Exam 3 - ASD

Question 1

Need to have a good understanding of ‘normal’ developmental in order to understand when it is going wrong.

Describe the typical development in:

• Communication (language and non-verbal)
• Play skills

Answer 1

COMMUNICATION
o Receptive/expressive language
 Around one year mark for first words
 Rapid development between 3-5 years.

o Non-verbal communication
 Body Language, facial expressions, eye-contact, gesture use. (some of which are occurring in normally developing children at

Question 2

Outline the DSM-V criteria for ASD

Answer 2

DSM-V criteria for ASD

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text): ALL THREE OF THE FOLLOWING MUST BE MET:

• Deficits in Social-emotional reciprocity
o Ranging from abnormal social approach an failure of normal back and forth conversation; to reduced sharing of interests, emotions or affect; to failure to initiate or respond to social interactions
• Non-verbal communicative behaviours
o Ranging from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication
• Developing, maintaining, and understanding relationships
o Reading from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behaviour or interests, or activities, as manifest by at least two of the following, currently, or by history (Examples are illustrative, not exhaustive; see text):
• Stereotypes or repetitive motor movements
o Use of objects, or speed (E.g., simple motor sterotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or non-verbal behaviour
o Extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day
• Highly restricted, fixated interests
o That are abnormal in intensity or focus (E.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest)
• Hyper- or hypo reactivity to sensory input. Or unusual interest in sensory aspects of the environment
o (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual-fascination with lights or movement.

Question 3

What are the components necessary for assessing ASD?

Answer 3

• Detailed history ( may include structured interview e.g., autism diagnostic interview-revised)
• Observations within natural setting
• Questionnaire (e.g., childhood autism rating scale-II
• Structured assessment (e.g., autism diagnostic observation schedule-2nd edition)
• Cognitive assessment (e.g., wppsi-IV, Wisc-V
• Adaptive skills (e.g., vineland-II)
• Speech and language assessment.

Question 4

Describe the neuropsychological profile of ASD:

Answer 4

• Central Coherence – focus on details (Frith & Happe, 1994)
• Executive Functions - thought operations driven by prefrontal cortex (eg. shifting attention, abstract thinking working memory, thinking flexibly, initiating) (Ozonoff & Pennington, 1991; Russell 1997)
• Social Cognition- including mental operations underlying this such as Emotional Recognition, Theory of Mind, Attributional Style

Question 5

What is ASD commonly comorbid with?

Answer 5

• Attention-Deficit/Hyperactivity Disorder
  inattention, hyperactivity
• Depression (Kim et al. 2000) – often do not have language skills to report changes
• Anxiety (Skokauskus et al. 2010; van Steemel. 2011)

Question 6

What might cause Anxiety in ASD?

Answer 6

• Social anxiety and worry about difficulties (particularly when insight is good)
• Changes in routine
• Academic difficulties at school
• Difficulty communicating

Question 7

What are some interventions suitable for ASD?

Answer 7

• Cognitive Behavioural Therapy (eg. Exploring Feelings by Tony Atwood)
• Communication Tools: Social Stories/Comic Strips (by Carol Gray 1998); Picture Communication Tools
• Teaching Emotion Recognition and Theory of Mind and Accurate Attributions: Mind Reading Programs (eg. by Simon Baron-Cohen)/ Junior Detective (Beaumont & Sofronoff) and SAS + transporters etc.
• Education placement
• Psychoeducation for parents

Question 8

How might CBT need to be adjusted to suit individuals with ASD?

Answer 8

• Make abstract concepts more concrete (e.g., e.g., rate anxiety on scale 1-10. Therapist might have thermometer or prop to illustrate or describe anxiety.
• using the child talents and special interests to keep them engaged and motivated.
• build in frequent breaks or sensory activities for those who might have problems with attention or sensory under- or over-reactivity.