Autism

Question 1

What are red flags that may be noticed in infants that indicate autism?

Answer 1

• being an easy baby (like being able to sit for long stretches without interaction, soothing or human interaction)
• watching hands at different orientations (like out of corner of eyes)
• low interest in faces or tracking adult movement in a room
• low interest in social games like peek-a-boo (may react but won’t initiate or simply a complete lack of interest)

Question 2

according to the DSM, what are the five criteria for a diagnosis of ASD?

Answer 2

1) social communication deficits
2) restricted repetitive and stereotyped patterns of behavior, interests and activities
3) symptoms must be present in early development
4) clinically significant impairment
5) not better explained by intellectual disability or growth and development disorders - though they can co-occur

Question 3

one diagnostic criteria for ASD is deficits in social communication.

what are the three parts of this criteria that must be met currently or by history?

Answer 3

• deficits in social-emotional reciprocity
• deficits in nonverbal communication behaviors (like eye contact, body language, gestures, facial expressions)
• deficits in developing, maintaining, and understanding relationships

all three must be met currently or by history

Question 4

how may facial expressions be different from that of normal children in an individual with ASD?

Answer 4

• individuals with ASD may have a absent facial expressions or may have over exaggerated
• may have a clear happy or sad, but other expressions may be absent

Question 5

one diagnostic criteria for ASD is restricted repetitive and stereotyped patterns of behavior, interests or activities.

what are the four parts of this criteria and how many must be met currently or by history?

Answer 5

-two must be met currently or by history

• stereotyped and repetitive motor movements, use of objects, or speech
• insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or non-verbal behavior
• highly restricted, fixated interests that are abnormal in intensity or focus
• hyper or hypo reactivity to sensory input or unusual sensory aspects of the environment

Question 6

what are some of the impairments that may or may not accompany ASD?

Answer 6

• impaired intellectual functioning
• impaired language
• medical or genetic conditions
• avoidant-restrictive food disorder
• sleep disorder
• constipation

Question 7

Of those with ASD, which gender is more likely to have accompanying intellectual disorder?

Answer 7

females

Question 8

what is the approximate incidence of ASD

Answer 8

1% in general population

however 1 in 70 live births

-not as common in older generations

Question 9

more than 80% of those with ASD have complex selective feeding, what are some examples of this?

Answer 9

• don’t like meat and alternatives or vegetables
• restricted range of foods they find acceptable (example only white foods)
• often prefer breads and cereals
• often prefer processed and predictable
• low fluid intake

Question 10

more than 66% of those with ASD have severe sleep disturbance, what are some examples of this?

Answer 10

• difficulty falling asleep
• waking in a fully alert state for over an hour in the middle of the night
• early waking

Question 11

approximately how many of those with ASD have motor coordination problems?

Answer 11

• up to 80%

- this often improves as children grow into school age, but can be quite noticeable during preschool years

Question 12

approximately 70% of children with ASD have additional mental health conditions, what are the three most common?

Answer 12

• social anxiety (this is often related to perfectionism)
• ADHD
• oppositional defiance disorder

Question 13

what is oppositional defiance disorder?

Answer 13

a pattern of negativistic interaction, with the core being refusal to do what is asked

Question 14

what is typically involved in making a ASD diagnosis?

Answer 14

• an interdisciplinary team
• analysis of if individual meets DSM or ICD criteria
• thorough developmental history
• 1 standardized parent report measure
• 1 standardized behavioral observation measure
• assessment of cognitive and developmental level
• multiple sources of information

Question 15

what are some red flags of ASD that may be noted in a toddler or preschool aged child?

Answer 15

-low or absent eye contact
-not responding to name or social smile
-delayed or absent language at age greater than 2
-echolalia (echoing language)
-regression of language (starts using and then stops using words, when language returns, word choices may be odd with more normal words missing)
-in “own world”
-not pointing
-using hand as a tool (leading adult by hand to get what they need)
-unusual emergence of language (obscure first words)
-pronoun errors (may refer to self as “you” or flip genders even with people they know well)
-reading or counting before speaking (hyperlexia or hypernumeracy)
-repetitive play
fixation on unusual objects or parts of objects

Question 16

what kind of treatments may be appropriate for ASD?

Answer 16

• behavior therapy (to work on social skills. taught like a playbook)
• speech, language and communication therapy
• social stories and visual schedules
• feeding therapy if required
• sensory integration
• fine/gross motor skill therapy
• biomedical strategies may be used (though not as well supported by research at this time)
• prescription medication

Question 17

what are some sensory differences that may occur in those with ASD?

Answer 17

-over or under reaction to sensory input

• most common is oversensitivity to sound
• second most common is oversensitivity to touch

Question 18

what kinds of sounds are commonly problematic for children with ASD?

Answer 18

-hand dryers, alarms, vacuums

these are most common, but all children are different

Question 19

what are types of sensory processing sensitivities

Answer 19

• may be over or under responsive to:
• sound
• smell
• sight
• touch
• tast
• vestibular
• proprioceptive

Question 20

what are some dangers associated with having low register sensory processing issues?

Answer 20

• may not respond to pain, hunger or temperature

- this can lead to injury or other issues

Question 21

what are some pointers to have clarity of communication with those who have ASD?

Answer 21

• avoid sarcasm, idioms or sayings, homonyms that could be ambiguous, rhetorical questions, watered down rules of life
• avoid saying can you ___ instead say you can ___
• use short, simple sentences
• give specific instructions
• say what you want
• limit number of choices
• get attention first and reduce distratctions

Question 22

what are some commands that can be useful for children with ASD as well as other children?

Answer 22

• say less
• stress what is important
• show what you want
• keep it simple and emphasize key words

Question 23

what are appropriate commands for 1 year olds?

Answer 23

• one direction at a time
• yes/no questions
• simple where questions that can be answered with pointing
• questions of what is this when talking about familiar objects

Question 24

what are appropriate commands for 2 year olds?

Answer 24

-2 word commands
-1-2 step instructions
-avoid first __, then___
-can ask basic questions about own wants and needs
-can answer longer questions like where, what, who is
-

Question 25

what are appropriate commands for 3-4 year olds?

Answer 25

• 3-5 word commands
• 3 step instructions
• should be able to understand “wh” questions
• starting to have understanding of subtleties of tone of voice

Question 26

which “wh” question is most challenging for younger children?

Answer 26

why?

• requires quite good language development
• better to ask what do you need? if there is difficulty with child complying

Question 27

when using visual strategies with children who have ASD, what kind of visual aids should be used for each age range

Answer 27

actual object - under 3
picture of actual object - 3-4 years
picture of life-like replica - 4 years
abstract representation - 5 years
written word with pictures - fluent reader (usually 6-7)
the more it looks like what you are trying to convey, the better

Question 28

What is the theory of mind?

Answer 28

• to attribute mental states like beliefs, intents, etc - to oneself and others
• to understand that other people’s beliefs, desires, intentions, and perspectives are different from one’s own

Question 29

how may theory of mind be challenging for those with ASD?

Answer 29

• may have difficulty comprehending when others don’t know something
• what they think is right is the only answer

Question 30

most people are aware of social cues and others, however this can be challenging for those with ASD. What is a strategy for helping kids fit in?

Answer 30

• teach explicit rules

- explain clearly social norms

Question 31

what challenges can rigidity present in patients with ASD?

Answer 31

• inflexible adherence to routines or rituals can make certain things challenging (like when clothing needs to be changed with seasons)
• need to modify things to adjust sometimes (like allowing individual to close dore, or place things in a certain order)

Question 32

what are some strategies for dealing with rigidity in individuals with ASD?

Answer 32

• provide warnings before starting or ending activities or when routine will be changed
• use visual supports and schedules
• use individuals interests as motivators and save for the hardest to motivate tasks
• in preschool children, reinforcer/motivator must be immediately after stressor
• in school aged children, there can be a delay before motivator/reinforcer

Question 33

how should self-harm behavior be handled with ASD patients?

Answer 33

• if something like headbaning is occuring, but pt is not actually doing harm- ignore as reacting can reinforce
• turn head away
• if harm is happening, move child to safe, soft spot, bring cushioning to them
• watch for and learn antecedents - these are triggers and can ideally start to be avoided

Question 34

what are some examples of times that use of visual aids coupled with words/simple explanations with ASD children can be particularly useful?

Answer 34

• teaching new language
• introducing unfamiliar tasks
• introducing abstract or non-specific visuals
• before going to an unfamiliar setting (show and explain where they will be going)

Question 35

what are some characteristics of problem eating with children with ASD?

Answer 35

• develops in early childhood (less than 3 years of age)
• sensory aversion
• aversive consequences (gag, pain, reflux)
• motor weakness
• temperament, anxiety
• parental psychopathology

Question 36

what is normally motivation for eating?

Answer 36

• hunger/satiety
• flavour & sensory
• social

these often aren’t motivating for problem feeders

Question 37

how does stress and motivation compare between picky eaters and problem eaters?

Answer 37

• picky eaters have about equal stress and motivation (at sort of an apathetic level)
• problem feeders have high stress and basically no motivation

Question 38

what are some oral-motor strategies or interventions that can aid with safety related to eating for problem feeders?

Answer 38

thickener
purees
bottles
cups
straws

Question 39

how is sensory sensitivity a factor in problem feeding?

Answer 39

-problem feeders are almost universally hyper-sensitive to the sensory aspects of feeding