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Autism Flashcards

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1
Q

Autism defined:

Generally evident when?

A
  • Before 3yrs of age
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2
Q

Autism defined:

A
  • Developmental disability sig. affecting verbal and non-verbal communication and social interaction, generally evident <3yrs of age, that adversely affects childs educational performance
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3
Q

Other Characteristics assocd w/ autism:

3:

A
  1. Repetitive activities and stereotyped mvmts
  2. Resistance to environ. change OR change in daily routines
  3. Unusual responses to sensory exp’s
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4
Q

Autism Spectrum Disorder “ASD”

Defined:

A
  • Term used to indicate behavior cond’s that exist on a continuum
  • Mildly→ severely involved
  • Social communication, social interaction, sensory integration are affected
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5
Q

3 areas affected w/ ASD:

A
  1. Social communication
  2. Social interaction
  3. Sensory integration
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6
Q

Genetic link found w/ ASD when?

A

1980s

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7
Q

ASD

Prevalence

*most important

A
  • FASTEST GROWING DEV. DISORDER
  • 1 in 44 children ID w/ ASD
  • Parents who have child w/ ASD have 2-18% chance having second affected
  • 10% ASD also IDd w/ DS, Fragile X, tuberous sclerosis, genetic/chromosomal disorders
  • 5x more common in bots
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8
Q

ASD

Prevalence

*Fastest growing develop. disorder

Contributing factors:

A
  • More likely to properly ID autistic vs intellec. disabled
  • Incd awareness/funding
  • More broad DX
  • Earlier diagnosis
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9
Q

ASD

Etiology

A
  • NO known single cause
  • Gen accepted→ abnorms in brain structure/function
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10
Q

ASD Risk Factors

Prenatal

A
  • Gene mutations, environ factors, adv. age either parent
  • DM, psychiatric drugs in mother
  • Infections→ rubella, CMV
  • Teratogenic causes
  • Prenatal stress
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11
Q

ASD Risk Factors

Perinatal

A
  • LBW
  • Hypoxi
  • Prematurity
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12
Q

Dx of ASD

Physicians use what?

A

Diagnostic and Statistical Manual (DSM) of Mental Disorders to det. whether person has ASD (DSM-5)

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13
Q

Dx of ASD according to DSM-5

A
  1. Dx called ASD
  2. No more sub-diagnoses
  3. New dx criteria arranged: 2 areas→
    1. Social communication/interaction**
    2. Restricted and repetitive behaviors**
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14
Q

2 areas of diagnostic criteria for ASD

A
  1. Social comm./interaction
  2. Restricted and repetitive behaviors
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15
Q

Clinically Diagnosing ASD

All following sx’s describing persistent deficits in social comm/interaction not acctd for by gen develop. delays, must be met:

MUST HAVE ALL OF THESE!!!

All of these are related to first area: Social communication/interaction

A
  1. Problems reciprocating emotions or social interaction
  2. Severe probs maintaining relationships
  3. Verbal/non-verbal communication probs
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16
Q

Clinically Diagnosing ASD

Two of the four sx’s related to restricted and repetitive behavior need to be present:

All of these are related to second area: Restricted and repetitive behavior

A
  1. Stereotyped or repetitive speech, motor mvmts or use of obj’s
  2. Excess adherence to routines, ritualized patterns of verbal or nonverbal behavior, OR excessive resistance to change
  3. Highly restricted interests that are abnorm in intensity or focus
  4. Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environ.
    1. not understanding environ.
    2. sensory feedback not working properly
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17
Q

Social Communication/Interaction Criteria

1.Problems reciprocating emotions or social interaction

Ex’s

A
  • diff holding conversations
  • unable to initiate interaction
  • probs w/ shared attn or sharing emos/interests
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18
Q

Social Communication/Interaction Criteria

2.Severe probs maint. relationships

Ex’s

A
  • lack interest in people
  • diff. w/ pretend
  • diff w/ age-approp social acts
  • probs adjust to diff social expects
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19
Q

Social Communication/Interaction Criteria

3.Verbal/Non-verbal communication probs

Ex’s

A
  • Abnormal eye contact, posture, facial express’s, tone of voice/gestures
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20
Q

ASD

Early warning signs

A

Lack eye contact, no resp to name, no interest in people, prefer not to be held*

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21
Q

ASD

More early warning signs:

A
  • Trouble adapt to changes, unusual rxns smell, sound, taste, feel
  • Unusual/repetitive way play w/ toys
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22
Q

ASD

More early warning signs w/ ages considered:

A
  • No babbling or gesturing by 12 mos
  • Inability to speak 1 word by 12-14mos
  • Regression in OR loss of lang or social skills********* BIG ONE!!!!
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23
Q

ASD Early Warning Signs

Studies show…

A
  • Parents notice dev. prob before 1st bday
  • Vison/hearing concerns more often reported 1st year
  • Diffs in Social, comm, fine motor skills evident from 6mos
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24
Q

Assoc’d Clinical Impairments:

BSF

A
  • Failure of lang/comm. dev., sensory processing, sensory abnorms-sensitivity
  • motor function, apraxia (motor planning)
  • control of voluntary mvmts→ clumsy/uncoord
  • restrictive repetitive behaviors
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25
Assocd Clinical Impairs: ## Footnote **BSF cont'd**
* over-rxns, intellectual impairs, poor eye contact, eating disorders, sleep, SZ's, GI impairs
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Assocd Activity Limits/Participation Restricts:
* Limtd gross motor skills, dec IND/safety, decd understanding rules, * Decd efficiency w/ functional mob, assist reqd to sit/attend school t/o day, diff w/ interpersonal relationships/social relationships
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ASD video
slide 32\*\*\*\*\*
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PTs play a role for children w/ ASD **MOST OFTEN in regards to:**
**BSF issues** that reduce safety during **activity** or dec **participation**
29
PTs play a role for ASD MOST often in regards to **BSF issues that reduce safety during activity OR dec participation** ## Footnote **SUCH AS:**
* Abnorm mm tone→ hypOtonia * A**p**raxia/motor **p**lanning * Gait impairs→ toe walking\*\*\* (very prevalent) * Balance defs * Gross motor delay * Atyp. motor performance→ motor imitation/coord * Sensorimotor integration
30
PT Exam for ASD ## Footnote **Hx → Important things to include:**
* Social interactions/activities, support system, dev. hx, phys/psycho/social function, * Behavioral habits, medical hx, chief complaints (family perceptions), functional status, meds
31
PT Exam for ASD ## Footnote **Systems Review**
* **CV/Pulm**→ BP, edema, HR, RR * **Integ→** scarring, skin integ, coloring * **MSK→** ROM, strength, symmetry, ht/wt * **\*\*NMSK→ _Gross_ coord'd mvmts---- KNOW THIS ONE!**
32
MOST COMMON MOTOR SX IN ASD
LOW MM TONE (HYPOTONIA) 51%
33
PT Exam for ASD **HypOtonia →** ***MOST COMMON motor sx***
* LOW mm tone * Most common→ 51% * **Improves over time w/ incd _strength_ about jts** * wont change it, but can **improve thru strength**
34
PT Exam for ASD ## Footnote **A**_p_**raxia (think **_P_**lanning)**
* Motor **p**lanning disorder affects ability to carry out _purposeful mvmts_ * **Assess→** dexterity, coord, agility * coord. screen * motor impair test * video * \*NOTE: improves over time
35
PT Exam for ASD ## Footnote **Gait impairment**
* Intermittent **toe-walking** * reduced ankle mob. is **rare**
36
Gait Assessment for ASD ## Footnote **Observation includes:**
* Balance, velocity control, symmetry, mvmts of UE/LE/trunk, wt transfer, foot placement, walking pattern\*\*\*
37
More on gait assessment for ASD
* Video analysis, time-distance variables, functional amb
38
ASD group shows sig impairment of motor control Ex's
* Dysrhythmias, timed mvmts hands/feet, overflow of mvmts
39
Balance Assessments for ASD ## Footnote **Sensory System** **aka what would you use to assess?**
* Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB) * Tilt board tip
40
Balance Assessments for ASD ## Footnote **Motor System** **aka what would you use?**
* The Clinical Observations of Motor and Postural Skills (COMPS) * Side-reach
41
Balance assessments of ASD ## Footnote **Biomechanical** **aka what would you use?**
* Goni * MMT
42
Balance Assessments for ASD ## Footnote **Developmental** **aka what would you use?**
PDMS-2, Mvmt-ABC, BOT-2
43
Gross Motor Delay in ASD ## Footnote **Of note… literature shows:**
* Rate of motor dev **slow** in **2nd→3rd year** * **50%** children w/ ASDs show developmental **regression** bw 14-24mos
44
50-100% **school-aged children w/ ASD** had **sig motor delays** compared to norms
\*\*\*\*\*\*\*\*\*\*\*\*\*\*
45
Standardized Assessment of Mvmt Functions -tests for infants/young children based on typ seq of **motor skill acquisition**
* Harris Infant Neuromotor Test (HINT) * Test of Infant Motor Performance (TIMP) * Mvmt Assess of Infants (MAI) * Gross Motor Performance Measure (GMPM) * Alberta Infant Motor Scale (AIMS)
46
Standardized Assess of Mmvt Functions -**Dev. tests** for young children w/ items related to **complex balance and coord→** SLS, hop, gallop, jumping
* Mvmt-ABC * Bayley Scales of Infant Dev (BSID-2) * Peabody Developmental Motor Scales (PDMS-2) * Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
47
PT Interventions for ASD **Motor/Mvmt Intervents:**
* Strength * Postural control/balance * Motor planning acts * aquatic/hippotx
48
Pt Interventions for ASD ## Footnote **Strengthening acts:**
* Use PLAY!!! * push/pull heavy objs * jumping, crab walk, scooter board, wheelbarrow
49
PT interventions for ASD ## Footnote **Postural control/Balance**
* Balance beams * SLS * Rocker board * Therapy ball---Conklin LOVES the ball!!!!
50
PT Interventions for ASD **Motor Planning/Mvmt Activities**
* **Obstacle course,** Simon says, RL/GL, jumping, balloon toss, throw/catch, diff walks, running
51
PT Interventions for ASD ## Footnote **Motor/Mvmt→ Aquatic Tx** **Why?**
Strengthening AND relaxation due to **warmth, buoyancy, resistance and anti-gravity pos'ing**
52
PT Interventions for ASD ## Footnote **Motor/Mvmt** **HippoTx** **Why?**
* **Rhythmical mvmts** of horse directed to **reduce limits** in **posture, balance, mobility**
53
**Sensorimotor Integration** Sensory Processing **defined:**
The way the nervous system receives messages from senses and turns them into approp. **adaptive responses** **\*Ex. hot outside=take off jacket**
54
Sensorimotor Integration for ASD ## Footnote **Includes:**
* Sensory processing * HypER/HypOsensitivity * Auditory, tactile, visual, gustatory, olfactory, proprio, vestib, enteroception
55
Sensory Integration **defined:**
Neuro processes that collect/receive sensation from body and environment→ makes possible to use body effectively w/in environment
56
Sensory Processing Disorder **Defined:**
* **Sensory signals** do not get organized into approp **responses→** * Motor clumsy, behavior probs, anxiety/depression, school probs
57
Sensorimotor Dysf Stats
90% ASD→ sensory abnorms 95% ASD→ sensory process impairs
58
Sensory Process Dysf. Types 7:
1. Tactile 2. Vestib→ gravity 3. Proprio→ force 4. Auditory→ no dx hearing probs 5. Oral input 6. Olfactory 7. Visual input→ no dx visual deficit
59
Sensory Processing Dysf Types ## Footnote **Tactile Dysf**
* Hyper/Hyposensitivity to touch * tactile defensiveness OR under-responsive * Poor tactile perception and discrim.
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**Sensory Processing Dysf Types** **Vestibular dysf:**
* Hyper/Hyposensitivity to mvmt * Over/under-responsive
61
**Sensory Processing Dysf Types** **Proprioceptive Dysf:**
* Sensory **seeking** behaviors * Diff w/ “Grading of mvmt”
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**Sensory Processing Dysf Types** Auditory Dysf: no dx hearing problem
* Hyper/Hyposensitivity to sounds * **auditory defensiveness vs under-registers sounds**
63
**Sensory Processing Dysf Types** **Oral-Input Dysf**
* Hyper/Hyposensitivity * **oral defensiveness vs under-registers**
64
**Sensory Processing Dysf Types** **Olfactory Dysf (smells)**
* Hyper/Hyposensitivity to smells * over/under responsive
65
**Sensory Processing Dysf Types** **Visual Input dysf: no dx visual def.**
* Hypersensitive→ over-respond * HypOsensitivity to vis. input * under-responsive or diff w/ **tracking, discrim, perception**
66
**Sensory Processing Dysf Types** **How do you know which dysf child has?**
* Sensory Processing Disorder Checklist→ S/S of dysf * Observe play, engagement preferred acts, interactions
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Intervention for ASD ## Footnote **Improve QoL and ability to participate in society** **Themes linked to positive outcomes:**
* Indiv analysis that includes basis for behaviors and environmental influence on the behaviors * Family is central to program * Services are intensive and comprehensive * Facilitating active engagement of child= **Essential\***
68
Potential Interventions for **Sensorimotor Integration** ## Footnote **4:**
1. Behavioral tx 1. applied behavioral analysis, floor time 2. Social skills intervents. 3. **\*Sensory integration/sensory-based intervents** 4. **\*Motor/mvmt intervents**
69
Applied Behavior Analysis (ABA)
Techs/principles to bring about meaningful/positive change in behavior * focus on principles that explain how learning takes place * + reinforcement * behavior followed by reward→ more likely to be repeated
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Applied Behavior Analysis (ABA) ## Footnote **what kind of techniques to use?**
Techs to INC useful behaviors and reduce those that may cause harm or interfere w/ learning
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Floor time is a type of _______ therapy
Behavioral therapy\*\*\*\*
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Floor Time \***IMPORTANT, KNOW IT!!!!!**
* From Developmental Individual-difference Relationship-based model (DIR) * **Encourages parents to _engage_ children _literally_ @ their lvl→ getting on floor to play!!!** * go into childs “world”
73
Sensory Integration Therapy ## Footnote **Addresses what?**
Sensory processing, motor/perceptual impairments * **Assumes→** child over/under stimulated by environment * **Aim→** improve ability of brain to process sensory info=== better function in daily acts
74
Sensory Diet
* Designed, personal act. plan provides sensory input needed to stay focused and organized t/o day * Ex. **calming input for kids over-stim'd, arousing input for kids “sluggish” or too tired** * **Brushes, wt'd vests, mats, big hug, swings, music, massagers, etc…**
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Sensory Integration Activities: ## Footnote **Tactile**
* Deep pressure/"Squishing"→ gym bal, “bear hug” * Firm massage, brushing, wtd vest/lycra undergarms
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Sensory Integration Activities: **Proprioception**
* **Pushing→** heavy objs, grocery cart, scooter, wheelbarrows * **Pulling→** Tug of War * **Hand/Eye coord→** hitting swinging balls * **Balance→** balance beams * **Vestib/tactile→** run & crash * **Tactile/motor planning→** crawl thru tunnels
77
Sensory Integration Activities: ## Footnote **Vestibular**
* Swings, mvmt on balls, spin on chair (vis/balance) * Jumping, tumbling, rocking
78
Sensory Integration Activities: ## Footnote **Auditory**
* Repetitive songs, quiet workspace, elim. chatter * Music→ classical, soothing
79
Sensory Integration Activities: ## Footnote **Vision**
Dim lights, avoid fluorescents, spinning
80
Sensory Integration Activities: ## Footnote **Aerobic Acts:** **\*RAISE arousal lvl**
* RAISE arousal lvl * TM, cycling
81
Sensory Integration Activities: ## Footnote **Tx Techniques:**
* Change acts freq→ **stations** * Routines and plan transitions * Vis. engaging toys→ provide sensory input * NON-overwhelming environ. * Create **Reward system\*\*\***
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Sensory Integration Activities: Therapy tools to use!!!!
IDEAS\*\*\*\*
83
ASD: **When to refer to OT→**
* Self-directed behavior * Limtd engagement * Cannot **follow commands**/1-2 step directs., despite visual and phys. cues * Unable to **regulate** or **attend** in PT environ. \*\*\*\*\*\*
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