Autism Spectrum Disorders - Characteristics and Assessment

What characterizes someone as having PPD-NOS?

The child has some symptoms of ASD but does not meet specific criteria for diagnosis

What are some examples of telegraphic utterances?

This my baby Mommy feeding baby Baby drink milk

The DSM-5 ASD diagnostic criteria require that a child must show how many types of impairment in social communication and interaction?

Three: 1. Social-emotional reciprocity 2. Non-verbal communication 3. Developing, maintaining and understanding relationships

Autism Spectrum Disorder is primarily a disorder of...

Communication. Not simply a language disorder.

What communication deficits do people with ASD present with?

-Delayed or absent verbal communication or gestures -Impaired initiation/maintenance of conversation -Lack of pretend play -Repetitive/idiosyncratic use of language

What is social-emotional reciprocity?

Appropriate interactions with another person

True/False: Once diagnosed, no children ever lose the label of ASD.

False

True/False: ASD is a language disorder.

False.

What are some examples of simplified grammatical forms?

Feeding the baby My baby

What are some proposed neurophysiological correlates of ASD?

-Abnormal cellular organization of limbic system -Elevated levels of neurotransmitter serotonin -Increased volume in several cortical areas

What are some trends in language skills in children with ASD?

-Articulation relatively unimpaired -Perform poorly in repetition of nonsense words due to poor phonological short term memory -Perform poorly on rhyme awareness tasks -Consistently depressed vocabulary scores -Deficits in language use

What are some specific diagnostic tools for children suspected of having ASD?

-Checklist for Autism in Toddlers (CHAT) -Pre-linguistic Autism Diagnostic Observation Schedule (PL-ADOS) -Autism Diagnosis Interview-Revised (ADI-R) -Childhood Autism Rating Scale (CARS)

How does the CARS work for assessing Autism?

-Considered the gold standard -Used for children over 2 years of age -Developmental scale relative to age peers -Based on observation and parent interview -High reliability and validity -Must be trained in use of this tool -List of items and rate each from 1-4

What are some clinical cues for ASD?

-Delay/absence of spoken language -Lack of awareness of others -Lack of pretend play -Lack of turn-taking -Lack of proto-declarative pointing -Lack of initiation of social play -Repetitive hand/finger mannerisms -Unusual reactions to sensory stimuli

What are some behaviors that suggest there is an impairment in reciprocal social interactions?

-Difficulty understanding/perceiving the emotions of others -Difficulty sustaining interactions initiated by others -Poor, fleeting or abnormal eye contact -Lack of comfort-seeking when distressed -Difficulty making peer friendships appropriate to developmental level -Lack of effort to share interests or enjoyment with others -Lack of turn-taking play with peers -Difficulty understanding social cues -Difficulty understanding and expressing own emotions -Seeking touch and affection on own terms, but shunning affection when offered by others -Preference for solitary play -Absence of symbolic play behavior -Frequent or sustained giggling, laughing or crying without visible cause - May appear deaf at times, yet hear sounds from a distance at other times

How does the PL-ADOS work for assessing Autism?

-Direct observation of elicited behavior -Must be trained in use of this tool

What is CDD (Childhood Disintegrative Disorder) aka Heller's Syndrome?

-Dramatic loss of language, motor, social skills around age 3-4 -Very rare -Children appear typically developing at birth and then regress -More common in males

What are some proposed causes of ASD that have not yet been disproved?

-Environmental contaminants -Allergies to gluten -Genetic factors -Neurophysiological correlates -Reduced connectivity of brain regions

What are some deficits in language and cognitive skills in people with ASD?

-Impaired acquisition of words, word combinations, syntax -issues with use and understanding of verbal and nonverbal communication -Symbolic play deficits -Conversation deficits -Literacy deficits -Executive functioning deficits

In what ways does a person with ASD have disordered pragmatics?

-Inability to appreciate perspective of others (theory of mind) -Speech not always directed at others -Echolalia

In what ways does a person with ASD have disordered communication?

-Inability to express communicative functions and engage in normal social behavior -Range from mutism to sparse language to aberrant but sufficient verbal language

What are some early warning signs in infants with ASD?

-Lack of positive response (no coo or goo) -Does not orient to name -Does not look at faces or make eye contact -Does not show objects to others or point at things -Smiles at others less -Does not try to imitate -Shows less interest in other children/prefers being alone

What are the three biggest red flags that a child may have ASD?

-Loss of previously learned language -Hand flapping -Spinning

What are some disproved proposed causes of ASD?

-Mercury in vaccines -Cold mothers/parents

What specialists are involved in the diagnostic evaluation of a child who may have ASD?

-Neurologist -Geneticist -Psychologist -SLP

What is typically including in a screen for ASD?

-Parent report -Teacher report -Interviews and observations -Hearing screening to rule out hearing loss as the reason for communication and behavior issues

ASD symptoms may or may not include...

-Problems with using and understanding language -Difficulty relating to people, objects and events -Unusual play with toys and other objects -Difficulty with changes in routine or familiar surroundings -Repetitive body movements or behavior patterns -Difficulty regulating emotions

What is Rett Syndrome or Rett's Disorder?

-Progressive neurodevelopmental disorder -Autism-like symptoms, such as repetitive hand washing -Microcephaly, intellectual disability -No longer included under ASD umbrella -More common in females

In what ways does a person with ASD have disordered behavior?

-Repetitive behavior -Narrow interests -Rituals

What behavioral deficits do people with ASD present with?

-Restricted repertoire -Preoccupation with restricted patterns of interest -Inflexible adherence to routines -Preoccupation with parts of toys

How does the CHAT work for assessing Autism?

-Screening test for children ages 18-36 months -Takes 5-10 mins to administer and score -No training needed -9 yes/no questions for parents -Observation of 5 brief interactions between child and clinician

What are some early differences in intentional communication in children with ASD?

-Sparse verbal expression and lack of spontaneity -Difficulty making relevant comments -Difficulty maintaining topic outside of own obsessive interests -Difficulty with turn taking -Literal/concrete language, doesn't understand jokes -Selective use of echolalia when not understanding what is said to them

Facts about ASD

-Spectrum from mild to severe -Pragmatic issues -Difficulty with theory of mind -Often co-morbidities, such as intellectual disability -Occurs more in males -Issues with inferencing -Speech/language issues -No medical detection or cure -Fastest growing developmental disorder -Often above normal in distinguishing small differences between stimuli -Sensory processing difficulties -Difficulties in selective attention, orienting and shifting attention -Able to express emotion and make attachments

How does the ADI-R work for assessing Autism?

-Structured interview -Must be trained in use of this tool -Aid to diagnosis, treat and educationally plan -Used for children and adults over the age of 2 -Contains 93 items in 3 functional domains (language and communication, reciprocal social interactions, restricted/repetitive/stereotyped behaviors and interests)

What are the two most common options for talking to a child with language impairments?

-Telegraphic Input (TI): language simplified to the point of being ungrammatical -Simplified but grammatical input

What did the Van Kleeck study on TI vs simplified grammatical forms show?

-Telegraphic Input group improved in terms of their expressive language but not their receptive language. -Sparse of optional presentation of morphosyntactic features makes those features more difficult to acquire.

How do the DSM-5 changes to ASD affect the field of speech-language pathology?

-There is no longer any criteria related to delay or lack of development of spoken language. -Allows the clinician to specify whether ASD occurs with or without language impairment

According to the DSM-5, to be diagnosed with ASD, a child's impairments must:

1. Be present in early development 2. Cause impairment in social, occupational or other areas of functioning 3. Not be better explained by intellectual disability or global developmental delay

Autism Spectrum Disorder impairs a person's ability to...

1. Interact with others (social-emotional reciprocity) 2. Communicate verbally and non-verbally 3. Form relationships

What are the 4 types of restrictive or repetitive patterns of behavior common in ASD?

1. Repetitive movements, speech or use of objects (e.g. hand/arm flapping, running in circles) 2. Insistence on sameness or ritualized patterns of verbal of nonverbal behavior 3. Highly restricted, fixated interests that are abnormal in focus/intensity 4. Under or over reaction to sensory input or unusual sensory interest

According to the DSM-5 a child must show how many of the 4 types of restrictive/repetitive patterns of behavior to be diagnosed with ASD?

2 of the 4

When do children with language delay and children with ASD begin to look different?

24 months/2 years

What number corresponds with a diagnosis of mild autism on the CARS?

30

What is dynamic assessment?

A method that seeks to identify an individual's skills as well as his or her learning potential. Highly interactive and emphasizes the learning process over time.

What are the main characteristics that differentiate ASD from other developmental disorders?

Deficits in: -Eye gaze -Orienting to one's name -Pointing to or showing objects of interest -Pretend play -Imitation -Nonverbal communication -Language development

What socialization deficits do people with ASD present with?

Deficits in: -Use of nonverbal behavior -Lack of social/emotional reciprocity -Failure to develop peer relationships -Observing social norms -Understanding nonverbal cues in interactions

What kind of delays in non-verbal communication might be missing in someone with ASD?

Early gestures missing, no reaching out for objects, no joint attention

True/False: Disordered communication in ASD does not include ritualistic language.

False

What is the difference between imitation and echolalia?

Imitation has intent, echolalia is automatic

What happens when a child has a high level of lead in their blood?

Intellectual deficits Learning challenges

Is PPD-NOS in the DSM V?

No, it was folded into the diagnosis of autism spectrum disorder

What is a naturalistic observation when used to evaluate a a child who may have ASD?

Observation of the individual in everyday social settings with othera

What are analog tasks when used to evaluate a a child who may have ASD?

Observation of the individual in simulated or staged communication contexts that mimic real-world events

What does PPD-NOS stand for?

Pervasive Developmental Disorder-Not Otherwise Specified

Autism Spectrum Disorder is a _______________ disorder with a ______________ basis.

Psychiatric disorder with a neurological basis

What were the DSM-5 changes to ASD related to sensory input?

Recognition of unusual reactions to sensory input, such as hyper or hypo reactivity or unusual interest in sensory aspects of environment

What type of deficits are paramount in ASD?

Social deficits

True/False: ASD is primarily a disorder of communication, it's not simply a language disorder.

True

True/False: Children with ASD typically have a limited ability to imitate

True

True/False: Incidence of ASD is higher if there is a family history.

True

True/False: Incidence of ASD is higher in males than females.

True

True/False: The DSM-5 uses the term Autism Spectrum Disorders (ASD) to replace the sub-groups such as asperger syndrome.

True

True/False: The etiology of ASD is thought to be biologic/genetic.

True

What is the relationship between communicative intent and gestures in children with Autism?

When speech does not develop (happens in 50% of children with ASD), it is not replaced by gestures. Communicative intent is not there either gesturally or in speech.

Do children with autism sometimes have difficulty with phonological processing and grammar?

Yes