Intro To ASD Week 1 History And Diagnosis Cnt'd PDF

INTRO TO ASD A HSCI 10041 FALL 2022 A MICHELLE TURAN, PHD, BCBA WEEK 1 – part 2 1 ...

INTRO TO ASD A HSCI 10041 FALL 2022 A MICHELLE TURAN, PHD, BCBA WEEK 1 – part 2 1  DSM Diagnostic and Statistical Manual of Mental Disorders Published by the American Psychiatric Association (APA) First published in 1952 (DSM I) Used by mental health professionals to promote reliable research, accurate diagnosis, and appropriate treatment and patient care 2 Image retrieved from: https://alzheimersnewstoday.com/2019/10/25/early-diagnosis-symptoms-caregiving-role-reversal/  DSM The DSM is a “living document”, meaning that it continues to evolve and changes over time The diagnostic criteria for autism have changed over the years as we continue to learn more 3 Image retrieved from: https://alzheimersnewstoday.com/2019/10/25/early-diagnosis-symptoms-caregiving-role-reversal/  AUTISM IN THE DSM DSM I (1952) and II (1968) – “autism” listed with schizophrenia DSM III (1980) – Autism became its own diagnostic category for the first time Called “infantile autism” Listed under the group “Pervasive Developmental Disorders” (PDD) Onset before 30 months of age 4 Image retrieved from: https://alzheimersnewstoday.com/2019/10/25/early-diagnosis-symptoms-caregiving-role-reversal/  AUTISM IN THE DSM DSM III-R (1987) (a revision to DSM III) “infantile autism” was changed to “autistic disorder” 16 criteria in the categories of social development, communication, activities, and interests Added “Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) 5 Image retrieved from: https://alzheimersnewstoday.com/2019/10/25/early-diagnosis-symptoms-caregiving-role-reversal/  AUTISM IN THE DSM DSM III-R (1987) (a revision to DSM III) 3 problems with the DSM III-R False positives due to “over-inclusiveness” Many differences with the ICD-10 (International Classification of Diseases) This led to research difficulties 6 Image retrieved from: https://alzheimersnewstoday.com/2019/10/25/early-diagnosis-symptoms-caregiving-role-reversal/  AUTISM IN THE DSM DSM IV (1994) Added Asperger Syndrome DSM IV-TR (2000; revision to DSM IV) Pervasive Developmental Disorder includes: Autistic Disorder Asperger’s Syndrome PDD-NOS Rett Syndrome Childhood Disintegrative Disorder (CDD) 7 Image retrieved from: https://alzheimersnewstoday.com/2019/10/25/early-diagnosis-symptoms-caregiving-role-reversal/ 8 9  DIAGNOSTIC CRITERIA IN DSM IV- TR Disorder Total # of Social Communicatio Behaviour Other items impairments n impairments Impairment s Autism 6+ 2+ 1+ 1+ Delay prior to age 3: social interaction; social communication; symbolic play (one or all) Asperger’s 3+ 2+ significant No delay 1+ No delay in cognitive, self impairment —help skills, adaptive behaviour (except social interaction) and curiosity PDD-NOS 2 Reciprocal social Verbal or non- Stereotyped Does not meet all the interaction verbal impairment behaviour criteria for other diagnosis or --> 10  AUTISTIC DISORDER Most common Cognitive impairments Deficits in verbal and non-verbal communication Deficits in social understanding Unusual behaviour, restricted interests 11 Image retrieved from: https://otsimo.com/en/typical-characteristics-autism-spectrum-disorder/  ASPERGER’S SYNDROME Neurodevelopmental disorder similar to autism; common 1944 – Hans Asperger described older children with verbal and intellectual abilities within normal range Mild to severe impairments in social interaction and understanding Restricted and repetitive activities and interest Deficits in communication No delay in language and cognitive development 12  ASPERGER’S SYNDROME Asperger’s traits can make it difficult for children to function well in schools, and for adults to find and keep employment May exhibit extensive knowledge of a specific interest 13  ASPERGER’S SYNDROME Social/communication challenges: Difficulty initiating or maintaining close relationships, despite a desire for friends Problems reading non-verbal or social cues or understanding/using social rules Unaware of others’ thoughts, feelings or perceptions, resulting in inadvertently appearing rude or inconsiderate Avoidance of social contact or events, possible heightened anxiety in social situations 14  ASPERGER’S SYNDROME Behaviour challenges: May respond poorly to changes, sensory stimuli, transitions, lack of structure, restrictions Cognitive challenges: Prefer technical/factual information over abstract information Asperger’s Syndrome Documentary 15  PDD-NOS Common Also called “atypical autism” Strict criteria for autistic disorders not met, but: Severe and pervasive impairment in some areas i.e., reciprocal social interaction or restricted activities and interests Often display some symptoms of autism but have higher cognitive or language skills Also used to diagnose those who displayed symptoms of autism in the past, but no longer do 16  RETT SYNDROME First described by Dr. Andreas Rett Rare Almost exclusively in girls Significant regression after a period of normal development Severely impaired language and motor skills Severe deficits in cognitive ability Genetic mutation = MECP2 mutation 17  RETT SYNDROME MECP2 is a gene that, when mutated, causes Rett syndrome Located at Xq28 site on the X chromosome Being on the X chromosome explains why it is usually found in girls Common symptoms: Loss of speech and/or purposeful use of hands Involuntary hand movements Loss of mobility or gait disturbances; Loss of muscle tone Seizures; breathing issues; sleep disturbances 18  CHILDHOOD DISINTEGRATIVE DISORDER Rare Significant losses in social behaviour, language, play, adaptive behaviour, after a period of normal development of 3 years or more Average age of onset = 3-4 years old Severe deficits in cognitive ability Often accompanied by loss of bowel and bladder control, seizures, and very low IQ 19  DSM V Released May 18, 2013 Integrated input from individuals with ASD, scientists, clinicians, and advocacy organizations Goal: Overcome inconsistencies in diagnosis Improve reliability in how ASD is diagnosed Major changes to ASD diagnosis 20 Image retrieved from: https://www.amazon.ca/Diagnostic-Statistical-Manual-Mental-Disorders/dp/0890425558  DSM V – NAME OF DIAGNOSIS Then: Autistic Disorder, Asperger’s Syndrome, PDD-NOS, and CDD Now: Autism Spectrum Disorder (ASD) 21  DSM V – NUMBER OF DOMAINS Then: 3 domains: Now: 2 domains: Repetitive/ Social Restricted Impairmen Behaviour Social Restricted t s Communicatio Interest/Repeti n Impairment tive Language/ Behaviours Communic ation Impairmen t 22  DSM V – NEW CATEGORY WITHIN DOMAIN Within restricted interests/repetitive behaviour: Hyper or hypo-reactivity to sensory input Or, unusual interests in sensory aspects of environment 23 Image retrieved from: https://www.additudemag.com/sensory-diet-for-adhd-helping-my-daughter-manage-spd/  DSM V – SEVERITY LEVEL Severity levels were added in DSM V based on amount of support needed due to challenges with social communication and restricted interests and repetitive behaviours Level 1 = requiring support Level 2 = requiring substantial support Level 3 = requiring very substantial support 24 Image retrieved from: https://www.dreamstime.com/royalty-free-stock-photo-1-2-3-guys-3d-image14484785  Level 1 Level 2 Level 3 Requiring Support Requiring Substantial Support Requiring Very Substantial Support Without supports in place, deficits in Marked deficits in verbal and nonverbal Severe deficits in verbal and Social social communication cause social communication skills; social nonverbal social noticeable impairments. Difficulty impairments apparent even with communication skills cause Communicati initiating social interactions, clear supports in place; limited initiation of severe impairments in on examples of atypical or unsuccessful social interactions; and reduced or functioning, very limited response to others. May appear to abnormal responses to social overtures initiation of interactions, and have decreased interest in social from others. minimal response to others. interactions. Inflexibility of behavior causes Inflexibility of behavior, difficulty Inflexibility of behavior, significant interference with coping with change, or other extreme difficulty coping with functioning in one or more contexts. restricted/repetitive behaviors appear change, or other Behaviour Difficulty switching between frequently enough to be obvious to the restricted/repetitive behaviors activities. Problems of organization casual observer and interfere with markedly interfere with and planning hamper independence. functioning in a variety of contexts. functioning in all spheres. Distress and/or difficulty changing Great distress/difficulty focus or action. changing focus or action. DSM V – SEVERITY LEVEL 25  DSM V – ONSET AGE ELIMINATED Then: onset by age 3 Now: no onset – symptoms can be currently present or reported in past history 26  DSM V – LANGUAGE DELAY ELIMINATED Then: required delay in language development Now: not required 27  DSM V – NEW DIAGNOSTIC CATEGORY Social Communication Disorder Allows for disabilities within social communication without a diagnosis of Autism (e.g., no repetitive behaviour aspects) 28 Image retrieved from: https://www.shutterstock.com/search/string+telephone  Impairment of pragmatics Pragmatics = a set of rules concerned with the way language is used rather than the way it is formed SOCIAL Diagnosed based on difficulty in the social COMMUNICATION uses of verbal and nonverbal DISORDER communication in naturalistic contexts These difficulties affect development of social relationships and discourse comprehension Cannot be explained by low abilities in word structure and grammar, or general cognitive ability 29  Low social communication abilities result in functional limitations in effective Low communication, social participation, academic achievement, or occupational performance (one or any combination of these) SOCIAL COMMUNICATION Rule out Rule out ASD DISORDER Be Symptoms must be present in early childhood 30  CASE 1 Ben is 2 1/2 and he loves trains. He is content to play with them alone for hours. Yet he doesn’t seem to really understand that they are trains. He doesn’t pretend to make them go on the track or have crashes or imagine what the cars are carrying or talk, as he plays alone. He just lines them up in the same way every time. He gets very upset if anyone rearranges his trains. Sometimes he carries a train around with him and rubs it against his chin or waves it in front of his eyes. He never brings a train to show his father, never points to the trains to show his sister. In fact, he completely ignores his sister. He doesn’t talk to her, doesn’t look at her no matter how hard she tries to be a good big sister. Ben doesn’t talk at all, rarely looks at other people and rarely smiles. His mother suspects something is wrong, but her doctor told her Ben is probably just slow talking and will outgrow the other odd behaviour. He will be starting nursery school soon and his mother hopes thatRetrieved will turn him around. from: Perry, A. & Condillac, R.A. (2003). Evidence-based practices for children and adolescents with Autism 31 Spectrum Disorders: Review of the literature and practice guide. Toronto: Children's Mental Health Ontario.  CASE 2 Kyla is a 2.5-year-old female presenting with poor growth, gradual loss of speech and hand skills, poor social interaction and stereotyped movements of the hands for the past year. Kyla’s mother reported that the child was healthy at birth, cried immediately and fed well. All milestones were normal for the first 13 months - characterized by adequate social interaction, eye contact with parents, speaking double syllables by 7 months and walking with support by 13 months. However, for the last year, Kyla was noticed to not grow adequately for her age, interact with others or develop any further milestones. Movements - characteristic midline hand stereotypical movement - were observed. Kyla repeatedly made fists with both her hands and touched them to her face. Gait was slightly clumsy. Usage of speech had regressed to mere babbling. There was no history of respiratory disturbances or seizures or ataxia. 32 Adapted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006212/  CASE 3 Dennis is a bright boy, with a rather vast vocabulary for a 7-year-old. He prefers to spend time with the adults in his life, rather than playing with his three cousins who live next door. Dennis has a real passion for airplanes, and can tell you the names, engine configurations, flight numbers, schedules and runways for all planes that takeoff and land from his local airport. He is a bit slow to warm up, and is awkward in social situations. He becomes very anxious when there are sudden changes in his schedule, power-failures, and other unpredictable events in his life. At school, Dennis loves to read, but hates to do puzzles or activities that require him to draw or copy from the board. He is rather clumsy, so he has a difficult time in gym class, and is often the last one to be picked for team sports. At recess, he talks with his teaching assistant, as he is rarely invited to play with the other children. Retrieved from: Perry, A. & Condillac, R.A. (2003). Evidence-based practices for children and adolescents with Autism 33 Spectrum Disorders: Review of the literature and practice guide. Toronto: Children's Mental Health Ontario.  CASE 4 Maggie was referred due to complaints of irritable behavior and communication problem. Maggie developed normally until the age of 4, at which point she started to lose all communicative milestones such as talking in sentences and calling family members by name. She sat alone all day, absorbed in solitary play and showed increased anger and irritability towards others. She stopped asking for food verbally, and instead cried to indicate hunger. In addition, Maggie started experiencing sleep difficulties, and lost her previously acquired toilet training skills. 34 Adapted from:  CASE 5 Justin is a very intelligent 16 year old who is excelling at school, especially in computer science and physics where he takes top honours in his class. He is very interested in playing the piano, and is able to play very complicated classical pieces that he has heard on the radio. Justin spends most of his time studying, using his computer, or playing piano rather than hanging out with other teens. Justin complains to his mother that he has no friends. He has never attended a high school dance or been on a date. At school he eats lunch with a younger boy from a special education class, but they don’t hang around together after school. Whenever his mother arranges for him to spend time with other teens who are friends of the family, things go poorly and Justin never quite knows why. Lately, he has become even more withdrawn than normal, and his grades are slipping. He is having trouble getting out Retrieved ofPerry, from: bed A. & in the R.A. Condillac, morning, and often (2003). Evidence-based falls practices for asleep before children and hewith adolescents hasAutism 35 Spectrum Disorders: Review of the literature and practice guide. Toronto: Children's Mental Health Ontario. THANK YOU! 36