty coping with change or other restricted or repetitive behaviours
- markedly interfere with functioning in all spheres
- great distress / difficulty changing focus or action.
