9 - Autism Flashcards
(18 cards)
What are criterion A and B for autism?
A: Social and communication differences
- Social-emotional reciprocity
- Nonverbal communication
- Relationship management
→ p.ex: the back and forth of conversations, using gesture socially, using pointing socially, knowing when to end and start a conversation, knowing how to maintain friendships over time, etc.
B: Focused interests and behaviours
- Repetitive behaviour (stimming; self-stimulating behaviour)
- Flexibility (cognitive flexibility (seeing things more black and white, sticking to a decision)
- Intense or unusual interests
- Sensory differences (sensitive to smells, tastes or textures, sensations from inside the body i.e., not recognizing when hungry or needing to go to the bathroom)
True or false: In order to meet the autism criteria for diagnosis, you need to meet all of A (social and communication differences) and 2 of 4 of criterion B.
True
What is the ADOS-2?
Autism diagnostic observation schedule
→ assessment tool – not necessary for an assessment or diagnosis, but can be added
→ lots of different toys and stimuli used during this assessment
→ very systematic way of observing the differences we see in autism
How would we differentiate between on the ASD and a child not on the ASD in a context of seeing social opportunity through play?
A child NOT on the ASD:
→ social back and forth: involving the adult, looking at them, offering them things, etc.
→ the child is using things as smt that they aren’t really
→ imitates the adult, follows along their ideas
A child on the ASD:
→ enjoys a specific toy (lots of phones at home that he plays with, so he went to the phone in the toy room), doesn’t share the toy with others, doesn’t show his enjoyment externally
→ doesn’t respond to his name, doesn’t have creative play with the phone
→ when an adult tries to distract him from the phone, and asks for the phone with a gesture, he doesn’t understand the physical cue
→ tickle the child which the kid enjoys, but doesn’t try to keep the tickling going (a child not on the ASD would try to keep it going, this is social reciprocity)
How would we differentiate between on the ASD and a child not on the ASD in a context of making social connections?
A child NOT on the ASD:
→ the child uses social gestures (pointing), coordinated gaze, vocalization
A child on the ASD:
→ hand flapping, doesn’t share enjoying by looking at the adult, looks at the adult’s pointed finger but does not look at where the finger is pointing
How would we differentiate between on the ASD and a child not on the ASD in a context of effective communication and sharing enjoyment?
A child NOT on the ASD:
→ stays engaged with the people nearby and shares the enjoyment of the toy in front of them, requests help
A child on the ASD:
→ attention focused on the toy and does not interact with the people nearby, when the toy stops moving the child doesn’t ask for help in any way, tenses face body and mouth, doesn’t understand that the adult is trying to help him
How can we reframe characteristics of a child with autism?
→ Honest, direct, enjoys interest-based interactions
→ Independent, deeply enjoys time alone, favors deep connections
→ Systematic, procedural, logical, analytical, detail-oriented
→ Reliable, consistent, predictable, trustworthy
→ Knowledgeable, focused, dedicated
→ Adventurous, brave, active
→ Not afraid to go “against the grain”
→ Independent
→ Unique ways of thinking, being, connecting, and regulating
What is the prevalence of autsim?
- ~1-2% of population fit the autism criteria (similar in adults than kids)
- 3:1 boys to girls with concerns about missing girls
→ although there’s a movement now to trying to find how autism is different between boys and girls - Heritability estimates ~80% (similar levels to ADHD)
→ not uncommon to see siblings with ASD or features of ASD, even the parents
What are some examples of autism experiences relevant to older adolescents and young adults (things they’ll do during a video)?
→ smiling through the whole video even when talking about serious topics
→ using lots or little gestures
→ rocking back and forth
→ eye contact: it’s not about not making eye contact, it’s about properly using eye contact in a social situation – we can see very intense eye contact, absent eye contact or no eye contact at all
→ using facial expressions to “control” a social situation
→ conscious awareness for masking (trying to act in a way that is more neurotypical)
→ don’t naturally understand certain nuances (p.ex: dating nuances or sexual nuances and cues)
→ very diverse, autism can look different for a lot of people
We often see a combination of diagnoses instead of one of autism, name these diagnoses.
→ Social anxiety disorder
→ Borderline personality disorder
→ Avoidant-restrictive food intake (ARFID)
→ Other eating disorders
→ Attention-deficit/hyperactivity disorder (ADHD)
→ Obsessive-compulsive disorder
→ the difference here is that in ASD, the obsession is seen as positive and the compulsion in ASD is not associated with a thought and is also positive
→ Anxiety disorders
→ Mood disorders
→ Developmental coordination disorder
→ Language disorder
What thinking style is commonly seen in autistic people?
Bottom-up processing
- Not part of diagnostic criteria, but commonly seen thinking style in autistic people
- Processing details before context, so tend to miss context or need it explicitly explained
→ looking at all the details and then building up your case of what’s going on as a whole
- this can lead to context blindness
→ p.ex: acting similarly in most contexts, like in a classroom vs at home vs with friends
→ p.ex: using someone else’s ipad in a context outside the home, standing very close to your doctor, asking very direct questions, etc.
- Tend to provide a lot of details, seem to struggle to know what is relevant/irrelevant
→ p.ex: not catch what you already know and what you don’t know – talking about video games but don’t ask what you already know like if you’ve already played the game or not
- Example: giving very detailed information in conversation that affects back and flow nature
- Example: requiring very detailed preparation for new situations
There are sub-criterion to criteria A of diagnosis, elaborate on criteria A.1: socio-emotional reciprocity.
→ Reduced, inconsistent, or unnatural ability with reciprocal social interaction skills
→ Initiating interactions (e.g., seeking play or joint attention, starting conversations)
→ Responding to interactions
→ Maintaining interactions (e.g., seeking to continue a social exchange, making connected comments, talking on a variety of topics including what the other person says)
→ Engaging in a variety of interaction types, like small talk and group discussions
→ Perspective-taking (e.g., understanding their perspectives may be different from one’s own, understanding emotions in others)
→ Sharing toys, objects, or even personal details about oneself
There are sub-criterion to criteria A of diagnosis, elaborate on criteria A.2: non-verbal communication
→ Differences in use of nonverbal communication and/or understanding meaning and integration of nonverbal information during social interaction
→ Speech tone and pace, facial expressions, eye contact, body language, body orientation, and different types of gestures, integrated with speech for communication
→ Eye contact differences (e.g., fleeting, unwavering)
→ Little use of gestures or unclear gestures
→ Hard to “read” based on facial/body language
→ Flat affect or little variation when discussing emotional topics, exaggerated or atypical affect (e.g., laughing when discussing really distressing content)
→ Speech differences (e.g., halting, slow or fast, difficulty coordinating breathing with talking)
→ Tone of voice differences (e.g., doesn’t vary much or varies in unusual ways)
→ Personal space (e.g., being too close or too far, walking behind or ahead)
→ Grimaces or odd facial expressions
→ Misunderstanding others’ cues (e.g., may pick up, but ask repetitively what it means, or assume the worst)
There are sub-criterion to criteria A of diagnosis, elaborate on criteria A.3: relationship management
→ Differences in development and understanding of friendships and other relationships
→ Making friends, maintaining friends, understanding different types of relationships, adjusting behavior to different contexts/relationship types (e.g., teacher vs. peer, partner vs. friend), managing conflicts, social motivation
→ Self-report of not knowing how to make friends
→ Difficulty making friends independently
→ Friends with older or younger people
→ Reduced interest in making new friends
→ Reduced interest in having social contact with friends
→ Having many acquaintances and play buddies but no close connections
→ Losing friends quickly or constant changing friends
→ Difficulty articulating what a friend is
→ Thinks everyone is their friend, even bullies
→ Treating adults the same way as friends, or friends the same way as family, etc.
→ Avoiding conflicts or mismanaging conflicts
There are sub-criterion to criteria B of diagnosis, elaborate on criteria B.1: Repetitive behaviour
- Repetitive movements, speech, or use of objects (stimming) that are used to self-regulate (often brings a sense of calm, focus, enjoyment)
- Movements:
→ Body rocking, pacing, hair flipping, picking skin/nails/scabs/hair, touching, tapping, leg shaking, repetitive blinking, throat clearing - Use of speech:
→ Echolalia: repeating back one’s own speech or the speech of others (“echo”); external or internal
→ Saying words or phrases in formal or funny ways
→ Repetitive sounds (meowing, grunting humming)
→ Repetitive questioning - Use of objects
→ Lining up, categorizing, list-making, systematizing (beyond typical organization)
→ Spinning wheels or objects, moving certain pieces back and forth, patterning
There are sub-criterion to criteria B of diagnosis, elaborate on criteria B.2: Flexing
→ Heightened need for things to be the same and predictable, rigid thinking or interpretations
→ Order-focused rituals that need to be done the same way each time
→ Difficulty transitioning from one activity/environment to the next (fixation/hyperfocus, difficulty with interruption or leaving tasks incomplete)
→ Black/white thinking, literal interpretations
→ Sensitivity to changes (big and small)
→ Need for high level of detail to prepare for new situations - need to know exactly what to expect
→ “Rule police” or “grammar police”
→ Eating the same food or wearing the same clothes according to rigid rules (e.g., only black clothes, only white foods)
There are sub-criterion to criteria B of diagnosis, elaborate on criteria B.3: Intense or unusual interests
→ Differences in interests: intensity in level of focus and/or detail, unusual in content, strong attachment to people or objects
→ Interests very intense in focus (“obsessed”), usually at the expense of variety (narrow range of interests)
→ Odd or unusual interests, based on age or perhaps the specificity of the interest (e.g., WWII airplane manufacturers as a child)
→ Strong attachment to people or objects that seem atypical (e.g., carrying special objects in pockets everywhere, or over-attaching to a single person)
→ Spending hours talking about or researching interest without actually engaging in it (e.g., video games)
→ Collecting paraphernalia (e.g., room covered in posters, books, and trinkets on a specific topic like Harry Potter or Taylor Swift
There are sub-criterion to criteria B of diagnosis, elaborate on criteria B.4: Sensory differences
- Differences in processing and perception of sight, touch, smell, sound, taste, movement
→ Hypo-sensitivity: Not reacting or noticing sensory input that others do
→ Hypersensitivity: Noticing/reacting more than others do
→ Sensory seeking: Seeking intense sensory input - Sight: noticing slight differences with different types of lights, visually examining objects close up or from odd angles
- Sound: noticing small sounds others don’t (electricity), significant distress with noises like vacuum, sirens
- Smell: complaining of smells others don’t, smelling hands or objects a lot
- Touch: not wanting to be touched, clothing sensitivities or texture sensitivities with food
- Taste: limited/bland diet, or seeking strong flavors
- Temperature: sensitivity to heat (e.g., affects ability to be outside), not noticing heat or pain
- Proprioceptive/movement: difficulty with balance, seeks a lot of compression/pressure, enjoys intense proprioceptive feedback like rollercoasters
