Semester 1 Week 3 - ASD Flashcards
definition of autism
Autism is a neurodevelopmental disorder characterised by difficulties with social communication and repetitive and restricted behaviours and interests
what is used to diagnose autism?
DSM-5
criticisms of DSM-5
- Focuses heavily on ‘impairment’ (medical model)
- Has faced criticism for pathologizing neurodivergent characteristics
- There is call for more focus on differences rather than difficulties or deficits (neurodiversity paradigm)
what has been removed from the diagnostic criteria in the DSM-5 that was present in the DSM-3
anything to do with speech and language - now focuses on social communication only since they are the most widely prevalent amongst autistic individuals
how many categories in the DSM-5
5
what are the 5 diagnostic criteria categories in the DSM-5
A. Persistent difficulties in social communication and social interaction across mulitple contexts
B. Restricted, repetitive patterns of behaviour, interests or activities
C. Symptoms must be present in the early developmental period
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 or global developmental delay
In category A how are the persistent deficits in social communication and interaction manifest? (3)
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communicative behaviors used for social
interaction - Deficits in developing, maintaining, and understanding relationships
in category B of the DSM-5 the restricted/repetitve patterns of behaviour are manifested how? (4) How many are needed to to meet the criteria?
at least 2 of the following:
1. Stereotyped or repetitive motor movements, use of objects, or speech
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environmen
do people need to have an obvious presentation of autism since childhood to get a diagnosis?
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
what needs to be present to make a co-morbid diagnosis of ASD and intellectual disability?
social communication should be below that expected for general development level
who developed ‘autism’ as a diagnostic concept and when?
developed by Leo Kanner in 1940s
how did Kanner charaterize autism
he identified many of the typical behaviours but did not discuss these interms of variation and so autism was understood to be a single entity and became known as a behavioural syndrome
how did the perception of autism change in the 70s and 80s?
Autism continuum of severity and triad of impairment came from Lorna Wing, Judith Gould and colleagues and was used to try and explain the variation in Autism
what is included in the triad of impairment?
communication
socialisation
imagination
what was included in the DSM-3
● ‘Pervasive lack of responsiveness to other people;
● Gross deficits in language development’
● Absence of delusions, hallucinations
why was the absence of delusions and hallucinations so important in the DSM-3
to differentiate autism from schizophrenia
how has presentation of autism changed since the 80s?
80s:
Intellectual disability common (75%)
Many children minimally verbal
Most children in special educational provision
Specialist diagnostic service
today:
Intellectual disability minority (25%)
Mainly mainstream schools
what does the DSM-5 now include? (3)
● Persistent deficits in social communication and social interaction across multiple contexts’
● ‘Restricted, repetitive patterns of behaviour, interests or activities’ can include ‘hyper or hypo-reactivity to sensory input’
● Currently or by history multiple diagnoses allowed for the first time, e.g., ASD and ADHD
prevalence of ASD in 1980s
6 in 10,000
male to female ratio of ASD in 1980s
M:F 5/10:1
prevalence of ASD in 2018
1 in 100
M:F ratio of ASD in 2018
M:F 3:1
what was the increase in recorded incidence of ASD from 1988 to 2018
787%
which groups saw a bigger increase in ASD diagnosis between 1988-2018?
females
adults
what is most likely to explain the increase in autism diagnoses
increase most likely due to increased reporting, application of diagnosis, particularly to ‘higher functioning’ adults - ASD is not increasing but ASD is now much more widely recognised and identified across all the population,
what is highlighted by autism advocates as especially important to remember?
‘functioning’ is transient, varying with time and place therefore the individual’s unique profile must be understood to specify meaningful supports
is the triad of impairment still recognised as a model to be used to diagnose autism?
no however it is still useful to understand it and recognise how speech, language and communication is affected in some autistic individuals
how is socialisation impacted by ASD (8)
Lack of ability to understand and interpret social signals and behaviours
Difficulty initiating social contact and forming relationships with others
A lack of reciprocal interest in others
Can result in social withdrawal, isolation or alienation
Unusual eye gaze
Atypical body posture/problems with proxemics (personal space)
Absent or deviant use of gesture
Unusual facial expressions
how is communication impacted by ASD (10)
Difficulties using language to communicate (potentially do not use spoken language or might use it but not in a way that is effective)
Some individuals with ASD use language in different ways.
Echolalia and implications for Gestalt Language Processing (GLP)
Perseveration
Stereotyped and idiosyncratic language
Neologism/jargon
Pronoun reversal
Often have unusual pitch, rhythm, intonation and stress
Many have additional language difficulties – syntax, vocabulary, word finding,
find inferential use of language difficult
which areas of inferential language are often found difficult? (5)
• Deictic words – “here”, “there”, pronouns, “this”, “that”…
• Time words – “before”, “after”, “while”, “later”…
• Humour/sarcasm/irony
• Metaphor and simile
• Narrative – lack of coherence
how does ASD impact imagination, thought and behaviour? (5)
Young children with ASD often appear to have delayed pretend play and symbolic play
Older individuals may play or behave imaginatively but in an unusual or routinised way – ‘scripted’
Often have stereotyped or repetitive behaviours, which can be simple (sensori-motoric) or complex (obsessive-compulsive) including what is often referred to as ‘stimming’
Often focus on details and the sensory properties of people/objects
More able individuals may show perceived ‘obsessive’ interests or factual knowledge
what were 3 conditions formally recognised in diagnostic criteria that were related to but seperate from ASD or part of the spectrum (no longer recognised)
• Asperger syndrome
• High Functioning Autism
• Pervasive developmental disorder not otherwise specified (PDD-NOS)
when did Hans Asperger coin the term Asperger syndrome and when did his work become more widely recognised?
main research condicted in 1944 but didn’t become known until 1981
presentation of Asperger syndrome
Referred to children who demonstrate deficits in social interaction, social use of language and restricted/repetitive interests (namely obsessions) but without language delay or disorder, or impaired intellectual ability.
often used language in unusual, overly formal ways and appeared clumsy – both socially and physically
why was Asperger’s work contreversial?
Hans was a Nazi involved in diagnosing Asperger’s and seperating them from ‘classic’ autism diagnoses. People that had Asperger’s were considered to be high-functioning enough to not be mudered in concentration camps. This was not known when his work first became published and so was used in the 80s however it is now incredibly contreversial and no one is now diagnosed with Asperger’s.
what was anither controversy surrounding Asperger syndrome?
Much controversy over whether Asperger Syndrome was a disorder or a difference - some researchers argued a very high prevalence of the condition (up to 1 in 50 males!)
