L19: ASD

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Questions and Answers

Which of the following best describes the evolution of autism diagnosis from DSM-IV to DSM-5?

  • DSM-5 eliminated the category of Autistic Disorder, replacing it with Social Communication Disorder to better capture the range of social communication deficits.
  • DSM-5 introduced new diagnostic criteria that specifically distinguish between high-functioning and low-functioning autism, providing clearer guidelines for differentiating severity levels.
  • DSM-5 consolidated Autistic Disorder, Asperger's Disorder, and PDD-NOS into a single umbrella diagnosis of Autism Spectrum Disorder (ASD) due to research indicating distinctions between groups were not meaningful. (correct)
  • DSM-5 maintained distinct categories for Autistic Disorder, Asperger's Disorder, and PDD-NOS, reflecting ongoing research supporting these separate classifications.

A child with ASD is observed to become intensely focused on the spinning wheels of a toy car, largely ignoring its other features and intended use. According to the diagnostic criteria for Autism Spectrum Disorder, this behavior primarily aligns with which of the following?

  • Modified sensory reactivity; hyper- or hypo-reactivity to sensory aspects of the environment.
  • Stereotyped or repetitive motor movements.
  • Deficits in social-emotional reciprocity.
  • Intense fixation on interests that are abnormal in intensity or focus. (correct)

A researcher is designing a study to investigate sensory processing differences in children with Autism Spectrum Disorder (ASD). Which experimental paradigm would best isolate and measure 'Modified sensory reactivity' as defined in Criterion B of the DSM-5 ASD diagnostic criteria?

  • A series of structured play activities designed to assess imaginative play skills and interest in peer interactions.
  • A task measuring the child's ability to understand and respond appropriately to social cues in a conversational setting.
  • Controlled exposure to varied sensory stimuli (e.g., textures, sounds, lights) while measuring behavioral and physiological responses. (correct)
  • A standardized observation of the child's reciprocal social interactions during a semi-structured interview.

In the context of assessing social communication deficits in Autism Spectrum Disorder (ASD), which of the following scenarios most directly illustrates a deficit in 'social-emotional reciprocity' as defined by DSM-5?

<p>A child with ASD struggles to initiate or maintain back-and-forth conversations, showing little interest in others' comments or sharing their own feelings. (D)</p> Signup and view all the answers

A 5-year-old child consistently uses phrases and sentences spoken by others in movies or conversations, often out of context. While echolalia can be a typical phase in language development, in the context of assessing for Autism Spectrum Disorder (ASD), how is this behavior best interpreted?

<p>As a language impairment that should be further evaluated in conjunction with other potential indicators of ASD, such as social interaction deficits and repetitive behaviors. (D)</p> Signup and view all the answers

During an ADOS assessment, a child with suspected ASD is presented with a 'birthday party' scenario involving dolls and pretend cake. Which of the following observed behaviors would provide the strongest evidence for a deficit in 'developing, maintaining, and understanding relationships' as per DSM-5 criteria?

<p>The child shows no interest in engaging in pretend play with the dolls or sharing the 'cake' with the assessor or other dolls, and does not seem to understand the social context of a birthday party. (C)</p> Signup and view all the answers

A teenager with ASD describes a social interaction as "the shapes bouncing off each other" rather than attributing intentions or emotions to the individuals involved. This description primarily illustrates a difficulty with which of the following?

<p>Social 'mind' (theory of mind). (A)</p> Signup and view all the answers

A researcher is evaluating the effectiveness of a new intervention designed to improve Theory of Mind (ToM) skills in children with ASD. Which assessment task would be most appropriate for measuring ToM development?

<p>Using a false belief task to assess the child's understanding that others can have beliefs different from their own. (D)</p> Signup and view all the answers

A child with ASD frequently engages in self-stimulatory behaviors, such as hand-flapping, especially when in a new or overwhelming environment. Which theoretical perspective provides the most comprehensive explanation for this behavior?

<p>The behavior can serve multiple functions, including seeking stimulation, blocking out unwanted stimuli, and providing sensory reinforcement. (B)</p> Signup and view all the answers

An adult diagnosed with Social Communication Disorder (SCD) is likely to experience the most significant challenges in which of the following everyday scenarios?

<p>Understanding and responding appropriately to indirect requests or implied meanings in a conversation. (B)</p> Signup and view all the answers

A researcher aims to differentiate between Autism Spectrum Disorder (ASD) and Social Communication Disorder (SCD) in a group of children with social communication difficulties. Which diagnostic feature would be most critical in distinguishing ASD from SCD?

<p>The presence of restricted, repetitive patterns of behavior, interests, or activities. (C)</p> Signup and view all the answers

During an assessment, a clinician observes a child with suspected ASD displaying difficulties in using and understanding gestures, along with reduced eye contact and limited facial expressions. According to the DSM-5 criteria, these observations primarily indicate deficits in which area?

<p>Deficits in non-verbal communicative behaviors used for social interaction. (C)</p> Signup and view all the answers

A team is developing a comprehensive assessment plan for a young child suspected of having Autism Spectrum Disorder (ASD). Considering the recommended best practices, which combination of assessment tools would provide the most thorough evaluation?

<p>ADOS (Autism Diagnostic Observation Schedule) paired with ADI-R (Autism Diagnostic Interview-Revised) and other background information. (B)</p> Signup and view all the answers

A therapist is working with a child with ASD who exhibits extreme distress when even slight changes occur in their daily routine. According to the DSM-5, this behavior falls under which diagnostic criterion?

<p>Tendency for sameness and inflexible adherence to routines or ritualized patterns of behavior. (D)</p> Signup and view all the answers

An individual with ASD consistently struggles to understand jokes, sarcasm, or figurative language. This difficulty primarily reflects an impairment in what aspect of communication?

<p>Pragmatics. (D)</p> Signup and view all the answers

Considering the historical context surrounding the term 'Asperger's Disorder,' what is the primary reason for the growing preference to avoid using this term in clinical and research settings?

<p>The term is associated with Hans Asperger, who was associated with the ideals of the Nazi party, making its use ethically problematic for some. (A)</p> Signup and view all the answers

A researcher is investigating the prevalence of autism traits within families. Which finding would provide the strongest evidence supporting the concept of autism as a dimensional spectrum?

<p>Parents of individuals with ASD report experiencing similar but less severe social and communication difficulties. (C)</p> Signup and view all the answers

During an ADI-R interview, a parent reports that their child with ASD exhibits a profound indifference to pain and temperature, often failing to react to minor injuries or extreme weather conditions. According to the DSM-5 criteria, this behavior primarily indicates which of the following?

<p>Modified sensory reactivity; hypo-reactivity to sensory aspects of the environment. (A)</p> Signup and view all the answers

Which of the following best illustrates an example of perseverative speech in a child with Autism Spectrum Disorder (ASD)?

<p>The child gets fixated on a particular topic and repeatedly brings it up, even when it's not relevant to the conversation. (C)</p> Signup and view all the answers

A clinician is assessing a child for potential Autism Spectrum Disorder (ASD) using the Autism Diagnostic Observation Schedule (ADOS). Which of the following 'presses' within the ADOS is specifically designed to elicit behaviors related to reciprocal social interaction?

<p>Creating a pretend play scenario, such as a birthday party, and observing the child's engagement and reciprocity. (D)</p> Signup and view all the answers

A researcher is investigating the neural mechanisms underlying stimming behaviors in individuals with ASD. Which neurobiological factor would most likely be implicated in the maintenance of these repetitive behaviors?

<p>Elevated levels of dopamine in the basal ganglia, reinforcing repetitive motor patterns. (A)</p> Signup and view all the answers

A child with ASD demonstrates significant deficits in 'joint attention.' In what scenario is this deficit most likely to be observed?

<p>The child independently engages in solitary play with a preferred toy for extended periods, and shows limited interest in sharing the experience or seeking interaction with peers. (D)</p> Signup and view all the answers

Compared to individuals diagnosed with Social Communication Disorder (SCD), individuals diagnosed with Autism Spectrum Disorder (ASD) are more likely to exhibit:

<p>A higher frequency of restricted, repetitive behaviors and intense fixations. (C)</p> Signup and view all the answers

A clinician is using the ADOS to assess a child for ASD. During a 'bubble-blowing' activity, the child shows no interest in the bubbles, does not make eye contact with the examiner, and repetitively flicks their fingers. Which combination of DSM-5 criteria does this behavior most directly address?

<p>Deficits in social-emotional reciprocity, restricted, repetitive motor movements. (D)</p> Signup and view all the answers

A researcher is investigating the potential genetic overlap between ASD and other neurodevelopmental conditions. Which of the following findings would provide the strongest support for shared genetic vulnerability?

<p>Identification of rare copy number variants (CNVs) present in unrelated individuals diagnosed with either ASD or schizophrenia. (C)</p> Signup and view all the answers

An individual diagnosed with ASD demonstrates an exceptional ability to recall and recite detailed information about a highly specific topic, but struggles to apply this knowledge to solve practical problems or engage in reciprocal social interactions. This pattern of abilities and deficits is most consistent with:

<p>Savant syndrome, highlighting the dissociation between specific cognitive strengths and broader adaptive functioning. (D)</p> Signup and view all the answers

A therapist is working with a teenager with ASD who exhibits significant difficulties in understanding the intentions and motivations of others. Which intervention strategy would be most directly targeting the development of Theory of Mind (ToM) skills?

<p>Social stories that describe social situations and explicitly outline the thoughts, feelings, and expected behaviors of the people involved. (A)</p> Signup and view all the answers

A researcher is conducting a study to examine the effectiveness of a novel intervention for improving social communication skills in adults with ASD. Which outcome measure would provide the most ecologically valid assessment of the intervention's impact on real-world social functioning?

<p>Reports from family members or close friends regarding the individual's social interactions and relationships in everyday life. (C)</p> Signup and view all the answers

During an assessment, a child with suspected ASD demonstrates the ability to use single words to label objects but struggles to combine words into meaningful phrases or sentences. According to diagnostic criteria, this child is most likely exhibiting difficulties in:

<p>Expressive language, specifically related to syntax and grammar. (A)</p> Signup and view all the answers

A child with ASD consistently uses phrases and sentences from movies in conversations, often out of context. While echolalia can be a typical phase in language development, in the context of assessing for Autism Spectrum Disorder (ASD), how is this behavior best interpreted?

<p>A potential impairment in pragmatics, where the child demonstrates difficulty understanding the social meaning and context of communication. (C)</p> Signup and view all the answers

What is the primary reason for the growing preference to avoid using the term 'Asperger's Disorder' in clinical and research settings?

<p>The psychiatrist for whom the disorder was named, was associated with/sympathetic to the ideals of the Nazi party. (A)</p> Signup and view all the answers

According to the DSM-5 criteria, during an ADI-R interview, a parent reports that their child with ASD exhibits a profound indifference to pain and temperature, often failing to react to minor injuries or extreme weather conditions, indicating which of the following?

<p>Modified sensory reactivity (D)</p> Signup and view all the answers

A therapist is working with a child with ASD to improve their ability to engage in reciprocal social interactions. Which of the following intervention strategies would be most directly targeting the development of social-emotional reciprocity?

<p>Practicing turn-taking and topic maintenance skills during structured conversations. (C)</p> Signup and view all the answers

Which of the following scenarios best exemplifies a deficit in 'developing, maintaining, and understanding relationships' as per DSM-5 criteria for Autism Spectrum Disorder (ASD)?

<p>A child who has difficulty engaging in imaginative play with peers, preferring to play alone with repetitive actions. (A)</p> Signup and view all the answers

A child with ASD exhibits a strong preference for sameness and becomes highly distressed when their routine is disrupted. From a behavioral perspective, what is the most likely function of this insistence on sameness?

<p>To exert control over their environment and reduce unpredictability, which may trigger anxiety. (B)</p> Signup and view all the answers

During an ADI-R interview, a parent reports that their child with ASD has a history of responding to their name inconsistently and infrequently, even when there are no apparent distractions. This behavior is most indicative of deficits in what area?

<p>Social Attention (B)</p> Signup and view all the answers

Which statement regarding stimming and self-stimulatory behaviors is most accurate?

<p>Stimming can serve various functions, including sensory regulation, emotional regulation, and communication. (A)</p> Signup and view all the answers

Which assessment tool relies heavily on eliciting specific behaviors through structured and semi-structured activities?

<p>The Autism Diagnostic Observation Schedule (ADOS) (A)</p> Signup and view all the answers

What key information is gathered from the Autism Diagnostic Interview-Revised (ADI-R)?

<p>Detailed developmental history and patterns of behavior. (C)</p> Signup and view all the answers

Flashcards

Impairment in Communication & Social Interaction

Difficulties with communication and interacting socially with others.

Repetitive Behaviors & Interests

Repetitive actions or intense obsessions with specific interests.

Echolalia

Repeating what others say, often seen as a step in language development for children with ASD.

Perseverative Speech

Getting stuck on or excessively talking about a specific topic.

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Impairment in Pragmatics

Difficulty understanding social cues and context, leading to miscommunications.

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Impairment in Social Imitation

Difficulty copying or learning from the actions of others.

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Joint Attention

Lack of shared focus or enjoyment with others.

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Impairment in Expressive Nonverbal Behavior

Difficulty using facial expressions, gestures, and body language for social interaction.

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Impairment in Reciprocity

Challenges in give-and-take and the shared flow of social interaction.

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Impairment in Social 'Mind'

Reduced ability to see others as social beings with thoughts and feelings.

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Theory of Mind

Understanding others have different beliefs, desires, and intentions that guide their behavior.

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Self-Stimulation (Stimming)

Repetitive movements/actions used to stimulate the nervous system.

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Intense, Narrow Interests

Being intensely focused on very specific interests to an extreme degree.

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Rigid Routines

Needing consistent routines and resisting changes in the environment.

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Preoccupation with Parts of Objects

Focusing on specific components rather than the object as a whole.

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Autism as a Spectrum

A perspective that autism exists on a continuum of severity and presentation.

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Deficits in Social-Emotional Reciprocity

Deficits in emotional and social give-and-take.

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Deficits in Non-Verbal Communicative Behaviors

Difficulties with non-verbal signals like eye contact, gestures, and facial expressions.

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Deficits in Developing, Maintaining, and Understanding Relationships

Impairments in creating, sustaining, or understanding relationships.

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ADOS (Autism Diagnostic Observation Schedule)

The ADOS is a tool used to help diagnose autism using observations.

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ADI-R

Formal, parent/caregiver interview for diagnosing ASD.

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Social Communication Disorder

A disorder with deficits in social communication without repetitive patterns.

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Study Notes

  • Core features of autism include impairments in communication and social interaction, alongside repetitive patterns of behaviors and interests.

Impairment in Communication

  • Approximately 50% of children with autism do not develop useful language.
  • Qualitative language impairments include echolalia (repeating what someone says), perseverative speech (getting stuck on a topic), and impaired pragmatics (difficulty understanding social contexts).

Impairment in Social Interaction

  • Qualitative impairments in social interaction involve social imitation, joint attention, expressive nonverbal behavior, reciprocity, and social "mind" capabilities.
  • Individuals with autism may struggle to interpret social situations or view others as social partners.

Difficulty with Theory of Mind (ToM)

  • Theory of Mind is understanding that others have mental states (desires, beliefs, intentions) that guide their behavior.
  • Children with ASD typically develop ToM slower, with first signs appearing around age 4.
  • ToM is assessed using false belief tasks.

Repetitive Patterns of Behaviors & Interests

  • Self-stimulation (stimming) includes behaviors like flapping arms or rocking.
  • Theories suggest stimming is a craving for stimulation, a way to block unwanted stimulation, or maintained by sensory reinforcement.
  • Intense, narrow interests, rigid routines, and preoccupation with parts of objects are also common.

Autism as a Spectrum

  • Autism is viewed as a spectrum disorder, not a classic, categorical disorder.
  • Severity of symptoms, language ability, and IQ levels vary within the diagnosis.
  • Traits may also be present in close relatives.

Autism: DSM-5 Definition

  • DSM-5 replaced previous diagnoses with Autism Spectrum Disorder.
  • Prior distinctions between Autistic disorder, Asperger's disorder, and PDD-NOS were deemed not meaningful.
  • Research indicated that most children with DSM-IV Pervasive Developmental Delay diagnoses met criteria for ASD.

Controversial Terminology

  • Hans Asperger, the psychiatrist for whom "Asperger's" was named, had associations with the Nazi party.
  • The use of terms like "high functioning" and "low functioning" is controversial.

Autism Spectrum Disorder (Criteria A): Deficits in social-emotional reciprocity

  • Criterion A involves persistent deficits in social communication and interaction, including:
    • Failure of back-and-forth conversation.
    • Abnormal social approach.
    • Reduced sharing of interests, emotions, affect.
    • Failure to initiate or respond in social interactions.

Autism Spectrum Disorder: Deficits in on-verbal communicative behaviors used for social interaction

  • Deficits in non-verbal communicative behaviors:
    • Contact issues (eye contact).
    • Understanding and using gestures deficits.
    • Expression of face deficits.

Autism Spectrum Disorder: Deficits in developing, maintaining, and understanding relationships

  • Deficits in developing, maintaining, and understanding relationships
    • Play deficits with imaginative/pretend play.
    • Interest deficits in peers.

Autism Spectrum Disorder: Criteria B

  • Criterion B includes restricted, repetitive patterns of behavior, interests, or activities, such as:
    • Stereotyped or repetitive motor movements, use of objects, or speech.
    • Tendency for sameness and inflexible adherence to routines or ritualized patterns of behavior.
    • Intense fixation on interests that are abnormal in intensity.
    • Modified sensory reactivity; hyper or hypo reactivity to sensory aspects of environment.

Autism Spectrum Disorder: Criteria C & D

  • Criterion C requires symptoms to be present during early developmental period
  • Criterion D requires symptoms to cause clinically significant impairment.
  • Severity is rated on a scale: requiring support, substantial support, or very substantial support.

Social Communication Disorder

  • Social Communication Disorder includes deficits in social communication without repetitive patterns of interest.
  • Involves impairment of ability to change contexts to needs of listener.
  • Difficulties include following rules for conversation and storytelling.
  • Restricted, repetitive patterns of interest are not present.

Assessment: ADOS

  • The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured observation.
  • "Presses" are used to naturally elicit ASD behaviors.

Assessment: ADI-R

  • The ADI-R (Autism Diagnostic Interview-Revised) is an interview with parents/caregivers.
  • It is often paired with ADOS.

Summary of Autism

  • Autism is characterized by impairments in communication and social interaction and repetitive behaviors and interests.
  • In DSM-5, earlier diagnoses were combined under Autism Spectrum Disorder.
  • The ADOS is a gold standard assessment tool, often paired with other information.

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