ASD

Question 1

How to describe ASD

Answer 1

• ASD is a complex neurodevelopmental disorder

characterised by difficulties with social communication and interaction,

and repetitive and restricted behaviours, interests or activities.

• Range from mild (requiring some support) to severe (requiring substantial support).

Question 2

Classification

Answer 2

Must be present in the early developmental period:

A. Persistent deficits in social communication and social interaction across multiple contexts (all 3):
1. Deficits in social-emotional reciprocity: failure of back and forth convo, sharing of interests, and emotions, initiating or responding to social interactions
2. Non-verbal communication. – eye contact body language, understanding or using gestures, lack of facial expressions and non-verbal communication
3. Developing, maintaining and understanding relationships – difficulties in imaginative play, making friends, or interest in having friends

B. Restricted, repetitive patterns of behaviour, interests or activities (2/4)
1. Repetitive motor movement, use of an object, speech e.g., hand flapping
2. Inflexible adherence to routine, ritual patterns of behaviour
3. Fixated interests that are abnormal in intensity
4. Hyper/hypo reactivity to sensory input or sensory aspects of the environment

Question 3

Differentials

Answer 3

• ID = ASD can have average IQ & social communication typically poorer
• ADHD =
  o sim- hyperfocus, rep beh look like hyperactivity, inattention look like aloofness in convos with others, sensory sensitivities
  o diff- lack social interest in ASD and impulsivity in ADHD, preference for novelty ADHD v sameness/routines ASD
• Social anxiety/ Anxiety (safety behaviours might look like RRBS)
• SLD, hearing impairments
• OCPD (routines & ritualistic beh)
• EDs eg Avoidant/restrictive food intake disorder (sensory diff lead picky eating)

Question 4

Assessment

Answer 4

• Risk to self and others (inc comorbid mood, ax etc)
• Presentation in room
• Dev hx,
• family scaffolding,
• sensory issues,
• lack of social interest,
• difficulties with social interactions (initiation, only want talk re fixed interests, reciprocity), routines/flexibility,
• understanding of metaphors/jokes,
• abstract v concrete understandings,
• special interests,
• self injury eg head banging,
• Gender differences: Social imitation/masking by females, boys have more restrictive areas of play, social communication problems earlier in boys
• High proportion neurodiverse ppl - Rainbow community

Question 5

Psychometrics

Answer 5

AQ (child & adult) - representative of population with higher SES and IQ
SQ (adult)
EQ (child & adult)
Social Responsiveness Scale-2 (2+ years)

Do well in task that require attention to details rather than the overall pattern.

Question 6

Risk factors:

Answer 6

• genetics,
• advanced maternal/paternal age,
• exposure to pesticides,
• neurobiological (accelerated brain development early in life leading to altered connectivity - child begins to adapt their beh to their own processing abilities)

Question 7

Theories

Answer 7

Extreme male brain theory
- Testosterone/male brain/ shorter index finger
- AQ, EQ, SQ based on this
- ‘male brain’ = systematise/how things work and less ‘woman’ empathy etc eg high systematise and low empathy- (not much evidence of high testosterone in ASD)

Theory of Mind Deficits

Question 8

Model

Answer 8

Gauss CBT model
- Core problems processing information about self (eg emo reg), others (poor perspective taking/social cues) and non-social info (eg need order, pref solitude)

• results in social and non-social behavioural differences (eg difficulty understanding/being understood by others, intense interests, fixation on routines etc),
• which leads to social consequences (eg difficulty making friends, others view you as non-compliant) and non-social consequences (exhaustion, guilt when not successful)
• = all lead to negative views of self (high stress/anxiety, low self esteem and mood
• Which are also maintaining factors because when anxious, likely do more of what makes feel good eg intense interests)

Question 9

Treatment

Consideration about making them typical?

Answer 9

CBT

Social Stories
- explain social situations and help them learn ways of behaving in these situations.

• ABA: An evidence-based intervention which aims to increase language and communication skills, improve attention, social skills, memory, and academics and decrease problem behaviours (controversial now eg trying to change to fit neurotypical world)
• Pharmacology: currently limited to the treatment of co-occurring symptoms (e.g. anxiety or irritability), and not ASD itself

**Work on what client wants to work on (functioning) not to fit neurotypical world!!

Question 10

CBT

accommodations (research by?)
evidence

Answer 10

• CBT adapted for ASD: (Rogers, 2016)
• Same techniques: Emotion + Social skills/perspective taking

Modification
- Increased psychoeducation:
- Emotions (why we have emotions, appropriate responses to emotions and how to identify and measure emotions) use feelings chart
- How clinical encounter works (i.e. what is to be expected from both sides of the encounter).

Abstract concepts concrete
- Use visual aids and cues
- Provide tangible and specific examples.
- Reduce reflective language or Socratic questioning (i.e. can give them several concrete answers to choose from).
- When providing information, be more specific and detailed (i.e. map and agree on an agenda on how the session will unfold).

Incorporate special interests and strengths
- Can incorporate special interests as a tool for completing CBT (e.g. what would Doctor Who do?), as well as to maintain engagement and motivation.
- Show an interest in special interests or specialist knowledge. Assists in building therapeutic relationships.
- Use specialist knowledge or strengths to investigate a problem together.

Increased parental involvement
- Are the experts on their children
- Psychoeducation, as may unknowingly be maintaining certain difficulties.

Modification
- Regular appointment days/times/rooms or forewarning if cant
- Sensory sensitivity (light, smell, sound)
- Limit eye-to-eye contact to reduce info processing and attention required
- Reduce potential anxiety (sit side by side, talk while playing)
- Forewarning when approach the end of therapy
- Understandable
- Simplify language
- Visual aids
- Check to understand
- Written summary with few points

Evidence: Autism CRC systematic review - CBT adapted to ASD had a positive impact on some areas but the quality of evidence is low (need more evidence)