Lecture 7: Autism Spectrum Disorder

Question 1

If we have low tone we want to facilitate movement, if we have high tone we want to inhibit it

Lots of developmental disorders / DS / Autism = low tone

Question 2

Autism is a developmental disability with 3 main subgroups. What are they

Answer 2

Socia Challenges
Communication Challenges
Behavioral Challenges

Question 3

Old school thought was that people w/ autsim need to be fixed. Stop the flapping etc… we’ve had a shift in this thinking

Question 4

What causes autism

Answer 4

Unknown. However, suspected that its genetic and environmental risk factors

1 in 68 children will be diagnosed w/ it, however, the prevalence may be as high as 1 in 50

Question 5

Who gets autism more, boys or girls

Answer 5

boys 4:1

Question 6

Genetic potential of autism
* increased incidence of children in families being diagnosed w/ autism

Genetic disorders associated:
* TB
* Fragile X syndrome
* Chromosome 15 deletion syndromes-Prader0Willi syndrome and Angelman syndrome
* DS
* Moebius syndrome
* CHARGE syndrome

NOTE: autism has to occur as its own diagnosis. So when its tied to somethign else its not really called autism

siblings of children w/ autism = 14.7 more likely

Although environmental factors may interact with genes to contribute to the expression of autistic symptoms- little indication of what these specific environmental factors may be

Question 7

Potential Neurological Abnormalities w/ Autism

Underconnectivity in the brain
* Decreased communication between brain regions and resultatnt impairments

Decreased cortical thickness

Decreased white matter connectivity

decreased neurochemical concentrations in the brain
* this is why ADHD medications help w/ autism symptoms

Inflammation in the glia of the brains

Decreased number of Purkinje cells in the vermis and hemispheres in the cerebellum

Function of mirrior neurons might be altered

Question 8

Is there an objective / blood test for autism?

Answer 8

No

Question 9

What is out criteria for diagnosing autism (name of it)

Answer 9

Diagnostic and Statistical Manual 5th edition (DSM-5)

Combines the criteria from:
* Autistic disorder
* Asperger disorder
* Childhood disintegrative disorder
* Pervasive developmental disorder not otherwise specified

as of now there is no longer a thing as an asperger diagnosis
* its kind of all in autism diagnosis now

Question 10

Name the 5 components of the DSM-5 test for autism

Answer 10

A: Deficits in social communication and interaction

B: restrictive or repetitive patterns of behavior or interests

C: Present in early development

D: Clinically significant impairment in social, occupational, or other important areas of current functioning

E: Not better explaiend by intellectual impairment

Question 11

A: in the DSM 5

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (EX are illustrative, not exhaustive)
* Do they make eye contact? Ask for help? Enjoy being near others?

Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back and forth converstaion; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions

Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, 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
* Don’t understand those non-verbal communications

Deficits in developing, maintaing, and udnerstanding relationsjips, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interests in peers
* don’t understand relationships

Question 12

DSM 5 critera: B
* repeittive patterns
* like routine
* hypo/hyper reactive to sensory input - so they might hate bright lights but love loud sounds, its not that they’re one or the other

Question 13

DSM-5 Autism Diagnostic Criteria

C: Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life)
* if they’re at home and their parents let them do all their habits (think lining everything up, and having order) they may not have all the symptoms. However, in an uncontrolled environment like school more of those symptoms may come on

Question 14

DSM 5

D: Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
* have to be able to prove that it effects them somehow

Question 15

DSM 5

E: These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level

Question 16

w/ autism

sensory processing disorder goes along w/ autism = those kids who can’t stand certain cloths because of the way they feel

Question 17

Autism can be treated not cured. You can mask lots of the symptoms

Question 18

When autism is first diagnosed: Autism diagnostic criteria

Specify if:
* With or w/o accompanying intellectual impairment
* With ot w/o accompany language impairment (coding note: use additional code to identify the associated medial or genetic condition)
* Associated with another neurodevelopmental, mental, or behavioral disorder (coding note: use additional codes to identify the associated neurodevelopmental, mental, or behavioral disorders)
* With catatonia (non responive)
* Associated w/ a known medical or genetic condition or environmental factor

Question 19

What is catatonia?

Answer 19

Non responsivenes

Question 20

Which level of autism requires support?

Answer 20

Level 1

Question 21

What level of autism requires substantial support

Answer 21

Level 2

Question 22

What level of autism requires very substantial support?

Answer 22

Level 3

Question 23

Level 1 Autism - lots of people, with this kind of hard to see. Might not see it if you arent a clinician

Social:
* Without supports in place, deficits in social communication cause noticeable impairments
* Difficulty initating social interactions
* Clear examples of atypical or unsuccessful response to social overtures of others
* May appear to have decreased interest in social interactions - they proably have interests but don’t know how to fit in (think coming up to the wrong person and giving a hug)

Restructed, repetitive behaviors:
* Inflexibility of behavior causes significant interference with functioning in one or more contexts
* Difficulty switching between activities (but they can)
* Problems of organization and planning hamper independence - write things down for them

Should be able to be in a regular class. may or may not have learning disabilities, meaning they may be forced to get a 504 instead of an IEP

Question 24

Level 2 - requiring substantial support
* You’ll def know they have it here

Social:
* Marked deficits in verbal and nonverbal social communication skills
* Social impairments apparent even with supports in place
* Limited initation of social interactions
* reduced or abnormal responses to social overtures from others

Restricted, repetittve behaviors:
* Inflexibility of behavior
* Difficulty coping with change
* Other restrcited/repetitive behaviors-Appear frequently enough to be obvious to the vasual observer and interfere with functioning in a variety of contexts
* Distress and/or difficulty changing focus or action

Question 25

Level 3 Autism - requriging substantial support - you'll know they have this wether you're a clinician or not Social: * severe deficits inv erbal and nonverbal social communication skills cause sebere impairments in functioniong * Very limited initation of social itneractions * Minimal responsr to social overtures from other - often nonverbal Restricted, repeittive behaviors * inflexibility of behavior - they will tantrum * Extreme difficulty coping with change * Other restricted/repetitive behaviors markedly interfere with functioning in all spheres * Great distress/difficulty changing focus or action hate changing what they're doing

Question 26

Diagnosis of atusim Experienced professional can identify it by the time the child is _ * however it is not often diagnosed until they're 4 Early ifentification and intervention - the earlier we can get them to communicate = less tantrums Screening tolls developed using previous diagnostic criteria and may not accurately screen for ASD under current DSM-5 criteria The American Academy of pediatrics recommends screening for autism during well child checks at 18 and 24 months for all children Earlier screening recommended if specific concern arises from parent or pediatrician or if sibling has ASD PT's, OT's, SLP's, teachers, physicians, psychiatrists, psychologists all screen for ASD Appropriate referral to pediatrician and interdisciplinary team fro diagnostic evaluation remember, school does not have to accept an outside diagnosis of autism

Answer 26

2

Question 27

Comprehensive Interdisciplinary Evaluation: Examins all areas of development including: * Communication - interacting (can be signing) * Speech - use of words/articiulation * Language * Fine motor - OT * Fross motor - PT * Perceptual motor skills - this is putting the senses togethre (can you use your vision to step forward) - PT/OT * Self-help skills - OT * Social-emotional * Cognitive skills All members of the team are eligible to be trained in the use of these tools, including PT's

Question 28

Question 29

great toe walking/asymmetry common kids w/ autism are very literal - don't understand sarcasm well

Question 30

Considerations for someone w/ autism: Might prefer an environment with low noise and minimal visual distractions * So we would progress from a quite closed environment --> open Age Cognitive status Coping style Past Experience Individual Motivating Factors Removing tags from clothing Avoiding certain materials/textures Food/drink limitations Parental choices/Parenting styles - think parents who never use the word no

Question 31

Patient/Caregiver Instruction * pt requires ongoing collaboration with family members and other caregivers * Develop new skills, learn tasks, and participate effectively when intervetion is intensive and embedded into the context of daily routines and activities * Should focus on strategies to promote a child's participation in daily routines and activities * Need to be salient - make the activities mean something to them

Question 32

Procedural Interventions - Autism * Team based-family is an equal, contributing member of the team * Interests of the child * Parents: - Ultimately choose interventions for their children. Often base decisions from nonmedical progressionals and lay publications - talk to the parents about this * Complementary and alternative medicine-52% and 95% of families with ASD * Nonjudgemental with families - envidence for the effects of various types of CAm - SAfe or unsafe - other options

Question 33

Guiding Principles of Effective Intervention * No single approach works for every child with ASD * Early intervention is best * Family involvement - need to be involved * Individualized programming - to the pt * Systematic intervention - think starting easy --> harder * Structured/predictable environments - they perform the best in these, however, they are going to have to go out in the real world * Functional approach to behavior

Question 34

Motor specific interventions for ASD * Exercise and PA * Strength - make it a game * Balance * Coordination * Motor planning * Functional mobility * Proprioceptive activities * Core strength * Deep proprioceptive input * Desensitatizion * Gait training * ROM

Question 35

Exercise and PA w/ autism **Tend to participate in more sedentary activites or individual PA's (swimming), limiting the social components or group or team based activities** Research on activity focused primarily on hcanges in behavioral or socail interactions We know that EX can reduce some of their symptoms. It does work **Decreasing sterotypic behaviors of autism w/ EX** * Aggression * Off-task behavior * Elopment - running away Increase in on-task behavior and improvement in motor skills acquisition * so the more challenging the PA is the more likely they are to pay attention (her daughter doing gymnastics)

Question 36

**How effective is sensory processing intervention?**

Answer 36

Limited proven effectiveness

Question 37

Sensory processing intervention: **Limited proven effectiveness** - however, it's widely used - kids love it Weighted vests and other compression garments * Used to provide proprioceptive input and calming to increase attention, concentration, and focus Brushing and sensory diets * To increase tolerance to tactile input, increase focus, and improve organization Fidget and fiddle toys * To help sustain attention and concentration Auditory integration and therapeutic listening programs

Answer 37

Some kids love the wieghted vests and others don't

Question 38

Lifelong implications and the role of PT **Transition to adulthood** This can be difficult for people w/ ASD Adult system often do not utilize a service coordination model Difficult for families to become aware of available programs and to synchronize services between programs Young adults w/ ASD were 3 to 14 times more likely to be socially isolated than young adults with an intellectual disability, emotional disturbance, or learning disability Talk with teenager and family about plans for education or employment after HS graduation Refer to appropriate resources to help achieve their goals Early involvement with transition and employment programs is key to a sucessful transition

Question 39

Behavior management for children w/ autism * Applied behavior analysis * Differential reinforcement * Discrete trial training * Schedules * Self-management

Question 40

Applied Behavior Analysis (ABA) * what is this * How intense is this intenvention? * How old do they have to be for this to work?

Answer 40

Tasks are broken down into discrete trials and then coupled w/ reinforcement to build positive behaviors * so its lots of using positive rewards * Not always great because its hard to generalize beavhior Shown to improve a wide variety of skills across all areas of development Intervention is usually intense (25-40 hours a week) Individualizing targeting of skills Parents are trained to become active co-teacher Strong evidence to support over age of 3

Question 41

What is differential reinforcement? * how old to children have to be

Answer 41

A form of applied behavior analysis Used to increase the occurrence of desired, functional behaviors using rewards * so basically ignoring them until they calm down, then they get a reward Interfering behaviors decrease because they are not reinforced Evidence to support in children over 4

Question 42

Schedules for people w/ Autism: * Assist w/ managing challenging behavior by providing a visual learning strategy * Masks routine more predictable * Photographs, line drawings, three-dimensional objects, or icons * Entire day or for a specific event * Single place or may travel with a child between palces * Established intervention for children ages 3 to 14 the problem is they can become too dependent on these schedules where if something changes they go crazy

Question 43

Self-Management * Teach children w/ ASD to regulate their behavior by recording when the target behavior does or does not occur * Independently seeks or delivers reinforcers * May involve the use of checklists, visual prompts, tokens, or wrist counters * Established intervention for children 3 to 18

Question 44

What kind of communication is used to improve social and communication skills? * Explain unaided vs aided?

Answer 44

Augmented and Alternative Communication (AAC) Unaided AAC - nothing external to your body * Gestures * Sign language * Facial expressions Aided AAC - something outside your body * Pictures * Symbols * Written cues * Speech-generating devices

Question 45

What is picture exchange system?

Answer 45

Form of AAC Consists of using pictures as a means for individuals with autism to communicate Considered an emerging intervention for children 0-9

Question 46

Sensory Diet * Individualized activity plan designed to provide the specific sensory input a child needs during the day - if you have a child that needs to move all the day - than maybe they sit on a bouncy ball instead of like bitting pens and stuff annoying the rest of the people around * Goal-Help children tolerate different sensations, regulate their alertness, increase attention span, limit sensory seeking behaviors, and handle transitions with less stress by reorganizing the NS

Question 47

What is the goal of sensory integration?

Answer 47

Goal = address overstimulation or understimulation from the environment * So calm it down Focuses on creating environmental that challenges children to use all of their senses effectively Studies suggest may improve play performance, enhance social interaction, and decrease sensitivity Considered unestablished intervention because findings have been inconsistent or do not apply to children w/ ASD

Question 48

Oharmacological Interventions * NOTE: There is no medication for autism, but there are medicaions that improve the below Generally used to contorl or improve: * Attention * Obessive compulsive behaviors * Tantrums * Irritability * Self-injury * Aggression Categories of medications: * Anticonvulsants * Antidepressants * Antipsychotics * Stimulants

Question 49

Dietary interventions for autism * Defeat Autism Now (DAN) protocol * Gluten free * Casein free diets * Omega 3 fatty acids * Little evidence that these dietary interventions are ffective in promoting skills or positively impacting behaviors or symptoms for children w/ ASD * Open discussion about the use of these interventions, benefits * Risks vs cost * Families should consult their health care providers before beginning any dietary intervention

Question 50

A pattern of observable behavioral and emotional responses, which are aversive, negative and out of proportion, to certain types of tactile stimuli that most people would find to be non-painful

Answer 50

Tactile defensiveness Think like "my clothing is hurting me" "The grass ins painful, or my shirt is hurting me"

Question 51

Sensory Processing Disorder * can have this w/o autism **Sensitivity to** * Light * Sound * Certain fabrics * Food Textures Oral motor difficulties which makes eating difficult Struggles with handwriting balance issues Can lead to anxiety issues, challenging behavior, poor academic perforamnce and isolation from peers It becomes a problem when it limits social play / school activities / ADLs. However, with lots of this they can work around it where its not noticiable