Autism Spectrum Disorder (ASD)
What is the gold standard for ASD screening tests?
Autism Diagnostic Observation Schedule (ADOS) - caregiver observation tool
Absolute Indications for Immediate Evaluation for ASD
1. no babbling at 12 months 2. no gesturing (pointing, waving goodbye, peek-a-boo, patty-cake, etc.) by 12 months 3. no single words by 16 months 4. no two-word spontaneous phrases by 24 months, no searching for hidden objects 5. any loss of any language or social skills, at any age
Restricted interests and repetitive behaviors for ACSF Level 2 (requiring substantial support)
-RRBs and/or preoccupation or fixated interests appear frequently enough to be obvious to the casual observer and interfere w/ functioning in a variety of contexts -distress or frustration is apparent when RRBs are interrupted, difficult to redirect from the fixated interest
Restricted interest/repetitive behaviors with ACSF Level 1 (requiring support)
-Rituals and repetitive behaviors (RRBs) cause significant interference w/ functioning in one or more contexts -resists attempts by others to interrupt RRBs or to be redirected from fixated interest
M-CHAT high risk
-Total score of 8-20 -refer immediately for diagnostic evaluation and eligibility for early intervention
With a developmental disability (DD) waiver, what additional services might become a part of an individual's service plan?
-adult day care -assistive technology -support provider training/edu -case management -consumer-directed comm supports -consumer training/edu -day training and habilitation services -housing access coordination -supported employment status -supported living services -transitional services -transportation services
Children with ASD who get intervention services at a young age are more likely to have:
-better language and communication skills -higher intelligence -improved behavior
60-80% of kids with ASD demonstrate motor signs, such as:
-hypotonia -poor motor planning -decr eye-hand coordination and balance -postural instability -diff imitating others motor activity -toe walking -sensory impairments: can be hypo- or hyper-
Social communication for ACSF Level 2 (requiring substantial support)
-marked deficits in verbal and nonverbal social comm skills -social impairments apparent even w/ supports in place -limited initiation of social interactions and reduced or abnormal response to social overtures from other
What is a new tablet-based diagnostic technology used for ASD?
-monitors a toddler's eye movements when looking at social interactions to determine if the toddler is focusing on interaction or gazing away from the interaction (results can be available in 30 min) -can identify disorder in children ages 16-30 months as accurately as a specialist would -IMPORTANT -> earlier diagnosis = earlier intervention = better prognosis
What are some other disorders associated with ASD?
-mood or attention disorders -depression and suicide risk more common
Level 5: ACSF
-most severe -few, if any, attempts to react to communication
Possible signs of ASD
-poor eye contact -doesn't know how to play with toys -excessively lines up toys or objects -overly attached to one particular toy/object -doesn't smile -may appear hearing imapired -performs repetitive movements (rocking, spinning, hand flapping) -problems with coordination or has odd movement patterns (clumsy, toe-walking) -sensitive to light/sound/touch, yet may be indifferent to pain or temperature -doesn't "pretend" play
Restricted interests & repetitive behaviors for ACSF Level 3 (requiring very substantial support)
-preoccupations, fixed rituals, and/or repetitive behaviors markedly interfere with functioning in all spheres -marked distress when rituals or routines are interrupted -very difficult to redirect from fixated interest or returns to it quickly
Social communication for ACSF Level 3 (requiring very substantial support)
-severe deficits in verbal and nonverbal social comm skills cause severe impairments in functioning -very limited initiation of social interactions and minimal response to social overtures from others
What does "neurodiversity" mean?
-the different ways a person's brain processes information, and ppl may do this differently -Common types: ASD, ADHD, DCD, dyslexia, etc.
Social communication observations for ACSF Level 1 (requiring support)
-without support in place, deficits in communication cause noticeable impairments -has difficulty initiating social interactions and demonstrating clear examples of atypical or unsuccessful responses to social overtures of others -may appear to have decreased interest in social interactions
Prevalence of ASD
1. 1/36 children have it 2. boys 4x more likely than girls 3. common age of diagnosis: 5 years old (school-age) 4. symptoms can occur as early as 18 months-3 years --> not impacted by race, region, or socioeconomic status
What are the statistic for autistic children and verbal communication?
1. 40% don't speak 2. 25-30% have some words at 12-18 months of age and then lose them 3. others might speak, but not until later in childhood
1. What 2 drugs are FDA-approved for tx of irritation and aggression in ASD? 2. What are some downsides of these drugs?
1. Risperidone and aripiprazole 2. can cause EPS and excessive weight gain
The ACSF distinguishes btw 2 aspects of ability for each child:
1. What does their social communication look like and when are they functioning at their best (capacity)? 2. What does it look like most consistently? (typical performance?
What are some previous names that are now under the umbrella of ASD?
1. autistic disorder 2. childhood disintegrative disorder 3. Asperger's 4. pervasive developmental disorder
What are some strategies for using clear, communication strategies with ASD individuals in the workplace?
1. avoid sarcasm, euphemisms, and implied messages 2. provide concise verbal and written instructions for tasks, and break tasks down into small groups
What two tests are recommended for all children with ASD to predict prognosis? What do they reveal?
1. chromosomal microarray - will detect genetic abnormalities in up to 42% of children w/ ASD 2. Fragile X testing: positive in less than 1% of pts w/ ASD, but is important for genetic counseling
Environmental causes of ASD
1. infectious diseases - virus, heavy metals, solvents, phenols used in plastic products, pesticides
Intervention guidelines for ASD
1. interdisciplinary w/ lots of overlap/reinforcement 2. If/Then model for selecting activities 3. communicating assistance - use augmentative and alternative communication (AAC) 4. sensory diets 5. maintain a schedule and allow time for transition
What are some strategies that employers can use to make workplaces more neurodiversity-friendly?
1. offer small workspace adjustments to accommodate any sensory needs, such as: -sound sensitivity: offer a quiet break space, communicate expected loud noises, offer noise-cancelling headphones -tactile: allow modifications to the usual work uniform -movements: allow use of fidget toys, allow extra movement breaks, offer flexible seating 2. use a clear communication style 3. inform people about workplace/social etiquette, and don't assume someone is deliberately breaking the rules or being rude 4. try to give advance notice if plans are changing and provide a reason for the change 5. Don't make assumptions - ask a person's individual preferences, needs, and goals 6. Be kind and patient
While etiology of ASD is unknown, onset appears to be preceded by 2 phases:
1. smaller than typical head size at birth 2. sudden and excessive increase in head size btw 1-2 months and 6-14 months
Autism is a bio-neurological developmental disability that is characterized by impaired:
1. social interaction 2. communication 3. cognitive function 4. repetitive behaviors
For ASD, the AAP recommends screening at
18 and 24 months at wellvisits with M-CHAT-2.
What are the critical items on the M-CHAT?
2. Does your child take an interest in other children? (socialization) 7. Does your child ever use his index finger to point to something? (early communication) 9. Does your child bring objects over to you to show you something? (socialization) 13. Does your child imitate you? 14. Does your child respond to his/her name when called? 15. If you point to a toy across the room, does your child look at it? (early comm)
ASD typically starts to manifest in childhood and is diagnosed by age
3 in most cases.
Children with persistent deficits on M-CHAT Revised with Follow-up have a
47% risk for ASD and a 95% risk for any developmental disorder.
Joe is a 6 y/o child with autism who appears to have trouble understanding/following social cues, appears uninterested in his PE class, and has trouble switching between tasks and staying organized. What ACSF level is he most likely at? A. level 1 B. level 2 C. level 3 D. level 4
A. level 1
Amara is a 4 y/o child who has a high interest in dinosaurs specifically, wears headphones during class to limit sensory input, has trouble with verbal and nonverbal communication, and has frequent repetitive and restrictive behaviors. What ACFS level is she most likely at? A. level 1 B. level 2 C. level 3 D. level 4
B. level 2
Tom is a child with ASD who is nonverbal, prefers to sit alone during school and at home, and has extreme distress when changing his focus between activities. What level is he most likely at? A. level 1 B. level 2 C. level 3 D. level 4
C. level 3
What is another useful ASD screening tesT?
Modified Checklist for Autism in Toddlers (M-CHAT)
Level 2 ACSF
Responding, initiating, attempting to communicate with FAMILIAR people but more focused on own needs
Level 1 ACSF (highest ability, most mild)
Responding, initiating, maintaining communication for social purpose: beyond own needs with UNFAMILIAR people -successful in familiar environments
The Autism Classification System of FUnctioning (ACSF) is a five-level tool that
classifies children/youth with ASD by their social communication abilities.
What types of modifications can you make in sensory environment in early life?
closed environment, decr sensory stimulation
M-CHAT Low-risk
Total score: 0-2 -If child is <24 months, screen again after 2nd birthday
M-CHAT medium risk
Total score; 3-7 -administer follow-up (2nd stage of MCHAT R/F) -If score remains 2+ --> refer
Autism affects information processing in the brain by
altering how nerve cells and their synapses connect and organize.
Disrupted sleep with ASD is common and can exacerbate
behavior issues and limit the effectiveness of behavior therapies.
The AAP recommends the M-CHAT for initial screening in
children up to 30 months of age. -free, translated into multiple langauges
Healthy People 2030 goals for ASD
increase the proportion of children with ASD who enroll in special services by age 48 months (proportion is worsening)
Early indicators of ASD in childhood (before age 3) include
lack of response to one's name and discomfort with maintaining eye contact.
Onset aggression or self-injury should trigger a
medical exam, review of home safety, and potentially an emergency stabilization with medication.
CBT is effective for anxiety in school-aged children w/ ASD, although
meds are often necessary.
When health care providers screen for ASD at primary care visits and refer children for diagnosis and treatment,
more young children with ASD get the services they need.
Why is wandering such a dangerous behavior with ASD?
nearly 1/2 of children younger than 10 years have wandered from home, leading to police calls, drowning, and accidents -strict supervision with boundaries, including locks, is often required
Treatments for disrupted sleep related to ASD
parent education, behavior interventions, melatonin
Ages and stages questionnaire
parent questionnaire w/ 19 age-specific questions screening communication, gross motor, fine motor, problem-solving, and personal adaptive skills -results in p/f score for domains
Who can use the ACSF?
parents and professionals who are familiar w/ the child's social communication abilities and are able to use the ACSF
Suicide risk for pts with ASD is elevated in
racial minorities, males, those with peer victimization, behavior problems, lower SES, and lower education level.
Genetic causes of ASD
rare mutations
Level 4 ACSF
reacting to communication from FAMILIAR people but NOT responding to UNFAMILIAR people
Current treatments for ASD are focused on:
reducing symptoms that interfere w/ daily functioning and quality of life.
What should you do if a child is unable to perform 3 items on the entire list of the M-CHAT?
refer for developmental evaluation
Level 3 ACSF
responding to communication when asked simple routine questions about OWN. NEEDS
Screening for ASD and developmental tests need to
screen all of development, not just gross motor skills.
Neural causes of ASD
synaptic dysfunction
T/F ASD affects each person differently and will have different treatment needs.
true
T/F An interdiscplinary team and TIME is required for ASD diagnosis.
true
T/F Antidepressants have inconsistent results in children w/ ASD and don't effectively treat aggression.
true
T/F There are no screening tools for ASD that are valid for children older than 30 months.
true
T/F Using a clinical diagnosis can improve time to early intervention for kids with ASD.
true
What age-range is indicated for the ACSF?
when used by parents and professionals for kids aged 2-16 -validated for ages 2-19
