Case 13: ASD

Question 1

Umbrella classification for autism that encompasses all levels of severity, with characteristics defined by the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V)1; typically, the most impaired functioning is in social and language skills.

Answer 1

Autism Spectrum Disorder

Question 2

most impaired function for ASD is

Answer 2

social

language skills

Question 3

risk factors for ASD

Answer 3

adv parental age

male sex

family history (especially having already had one child with autism)

Q

Question 4

common comorbidities

Answer 4

fragile X, tuberous sclerosis, Tourette syndrome, epilepsy, prematurity

Question 5

Classification used for children with “atypical autism”; individuals display some of the characteristics of typical autism, but demonstrate different onset, severity, or lack some characteristics of classic autism. This has changed under the implementation of DSM-V and this diagnosis is included under the diagnosis of ASD, with a severity level defined

Answer 5

PERVASIVE DEVELOPMENT DISORDER, NOT OTHERWISE SPECIFIED (PDD-NOS):

Question 6

Ritualistic movement pattern or behavior; when seen in children with a diagnosis of ASD, these movement patterns are considered secondary to the diagnosis.

Answer 6

STEREOTYPY

Question 7

Motor deficits that may be seen even before language skill deficits with children with ASD include:

Answer 7

difficulty with symmetrical movements

head lag in infancy

motor coordination deficits

low muscle tone

apraxia

Question 8

Why is working with other team members so critical in treating a child with ASD?

Answer 8

they prefer consistency and routine so you may need to adjust care to be consistent

Question 9

if evaluating a child already diagnosed, what skills should you asses?

Answer 9

bilateral coordination, distal strength, eye hand coordination

Question 10

Motor impairments in children with ASD typically include all of the following, except:

A. Low muscle tone
B. Early difficulty with head control
C. Early asymmetries in use of arms
D. Spasticity

Answer 10

D: spasticity (UMN)

Question 11

A valid and reliable outcome measure for evaluating bilateral coordination in children with ASD is:

A.Childhood Autism Rating Scale (CARS)
B. Bruininks-Oseretsky Test of Motor Proficiency (2nd edition; BOT- 2)
C. Movement Assessment Battery for Children, Second Edition (MABC-2)
D.Children’s Assessment of Participation and Enjoyment/Preference for Activities of Children

Answer 11

B. Bruininks-Oseretsky Test of Motor Proficiency (2nd edition; BOT- 2)
bilateral coordination + gross and fine motor performance, balance, running speed, strength, agility, manual dexterity

CARS: observational rating scale
MABC-2: movement skills, but not bilateral coordination
Option D: participation level, but bilateral coordination is a functional limitation level

Question 12

When would you not use the BOT2?

Answer 12

its long and can be complicated to score

if child is not 4-21

Question 13

Treatments that are effective for children with ASD in improving motor functioning include all except:
A. Hippotherapy
B. Aquatics
C. Repetitive play activities
D. Antidepressants

Answer 13

D. Antidepressants

There are no good studies evaluating the effectiveness of antidepressant use in children with ASD. Current recommendations are
that these medications should be a last resort, after other better- supported interventions.

Question 14

PT precautions for children with ASD

Answer 14

be aware of sensory system and overstimulation
difficulty with transitioning between activities, so cues and warnings may be needed

Question 15

Complications interfering with PT for children with ASD

Answer 15

Some children have difficulty with various sensory stimuli, becoming overwhelmed by sounds, visual input, and/or tactile stimuli, causing them to “shut down” and not be able to participate in therapy.

Question 16

What are 2 reliable, valid tools to measure successful outcomes for children with ASD?

Answer 16

MABC-2
BOT-2

participation tool with high-functioning autism: Children’s Assessment of Participation and Enjoyment/Preference for Activities of Children

Question 17

What are effective interventions for improving body function and structure and activity limits with children with ASD?

Answer 17

Use rhythm and music for encouraging movement
coordinate with speech (SLP) and behavioral analyst (ABA)
CATs (complementary and alternative treatments)
aquatics therapy
hippotherapy

Simple commands, modeling, and allowing time for the child to process. Each child has different needs (some like deep pressure, others averse to all touch, etc.)

Question 18

What does research say about the suggested CATS (complimentary and alternative treatments) that PTs can be aware of if the family asks?

Answer 18

Q

melatonin
multivitamins
massage therapy
acupuncture
exercise
music therapy
animal-assisted therapy

some families found benefit with gluten free or casein free diets

Question 19

Since multiple forms of input may be overwhelming, the therapist may choose strategies such as

Answer 19

modeling, video modeling, or tactile cueing with limited verbal cueing

Question 20

two most popular interventions for children with ASD

Answer 20

aquatics as a treatment modality!!

riding/hippo therapy

Question 21

PTs should be aware of medications + common adverse drug reactions (ADRs). The most common medications taken to mitigate irritability and aggression are

Answer 21

risperidone (Risperdal) and aripiprazole (Abilify).

The ADRs that can negatively impact participation in therapeutic activities include sleepiness, constipation, and weight gain

They may also be taking ADHD meds if also diagnosed with ADHD

Question 22

Which is an ADR that may be a complication during PT?

sleepiness
dizziness
constipation
weight gain

Answer 22

sleepiness
constipation
weight gain

not dizzy

Question 23

If pt is taking meds for ADHD, what should you monitor

Answer 23

vitals
BMI

Question 24

Medication to treat ____ is generally given as a last resort because there are few studies investigating their use in children with ASD and the ADRs may outweigh the benefits.

Answer 24

depression

Question 25

The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) uses 8 subtests for gross and fine motor performance for children ___ to __ years of age

Answer 25

4 to 21 years of age *takes a while to score

Question 26

The Movement Assessment Battery for Children, Second Edition (MABC-2) assesses gross and fine motor skills in children in three different age bands:

Answer 26

1. 3-6 years 2. 7-10 years 3. 11-16 years

Question 27

MACB-2 has 8 tasks focusing on what 3 things

Answer 27

balance ball skills manual dexterity

Question 28

Select complementary and alternative treatments (CATs) such as melatonin, multivitamins, massage therapy, acupuncture, exercise, music therapy, or animal-assisted therapy appear safe and may improve aspects of behavior in children with ASD. T or F

Answer 28

True grade B evidence

Question 29

t/f: Aquatic therapy DOES NOT improve motor skills and social interaction in children with ASD

Answer 29

False, it does (grade B evidence)

Question 30

___ practice with small changes can help the child to generalize the skill across situations

Answer 30

repetitive

Question 31

What's a valid motor assessment that does not specifically include bilateral coordination

Answer 31

MACB-2 Q

Question 32

What would not be helpful for improving coordination for a child with ASD 4/4 beat isolated muscle strengthening ryhtm music

Answer 32

isolated muscle strengthening

Question 33

MABC-2 movement assessment battery for children access what

Answer 33

gross and fine motor *balance, ball skills, manual dexterity

Question 34

BOT-2 bruininks oseretsky test of motor proficiency tests what what age

Answer 34

gross and fine motor *bilateral coordination, balance, running, strength,agility, and manual dexierity 4-21 yrs

Question 35

which measure assess ball skills

Answer 35

MABC-2

Question 36

modeling, video modeling, tactile cues are great but limit ___ rhythm and

Answer 36

verbal cueing b/c they get overwhelmed

Question 37

observational tool used to identify children with austism based on severity of symptoms

Answer 37

CARS childhood autism rating scale

Question 38

therapeutic riding and hippotherapy programs are good for autism patients

Answer 38

yes

Question 39

providing verbal cues with demonstration and tactile cueing followd with consisitent verbal feedback is overhwelming

Answer 39

yes instead: simple commands, modeling, allow time for child to process

Question 40

repeitive practice with small changes can help child generalize skills but __ changes in task make skill acquisition more difficult

Answer 40

large

Question 41

what are examples are CATs

Answer 41

melatonin multivitamins massage therapy acupuncture exercise music animal assisted

Question 42

evaluates participation level in ICF

Answer 42

Children assessment of participation and enjoinment/prefernce for activities of children CARE