Exam 1 Flashcards
Developmental symptoms of ASD
- social communication
- stereotyped or repetitive behavior
Definition of Autism Spectrum Disorder
ASD is a biologically based neurodevelopmental disorder
ASD is “qualitative” disorder, what does this mean?
this means that while one child may demonstrate only a few autistic-like symptoms, another child may demonstrate many significant autistic symptoms
parent friendly description of ASD
- ASD is a developmental brain disorder
- there are two areas: social communication and repetitive behaviors.
- There are lots of variations from child to child. Some may have many symptoms while others have few.
Prevalence of ASD
1 out of every 68 children.
- continuous increase since 1970 (1 in 2500). 1995 (1 in 500). 2000 (1 in 150). 2009 (1 in 110).
Male to female ratio for ASD
more males than females
4 males to every 1 female with ASD
ASD Co-occurs with what other disorders?
intellectual disabilities
seizure disorders
tuberous sclerosis
What are some of the social communication differences in people with ASD?
- different communication profiles than children with other language disorders.
- difficulty initiating social interaction.
- difficulty sharing affect.
- lack of coordination of nonverbal communication.
- difficulty with peer relationships
How do repetitive behaviors and restricted interests present in ASD?
- Hypersensitive to sensory stimulation
- narrow rigid interests
DSM-IV diagnostic criteria for pervasive developmental disorder (PDD)
- aka: ASD
- impairment in social interaction
- impairment in communication
- repetitive behaviors and fixated interests
DSM-IV PDD Characteristics
- what are impairments in social interactions
- impairment in the use of nonverbal behavior.
- lack of spontaneous sharing
- lack of social/emotional reciprocity
- failure to develop peer relationships
DSM-IV PDD characteristic
- what is impairment in communication?
- delay in or lack of development of spoken language and gestures.
- impairment in the ability to initiate or maintain conversation.
- Repetitive and idiosyncratic use of language.
- lack of pretend play.
DSM-IV PDD Characteristics
- what are repetitive behaviors and fixated interests?
- preoccupation with restricted patterns of interests.
- inflexible adherence to routines.
- repetitive movements.
- preoccupation with parts of objects.
DSM-5 Diagnostic Criteria for Autism Spectrum Disorder (ASD)
- Impairment in social communication
- Repetitive behaviors and restricted interests
DSM-5 ASD Characteristics
- what is impairment in social communication?
- impairment in social-emotional reciprocity
- impairment in the social use of nonverbal behavior (gestures, facial expression, gaze)
- difficulty developing relationships
DSM-5 ASD Characteristics
- what are repetitive behaviors and restricted interests?
- repetitive movements or speech.
- inflexible adherence to routines
- highly restricted or fixated interests.
- unusual sensory interests or responses
Changes from DSM-IV to DSM-5
- Autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and PDD-NOS all become ASD.
- Three domains -> Two domains: Social/communication and repetitive behavior/restricted interest.
Why the change to include Autistic disorder, Asperger’s, childhood disintegrative disorder, and PDD-NOS all as ASD?
- distinctions among these classifications are not consistent across times or sites and do not group individuals with ASD into meaningful subtypes.
- Representing ASD as a single diagnostic category reflects the current state of knowledge about this spectrum disorder and it’s clinical presentation
Why go from 3 domains in the DSM-IV to 2 domains in the DSM-5?
- social and communication are difficult to separate.
- language delays are not unique to ASD, and not all children with ASD have a language delay.
What is an impairment in social communication?
- social-emotional reciprocity aspect…
- responding/initiating interaction.
- turn-taking
- contingent responses.
- normal back and forth conversation
What is impairment in social communication?
- social use of nonverbal behavior joint attention aspect (orienting to people, sharing attention, monitoring partners) … this includes..?
- eye gaze
- body language (using and interpreting)
- understanding/use of gestures
- symbolic play (pretend play)
What are some types of gestures?
- reaching
- showing
- pointing
- waving
- giving
- clapping
- head shaking
What is impairment in social communication?
- difficulty developing relationships aspect..?
- adjusting behavior to social context
- sharing imaginative play
- making friends
- absence of interest in peers
What are repetitive behaviors and restricted interests?
- repetitive movements or speech aspect..
- body movements (ex. flapping).
- behaviors with objects (ex. stacking, lining up, spinning wheels)
- speech (echolalia)
What are repetitive behaviors and restricted interests?
- inflexible adherence to routines aspect…
- aka insistence on sameness
- transitions
- daily routines
- eating
What are repetitive behaviors and restricted interests?
- highly restricted or fixated interests aspect…
- preoccupation with unusual objects (for their age)
- circumscribed/perseverative interest
What are repetitive behaviors and restricted interests?
- unusual sensory interests or responses aspect…
- pain sensation
- sound response
- texture aversion
- proprioception seeking (where body is in space)
in what ways does ASD vary from child to child?
- high vs. low functioning
- verbal vs. nonverbal (~25% are nonverbal)
- range of intellectual abilities
Secondary Characteristics of ASD include which 2 areas?
- motor and perceptual differences.
- Learning differences
Secondary characteristics
- motor and perceptual differences area..
- delayed motor development
- toe walking
- body placement difficulty
Secondary characteristics
- learning differences area…
- impairment in memory for meaningful information.
- rote memory may be relatively intact
- empathizing
Causation/Risk factors for ASD
- Neurophysiologic/neurochemical studies.
- Genetic link
- environmental link
Causation/Risk Factors
- Neurophysiologic/neurochemical studies show…
- neurological patterns suggest cerebellar and brain stem abnormalities.
- neurochemical variations including differences in dopamine and Seratonin levels.
- Brain overgrowth during first year of life.
causation/risk factors
- genetic link factor..
- increase incidence of ASD in closely related children
- experts believe 2 or more genes involved - not a singular ‘autism gene’.
- gene mutations and combinations of mutations.
causation/risk factors
- environmental link
- no proof of vaccine link
- genetic risk factor combined with a ‘trigger’
what is joint attention
- ability of the child to share common focus of attention with another
- alternately lead and follow other’s focus. (responding to and initiating)
- Precedes symbolic understanding
when should children with autism receive intensive intervention?
- as early as possible
- preferably before 3 years
what is the median age of diagnosis in 2009 was..
5.7 years
early identification and intervention is key to improving _____________ for children and families
outcomes
Red flags for ASD
- no big smiles or other warm, joyful expressions by 6 mo.
- no back and forth sharing of sounds, smiles, or other facial expressions by 9 mo.
- no babbling by 12 mo.
- not responding to name by 12 mo.
- does not point to share interest by 14mo.
- no words by 16 mo.
- repetitive movements with body or objects
- no symbolic play by 18 mo.
- no meaningful, two-word phrases (non-imitative) by 24mo.
- any loss of speech, babbling, or social skills
screening for ASD
What is sensitivity?
True positive
want to be higher than .8
screening for ASD
- what is specificity?
True negative
want to be higher than .8
can SLPs do screenings for ASD?
yes!
What are some screeners for ASD?
- M-CHAT-R/F
2. Smart ESAC
What is an example of a general screener?
Infant Toddler Checklist
Steps of diagnostic process for ASD
- referral
- screening
- parent interview
- behavioral/observational testing (ASD testing)
- other testing
- diagnosis
- reevaluation
Appropriate roles for SLPs
- ASHA -
- screening
- diagnosis
- provide info to individuals and groups known to be at risk for ASD.
- educating other professionals
- comprehensive testing
- asses for need for AAC device
- participate as member of school team
- develop treatment plans
- provide treatment
- counseling persons with ASD and their family
ETC.
What should be done before testing?
- let the parents/caregivers know what to expect
- allow the child time to warm up
what to remember during testing
involve the parents in all parts of evaluation
What to remember to do after testing
ask if the child’s behavior was typical (meaning, was the behavior typical for how they would act with someone they do not know.)
what to do when providing a diagnosis to parents
- provide strengths as well as weaknesses
- ask parents what they know about ASD.
- listen to the parents
- provide written materials with more information for parents to take home very important!!
What are some diagnostic assessment tools?
- Autism Diagnostic Observation Scale - Second Edition (ADOS-2) (one part of a comprehensive evaluation)
- Autism Diagnostic Interview - Revised (ADI-R) (parent interview)
- Childhood Autism Rating Scale - Second Edition (CARS 2)
- Gilliam Autism Rating Scale - Third Edition (GARS 3)
What diagnostic assessment is considered the Gold Standard for ASD?
ADOS-2
the Autism Diagnostic Interview - Revised (ADI-R)
- 90-150 minutes to administer
- score online
- must be familiar with ASD and other developmental disabilities
- strongly advised to review training videos before administering.
What does “standardized” mean
that there is a specific way to administer the test.
What is the ADOS-2
- semi-structured, standardized assessment to help diagnose ASD.
- Assess communication, social interaction, and play/imaginative use of materials
- creates context to observe ASD behaviors and uses standardized coding to document those behaviors.
ADOS-2 Training and reliability
- clinical training- 2 days
- Research training- 3 days
ADOS-2 modules
- used with clients of ALL ages
- Determined by expressive language level
- toddler module, and modules 1-4.
Toddler Module
ADOS-2
- No speech to simple phrases
- under 30 months
Module 1
ADOS-2
- no speech to simple phrases
- over 30 months
Module 2
ADOS-2
- 3-word phrases to verbally fluent
Module 3
ADOS-2
- verbally fluent child/youth adolescent
Module 4
ADOS-2
- verbally fluent adolescent/adult
ADOS-2 activities
-Module 1-
- free play
- response to name
- response to joint attention
- bubble play
- anticipation of a routine with objects
- responsive social smile (without touching the child)
- anticipation of a social routine
- functional and symbolic imitation
- birthday party
- snack
additional activities for ADOS-2
- toddler module -
- blocking task
- teasing task
- unable task
- bathtime
- ignore
Additional activities for the ADOS-2 - module 2 -
- construction task
- make-believe play
- joint interactive play
- conversation
- demonstration task
- description of a picture
- telling a story from a book
ADOS-2 coding
0= behavior show no evidence of abnormality as specified 1= behavior is mildly abnormal or slightly unusual. 2= behavior is definitely abnormal in the way specified. 3= behavior is markedly abnormal in a way that it interferes with the assessment. 7= definite abnormality but not of specified type 8= N/A 9= unknown/missing.
the higher the score the more symptoms are present.
What ages can be tested with the PLS?
Birth to 6 years
** higher score indicates higher functioning.
What is the Social Affect Total?
Combination of communication and reciprocal social interaction
Childhood Autism Rating Scale Second Edition (CARS 2)
- 15 questions answered by a professional after conducting behavioral observations.
- Questionnaire for parents and caregivers: 38 questions.
- High specificity and sensitivity
- Aligned with DSM-IV
How many versions of the CARS 2 are there?
- two:
1. standard
2. high functioning
What age can be tested with the CARS 2?
ages 2 years and up
Gilliam Autism Rating Scale third edition (GARS 3)
- 56 items answered by a professional after behavioral observations.
- The items are in 6 sub-scales.
- can provide a measure of severity
- aligned with DSM-V
6 sub-scales of the GARS 3
- restricted and repetitive behaviors
- social interaction
- social communication
- emotional responses
- cognitive style
- maladaptive speech
What ages can be tested with the GARS 3?
ages 3 years to 22 years
** not for children under 3! ***
An effective language assessment includes evaluation of ..?
- hearing and oral-motor skills
- communication functions (verbal and nonverbal)
- observation of abilities during a variety of activities
- receptive and expressive language skills
- may be standardized evaluation tool or behavioral observations.
What does “best estimate diagnosis” mean?
- experienced clinicians look at the “whole picutre”
- based on parent interview and observational measures
- consider performance on language, cognitive, motor, and adaptive tests.
- ** combine everything together to form the best estimate! ***
why do people need a medical diagnosis of ASD?
needed for insurance to help pay for services provided out of school. (extra sevices)
Medical diagnosis vs. Educational diagnosis
- the child does not automatically get an educational diagnosis of ASD because they have a medical diagnosis of ASD.
- Some schools will take this diagnosis but others will not.
If a child does not meet the educational criteria for ASD…?
- They may meet the criteria for another eligibility area such as:
1. speech impairment
2. pragmatic impairment
3. expressive language impairment
what is social communication disorder?
- Difficulty socially using verbal and nonverbal communication.
- deficits in communicating for social purposes.
- unable to change communication to match context.
- difficulty following rules of conversation.
- difficulty understanding nonliteral and ambiguous language.
- This is basically ASD without the repetitive behaviors.
- It is it’s own diagnosis in the DSM
