#12 Autism Flashcards
What is autism?
A relatively common and diverse neurodevelopmental condition, it manifests across the lifespan and is associated with a continuum of needs and abilities.
What is the epidemiology of autism?
More common in boys (4:1), and genetic, epigenetic and environmental factors all play a role
Prevalence is 1/50
Likelihood of siblings both getting autism is 8-18%
Rates are relatively consistent across international studies (not a lot of caveats)
Prevalence estimates are steadily increasing over the past 40 years (maybe due to expanding the diagnostic criteria)
What are the two different perspectives on how autism is viewed?
Biomedical view: autism as a medical diagnosis, promote treatments, impairment results from symptoms, diagnostic language represents clinical needs
Neurodiversity/Social model: autism as an identity, remove diagnosis and references to medical classification, disability from barriers in the social/physical environment, language related to symptoms and levels of support are viewed as stigmatizing and perjorative
Both of these contribute to the CAHS Assessment on Autism
What is the DSM-5 criteria for ASD?
This is deficit based, frames differences as bad, focuses on disability
1. Persistent deficits in social communication and interactions by ALL of the following: deficits in social reciprocity, non-verbal communication for social interaction, developing relationships appropriate to developmental level
2. Restricted/repetitive patterns of behaviour/interests/activities that manifest as TWO of the following: repetitive speech/motor movement/use of objects, excessive adherence to routines/ritualized patterns of behaviour, restricted/fixated interests, hyper or hypo reactivity to sensory input or unusual sensory interests
What is the simplified version of the DSM-5 criteria for autism?
Social communication (need 3/3 deficits)
Interests, preferences, and sensory features (need 2/4 deficits)
brackets indicate what is necessary for diagnosis
What are the three necessary social communication features of autism?
Deficits in:
1. Social-emotional reciprocity: the ability to tailor/adjust social behaviour across diversity of partners/contexts
2. Non-verbal communicative behaviours: socially directed, multiple modes coordinated, adjustment to context, fluency/effort
3. Developing and maintaining relationships: within and outside family, understanding different types of social relationships and what is expected in each, friendships
What are the three steps in making an autism diagnosis?
General developmental surveillance
Autism-focuses surveillance
Diagnostic assessment
Interventions can be given on each of these steps
What are the unique features of the DSM-5 compared to previous criteria?
Uses diagnostic qualifiers, instead of subtypes (using language/intellectual ability, rather than Aspergers)
Severity (in each domain) relates to level of support needed
Flexibility in age on onset: no minimum age of diagnosis therefore you can diagnose older youth and adults
What are the interests/preferences aspects of autism?
Intense interests (focus, duration, impact)
Repetitive speech, movement or use of objects (scripted language, toys, motor)
Preference for sameness, specific routines/rituals (reactions to small changes)
Reactivity to sensory environment (sensations sought or avoided, threshold and intensity of reaction, adaptations may be needed)
What are some signs of autism in the first 18 months of life?
Not orient to name, no babbling, no eye contact, social interest and affect is off, absent social referencing, transitions are difficult, insistence on a particular object, atypical sensory behaviour, and engagement of attention
What are the four features that are considered “best practice” in autism diagnosis? Why are these the best?
Determine definitive diagnosis
Explore co-occuring conditions (that may overlap with autism)
Determine adaptive function (strengths, challenges, interests)
Gather sufficient information to inform about treatment planning
What are the steps in an autism assessment?
Gather a structured developmental and medical history (initial concerns, what others tell docs, developmental course, DSM-5 autism features, medical issues, family and psychosocial history)
Structured observation of social, communication, and play-related behaviours
Developmental context (assessment of language, cognitive and adaptive skills)
What are the two pathways to diagnose autism?
community model: collaborative/virtual team, less complexity, ongoing mentorship
specialty team: multi-disciplinary, more complexity, consults as needed
TRUE OR FALSE: Autism is diverse, manifests across lifespan, across many ethnicities, across sexes and gender, and across a continuum of language and intellectual abilities
TRUE (although girls and women may be underidentified)
What are four distinct patterns of brain development?
Acceleration in brain growth to age 2-3 years (starts postnatally)
Neural connectivity altered
Neuropathological findings
Pattern of brain activation with social perceptual tasks (decreased activation of fusiform gyrus during facial recognition, less amygdala activation and poorer performance on tasks requiring judging facial emotion)
