Untitled

• Chapter 17 discusses neurodevelopmental disabilities and diversity, focusing on intellectual disabilities and autistic spectrum disorder (ASD).

Intellectual Disabilities

• Intellectual disability involves impairments in both intellectual and adaptive functioning.
• Significantly below-average intellectual functioning is indicated by a standardized IQ test score below 70.
• Modern definitions emphasize facilitating adaptive functioning and ensuring accessibility, rather than exclusion, in education.
• Chromosomal disorders, like Down syndrome and fragile X syndrome, account for 25-30% of diagnosed cases.
• Metabolic disorders, often carried by recessive genes, include phenylketonuria (PKU) and Tay-Sachs disease.
• Congenital disorders are acquired before birth but not genetically inherited.
• Exposure to toxins (like lead), childhood infections, and poverty are examples of childhood environmental causes.
• Prevention includes campaigns and screening for maternal alcohol abuse and genetic risk factors.
• Behavioral training equips individuals with self-help and adaptive skills, utilizing applied behavior analysis.
• Inclusion strategies aim to provide access to mainstream educational and occupational opportunities for those with intellectual disabilities.

Autistic Spectrum Disorder (ASD)

• ASD refers to disorders displaying autistic-style symptoms across several areas of development, with varying severity.
• Characteristic impairments and delays include social and emotional disturbances, intellectual disabilities, and language/communication deficits.
• DSM-5 combines previous diagnostic categories (autistic disorder, Rett's disorder, childhood disintegrative disorder, and Asperger's syndrome) into a single diagnosis of ASD.
• Some children exhibit symptoms from early infancy, while others may not have any early onset indications
• Two central features include impairment in social interaction and in communication
• Those with milder forms of ASD can function effectively, while others require lifelong support due to more severe problems.

Characteristics of Autistic Spectrum Disorder

• Early development may be profoundly disturbed, apparent even before the age of one.
• Children may seem withdrawn, lack communication skills, and show disinterest in surroundings.
• Two central features of ASD include severe impairment in social interaction and communication.
• Some individuals with ASD function effectively, while others may require lifelong support.

Impairments of Reciprocal Social Interaction

• This is a marked and sustained feature of ASD.
• Sufferers exhibit difficulties with nonverbal behaviors and struggle to regulate social interaction and communication.
• In severe cases, individuals may rarely approach others or make eye contact.
• Autistic children often show a disinterest in making friends or engaging in peer communication.
• A key feature is the inability to understand the intentions or emotions of others, due to a failure to develop a 'theory of mind'.
• Some can learn to recognize the physical features associated with emotions but cannot explain why someone expresses a particular emotion.

Impairments in Communication

• There is often a delay in the development of spoken language and in the ability to sustain a conversation
• Speech may lack normal pitch or intonation.
• More than half of those diagnosed with autism may not speak at all, instead producing noises unrelated to communication.
• Some individuals may exhibit echolalia, which is the immediate imitation of sounds or words someone has just heard
• Others may only communicate in a limited way and exhibit oddities in grammar and articulation.
• Some exhibit pronoun reversal in which they refer to themselves as 'he', 'she', or 'you'.
• The ability to learn language is a good indicator of prognosis.

Impairments in Imagination and Flexibility of Thought

• Feature restricted, repetitive, and stereotyped patterns of behavior and interests.
• Manifest as specific, detailed interest in only a small number of games, which may extend into their preferred methods of arranging toys etc
• A need to retain sameness in all experiences to ensure consistent routine
• Display attachments to inanimate objects or objects with specific tactile characteristics.
• They rarely indulge in symbolic or imaginative play
• It is common is the appearance of stereotyped body movements, such as hand clapping, rocking, and swaying, and the patterns of behavior often appear to be self-stimulatory in nature

Intellectual Deficits

• Around 70% of individuals with ASD have some level of intellectual disability.
• The remaining 30% may have other disabilities like speech, behavior, or cognitive impairment.
• Intellectual deficits in children with ASD differ from those with a primary diagnosis of intellectual disability.
• Those with ASD perform better on tests of visuospatial ability compared to tests of social understanding or verbal ability.
• Extraordinary proficiency in one isolated skill is known as savant syndrome.

The Diagnosis of Autistic Spectrum Disorder

• The DSM-5 diagnosis includes persistent deficits in social communication/interaction, and restricted, repetitive patterns of behavior, interests, or activities.
• Individuals must demonstrate deficits in social-emotional reciprocity
• Nonverbal Communication includes abnormal eye contact
• Difficulties in understanding/maintaining relationships with others
• And must demonstrate a hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.
• Symptoms must be present in early development, and include repetitive motor movements with strong adherence to routines
• And cause significant impairment in social and occupational etc areas of functioning, while being individualised to include whether it affects and includes intellectual or language impairment (or both)
• It indicates whether there is little to no support requirements for the diagnosis to manifest

The Prevalence of Autistic Spectrum Disorder

• The latest studies of adults with ASD in the UK indicate a presence of around 1.1% of the population.
• In childhood, a significant amount of this population is mainly boys at a frequent ratio cited as 4:1
• Autism appears to occur equally in all socio-economic classes and racial groups.
• Epidemiological studies suggest a prevalence of the disorder has been seen over the last 2-3 decades
• For example, in 2000 in the US, 1 in 150 children were diagnosed with ASD, but by 2016 this figure had risen to 1 in 54

The Aetiology of Autistic Spectrum Disorder

• 1960s was thought to be caused by rejecting parenting styles
• Subsequent studies have failed to uphold this view and have confirmed that the parents of autistic children are normal
• A significant genetic element has been pinpointed as the major genetic cause
• In some individual cases, environmental factors can also be to blame, and may range from maternal infections to other pregnancy-related complications to the individual during developmental stages

Genetic Factors

• Family history is an indicator in genetic links to the disorder to include social and language deficits as well as psychological problems
• Evidence indicates a strong familial aggregation of symptoms found in higher instances with siblings
• ASD can even cause instances of phenylketonuria and fragile X syndrome
• Additionally, twin studies comparing MZ and DZ twins showed a major likeness for genetic dispositions
• And have each demonstrated symptom traits to be highly heritable
• Molecular genetics have pinpointed over 100 genes as factors for ASD
• Genes that affect the devlopment of brain synapses or regulate their connections
• And may include abnormalities from gene copy number variations, as well as abnormalities resulting from two rearrangement variants

Perinatal Factors

• Factors in the same category have played a significant role in determining intellectual impairments and the same may be true in the case of ASD in the range of birth

Support and Interventions and Individuals with Autistic Spectrum Disorder

• Support for individuals with ASD aids them in dealing with the day-to-day living issues raised when their neurological and cognitive differences come out.
• Many individuals may struggle with the disorder and will need to be on some amount permanent constant support
• Interventions include a three pronged approach in the form of drug treatments can reduce problematic behavior, communication, and self-injury
• Some difficulties are associated with an already tricky disorder because of the symptoms experienced by it such as easy tolerance to tolerance in changes to the intervention
• Children can sometime show no interest or a very limited range, which can make intervention difficult due to having to appeal with communication or eye contact
• This means it is very difficult to implement interventions for them because of the symptoms causing problems for the intervention to even occur

Drug Treatments

• A number of drugs are used to help with behavioral autism treatments
• With the primary drug classes being antipsychotic medications and haloperidol
• These can reduce repetitive behavior and reduce social withdrawal
• Other drugs classes like risperidone can reduce symptoms such as those associated with aggressive temper tantrums
• It has side effects that could potentially upset the order and are taken with careful consideration
• The opioid receptor antagonist naltrexone has also been found to be helpful in the control of hyperactivity and self-injurious behavior
• Some studies even indicated that some of the tested medications has given rise to moderate increases in social interaction and communication

Behavioral Training Methods

• Programs will attempt to develop basic self-help, social, and communication skills in children who otherwise may not respond
• The clinicians adopt an conditioning based approach that will reinforce skills in things like eye contacts and self-help
• By also supplementing with other helpful tactics that may include modelling where one therapist indicates appropriate behaviour before attempting the interventions themselves
• Some studies has suggested an increased result during early stages and the literature suggest that they may promote communication in certain ways
• Some studies shows that it can indicate gains in tests of communications

Inclusion Strategies

• Basic strategies are for those with highly functioning ASD that teach self-help tactics as designed to help the individual
• These assist individuals in transitioning with job search/keeping
• Schemes are well know to help improve interactions