Autism

Question 1

Autism classification

Answer 1

A lifelong neurodevelopmental disorder

Question 2

Autism is in DSM and

Answer 2

an aspect of self and identity

Question 3

DSM 4 to 5

Answer 3

In 4, 5 Autism spectrum disorders
In 5, Rett’s Disorder moved out because genetic component; Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorders not otherwise specified, and Childhood Disintegrative Disorder were collapsed into Autism Spectrum Disorder- commonalities so strong and reliability so weak

Question 4

Autism meaning

Answer 4

Within oneself

Question 5

Spectrum added to refer to

Answer 5

The fact that symptoms, abilities, characteristics are expressed in many combinations across many degrees of severity

Question 6

ASD Diagnostic Criteria A

Answer 6

One core:
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history:
- Deficits in social-emotional reciprocity (ie abnormal social approach, failure to initiate or respond to social interactions)
- Deficits in nonverbal communicative behaviors used for social interaction (ie abnormalities in eye contact)
- Deficits in developing, maintaining, and understanding relationships (ie absence of interest in peers)

Question 7

What do Criteria A symptoms reflect?

Answer 7

Not necessarily a lack of interest in other people

Question 8

ASD Diagnostic Criteria B

Answer 8

Another core:
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
- Stereotyped or repetitive motor movements, use of objects, or speech (a stereotypy is a repeated action) (ie echolalia- repeating words someone has said) (these are seen in p much all kids when very young but less common as older)
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
- Highly restricted, fixated interest that are abnormal in intensity or focus
- Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (ie overreactive to things or apparent indifference to temperature)

Question 9

ASD other criteria

Answer 9

Symptoms present in early developmental period but may not become fully manifest until social demands exceed limited capacities or masked by learned strategies (mostly diagnosed in preschool or early elementary)
Impairment in functioning
Not better explained by an intellectual disability

Question 10

ASD evidence in earliest weeks of life

Answer 10

In infancy, crying is communication
As early as one month old, kids who are later diagnosed with ASD have cries that sound different (prospective longitudinal study)- louder, more distressed, more screaming, variations in pitch, sound wave frequency, amount of breath exhaled between cried make cries difficult to decode for parents
Could be bc of sensory sensitivity

Question 11

ASD evidence later in infancy

Answer 11

Reduced responsiveness to direct gaze
Reduced joint attention- shown though switching gaze between something interesting and another person or through pointing

Question 12

ASD evidence in toddlers and preschoolers

Answer 12

Variations in pretend play- don’t engage at all or will engage in objects not with their intended purpose

Question 13

ASD over time

Answer 13

In early-middle childhood, tend to see symptoms of autism decrease (maybe bc of interventions ramping up), pubertal deterioration- tough transition to adolescence as social pressures intensify, see comorbid depression + anxiety + eating disorders can emerge

Question 14

ASD in adulthood

Answer 14

20%- content, autonomous, fulfilled lives
30%- some difficulties by good social, educational, occupational functioning
50%- unable to live independently
Adults report being better able to understand social expectations and social responsiveness, but not change in stereotypies and repetitive behaviors

Question 15

Stereotypies

Answer 15

Meaningful and functional, a way to self-calm, buffer against overstimulation, express emotions
People can learn to suppress stereotypies but comes at a cost- takes away effective ways of managing information
Stigma - Kids report being mocked by others, parent report that other people’s negative reactions make them reluctant to bring them to public places, adults report they are treated as though dangerous or childish

Question 16

Theory of Mind

Answer 16

Awareness of mental states in self and others, understanding that others have beliefs, desires, intentions that are different from own, by age 4 children can comprehend what others might know or think, older people w ASD struggle with this

Question 17

Mindblindedness Theory

Answer 17

Children w autism fail to develop capacity to mindread in the same way others do, can learn and know things about the social world but don’t intuitively understand them

Question 18

Sally-Anne Test

Answer 18

Test of mindreading, unique to autism to struggle, children (even Down’s Syndrome) get it right by age 4 or 5, older autistic people can’t, can learn the answer but don’t get why
COME BACK

Question 19

Unique deficit of ASD

Answer 19

Deficits in Theory of Mind are very specific to ASD, unlike other symptoms bc social difficulties can be part of other disorders

Question 20

Emotion assessment in ASD

Answer 20

When assessing emotions, non-ASD look at eyes and mouth, ASD more variability

Question 21

ASD and eye contact

Answer 21

ASD people report eye contact is effortful, exhausting, frightening, not helpful- hard to determine emotion looking at eyes, but stigmatized for this, doesn’t indicate lack of empathy

Question 22

Cognitive empathy-

Answer 22

Inferring another person’s emotions accurately

Question 23

Empathic concern-

Answer 23

Responding to another’s emotions supportively

Question 24

Affective empathy-

Answer 24

Feeling the same emotions as another person

Question 25

ASD and empathy

Answer 25

Cognitive empathy and empathic concern are difficult for people with ASD, but affective empathy is better When watching others experience pain or something upsetting, fMRI studies show that people with ASD have strong activation (maybe stronger than others) in own insula- region of brain that processes pain

Question 26

Milton's Double Empathy Problem

Answer 26

Hypothesis: mutual misunderstanding bw people who have autism and people who don't Not just that people w ASD have trouble mindreading people who don't, but bidirectional difficulty in understanding e/o bc of different communication styles and life experiences Empirical support: People w/o autism are much better at reading emotions/mental states of people w/o autism than people w autism

Question 27

ASD + sex disparities

Answer 27

ASD 3-4x more common in males Difference magnified in higher-functioning range, high-functioning people w ASD 10x as likely to be male

Question 28

Systemizing

Answer 28

Drive to analyze, explore, classify, construct, evaluate systems and the rules that govern them

Question 29

Empathizing

Answer 29

Drive to identify another person's thoughts and emotions, respond to these appropriately

Question 30

Gender + drives

Answer 30

Males more prone to systemizing, women to empathizing

Question 31

Baron-Cohen's Extreme Male Brain Theory

Answer 31

Autistic brain is an extreme male brain, leads to fixations on things, people w ASD score very highly on tests of systemizing, hypothesis that ASD caused by excessive exposure to fetal testosterone and other androgens- studies of pregnant mothers show higher levels of testosterone associated w more autistic traits in kids 6-10 yrs, figured out problem but not yet how to employ strengths

Question 32

Two core diagnostic criteria of ASD

Answer 32

Difficulties with/impairments in social communication and social interactions Restrictive, repetitive behaviors, interests, activities

Question 33

ASD prevalence

Answer 33

2.5-2.8% in Western countries, lower in Middle East and Africa, prevalence has increased in recent years

Question 34

History of ASD

Answer 34

Not clearly described until 20th century, as refined diagnosis, prevalence has shifted

Question 35

Donald Triplett

Answer 35

First person diagnosed with autism, placed in institution- but didn't change, his brother didn't show same qualities, inspired Kanner in 1943 to describe 11 children who had difficulty relating to other people and a strong preference for sameness

Question 36

Autism in DSM

Answer 36

First in DSM III in 1952, reflected first 11 children

Question 37

Near misses

Answer 37

Children who resembled Kanner's children but didn't qualify for autism diagnosis

Question 38

ASM in DSM IV

Answer 38

Added to catch near misses, 5 disorders to cover how people almost meet autism

Question 39

Asperger's

Answer 39

Core identical criteria for autism- what??

Question 40

Tim Page's memoir

Answer 40

Bullied, disliked being touched, repetitive interests, childhood rages

Question 41

Why a single diagnosis?

Answer 41

No consistent differences between individuals diagnosed with mild autism and those with Asperger's or other near miss diagnoses Not reliable diagnosis- should be agreed upon and easy to differentiate across people, this wasn't- people changing diagnoses all the time based on time in life No agreement among practitioners- diff practitioners diagnosing same person with different diagnosis- bad validity

Question 42

Why clarify diagnostic criteria?

Answer 42

Better inter-rater reliability Awareness that name of diagnosis could determine access to services (could only get if autistic disorder not Asperger's)

Question 43

Concerns with new taxonomy

Answer 43

Stigma- autistic disorder "worse" in terms of how treated/viewed in word or prognosis Erodes trust Asperger's was an identity and community, linked to genius and creativity, brought comfort

Question 44

Changes in how we conceptualize and study autism

Answer 44

Narrow to wide description of symptoms- no longer classic Kanner child but all different manifestations, no longer only study language but study communication more broadly Rare to common- researchers now think ASD is underdiagnosed, esp for females (if diagnosed more severe symptoms, idea aof masking) Childhood to lifespan- at first a disorder of early childhood (Kanner) and now we think about it as not just childhood Discrete to dimensional- characteristics of ASD can and do exist in people who are not diagnosed with ASD, stereotypies in people w/o ASD, same w pronoun reversals, etc, spectrum is off the spectrum, expected signs of development in many cases, not categorical binary distinctions One to many- we don't understand etiology, not a single cause

Question 45

Copy Number Variations

Answer 45

DNA mutations where some sections of a chromosome are repeated and others are not included Can be inherited or spontaneous (de novo)

Question 46

CNVs and ASD

Answer 46

High CNVs in 30% of ASD cases In families with just one child w ASD, only that child shows CNVs More CNVs-more severe symptoms of autism CNVs associated w these symptoms are in regions of chromosomes that facilitate communication across different parts of the brain, transmission of neural signals

Question 47

CNVs and parental age

Answer 47

Higher prevalence of autism in children born to older parents Age also associated w greater likelihood of CNVs esp paternal age

Question 48

Treating ASD

Answer 48

Idiographic approach is esp important bc breadth of symptoms and severity Only one core approach to treatment has strong empirical support- ABA

Question 49

Applied Behavior Analysis

Answer 49

Based on principles of operant conditioning to shape behavior Begins with intensive relationships and rapport building 2-3 hour sessions, 35-40 hrs/week Short period of structured time devoted to task, free time for child, breaks every hour Starts at home individually, goes to small group setting at school; as treatment progresses 1:1 therapist goes to school with child and then small group setting at school w parent training for home, 1:1 as needed

Question 50

Behavior Analysis in ABA

Answer 50

Observation of child's environment to determine what triggers undesirable behaviors, effective reinforcers, what makes desirable behavior more likely Removal of triggers/antecedents to difficult situations, implementation of rewards

Question 51

Discrete trial learning - ABA

Answer 51

Breaks down large tasks into small, manageable ones Completed request is positively rewarded If not completed, child prompted and guided

Question 52

Incidental Learning - ABA

Answer 52

Naturalistic, real-world Can occur in breaks, outside therapy session etc Guide them towards behavior

Question 53

Pivotal Response Training

Answer 53

Update to ABA Main difference- more child-guided, child determines what to do, topics, toys More expansive in rewards and reinforcements- rewards attempts to complete tasks not just completed ones Rewards more sensical, in-session rewards match out-of session results (say cup and get a drink rather than say cup and get a sticker)

Question 54

Four Pivotal Areas of PRT

Answer 54

Motivation Managing emotions Initiation of speech and activity Multiple cues (ability to absorb and respond to many different sources of information)

Question 55

ABA goal

Answer 55

Make people w ASD indistinguishable from peers People have negative experiences It achieves goals but comes at high cost People believe goal is misguided Most narratives come from more mild autism Goal should be to change social environment and expectations to be more respective of differences across people

Question 56

ABA history

Answer 56

Questionable + unethical Electric shocks to shape behaviors Tested theory on nonverbal foster children without people to advocate for them

Question 57

Components of effective ABA treatment

Answer 57

Early- begin intervention as soon as diagnosis is discussed Intensive- active engagement of child in at least 25 hours a week, 12 months a year, in systematically planned, developmentally appropriate educational activities with specific, individualized goals High structure- use of predictable routines, visual activity schedules, clear physical boundaries, minimal distractions Family inclusion- parent training in ABA Ongoing assessment- monitor child's progress and update goals