Rogers- Autism Spectrum Disorder Flashcards
Autism spectrum disorder (ASD) is a disorder with onset in early childhood
neurobiologic
What are the key features for ASD?
impairment in social communication and social interaction
accompanied by restricted and repetitive behaviors
There is currently no diagnostic for ASD
biomarker
What components are required for an accurate diagnosis of ASD?
thorough history and direct observation of child’s behavior
Numerous genes involved in brain development and function have been associated with ASD
synaptic
Mutations that include large genetic deletions or duplications and small sequencing changes have been implicated; these can be or occur de novo
inherited
Which 3 types of disorders have higher rates of ASD?
genetic syndromes (fragile X, Down, Smith-LemliOpitz, Rett, Angelman, Timothy, Joubert)
metabolism disorders
mitochondrial function disorders
What are some examples of genetic disorders with higher rates of ASD?
fragile X, Down, Smith-LemliOpitz, Rett, Angelman, Timothy, Joubert
Younger/Older maternal or paternal age may increase the risk of ASD
older
What factors that influence the intrauterine environment are associated with ASD?
maternal obesity or overweight,
short interval from prior pregnancy,
premature birth,
and certain prenatal infections (e.g., rubella, cytomegalovirus)
What are 2 prenatal infections associated with ASD?
rubella,
cytomegalovirus
What are 2 strong predictors for risk of ASD that can present in early infancy?
reduced response to name and unusual use of objects
Symptoms before age months are not as reliably predictive of later diagnosis
12
When do children with milder severity usually present with symptoms?
may not present until preschool or school age, when the social demands for peer interaction and group participation are higher
What is the prevalence of ASD?
1 in 59
male/ female ratio of ASD
4:1 male predominance
Prevalence in siblings?
in identical twins?
fraternal twins?
20%
77%
31%
There are/are no racial or ethnic differences in prevalence of ASD?
are no
• Individuals from racial minorities and lower socioeconomic status are at risk for diagnosis
later
The etiology of ASD is thought to result from disrupted connectivity and is primarily impacted by genetic variations affecting brain development
neural
early
Studies indicate changes in brain volume and neural cell density in which 3 parts of the brain?
limbic system,
cerebellum, and
frontotemporal regions
What could be some items on the differential diagnosis?
What % have a comorbid intellectual disability?
50%
What % have comorbid gastrointestinal problems?
What kinds of GI problems?
70%
constipation, esophagitis, and gastroesophageal reflux disease (GERD) are reported in children with ASD
Epilepsy occurs in up to % of children with ASD and presents in 2 peaks, in childhood and in
35
early
adolescence
There are higher rates of anxiety (~40%) and mood disorders in ASD, particularly during what phase of life?
adolescence
Sleep problems, including delayed sleep onset, frequent night waking, and abnormal sleep architecture, are reported in % of children with ASD
50–80
What are 3 common sleep problems that up to 50-80% of children with ASD have?
delayed sleep onset, f
requent night waking, and
abnormal sleep architecture
Disruptive behaviors such as and aggression are common in ASD patients, but most common in individuals with lower cognitive function and limited language
self-injury
What are 5 issues that could contribute to disruptive behaviors?
Sleep deprivation,
nutritional deficits,
pain,
epilepsy, and
medication side effects
The following are examples of what in the DSM-5?
•Repetitive “stereotypic” movements such as hand flapping, body rocking while standing, spinning, and finger flicking
- Repetitive or stereotyped play; e.g., opening and closing doors
- Over focused or unusual interests
- Excessive insistence on following own agenda
- Extremes of emotional reactivity to change or new situations; insistence on things being “the same”
- Overreaction or underreaction to sensory stimuli, such as textures, sounds, or smells
•Excessive reaction to the taste, smell, texture, or appearance of food, or having extreme food fads
Unusual or Restricted Interests and/or Rigid or Repetitive Behaviors
The following are examples of what criteria in the DSM-5?
•Reduced or absent use of gestures and facial expressions to communicate (although may place an adult’s hand on objects)
•Reduced and poorly integrated gestures, facial expressions, body orientation, eye contact (looking at people’s eyes when speaking), and speech used in social communication
- Reduced or absent social use of eye contact (assuming adequate vision)
- Reduced or absent “joint attention” (when 1 person alerts another to something by means of gazing, finger pointing, or other verbal or nonverbal indication for the purpose of sharing interest)
Following a point (looking where the other person points to—may look at hand
Using pointing at or showing objects to share interest
Eye Contact, Pointing, and other Gestures
What does reduced or absent joint attention mean?
(when 1 person alerts another to something by means of gazing, finger pointing, or other verbal or nonverbal indication for the purpose of sharing interest)
In the DSM-5 category of interacting with others:
Reduced or absent awareness of personal , or unusually intolerant of people entering their personal space
space
Under DSM-5 category of interacting with others
Reduced or absent interest in others
can seem disruptive and
social
aggressive
•Reduced or absent of others’ actions
imitation
Under interacting with others criteria of DSM 5:
Reduced or absent of social play with others; plays alone
- Reduced or absent of situations that most children like; e.g., birthday parties
- Reduced or absent sharing of enjoyment
initiation
enjoyment
DSM-5 Responding to Others:
Absent or delayed response to name being called, despite normal
- Reduced or absent responsive social smiling
- Reduced or absent responsiveness to other people’s facial expressions or feelings
- Unusually negative response to the requests of others (“ avoidance” behavior)
- of cuddles initiated by parent or caregiver, although the child may initiate cuddles
hearing
demand
Rejection
• Language delay (in babbling or using words; e.g., using < words by age 2yr)
10
What is the term when there is a reduction in, or loss of, use of speech?
Regression
What is one of the first clues in a young child of suspected autism?
language delay
(less than 10 words by age 2)
What are some unusual features in speech?
vocalizations that are not speech-like; odd or flat intonation; frequent repetition of set words and phrases (echolalia);
When is the screening for all children recommended for ASD?
at age 18 mo and 24 mo
Other than at 18 mnths and 24 mnths, when should screening for ASD be indicated?
Screening should also occur when there is increased risk for ASD, such as a child with an older sibling who has ASD, or concern for possible ASD
What is the most frequently used screening tool for ASD?
Modified Checklist for Autism, Revised/ Follow-Up Interview (MCHATR/FU)
What are the scoring criteria of the MCHAT-R/FU?
Diagnostic assessment should include medical evaluation and assessment of the child’s cognitive, language, and function
adaptive
What are things to look for in the physical examination of child suspected of ASD?
What are 4 diagnostics tests that can be included if ASD suspected?
What is a diagnostic test only performed in males with suspected ASD?
Fragile X DNA test in males
What is the primary treatment for ASD and where is it usually performed?
The primary treatment for ASD is done outside the medical setting and includes developmental and educational programming
What type of therapy for ASD has the strongest evidence?
Intensive behavioral therapies (ABA) such as applied behavioral analysis therapy
age at initiation of treatment and intensity of treatment are associated with better outcomes
Earlier
higher
The treatment (intensive behavioral therapies) must be individualized/standardized
individualized
What type of ASD treatment involves direct incremental teaching of skills within a traditional behavioral framework using reinforcement of desired behavior?
applied behavioral analysis (ABA)
What educational approach incorporates structured teaching, visual supports, and adjustment of the environment to the individual needs of students with ASD, such as difficulty with communication, understanding time, and need for routine?
Treatment and Education of Autistic and Communication Handicapped Children (TEACCH)
What kind of therapy can help build vocabulary, comprehension, and pragmatic skills?
Speech and language therapy
Children with ASD benefit from supports for comprehension, understanding expectations, and communicating their needs
visual
What type of communication approaches using photographs or picture icons and can improve comprehension and ability to communicate?
Augumentative communication
What 3 kinds of drugs can treat hyperactivity and/or inattention in those with ASD?
stimulants
a2- agonists
selective norepinephrine reuptake inhibitor
What type of medication can be used to treat anxiety in those with ASD?
SSRIs
What drugs can treat irribility in kids with ASD?
atypical antipsychotics (risperidone, aripiprazole)
What can be used to treat insomnia in those with ASD?
melatonin
