Study Guide - QASPS Module 8 .pdf

Qualified Autism Services Practitioner Supervisor (QASP-S) Study Guide Module 8 – Autism Task Definition- Example ASD...

Qualified Autism Services Practitioner Supervisor (QASP-S) Study Guide Module 8 – Autism Task Definition- Example ASD Autism Spectrum Disorder is neurodevelopmental condition Pervasive People with PDD-NOS often displayed some symptoms of autism but didn't meet the Developmental full criteria for a specific autism spectrum disorder. It was used as an "umbrella" term Disorder-Not for those who didn't fit the criteria for autism or Asperger's Syndrome Otherwise Specified (PDD- NOS) DSM-5 DSM-5 integrated Asperger's Syndrome, PDD-NOS, and other related diagnoses into a single category called "Autism Spectrum Disorder” History of Carl Gustav Jung's personality types: Autism o extroverts and introverts 1900 o indirectly classified the autistic person as a schizophrenic introvert. 1 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  The concept of autism was coined “to invent a new word or expression” in 1911 1911 by the German psychiatrist Eugen Bleuler to describe a symptom of the most severe cases of schizophrenia 1943 Leo Kanner (1894-1981) Austrian-American physician and psychiatrist published the landmark paper Autistic Disturbances of Affective Contact in 1943 Kanner named their condition “early infantile autism” 1944 Asperger's Syndrome was named after the Austrian pediatrician Hans Asperger’s Asperger, who first described the condition in 1944. Syndrome He identified a group of children with significant difficulties in social interaction and communication but showed no delay in language development. Asperger's Syndrome was considered a milder form of autism, with higher cognitive abilities and language skills 1950 ‘autism’ in the 1950s referred to excessive hallucinations and fantasy in infants During the 1950s and 1960s, autism was thought to be rooted in cold and unemotional 1950s and 1960s mothers, whom Bruno Bettelheim dubbed ‘refrigerator mothers” 1964 Bernard Rimland: autism is a biological disorder he argued convincingly that autism was not a result of emotional neglect—the prevailing theory at the time—but instead had biological roots 2 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  1966 Dr. Andreas Rett first describes Rett disorder as a distinct clinical condition 1968 The second edition of the DSM, the DSM-II, published in 1968, defined autism as a psychiatric condition — a form of childhood schizophrenia marked by a detachment from reality. 1972 Michael Rutter, a leading child-psychiatric researcher from the UK’s Maudsley Hospital who conducted the first-ever genetic study of autism claimed in 1972 that ‘the autistic child has a deficiency of fantasy rather than an excess 1977 Dr. Susan Folstein and Dr. Michael Rutter published the first autism twin study, which revealed evidence of a genetic basis for autism 1980 "Infantile autism" listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) Autism is officially separated from childhood schizophrenia. 1987 DSM replaces "infantile autism" with "autism disorder" o more expansive definition o includes a checklist of diagnostic criteria. o Ivar Lovaas: Intensive behavior therapy 1994 Asperger's Syndrome is added to the DSM, expanding the autism spectrum 3 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  1997-1998 Judy Singer “Australian sociologist ” & "neurodiversity" Singer coined the term neurodiversity to represent both the idea of neurological diversity and to think about the existence of a social movement of neurological minorities that would also include the autism rights movement DSM-III The DSM-III, published in 1980, established autism as its own separate diagnosis and described it as a “pervasive developmental disorder” distinct from schizophrenia. 1980 The DSM-IV The DSM-IV, released in 1994 and revised in 2000, was the first edition to categorize autism as a spectrum 1994 2013 The DSM-5 & the Autism Spectrum o folds all subcategories of the condition into one o Asperger's no longer considered separate condition o defined by two categories: 1) Impaired social communication/interaction 2) Restricted/repetitive behaviors DSM-5 The DSM-5 introduced the term ‘autism spectrum disorder characterized by two groups of features: both present in early childhood. A-- Persistent impairment in reciprocal social communication and social interaction B-- Restricted, repetitive patterns of behavior 4 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  DSM-5 Eliminated Asperger syndrome, PDD-NOS and classic autism. Childhood disintegrative disorder and Rett syndrome were removed from the autism category Debuted a diagnosis of social communication disorder to include children with only language and social impairments Prevalence The new report shows an increase in prevalence with 1 in 36 children or over 2.7% of 8-year-old children diagnosed with an autism spectrum disorder in 2020 ASD is nearly 4 times more common among boys than among girls Diagnostic DSM-5 eliminated the subtypes and combined them into a single diagnosis of Criteria Autism Spectrum Disorder (ASD) F84.0 Individuals with ASD and intellectual disability are classified as having ASD with an associated intellectual or language impairment. DIAGNOSTIC focus on social communication deficits and repetitive behaviors AND DSM-5 includes a severity rating system for ASD STATISTICAL MANUAL OF DSM-5 includes sensory processing issues as part of the diagnostic criteria for MENTAL ASD DISORDERS DSM-5 does not specify a specific age of onset. DSM-V (2013) 5 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  DSM-4 identified three autism spectrum disorders, which were autism. Asperger's syndrome, and pervasive developmental disorder-not otherwise specified (PDD-NOS) includes a separate diagnosis of autism with intellectual disability DSM-4 (2000) DSM-4 emphasized language development and social interaction Severity levels are not present in DSM-4 DSM-4 did not include sensory processing issues as part of the diagnostic criteria for ASD DSM-4 required that symptoms of autism be present before the age of 3 Diagnostic To diagnose ASD, all of the five criteria must be met. criteria In the two symptom domains: By Social communication DSM-5 fixated interests and repetitive behaviors A- A. Persistent deficits in social communication and social interaction across multiple Persistent contexts, as manifested by all of the following, currently or by history (examples are deficits in social illustrative, not exhaustive): communication and social 1. Deficits in social-emotional reciprocity interaction Abnormal social approach and failure of normal back-and-forth conversation reduced sharing of interests, emotions, or affect 6 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  failure to initiate or respond to social interactions. 2- Deficits in nonverbal communicative poorly integrated verbal and nonverbal communication abnormalities in eye contact and body language deficits in understanding and use of gestures total lack of facial expressions and nonverbal communication. 3- Deficits in developing, maintaining, and understanding relationships difficulties adjusting behavior to suit various social contexts. difficulties in sharing imaginative play or in making friends absence of interest in peers. B- 1- Stereotyped or repetitive motor movements, use of objects, or speech Restricted, (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, repetitive idiosyncratic phrases) patterns of behavior, Examples: interests, or Extreme distress at small changes activities, as Difficulties with transitions manifested by at Rigid thinking patterns least two of the Greeting rituals following, Need to take same route or eat same food every day 7 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  currently or by history 2- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of (examples are verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with illustrative, not transitions, rigid thinking patterns, greeting rituals, need to take same route or eat exhaustive same food every day). 3- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4- Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). C Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life) D Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning 8 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  E These disturbances are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay. Intellectual developmental disorder and autism spectrum disorder frequently co- occur; to make comorbid diagnoses of autism spectrum disorder and intellectual developmental disorder, social communication should be below that expected for general developmental level. Severity Levels Social communication Without supports in place, deficits in social communication cause noticeable Level 1 is the impairments. Difficulty initiating social interactions, and clear examples of atypical or mildest, or unsuccessful responses to social overtures of others. May appear to have decreased “highest interest in social interactions. For example, a person who is able to speak in full functioning” sentences and engages in communication but whose to-and-fro conversation with form of autism. others fails, and whose attempts to make friends are odd and typically unsuccessful. Restricted, repetitive behaviors Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence. 9 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Severity Levels Social communication Marked deficits in verbal and nonverbal social communication skills; social Level 2 impairments apparent even with supports in place; limited initiation of social “Requiring interactions; and reduced or abnormal responses to social overtures from others. For substantial example, a person who speaks simple sentences, whose interaction is limited to narrow support” special interests, and who has markedly odd nonverbal communication Restricted, repetitive behaviors Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action. Severity Levels Social communication Level 3 Severe deficits in verbal and nonverbal social communication skills cause severe “Requiring very impairments in functioning, very limited initiation of social interactions, and minimal substantial response to social overtures from others. For example, a person with few words of support” intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches. 10 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Restricted, repetitive behaviors Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action. The behavioral features of autism spectrum disorder first become evident in Red Flags to early childhood, with some cases presenting a lack of interest in social Early Diagnosis interaction in the first year of life. Symptoms are typically recognized during the second year of life (age 12–24 months) but may be seen earlier than 12 months if developmental delays are severe, or noted later than 24 months if symptoms are more subtle. Prospective studies demonstrate that in most cases the onset of autism spectrum disorder is associated with declines in critical social and communication behaviors in the first 2 years of life. Such declines in functioning are rare in other neurodevelopmental disorders and may be an especially useful indicator of the presence of autism spectrum disorder 11 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  First symptoms of 1- lack of social interest or unusual social interactions (e.g., pulling individuals by the ASD frequently hand without any attempt to look at them) involve delayed 2- odd play patterns (e.g., carrying toys around but never playing with them) language development, often 3- unusual communication patterns (e.g., knowing the alphabet but not responding to accompanied by: own name). Identify The Does not smile or interact with others “Red Flags” To Not sharing enjoyment with others using eye contact Early Diagnosis Does not notice new things Social Lack of interest Unfunctional play skills No interest in pretend play or interacting with other children Difficulty understanding feelings in themselves and others Lack or limited eye contact Identify The Not starting to babbles “Red Flags” To Not using gestures (pointing, showing, waving) Early Diagnosis No babbles phrases that sounds like talking. No responding to familiar words Communication No clear words Not able to understand short requests Not learning new words Speech difficulties for familiar people to understand 12 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Not able to follow direction of multiple steps Not able to answer simple questions Identify The Not searching for and holding toys “Red Flags” To Hands frequently clenched Early Diagnosis Does not explore objects with hands Cognitive, Fine Does not give objects on request Motor Skills Unable to pick up small items using index finger and thumb And Self Care Does not scribble with crayon Does not attempt to feed self with spoon or help with dressing Not holding head and shoulders up with good control Identify The Not rolling “Red Flags” To Not sitting independently with support Early Diagnosis Not attempting to walk without support Gross Motor Not able to walk up and down stairs independently Not able to climb, jump, run risk factors Children born from elder parents Children born underweight When mothers use “Valproate” while pregnancy 13 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Risk of If parents have a child with some form of autism, there is a 1 in 5 chance (20%) recurrence chance that their next child will have autism too (Journal of Pediatrics). Twins’ studies Identical twins: if one has autism, 60% chance the other will have autism Non-identical twins: if one has autism, 10% chance the other will have autism Vaccines Studies have shown that there is no link between receiving vaccines and developing ASD “A CDC study published in 2013 added to the research showing that vaccines DO NOT cause ASD Common co- Epilepsy/ seizures morbid Sleep disorders/disturbance diagnoses: ADHD OCD Academic Challenges Gastrointestinal disorders Feeding/eating challenges Obesity Depression Anxiety Bipolar Disorder 14 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Deficits Social-emotional reciprocity associated with Nonverbal communication ASD Stereotyped motor movements Restrictive or ritualized behaviors Pragmatic language Social-emotional abnormal social approach reciprocity failure of normal back-and-forth conversation reduced sharing of interests, emotions, or affect failure to initiate or respond to social interactions. Nonverbal poorly integrated verbal and nonverbal communication communication abnormalities in eye contact and body language deficits in understanding and use of gestures lack of facial expressions and nonverbal communication. Stereotyped Stereotypies do not only occur in the context of a neurodevelopmental disorder motor (i.e., secondary stereotypies) like autism, or intellectual disability, they are also movements observed in typically developing infants (i.e., primary stereotypies) primary stereotypies usually subside around age 3 years secondary stereotypies tend to persist through life in various forms 15 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Restrictive or Repetitive restricted behaviors (RRBs). ritualized usually detected in early childhood. behaviors RRBs are behavioral patterns characterized by repetition, inflexibility, invariance, inappropriateness, and frequent lack of obvious function or specific purpose. Pragmatic Pragmatics covers such notions as language how thoughts are transformed into language during social interaction the selection of words relative to the social context the selection of words relative to the social context Pragmatic People with autism who do not appreciate abstraction tend to speak in a rigid or language overly literal Verbal aspects Providing insufficient or excessive information of pragmatic Abrupt topic changes language Limited back and forth conversation difficulties in Having difficulty interpreting non-literal language individuals with ASD include: 16 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Joined Attention Joint attention has been described as two persons actively sharing attention to an object or an event, while they are monitoring each other’s attention to that object or the event Joint attention may be best defined in terms of an information processing system that begins to develop by 4–6 months of age Initiating Joint refers to infants ’ ability to spontaneously create or indicate a shared point of Attention reference by the use of gestures, or more frequently, alternating gaze between objects or events and other people. Responding to refers to infants’ ability to follow the direction of gaze, head posture or gestures of Joint Attention other people and consequently share a common social point of visual reference. Receptive Receptive language refers to the ability to understand spoken or written language language. It involves processing and interpreting language input from the environment. Examples of receptive language skills include understanding vocabulary, following directions, and comprehending complex sentences. Expressive Expressive language refers to the ability to produce spoken or written language. language It involves using words and grammar to convey meaning and express thoughts and feelings. Examples of expressive language skills include telling stories, describing events, and expressing emotions. 17 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Sensory-motor Sensory-motor skills refer to the ability to integrate sensory information and motor movements. It involves using sensory information to plan and execute purposeful movements. Examples of sensory-motor skills include crawling, walking, and catching a ball. Differential diagnosis simply means that there is more than one possibility for a Differential diagnosis. diagnosis Oxford Dictionary describes ‘differential diagnoses’ (plural noun) as ‘the process of differentiating between two or more conditions which share similar signs or symptoms.’ The conditions Learning Disability/Intellectual Disability (LD/ID) that can mimic ADHD or present as Social Communication Disorder (SCD) ASD Gifted and Talented Children Anxiety Sensory Processing Difficulties (SPD) Epilepsy Genetic disorders and Syndromic Regression and Rett’s Language Disorder 18 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Autism and Abnormalities of attention are common in individuals with ASD ADHD some individuals with ADHD may exhibit social communication deficits the developmental course and absence of restricted, repetitive behaviors and unusual interests in ADHD help in differentiating the two conditions. Intellectual developmental disorder is the appropriate diagnosis when there is no Intellectual apparent discrepancy” there is a noticeable difference“ between the level of social disability communicative skills and other intellectual skills. Language Specific language disorder is not usually associated with abnormal nonverbal disorders and communication, nor with the presence of restricted, repetitive patterns of behavior, social interests, or activities. (pragmatic) communication disorder Selective mutism In selective mutism, early development is not typically disturbed. The affected child usually exhibits appropriate communication skills in certain contexts and settings. Even in settings where the child is mute, social reciprocity is not impaired, nor are restricted or repetitive patterns of behavior present. 19 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  Stereotypic Motor stereotypies are among the diagnostic characteristics of autism spectrum movement disorder, so an additional diagnosis of stereotypic movement disorder is not given disorder when such repetitive behaviors are better explained by the presence of autism spectrum disorder. However, when stereotypies cause self-injury and become a focus of treatment, both diagnoses may be appropriate. Serial vs. parallel processing related to learning style of individuals with ASD Serial processing refers to the cognitive process of handling tasks sequentially, one Serial processing step at a time. The brain processes information in a linear order, where each task is completed before the next one begins Parallel processing involves handling multiple tasks or streams of information simultaneously. Parallel processing The brain processes various elements at once, integrating information across different domains. The two core 1- a detailed developmental history that is usually obtained from parents, covering elements of the first concerns and early history to the present day diagnostic 2- observation of the child’s interactions with their parents and with unfamiliar adults process of during a combination of structured and unstructured assessments (observations of the 20 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA  autism in young person in peer-group settings such as school or nursery would also form part of children are: the diagnostic process) structured diagnostic The Autism Diagnostic Interview-Revised (ADI-R) interviews and The Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2) observational assessments for autism Parent-report The Modified Checklist for Autism in Toddlers (M-CHAT) instruments The Early Screening of Autistic Traits (ESAT) Typical and Please check: atypical https://www.cdc.gov/ncbddd/actearly/pdf/LTSAE- milestones Checklist_COMPLIANT_30MCorrection_508.pdf https://www.cdc.gov/ncbddd/actearly/milestones/index.html All the best From ABA Experts 21 2023 All Rights Reserved to Wael Al Awabdah BCBA, IBA & Rouba Samoul, BCaBA, QBA, IBA