Week 3 - Autism Spectrum Disorder (ASD) Flashcards
What are the diagnostic criteria for ASD?
- Persistent deficits in each of the 3 areas of social communication & social interaction across multiple context
- Deficits in social-emotional reciprocity
- Deficits in non-verbal communicative behaviours used for social interaction
- Deficits in developing, maintaining and understanding relationships
- Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at
least two of the following
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of
verbal or nonverbal behavior - Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of
the environment
- Symptoms must be present in the early developmental period
- Symptoms cause clinically significant impairment in social, occupational, or other important
areas of current functioning - These disturbances are not better explained by intellectual disability (intellectual developmental
disorder) or global developmental delay
What are the severity levels for ASD?
Level 1 - Requiring support
- Social communication: without support in place, difficulty initiating social interaction, decreased interest in social communication
Example: a person who is able to speak in full sentences but whose to-and-fro conversation with others fails; attempt to make friends unsuccessful
- Restricted, repetitive behaviour: inflexibility cause significant interference with functioning in one or more context, problems with organization and planning hamper independence
Level 2 - Requiring substantial support
- Social communication: marked deficits in verbal and non-verbal social communication skills, social impairments apparent even with support in place, limited initiation, reduced / abnormal response to others
Example: a person who speaks simple sentences, whose interaction is limited to narrow special interests and who had markedly odd non-verbal communication
- Restricted, repetitive behaviours: inflexibility, difficulty coping with change, behaviour frequent enough to be obvious to observer, distress and / or difficulty changing focus or action
Level 3 - Requiring very substantial support
- Social communication: severe deficits in verbal & non-verbal communication, very limited social interactions, minimal response to social interactions
Example: a person with few words of intelligible speech who rarely initiate interaction. when they do initiate, makes unusual approaches to meet their needs only
- Restricted, repetitive behaviour: extreme difficulty in coping with change, behaviour markedly interferes with functioning in all areas, great distress / difficulty changing focus or action
What are the conditions that are viewed as ASD?
- Atypical autism
- Autism
- Childhood autism
- Pervasive Developmental Disorder (PDD)
- Pervasive Developmental Disorder not otherwise specified (PDD-NOS)
- Aspergers
What are some common comorbidity of ASD?
- ADHD
- Depression
- Anxiety (social interaction & routine)
- Developmental Coordination Disorder (DCD)
- Sensory processing difficulties
What are the areas of performance skills that are affected in ASD?
- Gross motor
- Praxis (difficulty planning and producing movement)
- Communication skills
- Social emotional regulation
- Sensory processing skills (poor auditory filtering, sensory seeking, hypersensitive)
What are the areas of occupational performance skills that are affected in ASD?
- Social participation
- Initiating, forming friendships, romantic relationships
- Play
- Engage in more sensorimotor & exploratory play than typically developing peers, prefer solitary and functional play, difficulty with generating flexible & novel ideas for play
- Sleep
- Difficulty falling asleep, staying awake, often wake early; associated with bedtime routines; sleep problems associated with other ASD symptoms and behaviour problems
- ADL (sensory issues)
- Toileting, feeding, oral care, dressing, showering
- Education
- Require accommodation for them to fully participate in academic tasks, classroom & social activities; special education required due to social difficulties & behavioural concerns instead of cognitive abilities
What are the family impact brought about by ASD?
- Specific needs for routine & predictability: activities often revolves around the needs of the child, difficulty balancing between need for predictable routine and flexibility for other members, family may avoid social events & activities outside of home (social isolation)
- Higher stress level: as compared to children with other disabilities
What are the impact of ASD on school?
- Preschool
- ADL skill development, play & social skills, building relationship with people around them, school readiness
- Primary school
- Transition to new routines, places & people, academic demands (multiple instructions, exams, problem solving), social demands (CCA, interacting after school hours)
How to identify ASD?
- Developmental surveillance: on-going process of identifying the child at risk of DD, deviance or abnormality
What are the signs & symptoms of ASD in young children?
- No babbling, pointing or gesturing by 12 months
- No single word by 18 months
- No spontaneous (non echoed) 2 words phrases by 24 months
- Any loss of language or social skills at any age
*Child with 1 or more of the following features must be referred promptly
What are the screening tools for ASD?
- Checklist for Autism in Toddlers (CHAT)
- Autism in Toddlers (M-CHAT)
What is the recommended age to screen for ASD in high risk populations?
18 or 24 months
Signs to look out during screening at 6 to 12 months
- Does not babble, point or use gestures by 12 months
- Has lost any language skills
- Does not respond readily to affection
- Has poor eye contact
Signs to look out during screening at 15 to 22 months
- Does not babble, point or use gestures by 12 months
- Does not speak a single word by 18 months
- Has lost any language skills
- Does not respond readily to affection
Signs to look out during screening at 24 to 36 months
- Does not use spontaneous 2 word phrases by 24 months
- Has lost any language or social skills
- Does not point to show interest
- Does not follow when someone is pointing something out to them
- Does not respond readily to affection
- Prefer to play alone
Signs to look out during screening at 4 to 6 years
- Does not follow when someone is pointing something out to them
- Unable to sit through, follow instructions and take turns when playing
- Does not respond readily to affection
- Not interested in playing with others
- Seems to be in his own world
- Becomes upset / anxious / clingy when separating from you
- Has great difficulty controlling his temper or gets very moody / physically aggressive when upset
- Finds it hard to make friends
What are some assessment tools to diagnose ASD?
- ASD-Specific Developmental History
- Autism Diagnostic Interview - Revised (ADI-R)
- Diagnostic Interview for Social Communication Disorder (DISCO)
- Direct observation
- Autism Diagnostic Observation Schedule (ADOS)
- Childhood Autism Rating Scale - 2 (CARS2)
- Contextual & Functional Implications
- Interview family & teacher
- Clinical & neurological exam to exclude associated medical conditions
- Hearing test, metabolic test, EEG, genetic evaluation
What are the areas to observe during assessments?
- Free play: repetition, limited play actions, stimming, less mature play, lining up of toys
- Functional & symbolic play: ability to have imaginative play
- Preverbal skills: joint attention, eye contact, imitation, turn taking, pointing
- Actual skills: gross, fine,
- Responding to name
- Interaction with caregiver
What level of support is eligible for EI centre?
Moderate to high
What are some intervention approaches that can be used with children with ASD?
- Positive Behavioural Approach (PBA)
- Occupational Therapy Sensory Integration (Ayres SI) & Sensory Strategies
- Cognitive Orientation to Daily Occupational Performance Approach (CO-OP)
- Floortime DIR
What can we use Positive Behavioural Approach for?
- To understand purpose of behaviours and use problem solving approach to find solutions for the behaviour
- Usually used for children with challenging behaviours
What are the specific strategies used in PBA?
Prompting, shaping, chaining, fading out
What is Sensory Integration & Sensory Strategies based on?
That learning & development is based on a foundation of multi sensory integration within the brain
What are the different types of sensory strategies?
- Modifying tasks & environment
- Altering arousal level to support learning
- Modifying time of activities to minimise reactions & meet sensory needs
Who can we use Floortime DIR (Development, Individual difference, Relationship) for?
Used for children who are lower functioning & non-verbal to improve their preverbal skills and interaction with others
What are the 3 primary strategies of Floortime DIR?
- Following the child’s lead / joining their world
- Challenging creativity & spontaneity
- Expanding interactions to include sensory motor skills & emotions
What are the 6 levels of Floortime?
- Level 1: shared attention & regulation
- Level 2: engagement and relating
- Level 3: purposeful communication
- Level 4: complex communication & problem solving
- Level 5: creating emotional ideas
- Level 6: emotional & logical thinking, communicating reasoning & building bridges between ideas
Who can we use CO-OP on?
Older children who have adequate language skills
What approach is CO-OP based on?
Cognitive & cognitive-behavioural approaches
What are some challenging behaviours in ASD?
- Avoiding difficult tasks
- Poor communication
- Seeking stimulation
- Unusual sensory response
- Seeking attention / preferred tasks
How can we improve parent’s self-efficacy?
- Behavioural intervention: increase self-efficacy, confidence, competency
- Parent training, education & coaching: improve skills, knowledge, coping and resilience
What are some interventions that can be used to improve social interaction?
- Structured programmes
- Social skills group: facilitate with normal everyday activities, address environmental factors, emphasize generalisation of skills, focus on achieving desirable behaviour and eliminate undesirable behaviours
- Taught explicitly with modelling and feedback
- Make concepts concrete
- Provide structure, predictability and visual cues
What are some existing programmes that can help with social skills?
- Stop Think Do
- Social stories
- Sensory stories
- Social thinking
What are some interventions that can be used to regulate behaviours?
- Teach whole body listening
- Teach child to adjust volume of speech according to situations (i.e. pretending voice has a remote control)
Structured teaching (TEACCH)
Helps to reduce behavioural problems, improve child’s understanding and promote independence
What are the elements of structured teaching?
- Physical environment
- Predictable activities
- Visual schedules
- Routines with flexibility
- Work activity system
- Visual structured activities
What are some interventions that are not usually done with ASD children?
- Brain imaging
- Lead screening
- Food allergy test
- Hair mineral analysis
- Immunological investigation
