Module 12 - Mental Health Issues in Childhood and Adolescence Flashcards
Autism was first identified as a childhood disorder in ____ (what year) by _______ (who).
1943 by Leo Kanner.
True or False?
Autism occurs three to four times as often in males as in females.
True.
(The sex difference appears to occur among people with higher IQs; no such sex difference is found among individuals functioning at a lower level.)
What is the strongest single predictor of functional outcome among people with autism?
The development of functional speech by age five.
Flip to see the DSM Criteria for Diagnosing Autism Spectrum Disorder.
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):
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; 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.
Deficits in developing, maintaining, and understanding relationships, 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 interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., 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 that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (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).
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).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
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.
What are the 2 critical features of autism?
Social impairment and unusual responses to the environment.
How might autism look from birth-age 2?
From infancy, parents often note the lack of emotional attachment, comfort-seeking behaviours and show little interest in the human face and often avoid eye contact, smiling etc.
Abnormal or absent social behaviours are noted in the first two years of life of most children with autism. They’re often much more responsive to the non-social environment and curious about inanimate objects or sensory stimuli.
_______ percent of children with autism are mute.
50%
(Moreover, those who do develop language often have speech that is abnormal in tone and content.)
What is echolalia?
A common characteristic of speech in children with autism, where they repeat another person’s words or phrases, using the same or similar intonation.
What is pronoun reversa?
Autistic individuals often refer to themselves as “he” or “she” rather than “I,” perhaps because they have trouble shifting reference between speaker and listener or a third party. (difficulties in understanding the perspectives of others and the distinction between the self and the other = theory of mind)
Define savant.
A small proportion of autistic individuals who display islets of exceptional ability in areas such as mathematics, music, or art, or unusual feats of memory.
Why did the DSM-5 has consolidated symptoms and included a single diagnostic category of Autism Spectrum Disorder?
Although clinicians are able to reliably differentiate between individuals with autism and individuals who are typically developing, there is often diagnostic confusion between individuals historically called classically autistic, those with Asperger’s disorder, and high-functioning individuals with autism.
The new category focuses on common behaviours and specific clinical characteristics, such as deficits in social-communication and restricted, repetitive patterns of behaviour. And info concerning levels of severity is outlined to assist diagnostic clarity and support planning.
How many levels of severity are there in ASD?
3.
Level 3 “Requiring very substantial support”
Level 2 “Requiring substantial support”
Level l “Requiring support”
In 1944, a year after Kanner first described autistic children, Hans Asperger described a group of children with similar characteristics. Controversy continues as to whether the disorders described by Kanner and by Asperger are separate conditions or represent different parts of a continuum of autistic spectrum disorders as outlined in DSM-5. Generally, Asperger’s disorder has been viewed as a ______ version of autism associated with higher intellectual functioning.
Mild.
What are the etiological factors suggested for ASD?
Genetic factors - are now considered to play a dominant role in the development of autism spectrum disorders.
The relatively high frequency of autism among siblings of a per- son with autism; the frequent occurrence of autistic features in individuals with Fragile X syndrome, phenylketonuria (PKU), and tuberous sclerosis; and evidence that the phenotype (the pattern of social, cognitive, and behavioural abnormalities) extends beyond autism support a strong genetic component. Overall in about 25 percent of cases of ASD an identifiable genetic cause in the form of copy number variation or muta- tion is present
What are the treatment recommendations for ASD?
Medication - the two best- studied medications in autism include a first-generation agent, haloperidol (Haldol), and a second-generation agent, risperidone (Risperdal). However, Research data on the six most frequently prescribed medications—methylphenidate (Ritalin), thioridazine (Mellaril), diphenhydramine (Benadryl), phenytoin (Dilantin), haloperidol (Haldol), and carbamazepine (Tegretol)— indicate benefits in less than one-third of cases and adverse reactions in almost half of cases.
Supplements - there is some limited support for the effectiveness of omega-3 fatty acid supplements in reducing hyperactivity and stereotyped behaviours.
Behavioural Interventions - Evidence is strong for the effectiveness of proactive and positive interventions, with reductions in challenging behaviours occurring in 80 to 90 percent of cases. Some studies indicate that 75 to 95% of children who participated in EIBI (early intensive behavioural intervention) programs developed useful speech by age five.
