MH132.pdf

11/27/23, 3:50 AM Realizeit for Student Autism Spectrum Disorder Autism spectrum disorder (ASD) is the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) diagnosis that includes disorders previously categorized as different types of a pervasive developmental disorder (PDD...

11/27/23, 3:50 AM Realizeit for Student Autism Spectrum Disorder Autism spectrum disorder (ASD) is the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) diagnosis that includes disorders previously categorized as different types of a pervasive developmental disorder (PDD), characterized by pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavioral patterns. Previous PDDs, such as Rett disorder, childhood disintegrative disorder, and Asperger disorder, are now viewed on a continuum called the autism spectrum. This change helps eliminate problems that existed when attempting to distinguish among these sometimes similar disorders. Also, there is a great deal of difference among individuals diagnosed with autism, ranging from mild to very severe behaviors and limitations, which is easier to conceptualize along a continuum. ASD, formerly called autistic disorder, or just autism, is almost five times more prevalent in boys than in girls, and it is usually identified by 18 months and no later than 3 years of age. The behaviors and difficulties experienced vary along the continuum from mild to severe. Children with ASD have persistent deficits in communication and social interaction accompanied by restricted, stereotyped patterns of behavior and interests/activities. These children may display little eye contact and make few facial expressions toward others; they use limited gestures to communicate. They can have limited capacity to relate to peers or parents. They may lack spontaneous enjoyment, express no moods or emotional affect, and may not engage in play or make-believe with toys. There can be little intelligible speech. These children engage in stereotyped motor behaviors, such as hand flapping, body twisting, or headbanging (Box 22.1). These behaviors and difficulties are less prominent on the milder end of the autism spectrum and more pronounced on the severe end (Volkmar, Klin, Schultz, & State, 2017). BOX 22.1 Behaviors Common with ASD Not responding to own name by 1 year (e.g., appears not to hear) Doesn’t show interest by pointing to objects or people by 14 months of age Doesn’t play pretend games by 18 months of age Avoids eye contact Prefers to be alone Delayed speech and language skills https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%2… 1/6 11/27/23, 3:50 AM Realizeit for Student Obsessive interests (e.g., gets stuck on an idea) Upset by minor changes in routine Repeats words or phrases over and over Flaps hands, or rocks or spins in a circle; answers are unrelated to questions Unusual reactions to sounds, smells, or other sensory experiences Adapted from Centers for Disease Control and Prevention. (2018). Autism and developmental disabilities monitoring network. https://www.cdc.gov/ncbddd/autism/facts.html Eighty percent of cases of autism are early onset, with developmental delays starting in infancy. The other 20% of children with autism have seemingly normal growth and development until 2 or 3 years of age when developmental regression or loss of abilities begins. They stop talking and relating to parents and peers and begin to demonstrate behaviors previously described (Volkmar et al., 2017). Autism was once thought to be rare and was estimated to occur in four to five children per 10,000 in the 1960s. Current estimates are one in 59 children in the United States across all ethnic, racial, and socioeconomic groups, and 1% to 2% worldwide (Centers for Disease Control and Prevention, 2018). The increase in prevalence has been observed worldwide, though it is somewhat lower in countries outside North America and Europe. Figures on the prevalence of autism in adults are unreliable. Autism does have a genetic link; many children with autism have a relative with autism or autistic traits (Volkmar et al., 2017). Controversy continues about whether measles, mumps, and rubella (MMR) vaccinations contribute to the development of late- or regressive-onset autism. The National Institute of Child Health and Human Development, Centers for Disease Control and Prevention, and the Academy of Pediatrics have all conducted research studies for several years and have concluded that there is no relationship between vaccines and autism and that the MMR vaccine is safe. Studies specifically targeting children with regressive-onset ASD and any relationship to vaccines have found that no relationship exists (Goin-Kochel et al., 2016). However, litigation and class action lawsuits are still in progress because some parents and public figures refuse to accept these results. Autism tends to improve, in some cases substantially, as children start to acquire and use language to communicate with others. If behavior deteriorates in adolescence, it may reflect the effects of hormonal changes or the difficulty meeting increasingly complex social demands. Autistic traits persist into adulthood, and most people with autism remain dependent to some degree on others. Current research estimates that 20% of adults with ASD achieve most independent living outcomes, https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%2… 2/6 11/27/23, 3:50 AM Realizeit for Student while 46% require substantial levels of support in most independent living outcomes (Farley et al., 2018). Many continue to live with parents or adult relatives. Manifestations vary from little speech and poor daily living skills throughout life to adequate social skills that allow relatively independent functioning. Social skills rarely improve enough to permit marriage and child-rearing. Adults with autism may be viewed as merely odd or reclusive, or they may be given a diagnosis of obsessive– compulsive disorder (OCD), schizoid personality disorder, or mental retardation. Until the mid-1970s, children with autism were usually treated in segregated, specialty outpatient, or school programs. Those with more severe behaviors were referred to residential programs. Since then, most residential programs have been closed; children with autism are being “mainstreamed” into local school programs whenever possible. The goals of treatment of children with autism are to reduce behavioral symptoms (e.g., stereotyped motor behaviors) and to promote learning and development, particularly the acquisition of language skills. Comprehensive and individualized treatment, including special education and language therapy, as well as cognitive behavioral therapy for anxiety and agitation, is associated with more favorable outcomes. Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol), risperidone (Risperdal), aripiprazole (Abilify), or combinations of antipsychotic medications, may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors (Sharma, Gonda, & Tarazi, 2018). Other medications, such as naltrexone (ReVia), clomipramine (Anafranil), clonidine (Catapres), and stimulants to diminish selfinjury and hyperactive and obsessive behaviors, have had varied but unremarkable results. There are no medications approved for the treatment of ASD itself. Related Disorders Tic Disorders A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization. Tics can be suppressed but not indefinitely. Stress exacerbates tics, which diminish during sleep and when the person is engaged in an absorbing activity. Common simple motor tics include blinking, jerking the neck, shrugging the shoulders, grimacing, and coughing. Common simple vocal tics include clearing the throat, grunting, sniffing, snorting, and barking. Complex vocal tics include repeating words or phrases out of context, coprolalia (use of socially unacceptable words, frequently obscene), palilalia (repeating one’s own sounds or words), and echolalia (repeating the last-heard sound, word, or phrase). Complex motor tics include facial gestures, jumping, or touching or smelling an object. Tic disorders tend to run in families. Abnormal transmission of the neurotransmitter dopamine is thought to play a part in tic disorders. Tic disorders are usually treated with risperidone (Risperdal) or olanzapine (Zyprexa), which are atypical antipsychotics. It is important for clients with https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%2… 3/6 11/27/23, 3:50 AM Realizeit for Student tic disorders to get plenty of rest and to manage stress because fatigue and stress increase symptoms (Jummani & Coffey, 2017). Tourette disorder involves multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year. The complexity and severity of the tics change over time, and the person experiences almost all the possible tics described previously during his or her lifetime. The person has significant impairment in academic, social, or occupational areas and feels ashamed and selfconscious. This rare disorder (4 or 5 in 10,000) is more common in boys and is usually identified by 7 years of age. Some people have lifelong problems; others have no symptoms after early adulthood (Jummani & Coffey, 2017). Chronic Motor or Tic Disorder Chronic motor or vocal tic differs from Tourette disorder in that either the motor or the vocal tic is seen, but not both. Transient tic disorder may involve single or multiple vocal or motor tics, but the occurrences last no longer than 12 months. Learning Disorders A specific learning disorder is diagnosed when a child’s achievement in reading, mathematics, or written expression is below that expected for age, formal education, and intelligence. Learning problems interfere with academic achievement and life activities requiring reading, math, or writing. Reading and written expression disorders are usually identified in the first grade; math disorder may go undetected until the child reaches fifth grade. Approximately 5% of children in U.S. public schools are diagnosed with a learning disorder. The school dropout rate for students with learning disorders is 1.5 times higher than the average rate for all students (Tannock, 2017). Low self-esteem and poor social skills are common in children with learning disorders. As adults, some have problems with employment or social adjustment; others have minimal difficulties. Early identification of the learning disorder, effective intervention, and no coexisting problems is associated with better outcomes. Children with learning disorders are assisted with academic achievement through special education classes in public schools. Motor Skills Disorder The essential feature of developmental coordination disorder is impaired coordination severe enough to interfere with academic achievement or activities of daily living. This diagnosis is not made if the problem with motor coordination is part of a general medical condition, such as cerebral palsy or muscular dystrophy. This disorder becomes evident as a child attempts to crawl or walk or as an older child tries to dress independently or manipulate toys such as building blocks. Developmental coordination disorder often coexists with a communication disorder. Its course is variable; sometimes https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%2… 4/6 11/27/23, 3:50 AM Realizeit for Student lack of coordination persists into adulthood. Schools provide adaptive physical education and sensory integration programs to treat motor skills disorder. Adaptive physical education programs emphasize inclusion of movement games such as kicking a football or soccer ball. Sensory integration programs are specific physical therapies prescribed to target improvement in areas where the child has difficulties. For example, a child with tactile defensiveness (discomfort at being touched by another person) might be involved in touching and rubbing skin surfaces (Patacki & Mitchell, 2017). Stereotypic movement disorder is characterized by rhythmic, repetitive behaviors, such as hand waving, rocking, headbanging, and biting, that appears to have no purpose. Self-inflicted injuries are common, and the pain is not a deterrent to the behavior. Onset is prior to age 3 years and usually persists into adolescence. It is more common in individuals with intellectual disability. Comorbid disorders, such as anxiety, ADHD, OCD, and tics/Tourette syndrome, are common and often cause more functional impairment than the stereotypic behavior (Doyle, 2017). Communication Disorders A communication disorder involves deficits in language, speech, and communication and is diagnosed when deficits are sufficient to hinder development, academic achievement, or activities of daily living, including socialization. Language disorder involves deficit(s) in language production or comprehension, causing limited vocabulary and an inability to form sentences or have a conversation. Speech sound disorder is difficulty or inability to produce intelligible speech, which precludes effective verbal communication. Stuttering is a disturbance of fluency and patterning of speech with sound and syllable repetitions. Social communication disorder involves the inability to observe social “rules” of conversation, deficits in applying context to conversation, inability to tell a story in an understandable manner, and inability to take turns talking and listening with another (Koyama & Beitchman, 2017). Communication disorders may be mild to severe. Difficulties that persist into adulthood are related most closely to the severity of the disorder. Speech and language therapists work with children who have communication disorders to improve their communication skills and to teach parents to continue speech therapy activities at home. Elimination Disorders Encopresis is the repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally. It is often involuntary, but it can be intentional. Involuntary encopresis is usually associated with constipation that occurs for psychological, not medical, reasons. Intentional encopresis is often associated with oppositional defiant disorder (ODD) or conduct disorder. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%2… 5/6 11/27/23, 3:50 AM Realizeit for Student Enuresis is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally. Most often, enuresis is involuntary; when intentional, it is associated with a disruptive behavior disorder. Of children with enuresis, 75% have a first-degree relative who has had the disorder. Most children with enuresis do not have a coexisting mental disorder. Both encopresis and enuresis are more common in boys than in girls; 1% of all 5-year-olds have encopresis and 5% of all 5-year-olds have enuresis. Encopresis can persist with intermittent exacerbations for years; it is rarely chronic. Most children with enuresis are continent by adolescence; only 1% of all cases persist into adulthood. Impairment associated with elimination disorders depends on the limitations on the child’s social activities, effects on self-esteem, degree of social ostracism by peers, and anger, punishment, and rejection on the part of parents or caregivers. Enuresis can be treated effectively with imipramine (Tofranil), an antidepressant with a side effect of urinary retention. Both elimination disorders respond to behavioral approaches, such as a pad with a warning bell, and to positive reinforcement for continence. For children with a disruptive behavior disorder, psychological treatment of that disorder may improve the elimination disorder (Mikkelsen, 2017). Sluggish cognitive tempo (SCT) is a syndrome that is not a DSM-5 diagnosis. It includes daydreaming, trouble focusing and paying attention, mental fogginess, staring, sleepiness, little interest in physical activity, and slowness in finishing tasks. Many of these are observed in children with ADHD; however, there is no hyperactivity or impulsivity—just the opposite. This leads some to believe that it is separate for ADHD, while others believe it is a variant of ADHD. Investigation is ongoing (Becker & Willcutt, 2019). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%2… 6/6