Lecture 2: Autism Spectrum Disorder Flashcards
(34 cards)
After this lecture, you will be able to:
Describe early signs and outcomes of ASD
Name evidence-based interventions for ASD and explain how they work
Describe the optimal timing and dosage of these interventions
Discuss options on how to deliver treatments when families experience barriers to care
Explain the difference between efficacy and effectiveness
oke
neurodiversity movement
- Aims to increase acceptance and inclusion of all people while embracing neurological differences (e.g., ASD, ADHD)
- Argues autism is not a disorder, but a neurological difference: individuals with autism learn, think, and problem-solve in unique ways
- Impairment signals a mismatch between the individual and the environment, which is
based on neurotypical standards - A combination of clinical treatment (to provide additional resources) and transformation of the neurotypical attitude will improve the lives of neurodiverse individuals
prevalentie neurotypische mensen (online)
15%
two areas of difficulties of ASD DSM5
- persistent deficits in social communication and social interaction, in multiple domains
- restricted repetitive patterns of behavior, interests or activities
early signs of ASD
Communication-interaction:
* Lack of responsiveness
* Lack of speech
* Avoiding eye contact
Repetitive behaviors:
* Hand flapping
* Tiptoeing
* Stimming (head banging)
Aggressiveness
* Excessive biting
* Hitting
verschil common trantrums and sensory meltdowns
- common tantrums: last minutes
- sensory meltdowns: can last hours
stimming =
form of emotion regulation, to handle overstimulating situations
prevalence of ASD
1-2% of the population
secondary symptoms=
- self harm (head banging)
- aggressiveness, tantrums
their communicative function: something is wrong, i feel overstimulated
comorbidities
- adhd
- sleeping problems
- anxiety and depression
first signs of ASD are detectable at…
6 months (diagnosis in toddlerhood is possible)
what are the goals of treatment
we cant and dont want to change the nature of individuals
but we want to help them lead satisfying lives in their community:
- reduction in symptoms (less repetitive behaviours, self harming)
- developmental improvements (childlearns to speak)
- reduction problem behavior (child shows less temper tantrums)
- better coping (attending regular education)
first ‘interventions’ for asd
- First ‘interventions’ for children with ASD were intense and radical.
- Examples: Electroconvulsive therapy, strict dietary restrictions,…
- Little to no early intervention.
Poor outcomes:
* Almost all children with ASD were placed in mental institutions by adolescence
* 50% of children with ASD remained non-verbal throughout their lives
* Only 1.5% achieved ‘normal’ functioning
behavioural interventions are based on…
the theory of Skinner
Behavior takes place in and is determined by the environment. According this his principle of reinforcement, behavior is dependent upon its consequences.
Reinforcement: if the consequence of the behavior is good, the behavior will likely be repeated
* Positive reinforcement: add environmental stimulus
* Negative reinforcement: remove environmental stimulus
Punishment: if the consequence of the behavior is bad, the behavior will likely not be repeated
* Positive punishment: add environmental stimulus
* Negative punishment: remove environmental stimulus
Extinction:
By removing the reinforcer, the behavior will fade and eventually disappear.
Example:
A child has previously learned that persistent
crying results in receiving a treat. When the
parent stops giving treats to the crying, the
crying eventually stops.
4 principles of applied behavioral analysis
- behaviours are affected by their environment
- behaviours can be strenghtened or weakened by their consequences
- behaviour changes are more effective with positive instead of negative consequences
- behaviours need to be reinforced or disciplined for socially significant changes
Lovaas: ABA
He developed the first intensive ABA treatment for ASD.
Early work (1960s-1970s):
* Focus on punitive aspects of ABA (e.g., electric shocks to modify behaviors such as self-injury)
* Intervention setting: impersonal, empty room
* No family involvement during interventions
* Later also a focus on primary reinforcers such as food and affection to modify behaviors
Later work: Early and Intensive Behavioral Intervention (EIBI):
* He compared children with 40hrs of weekly one-on-one therapy to children with less than 10hrs of weekly therapy
* These young children received discrete-trial training (DTT):
- Important skills are taught in a repeated and brief fashion with a specific instruction (‘discriminative stimulus’). Dus bv. klappen: eerst zeggen ‘show me clapping’, dan hun helpen, en daarna kunnen ze het zelf.
- Skills are divided into small components, taught one at a time
- Operant techniques (ABA principles) are applied to establish learning skills and to eliminate atypical behavior
- Skill development is tracked
- Children with intensive treatment: 47% achieved ‘normal’ intellectual and educational functioning, and ‘only’ 10% were intellectually disabled
- Children with light treatment: 2% achieved ‘normal’ intellectual and education functioning, 45% were mildly intellectually disabled and placed in language-delayed classes, and 53% were severely intellectually disabled and placed in classes for children with ASD
skills taught to children with ASD
- Social skills (e.g., sharing, turn-taking)
- Communication skills (e.g., using words to get what you want)
- Play (e.g., joint attention)
- Behavior (e.g., waiting, emotion regulation)
- Motor skills (e.g., fine/gross)
- Cognitive skills (e.g., imitation)
- Adaptive skills (e.g., dressing, feeding, toileting)
Naturalistic Developmental Behavioral Interventions (NDBI’s)
Emergence of more sophisticated models of early developmental learning processes involved in communication, language, and social learning
* Joint attention (the shared focus of individuals on an object to share information) as a key precursor of language development, social interactions
* Imitation (~ Theory of Mind) as a key precursor of language development, social interactions, and many other skills
* Children are active (rather than passive) learners (‘hypothesis-testers’)
* Social relationships (also with therapist) are essential contexts for learning
* Affective engagement facilitates learning
Early ABA interventions are effective in teaching skills, but:
- Lack of generalization: newly learned skills are limited to specific environments and circumstances (clinic versus home environment)
- Lack of spontaneity: highly-structured teaching approaches
- Overdependence on prompts (something you add between the DS and the response to assist the child in learning the correct response)
- Avoidance behaviors: child is not internally motivated
- Extremely time and labor intensive
NDBI’s characteristics
- developmental tasks
- natural setting -> generalisatie, natural contingencies of behavior
- bidirectional interactions between children and adults
- motivation comes from own interests and preferences
- evidence based (ABA is core)
- prompting and then fading - learn just beyond present knowledge (zone of proximal development)
- modeling by therapist, encourage imitation by child
- broadening the attentional focus to counter stimulus overselectivity
examples of NDBI’s
- Incidental Teaching (IT)
- Enhanced Milieu Training (EMT)
- Reciprocal Imitation Training (RIT)
- Project ImPACT
- Joint Attention Symbolic Play Engagement and Regulation (JASPER)
- Early Start Denver Model (ESDM)
- Pivotal Response Treatment
pivotal response treatment
PRT is focused on targeting “pivotal” areas/skills/responses within a child’s natural environment to support language development and social interaction
PRT is focused on increasing the motivation to interact with others, which underlies multiple learning opportunities such as:
* Self-management or self-regulation (stay seated during lunch time)
* Self-initiate social interactions (e.g., joint attention, asking for help, asking questions)
If learning occurs here, other skills will develop naturally
Increase motivation: Child-selected stimulus materials, direct and natural reinforcers, play-based
For children between 2 and 6 years old
Family involvement in both the creation and implementation of the intervention:
* Trainers and parents work together to create goals for the child
* Parents are trained to deliver PRT at home
Early Start Denver Model (ESDM)
- Based on ABA, PRT and social motivation hypothesis
- Focused on building close relationships
- Through play and imitation
- To facilitate language and social development
- For infants and toddlers
- More structured than PR
Impaired sensitivity to reward value of social stimuli -> Reduced attention to and interaction with social stimuli -> Impairments in communication and social-emotional skills
evidence for ESDM
- Intensive delivery at home by trained therapist (20hrs/week, one-on-one, two years): large improvements in IQ, adaptive behavior, language, and ASD severity
- Parent coaching (1hr/week, 12 weeks): single case studies with positive effects on language, play, imitation, two RCT’s with mixed findings
- Preschool/day care delivery (group-based, 15-25hrs/week): improvements in developmental rate and language skills
- Adapted for use with infants (7-12 months old, parent coaching, 1hr/week, 12 weeks): positive effects (but N = 7)
