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Overview 8/28 Flashcards

1
Q

Leo Kanner 1894-1981

A

SC/RRB domains still used

But historical inaccuracies (ex. refrigerator mothers)

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2
Q

Hans Asperger 1906-1980

A

Was known for Aspergers

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3
Q

Lorna Wing 1928-2014

A

British, first to describe it in English

Assessed need for support

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4
Q

Ivar Lovaas 1927-2010

A

first to publish in 1987, paper on 47% of kids with early behavioral program have IQ leaps. Moved where ASD was on DSM. Axis 1 vs. Axis 2. (“lifelong” vs. treatable).

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5
Q

Prevalence of ASD

A

1%, CDC rates keep going up

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5
Q

about ____ of those with ASD function in ID range

A

1/3 (<70)

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6
Q

Boy Girl ASD ratio

A

4:1

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7
Q

Are outcomes in ASD uniform?

A

No they are variable

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8
Q

Why is ASD prevalence rising?

A

Rates vary on methodological factors

Studies after 2000 have higher rates of ASD

Rise can be attributed to change diagnostic standards, availability of services and greater public awareness.

One criteria and you stick to that criteria.

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9
Q

DSM-5 ASD critieria:

A

Social need all 3: Reciprocity, NV communication, developing and maintaining relationships

RRBs (Need 2): Stereotyped, Adherence to routines, restricted/fixated interests, hyper/hypo sensory sensitivity

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10
Q

ASD diagnosis depends on SUPPORT NEED

A

score high, but significant other and job no diagnosis.

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11
Q

______ is used for classification of ASD rather than genetic, psychological/neuro/biochem

A

Phenomenological DSM

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12
Q

Why nosology (classification of ASD)?

A

Necessary for communication, prognosticating, treating, and etiology

Meets patient/parent expectations: tame beast by naming it, eligibility for services

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13
Q

Main point of brain research in ASD

A

Different parts, different symptoms and problems (social, communication, RRB)

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14
Q

Monozygotic twins _____% concordance for ASD

Dizygotic twins ____% rates for ASD

At risk younger siblings _____% risk

What runs in families?

A

60-90%

0-30%

15-20%

Broader phenotype

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15
Q

What chromosomes have ASD risk genes?

A

7, 15, X, 11

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16
Q

Genetics in ASD: recent switch from focus on inherited genes control NT to

A

Rare de novo copy number variants that affect genes regulating synaptic and axonal development

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17
Q

Synaptic Scaffolding protein gene

A

SHANK3

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18
Q

Synapse formation gene

A

NLGN 3 and 4

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19
Q

Abnormal structure and function of synapse

A

PTEN

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20
Q

Neuronal Network gene

21
Q

Synaptogenesis gene

22
Q

Maternal risk factors

A

low/high age, smoking, high/low education, hypertension, diabetes, SSRI 1st t, immigration, breech, C-section, weighing more than 90 kg, epilepsy, preterm, etc.

23
Q

ADHD CDC 2003 study asking parents for symptoms and looking at med usage.

A

Rates of clinicians across country vary.

Poor/low incomes States lower rates? Higher in South?

Cultural variables on who is identified and gets services.

24
Implications of Gene-Environment interaction
Match of genes & environment = health * Desynchronization = Pathology * Environment and genes can change * Environment usually changes faster than genes * The illusion of heritability – Cannot subtract heritability from 100% and conclude environmental percent – The case of PKU (100% genetic and 100% environmental)
25
Do we know for sure what causes ASD?
It's complicated maybe course of brain development, maybe risk factors in maternal fetal environment, maybe environmental factors act in concert with inherited susceptibilities or inducing epigenetic changes
26
Diagnostic Instruments for ASD
ADOS, ADI-R, Rating Scales
27
When are the following time foci used to diagnose ASD on ADOS? 1. Current 2. Ever 3. Most abnormal 4. Occasionally/other
1. Current- last 3 months 2 Ever-abnormal items 3. Most abnormal- 4-5 years (Maturational influenced) 4. Occasionally/other- friendships
28
0, 1, 2, 3, 7 coding conventions on ADOS
0- not present 1- is present, not sufficiently severe enough for 2 2- present AND meets criteria 3- Behavior present and interferes with functioning or ordinary life 7- abnormality in area of coding but NOT type specified
29
ADI-R pointing to express interest
Focus on: Pointing to show (not request), pointing at distance (not proximal), coordination (head/eye movements, object to person), spontaneity/variety, social quality
30
ADI-R approach to social/vocalization "chat"
Requires: Reciprocity, turn taking, maintenance of interchange, social quality (not because you want something)
31
"0" (no impairment) code for ADI-R friendships
Own age group, sharing of non-stereotyped activities, seen outside prearranged group settings, definite reciprocity and mutual responsiveness
32
ADI-R code 3 for sharing suggests
No sharing
33
What is the ADOS goal?
to create a social environment in which the child realizes the expectation is for him/her to interact with the examiner
34
What 3 things does the ADOS provide information about.
Social behavior, ability to communicate, play behavior
35
ADOS modules: 1 2 3 4
1- no speech-simple phrases 2- 3 word phrases/not yet fluent - verbally fluent 3- child/young teen, toys not helpful 4- verbally fluent teen/adult
36
Rating Scales are all about what?
ACCURACY (determined by sensitivity, specificity, positive and negative predictive power)
37
What impacts sensitivity, specificity, positive and negative predictive power of rating scale?
development/content of the scale, comparison group, diagnostic ascertainment of ASD, age, ID level, language level.
38
Behavior problems: part of ASD?
Tricky. Part of clinical description according to APA, highly prevalent. BUT point prevalence varies on instrument used.
39
Behavior problems study: what are behavior problems associated with
Psychotropic medicine use High caregiver stress Behavior problems, not functioning level related to stress Transactional model
40
Does it work? STudy of citalopram hyrobromide
No. Done to reduce stereotyped behavior. SSRI. Improve, but so does placebo.
41
Clinical reality of multiple meds, what is most helpful?
Stimulant + antipsychotic + parent training
42
Drug studies target what symptoms
irritability, RB, ADHD symptoms
43
Are there drugs for social behavior or RRB?
No
44
What are the 2 FDA drugs for Autism?
Risperidone and aripriprazole
45
Obstacles to psychopharmacology
great genetic & phenotypic heterogeneity – large placebo responses – positive publication bias – low incidence disorder
46
RUPP Autism Network study of Risperidone found what?
Reduced irritability on ABC and CGI
47
Side effects of risperidone and anitpsychotics
Sedation first month * Weight gain, metabolic syndrome * Hormone changes * Neurological (EPS) * Constipation * Photosensitivity * Temperature regulation * ECG changes * Reduced white count
48
Parent Training vs. Parent education Paper (Luc is on it will be on exam)
1st study with large sample comparing people trained on behavior principles: Parent training (PT) vs. Parent education program (PEP) Placebo: 12 session 24 week trial compare placebo (education with therapist) Both improved and loved it. Parent training was better by week 24, but still great. on CGI rating
49
What do good comprehensive intervention packages have?
Timing, intensity, direct provision of learning experiences, breadth, individual differences, environmental maintenance of development

Autism7717 (6 decks)

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