New DSM criteria for ASD
A. persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays B. Restricted, repetitive patterns of behavior, interests, or activities
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limitied capacities)
D. Symptoms together limit and impair everyday functioning
3 levels of severity
Level 3 = very substantial support
Level 2 = substantial support
Level 1 = some support
in terms of social communication and repetitive interests and behaviors
What changed from DSM IV
ASD is spectrum disorder for autism, PDD-NOS, Childhood disintegrative disorder, asperger’s disorder, and rett’s syndrome
Rett’s Disorder
Genetic disorder (mostly non-heritable) affecting almost exclusively girls
Initial normal development then regression, motor impairment (loss of use of hands) and autistic-like characteristics
Childhood disintegrative disorder
regression
normal development to 3-4 years, loss of skills; look like children with severe autism by age 10
Gender ratio
5:1 boys
Prevalence of ASD/why the increase
1 in 68. More included in the diagnosis now, increased awareness, diagnosing kids younger, so increasing the rate
Cause of ASD
Parents who have one child with ASD have a 2-18% chance of another child having ASD
Why is it hard to identify a gene that causes autism?
Because there is more than one gene
Because autism is heterogenous (syndromic vs. non-syndromic, individual variation in genotype and phenotype)
Neurobiological difference in ASD
- head circumference - average 10% larger in preschool years
- Gray matter - more “mini-columns”; poor organization
- white matter - increased white matter with more connections (more is not better..it’s inefficient)
- Decreased “mirror neuron” activity
- Fewer Purkinje cells in cerebellum (in charge of motor output)
Do children with autism have larger heads?
by school years, not consistent difference in head size anymore. There is a systematic pattern of different growth. Not brain insult because no injury to brain to cause difference
Early characteristics of ASD
- delayed onset of intentionality
- lack of joint attention behavior
- lack of social reciprocity in interactions with others (verbal or nonverbal)
- decreased response to human faces and voices
- restricted range of communication intentions
- requests & protests may be maladaptive OR rely on physical communication
- limited symbolic play
Other early characteristics
sensory differences
attentional fixation, especially with parts of objects
difficulty with change
splinter skills - uneven profile, with advanced development in specific areas
Language characteristics in emerging/developing stage
Late onset
language loss between 15-24 mo
significant comprehension defictis
exp > rec language
echolalia
perseveration, stereotypic language
impaired nonverbal communication (few gestures, atypical prosody, decreased use of facial expression)
Language characteristics developing language and on
- low productivity (sparse verbal expression) and lack of spontaneity2. impaired initiation, maintenance of conversation, adding new information3. lack of speaker/hearer perspective (shows up in difficulty with pronouns you and i)4. difficulty talking about topics outside own interests5. absence of social language (greetings, politeness markers)
Theory of mind
- An understanding of mental states (beliefs, desires, and knowledge), of
others as well as our own, that enable us to predict and explain
behavior - the ability to reason about the thoughts, feelings, and intentions of self
and others
Early theory of mind milestones
18 mo - engage in behavior to satisfy an adult even when it conflicts with own desire
3 yrs - understand that “seeing leads to knowing”
4 yrs - attribute a false belief to someone else
Sally-Anne task
- young child will say sally will look in the box
- ToM developed child will say she will look in the basket
Strengths of children with ASD
- visuospatial judgement and pattern recognition
- constructing visuospatial arrays (blocks)
- solving jigsaw puzzles - visual discrimination
- detecting small differences in stimuli - rote memory
- memorizing unanalyzed “chunks” of speech
Weaknesses of children with ASD
- problem-solving that requires any application of social cognition
- executive functions: planning, organizing, monitoring, correcting
How is ASD diagnosed
• Gold Standard = Autism Diagnostic
Observation Schedule (ADOS)
• Administered by trained psychologist or MD
• Semi-structured interaction have to go through training to administer
– Setup is dependent on child’s verbal abilities
• Observed/recorded and coded for key behaviors: social overtures, play, joint
attention, imitation, requesting, reciprocity, nonverbal communication
When should you diagnose ASD?
early as possible. disadvantage to this is that you might be wrong
-accurate diagnosis is possible at 18-24 months, quite accurate once a child has an MA of 18 mo and a CA of 3 years
use of standardized tests in ASD is driven by
- language level
- ability to participate in structured test
- remember that formal testing makes a child a respondent, not an initiator of communication
- self-directed behavior may interfere with accurate assessment of comprehension
Traditional behavioral approaches - ABA
- intensive 30-40hrs/week
- teacher directed and mass trials, highly structured
- edible reinforcers paired with social
- has evidence supporting it
- not natural reinforcement
- not generalized because not natural. trained to do things in very specific way
- positive-can count trials and goals, can track progress
