Lecture 8 (ASD and ID) Flashcards
(10 cards)
DSM definition of neurodevelopmental conditions and Neurodiversity affirming network
DSM -> neruodevelopmental conditions -> group of conditions with onset in developmental period, typically manifest early in development characteried by developmental differences, and impairments of personal, social, academic, occupational functioning
Neurodiversity affirming network
-> recognising natural diversity and encouraging respect for different neurobiological functioning
-> shifting from medical model that focuses on fixing and cueing
Autism criteria and specifiers
A -> persistent differences in social communication and social interaction across multiple contexts -> manisfested by ALL
-> social-emotional reciprocity
-> nonverbal communicative behaviours
-> developing maintaining and understanding relationships
B -> restrictive/repetitive patterns 2 or more
-> repetitive motor movements
-> insistence on sameness
-> fixated interests
-> hyper or hyporeactivity to sensory input
C -> must be present in early developmental period (may not manifest until older because of masking ( pretend to do something in neurotypical way)
D-> significant impairment on functioning
E -> not better explained by ID
Specify;
With or w/o intellectual impairment and language impairment
Severity
Lvl 3 -> requires very substantial support
Lvl 2 -> requires substantial support
Lvl 1 -> requires support
Associated difficulties / conditions
mood problems
alexithymia -> inability to understand, express, identify emotions
Prevalence ASD
1 in 36, increase from 1 in 44 in 2018
50% children aged 4 had 70 or less IQ test
Autism happens in all racial ethnic and SES groups
Females express autism through subtle variations
Its not just a linear spectrum, there is a heterogeneity that underlines autism
-> difference in presentation, developmental history, comorbidities, different aetiologies, gender differences
Aspergers syndrome was removed in 2013
ASD aetiology and Prognosis
Genetics and neurobiology
-> 80% heritability
60-90% MZ, low DZ
low birth weight was a risk factor for ASD and ADHD, same with meds, convulsions, and strep infection
deficits in left cerebral hemispheres (emotions)
subcortical brain structures (cerebellum, and amygdala)
Psychological theories
unrewarding, and fridge parents (cold and emotionally unavailable)
No evidence supporting a psych cause for ASD
Prognosis
Children -> early identification improve developmental outcomes
Adults -> if you had a 70 or more IQ could help in adulthood, and degree of support from family
No diagnosis of epilepsy
ASD interventions
Using neurodiversity affirming practices -> positive approaches to support disability, adapt psych practice to make reasonable adjustments -> use of alternative and augmentative communication (replacing spoken or written languages)
Interventions
->autistic identity
-> adapting environment to suit needs
-> enhance autonomy
use a modified CBT for anxiety, depression or burnout
Mindfulness based intervention -> changing relationship with emotions
Parenting support
Meds
Technology assisted therapies -> e.g. pictures and apps
ID and specifiers
Identified by significant limitations in intellectual functioning and adaptive behaviour
Intellectual and cognitive functioning -> learning, reasoning, abstract thinking (anything below 70 IQ is impaired (2 SD below mean)
Adaptive functioning -> activities of daily life like communication skills, and social participation
3 areas of adaptive functioning
Conceptual -> language, reading, math e.g.
Social -> empathy, judgement, communication skills,
Practical -> independence e.g. personal care, organising school and work tasks
Age of onset for criterion before age 22
Three elements for ID diagnosis
1. testing intellectual functioning
2. Testing adaptive functioning
3. Age of onset
Specifiers -> based on adaptive functioning NOT IQ
Mild, moderate, severe, profound
Measuring intellectual functioning and Adaptive functioning and factors that affect them
Measuring intellectual functioning
Individualised standardised testing
IQ test measures -> comprehension, visual spatial, reasoning, WM, processing speed
Factors affecting IQ scores
-> repeated testing
-> flynn effect -> average IQ of humans is increasing over time
-> doing really well on subtests which is an outlier -> makes overall IQ invalid
-> Co-occuring disorders affecting stuff e.g. anxiety
Use the relative strengths to guide intervention
IQ is insufficient to assess reasoning in real life situations
2/3 people have 85-115 IQ
Adaptive functioning
Clinical observations, additional sources of information e.g. school, teachers, family
Standardised measures -> adaptive behaviour assessment system, vineland adaptive behaviour scale
Factors affecting adaptive functioning score
-> difficult to quantify and less stable than IQ
-> not appropriate for infants
-> adaptive skills can be taught
Different types of ID severity
Borderline/mild
IQ in range of 71-84 (borderline)
IQ 50-55 to 70 (Mild)
85% of people with below IQ 70 are in this range
Mental age: 9-12
Dont require adult support
Usually from people in low intelligence or low SES
Moderate
IQ -> 35-40 to 50-55
10% of those with < 70 IQ
mental age: 6-9
pathologies frequent
Most live dependently
Found in all SES groups
Severe
IQ -> 20-25 to 35-40
3-4% of people below 70 IQ in this range
mental age: 3-6
Pathology is common
Most require constant supervision
Communication limited to concrete level
Profound
IQ -> <20
mental age: < 3
require toal supervision or nursing home
High mortality rate during childhood
Aetiology of ID
Genetics (Down syndrome = moderate to severe IQ), dominant gene disorders (not all have IDs, recessive gene disorders -> early identification needed
Exposure to infectious diseases from mother to fetus, or after birth
Exposure to toxins -> FASD, or lead after birth exposure
Biological -> premature birth, low weight, pregnancy/birth complications
TBI
Psychosocial disadvantage and poverty
ID prevention and treatment
Historically -> promoted eugenics
Health care measures
-> getting vaccines, diagnostic testing, promoting health enhancing behaviours
Secondary preventions (detect and treat early)
-> focus on developing early cognitive and social skills
Tertiary prevention (teaching how to manage)
-> early interventions
-> making home based adaptions
-> inclusion, and teaching strategies
-> play therapy
-> shaping, backward chaining, to teach ADLs
-> family support, transition services from child to adult
Case management -> setting goals and creating help
