1
Q
– Neurodevelopmental Psychopathology –
A
2
Q
Biological/Genetic causes of ASD vs. Environment - how do the two interact?
A
- Rooted in brain development and neurobiology, but outcomes depend on environment
- “Disorders unfold over time”
3
Q
How can developmental disruptions affect later skills?
A
- Missing early steps impacts later skills
- E.g., joint attention (sharing attention with another, e.g. pointing someone’s attention somewhere: “look!”) → peer interactions
4
Q
How can biological disruptions affect later skills?
A
- Early biological disruptions can cascade into downstream effects/skills
- E.g., Sensory processing issues leading to social withdrawal
5
Q
What’s one way can we detect clinical symptoms early on?
A
- Essential to distinguish age-appropriate behaviours from clinical symptoms
- E.g., Echolalia in toddlers vs. marker for autism in older children
6
Q
– “AuDHD” Overlap (Autism + ADHD) –
A
7
Q
What % of individuals with Autism meet criteria for ADHD?
A
- 50-70%
- DSM removed the prohibition of diagnosing both
8
Q
The “AuDHD” Paradox (Internal Conflict): “craves”
Autism vs ADHD
A
- Autism craves routine & sameness
- ADHD craves novelty & stimulation
9
Q
The “AuDHD” Paradox (Internal Conflict): “can be”
Autism vs ADHD
A
- Autism can be cautious/rule-bound
- ADHD can be impulsive/risk-taking
10
Q
“AuDHD” Overlap (Autism + ADHD) - Clinical Implications #1
A
Stimulant medication may help focus but can “unmask”/heighten awareness of sensory sensitivities previously ignored due to distraction
11
Q
“AuDHD” Overlap (Autism + ADHD) - Clinical Implications (2)
A
Higher risk of autistic burnout due to constant internal regulation fatigue
12
Q
– Autism + ADHD: The Focus Struggle Attention & EF –
A
13
Q
General surface observation
A
Zoning out, unable to finish tasks, distracted
14
Q
Zoning out, unable to finish tasks, distracted - ADHD Mechanism
A
Mechanism: Distractibility & Orienting
15
Q
Zoning out, unable to finish tasks, distracted - ADHD Impact
A
Impact: Cannot filter/ignore out new inputs, like an overly responsive spotlight (focus on many different interests)
16
Q
Zoning out, unable to finish tasks, distracted - Autism Mechanism
A
Mechanism: Monotropism (intense attention on certain things) & Disengagement
17
Q
Zoning out, unable to finish tasks, distracted - Autism Impact
A
Impact: Cannot switch off current focus, like an overly stuck spotlight (focus on one specific interest)
18
Q
– Autism + ADHD: The Social Struggle - Face/Social Processing & Feedback –
A
19
Q
Surface Observation
A
Missed cues, awkward interactions, saying the “wrong” thing
20
Q
Missed cues, awkward interactions, saying the “wrong” thing - ADHD Mechanism
A
Mechanism: Bias toward perceiving anger and rejection cues (more likely to be scanning for cues/stimuli for them to interpret)
21
Q
Missed cues, awkward interactions, saying the “wrong” thing - ADHD Impact
A
Hyper-monitoring disapproval, related to emotion dysregulation
22
Q
Missed cues, awkward interactions, saying the “wrong” thing - Autism Mechanism
A
Mechanism: Self-Relevance & Feedback Processing
23
Q
Missed cues, awkward interactions, saying the “wrong” thing - Autism Impact
A
- Under-monitoring social feedback
- Emotion dysregulation often a consequence due to others demonstrating frustration/rejection
24
Q
– Autism + ADHD: The Internal Struggle - Sensory Processing Emotion Regulation –
A
25
Surface Observation
Meltdowns, intense emotions, overwhelmed by environments
26
Meltdowns, intense emotions, overwhelmed by environments - **ADHD Mechanism**
Impulsivity & Sensory Modulation
27
Meltdowns, intense emotions, overwhelmed by environments - **ADHD Input**
Attention/arousal regulation failure
28
Meltdowns, intense emotions, overwhelmed by environments - **Autism Mechanism**
Perceptual Capacity & Alexithymia
29
Meltdowns, intense emotions, overwhelmed by environments - **Autism Input**
Processing overload
30
--- Autism Spectrum Disorder (ASD) ---
31
Autism Spectrum Disorder (ASD) - **Clinical Description**
Neurodevelopmental disorder **affecting social interaction** and **communication**
32
DSM Requirements - **Cluster A**
Persistent **deficits in social communication and interaction** across multiple contexts
33
DSM Requirements - **Cluster B**
***Restricted*, *repetitive* patterns** of **behavior, interests, or activities**
34
How is severity measured? From _ to _?
* Rated by support level
* Level 1: **Requiring Support** → Level 3: **Requiring Very Substantial Support**
35
-- Re-imagining the Spectrum --
36
The Linear (Older) Model
## Footnote
Problem?
* **Mild (High Functioning) <-----> Severe (Low Functioning)**
* Problem: **Implies a person is "more" or "less" autistic**; ignores specific struggles and fluctuating needs
37
The "Spiky Profile" (Wheel Model)
## Footnote
Domains?
* A spider-web graph with different domains as "spokes" (basically on the outside of the circle)
* **Domain** = Sensory processing, Motor skills, Verbal communication, Executive function
* A person can be "high functioning" in verbal skills (Level 1) but have "high support needs" in sensory processing (Level 3)
38
Takeaway?
Functioning is **dynamic** and **context-dependent**
39
-- The Double Empathy Problem --
40
Traditional theories (e.g., Theory of Mind) framed autism as...
a **one-sided** individual **social deficit**
41
The Double Empathy Problem
* reframes social struggles as a **"disconnect (disjuncture) in reciprocity"** between **differently wired brains**
* e.g. Autistic-to-Autistic communication, Autistic-to-Non-Autistic
42
The Double Empathy Problem is **two sided - researchers showed matches/mismatches between which?**
* **Match with *Autistic-to-Autistic individuals***; communication is effective, smooth, and enjoyable
* **Mismatch with *Autistic-to-Non-Autistic* individuals**
Non-Autistic people struggle to interpret Autistic social cues as much as Autistic people struggle with Non-Autistic norms
43
Implication?
Interventions should shift from teaching "acting non-Autistic" to fostering mutual understanding & translation
44
-- ASD Cluster A: Social Communication --
45
DSM-5 Criteria (Must meet all **3**):
* **1. Deficits in Social-Emotional Reciprocity**: Difficulty with back- and-forth conversation; reduced sharing of interests/emotions
* **2. Deficits in Nonverbal Communication**: Atypical eye contact, gestures, or facial expressions; mismatch between verbal/nonverbal cues
* **3. Deficits in Relationships**: Difficulty adjusting behavior to social contexts; difficulty making friends or absence of interest in peers
46
Clinical Context: **Joint Attention - often absent in...**
Often absent in **young children** (e.g., not following a point)
47
Clinical Context - **Theory of Mind gap:**
Difficulty **intuitively predicting others' intentions** (though many learn this cognitively over time)
48
--- ASD Cluster B: Restricted & Repetitive Behaviors ---
49
DSM-5 Criteria (Must meet at least 2 of **4**):
1. **Stereotyped Movements/Speech**: Hand-flapping, lining up toys, echolalia (repeating words)
2. **Insistence on Sameness**: Extreme distress at small changes; rigid adherence to routines/rituals
3. **Highly Fixated Interests**: Strong attachment to unusual objects; circumscribed interests (e.g., deep knowledge of vacuum cleaners)
4. **Sensory Anomalies**: Hyper- or hypo-reactivity to sensory input (e.g., pain, sound, texture, smell, lights)
50
-- ASD Onset, Course & Differential Diagnosis --
51
Symptoms must be present **WHEN**?
in the **early developmental period**; typically around 2-3
52
Diagnosis requirement
Must cause **clinically significant impairment** in **social, occupational, or other important areas**
53
Diagnosis requires WHAT specialized tools (e.g., ADOS-2, ADI-R)
A **standardized, semi-structured assessment** that uses ***direct observation* of social communication, play, and restricted behavior**
54
Differential Diagnosis (Rule-Outs): **Social (Pragmatic) Communication Disorder**
Social deficits without the restricted/repetitive behaviors (Cluster B)
55
Differential Diagnosis (Rule-Outs): **Intellectual Disability**
Can co-occur, but **social communication should be below that expected for general developmental level**
56
Differential Diagnosis (Rule-Outs): Rett Syndrome
Now a **separate genetic condition** (MeCP2 mutation), though can have autistic features
57
--- ASD Prevalence & Demographics ---
58
Prevalence
* Estimated **1 in 66** children in Canada (Public Health Agency, 2018)
* **Diagnosed ~4x more often in boys**
* Girls are likely under-diagnosed due to different symptom presentation ("masking," internalizing) and provider bias
59
Demographics
Diagnosis more common in **high-resource areas, due to better access, detection, and identification**
60
-- ASD: Cognitive & Language Profile --
61
Intellectual Functioning for ASD
Extremely diverse range:
* ~31% have **comorbid Intellectual Disability** (ID)
* Others have **average or superior intelligence** (e.g., ~10% Savant skills)
62
Language - **variability**
Ranges from **non-speaking** to **highly articulate** (but potentially lacking prosody/pragmatics)
63
Language - Echolalia
Repeating words/phrases; often serves a **communicative** or **regulatory function**
64
Prognosis - **2 strongest predictors of independance?**
* **Functional language by age 5** and **higher IQ (70+)** are the strongest predictors of independence
* But even above average IQ (100+) comes with significant challenges
65
-- ASD Causes: Genetic & Neurobiological Influences --
66
Genetic Components
* Likely results from **polygenic risk (multiple genes with small effects)** interacting with **environmental factors**
* **Strong heritability** (~20% sibling recurrence); risk increases with advanced parental age
67
Brain Development - **early overgrowth**
**Larger total brain volume in early childhood** followed by **atypical "pruning" or atrophy**
68
Brain Development - **Amygdala**
## Footnote
(atypical growth associated with...)
Atypical amygdala growth/structure associated with **anxiety and emotional processing differences**
69
Brain Development - **Oxytocin**
**Receptor gene differences** may influence social bonding and affiliation
70
-- Debunking Myths & Stereotypes of ASD --
71
The "Refrigerator Mother"
Historical myth **blaming "cold" parenting**; debunked but caused decades of harm/stigma
72
Vaccines
Multiple large-scale studies confirm **NO link between vaccines and ASD**; origin was a fraudulent (retracted) study
73
Behavior as Choice
**"Bad behavior" is often a stress response** (meltdown) **or communication breakdown**, not a character flaw
74
-- Treatments of ASD: Biological and Psychosocial --
75
Biological (Adjunctive)
## Footnote
medications target...
* **No pharmacological "cure"** for ASD
* Medications target **comorbidities or distress** (e.g., anxiety, aggression, sleep)
76
Psychosocial & Behavioral - **Traditional ABA**
## Footnote
+ why was it bad?
* Historically, **focused on compliance and "normalization”**; E.g., forced eye contact, suppressing stimming
* Some Autistic adults report traditional **ABA was traumatic**; viewed as "conversion therapy"
77
Psychosocial & Behavioral - **Affirming approach: goal?**
Support **functional skills, safety, and autonomy** (not just compliance)
78
Psychosocial & Behavioral - **Affirming approach: strategies?**
* **Naturalistic interventions**
* **Occupational Therapy** (sensory),
* **Speech** (communication)
79
Psychosocial & Behavioral - **Affirming approach: philosophy?**
Treat the **distress and the environment**, ***not* the "autism" itself**
PSYC 300
flashcards
Decks in class (25)
# Cards
-
Ch1: Psychopathology in Historical Context28
-
Ch1: Part 249
-
Ch2: Approaches to Psychopathology59
-
Ch2: Pt. 239
-
Ch4: Research Methods0
-
Ch3: Clinical Assessment + Diagnosis47
-
Ch5: Anxiety43
-
Ch6: OCD + Related Disorders23
-
MIDTERM 21
-
Trauma44
-
Dissociation79
-
Mood Disorders Pt. 160
-
Mood Disorders Pt. 252
-
Eating Disorders47
-
Sleeping Disorders48
-
Substance Abuse51
-
M20
-
Sex + Gender75
-
Personality Disorders84
-
Psychosis115
-
Neurodevelopment - ADHD44
-
Neurodevelopment - ASD79
-
Neurodevelopment - SLD72
-
Neurocognition + Aging114
-
Mental Health + The Law54
