CMN 554 Final Exam Study Guide | Questions with 100% Correct Answers |
Verified | Latest Update - University of South Alabama
MODULE 1
1. Autism – age of onset, diagnostic criteria
Autism Spectrum Disorder: Diagnostic Criteria pg 50
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the
following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal
back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to
social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly
integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in
understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to
absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by
history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up
toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
(e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need
to take same route or eat 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 hyporeactivity 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.
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.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive
developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who
have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum
disorder, should be evaluated for social (pragmatic) communication disorder.
Specify current severity based on social communication impairments and restricted, repetitive patterns of behavior (see
Table 2):
Requiring very substantial support
Requiring substantial support
Requiring support
Specify if: With or without accompanying intellectual impairment With or without accompanying language impairment
Specify if: Associated with a known genetic or other medical condition or environmental factor (Coding note: Use additional
code to identify the associated genetic or other medical condition.) Associated with a neurodevelopmental, mental, or
behavioral problem.
1
, Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, p. 135, for definition)
(Coding note: Use additional code F06.1 catatonia associated with autism spectrum disorder to indicate the presence of the
comorbid catatonia.)
Autism Spectrum Disorder: Development and Course
The age and pattern of onset also should be noted for autism spectrum disorder. The behavioral features of autism
spectrum disorder first become evident in early childhood, with some cases presenting a lack of interest in social 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. The
pattern of onset description might include information about early developmental delays or any losses of social or language
skills. In cases where skills have been lost, parents or caregivers may give a history of a gradual or relatively rapid deterioration
in social behaviors or language skills. Typically, this would occur between ages 12 and 24 months.
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. In rare
cases, there is developmental regression occurring after at least 2 years of normal development (previously described as
childhood disintegrative disorder), which is much more unusual and warrants more extensive medical investigation (i.e.,
continuous spike and waves during slow-wave sleep syndrome and Landau-Kleffner syndrome). Often included in these
encephalopathic conditions are losses of skills beyond social communication (e.g., loss of self-care, toileting, motor skills) (see
also Rett syndrome in the section “Differential Diagnosis” for this disorder).
First symptoms of autism spectrum disorder frequently involve delayed language development, often accompanied by
lack of social interest or unusual social interactions (e.g., pulling individuals by the hand without any attempt to look at them),
odd play patterns (e.g., carrying toys around but never playing with them), and unusual communication patterns (e.g., knowing
the alphabet but not responding to own name). Deafness may be suspected but is typically ruled out. During the second year,
odd and repetitive behaviors and the absence of typical play become more apparent. Since many typically developing young
children have strong preferences and enjoy repetition (e.g., eating the same foods, watching the same video multiple times),
distinguishing restricted and repetitive behaviors that are diagnostic of autism spectrum disorder can be difficult in
preschoolers. The clinical distinction is based on the type, frequency, and intensity of the behavior (e.g., a child who daily lines
up objects for hours and is very distressed if any item is moved). Autism spectrum disorder is not a degenerative disorder, and
it is typical for learning and compensation to continue throughout life. Symptoms are often most marked in early childhood and
early school years, with developmental gains typical in later childhood in at least some areas (e.g., increased interest in social
interaction). A small proportion of individuals deteriorate behaviorally during adolescence, whereas most others improve.
While it was once the case that only a minority of individuals with autism spectrum disorder lived and worked independently in
adulthood, as diagnosis of autism spectrum disorder is made more frequently in those who have superior language and
intellectual abilities, more individuals are able to find a niche that matches their special interests and skills and thus are
productively employed. Access to vocational rehabilitation services significantly improves competitive employment outcomes
for transition-age youth with autism spectrum disorder.
In general, individuals with lower levels of impairment may be better able to function independently. However, even
these individuals may remain socially naive and vulnerable, have difficulties organizing practical demands without aid, and are
prone to anxiety and depression. Many adults report using compensation strategies and coping mechanisms to mask their
difficulties in public but suffer from the stress and effort of maintaining a socially acceptable facade. Relatively little is known
about old age in autism spectrum disorder, but higher rates of cooccurring medical conditions have been documented in the
literature.
Some individuals come for first diagnosis in adulthood, perhaps prompted by the diagnosis of autism in a child in the
family or a breakdown of relations at work or home. Obtaining detailed developmental history in such cases may be difficult,
and it is important to consider self-reported difficulties. Where clinical observation suggests criteria are currently met, autism
spectrum disorder may be diagnosed, particularly if supported by a history of poor social and communication skills in
childhood. A compelling report (by parents or another relative) that the individual had ordinary and sustained reciprocal
friendships and good nonverbal communication skills throughout childhood would significantly lessen the likelihood of a
diagnosis of autism spectrum disorder; however, ambiguous, or absent developmental information in itself is not sufficient to
rule out a diagnosis of autism spectrum disorder.
2
, Manifestations of the social and communication impairments and restricted/repetitive behaviors that define autism
spectrum disorder are clear in the developmental period. In later life, intervention, or compensation, as well as current supports,
may mask these difficulties in at least some contexts. Overall, symptoms remain sufficient to cause current impairment in
social, occupational, or other important areas of functioning.
2. Non-pharmacological treatment of autism spectrum disorder
Treatment
The goals of treatment for children with autism are to reduce disruptive behaviors and promote learning,
particularly in the areas of language acquisition, communication, and self-help skills. These goals are
best achieved based on a comprehensive assessment to determine a profile of strengths and needs, and
an individualized and structured program is implemented by professionals experienced in working with children who are autistic
- Educational Approaches: Autistic children require intensive and highly structured special education from as early as the
child is able to tolerate a school routine. Given the challenges involved in teaching children with autism, a classroom
setting with a low student to teacher ratio is usually essential. For the more impaired children, a typical hierarchy of
priorities should include the ability to: (1) tolerate individual adult guidance in performing tasks; (2) consistently follow a
daily routine; (3) develop communication intent and communication means; and (4) move from associative to conceptual
learning. Learning should take place in an environment that minimizes distractions (e.g., nearby windows, richly decorated
walls).
- Behavior Therapy: This treatment, based on learning theory principles, uses behavior-modification techniques to establish
desired behaviors and eliminate problem behaviors. Most educational programs for children with autism use behavioral
management techniques, although they vary in terms of how integrated these procedures are in the comprehensive
educational program. Such techniques can be particularly useful in the management of disruptive behaviors that impact on
the child’s ability to engage in remedial educational intervention. After a functional analysis of the target behavior is
performed and patterns of reinforcement are identified, techniques such as shaping, prompting, and extinction are used to
promote the desired behavioral alternative, which is then reinforced by increasingly mature rewards. Behavior therapy is
also used for the facilitation of learning, including the promotion of early cognitive skills such as categorization and
elicitation of vocalization and speech. It is clear that many children, although not all, will significantly benefit from
behavior therapy; other forms of teaching can also be used particularly for more intellectually able children.
- Psychotherapy: With the shift from a psychogenic to a biological understanding of autism, it became clear that
psychodynamic psychotherapy and unstructured play therapies, in general, were not appropriate in the treatment of young
children. Individual psychotherapy may be appropriate for higher-functioning individuals who may present with anxiety
and depressive symptoms as they grow older and become more aware of their differences and difficulties relating to others.
In these cases, psychotherapy should focus on rather explicit problem-solving skills rather than being insight oriented, with
the goal to promote better adjustment and self-satisfaction. New approaches that include modified CBT specific to
individuals with ASD should be considered.
3. Echolalia, circumlocutions, cluttering, prosopagnosia, dyscalculia
- Echolalia (Sadock Chp 44): Leo Kanner noted unusual responses to the environment seen in autism such as echoing
language.
- Circumlocutions (DSM pg 46): Childhood-onset fluency disorder (stuttering) word substitutions to avoid problematic
words.
- Cluttering: is another disorder of fluency characterized by rapid speech, reduced intelligibility, and frequent telescoping of
words. Cluttering is often marked by grammatical and syntactic errors and is not typically associated with any specific
sound or word fears or even limited awareness of the speech disorder. Cluttering has often been associated with a central
language imbalance, and some authors have suggested that cluttering exists when an individual presents with one or more
impairments in each of five broad communicative dimensions reflecting cognitive, linguistic, pragmatic, speech, and motor
abilities. One of the features differentiating cluttering from developmental stuttering is self-monitoring and general
awareness. Whereas the person with developmental stuttering is usually hypersensitive to the sound of his or her own
speech, the person who clutters is often only vaguely aware of the aberrant speech pattern. Prognosis for improvement with
treatment for cluttering is usually guarded, in large part because of the individual’s general lack of awareness of the speech
pattern.
3
, - Prosopagnosia: variety of disorders of higher visual function has already been mentioned in describing the complex
structure of visual association cortices. Prosopagnosia is a defect in recognition of faces. Such a defect may be obvious
from the history or may be a more subtle abnormality; it can be spotted at the bedside, albeit insensitively, with the use of a
few pictures of famous people.
- Dyscalculia: The term “dyscalculia” (from the Greek dys and Latin calculia) was used by Cohn (1968) to refer to a “failure
to recognize numbers or manipulate them in an advanced culture,” Seen in Specific Learning Disorder specifically in
mathematics, Dyscalculia is an alternative term used to refer to a pattern of difficulties characterized by problems
processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. If dyscalculia
is used to specify this particular pattern of mathematic difficulties, it is important also to specify any additional difficulties
that are present, such as difficulties with math reasoning or word reasoning accuracy.
4. Complex symbolic play
Table 36.1-6 Structure of play Pg 3393
- Play
Play is a primary mode of information gathering for all sections of the Infant and Toddler Mental Status Examination. In
young children, play is especially useful in the evaluation of the child’s cognitive and symbolic functioning, relatedness, and
expression of affect.
Themes of play are helpful in assessing older toddlers.
The management and expression of aggression are assessed in play as in other areas of behavior. Play may be with toys or with the
child’s own or another’s body (e.g., peek-a-boo, roughhousing), verbal (e.g., sound imitation games between mother and infant), or
interactional or solitary. It is important to note how the child’s play varies with different familiar caregivers and with parents versus
the examiner.
A. Structure of play (ages are approximate).
1. Sensorimotor play
a. 0–12 months of age: Mouthing, banging, dropping and throwing toys or other objects.
b. 6–12 months of age: Exploring characteristics of objects (e.g., moving parts, poking, and pulling).
2. Functional play
a. 12–18 months of age: Child’s use of objects shows understanding and exploration of their use or function (e.g., pushes
car, touches comb to hair, and puts telephone to ear).
Early symbolic play
b. 18 months of age and older: Child pretends with increasing complexity; pretends with own body to eat or to sleep; child
pretends with objects or other people (e.g., “feeds” mother); child uses one object to represent another (e.g., a block
becomes a car); child pretends a sequence of activities (e.g., cooking and eating).
3. Complex symbolic play
a. 30 months of age and older: Child plans and acts out dramatic play sequences, uses imaginary objects. Later, child
incorporates others into play with assigned roles.
4. Imitation, turn taking, and problem solving as part of play.
5. Piaget – concrete operations
- Piaget’s Cognitive Development Stages
• Sensorimotor
¨ Ages birth - 2: the infant uses his senses and motor abilities to understand the world.
• Preoperational
¨ Ages 2-7: the child uses metal representations of objects and is able to use symbolic thought and language.
• Concrete operations
¨ Ages 7-11; the child uses logical operations or principles when solving problems.
• Formal operations
¨ Ages 12 up; the use of logical operations in a systematic fashion and with the ability to use abstractions
4
Verified | Latest Update - University of South Alabama
MODULE 1
1. Autism – age of onset, diagnostic criteria
Autism Spectrum Disorder: Diagnostic Criteria pg 50
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the
following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal
back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to
social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly
integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in
understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to
absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by
history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up
toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
(e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need
to take same route or eat 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 hyporeactivity 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.
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.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive
developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who
have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum
disorder, should be evaluated for social (pragmatic) communication disorder.
Specify current severity based on social communication impairments and restricted, repetitive patterns of behavior (see
Table 2):
Requiring very substantial support
Requiring substantial support
Requiring support
Specify if: With or without accompanying intellectual impairment With or without accompanying language impairment
Specify if: Associated with a known genetic or other medical condition or environmental factor (Coding note: Use additional
code to identify the associated genetic or other medical condition.) Associated with a neurodevelopmental, mental, or
behavioral problem.
1
, Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, p. 135, for definition)
(Coding note: Use additional code F06.1 catatonia associated with autism spectrum disorder to indicate the presence of the
comorbid catatonia.)
Autism Spectrum Disorder: Development and Course
The age and pattern of onset also should be noted for autism spectrum disorder. The behavioral features of autism
spectrum disorder first become evident in early childhood, with some cases presenting a lack of interest in social 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. The
pattern of onset description might include information about early developmental delays or any losses of social or language
skills. In cases where skills have been lost, parents or caregivers may give a history of a gradual or relatively rapid deterioration
in social behaviors or language skills. Typically, this would occur between ages 12 and 24 months.
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. In rare
cases, there is developmental regression occurring after at least 2 years of normal development (previously described as
childhood disintegrative disorder), which is much more unusual and warrants more extensive medical investigation (i.e.,
continuous spike and waves during slow-wave sleep syndrome and Landau-Kleffner syndrome). Often included in these
encephalopathic conditions are losses of skills beyond social communication (e.g., loss of self-care, toileting, motor skills) (see
also Rett syndrome in the section “Differential Diagnosis” for this disorder).
First symptoms of autism spectrum disorder frequently involve delayed language development, often accompanied by
lack of social interest or unusual social interactions (e.g., pulling individuals by the hand without any attempt to look at them),
odd play patterns (e.g., carrying toys around but never playing with them), and unusual communication patterns (e.g., knowing
the alphabet but not responding to own name). Deafness may be suspected but is typically ruled out. During the second year,
odd and repetitive behaviors and the absence of typical play become more apparent. Since many typically developing young
children have strong preferences and enjoy repetition (e.g., eating the same foods, watching the same video multiple times),
distinguishing restricted and repetitive behaviors that are diagnostic of autism spectrum disorder can be difficult in
preschoolers. The clinical distinction is based on the type, frequency, and intensity of the behavior (e.g., a child who daily lines
up objects for hours and is very distressed if any item is moved). Autism spectrum disorder is not a degenerative disorder, and
it is typical for learning and compensation to continue throughout life. Symptoms are often most marked in early childhood and
early school years, with developmental gains typical in later childhood in at least some areas (e.g., increased interest in social
interaction). A small proportion of individuals deteriorate behaviorally during adolescence, whereas most others improve.
While it was once the case that only a minority of individuals with autism spectrum disorder lived and worked independently in
adulthood, as diagnosis of autism spectrum disorder is made more frequently in those who have superior language and
intellectual abilities, more individuals are able to find a niche that matches their special interests and skills and thus are
productively employed. Access to vocational rehabilitation services significantly improves competitive employment outcomes
for transition-age youth with autism spectrum disorder.
In general, individuals with lower levels of impairment may be better able to function independently. However, even
these individuals may remain socially naive and vulnerable, have difficulties organizing practical demands without aid, and are
prone to anxiety and depression. Many adults report using compensation strategies and coping mechanisms to mask their
difficulties in public but suffer from the stress and effort of maintaining a socially acceptable facade. Relatively little is known
about old age in autism spectrum disorder, but higher rates of cooccurring medical conditions have been documented in the
literature.
Some individuals come for first diagnosis in adulthood, perhaps prompted by the diagnosis of autism in a child in the
family or a breakdown of relations at work or home. Obtaining detailed developmental history in such cases may be difficult,
and it is important to consider self-reported difficulties. Where clinical observation suggests criteria are currently met, autism
spectrum disorder may be diagnosed, particularly if supported by a history of poor social and communication skills in
childhood. A compelling report (by parents or another relative) that the individual had ordinary and sustained reciprocal
friendships and good nonverbal communication skills throughout childhood would significantly lessen the likelihood of a
diagnosis of autism spectrum disorder; however, ambiguous, or absent developmental information in itself is not sufficient to
rule out a diagnosis of autism spectrum disorder.
2
, Manifestations of the social and communication impairments and restricted/repetitive behaviors that define autism
spectrum disorder are clear in the developmental period. In later life, intervention, or compensation, as well as current supports,
may mask these difficulties in at least some contexts. Overall, symptoms remain sufficient to cause current impairment in
social, occupational, or other important areas of functioning.
2. Non-pharmacological treatment of autism spectrum disorder
Treatment
The goals of treatment for children with autism are to reduce disruptive behaviors and promote learning,
particularly in the areas of language acquisition, communication, and self-help skills. These goals are
best achieved based on a comprehensive assessment to determine a profile of strengths and needs, and
an individualized and structured program is implemented by professionals experienced in working with children who are autistic
- Educational Approaches: Autistic children require intensive and highly structured special education from as early as the
child is able to tolerate a school routine. Given the challenges involved in teaching children with autism, a classroom
setting with a low student to teacher ratio is usually essential. For the more impaired children, a typical hierarchy of
priorities should include the ability to: (1) tolerate individual adult guidance in performing tasks; (2) consistently follow a
daily routine; (3) develop communication intent and communication means; and (4) move from associative to conceptual
learning. Learning should take place in an environment that minimizes distractions (e.g., nearby windows, richly decorated
walls).
- Behavior Therapy: This treatment, based on learning theory principles, uses behavior-modification techniques to establish
desired behaviors and eliminate problem behaviors. Most educational programs for children with autism use behavioral
management techniques, although they vary in terms of how integrated these procedures are in the comprehensive
educational program. Such techniques can be particularly useful in the management of disruptive behaviors that impact on
the child’s ability to engage in remedial educational intervention. After a functional analysis of the target behavior is
performed and patterns of reinforcement are identified, techniques such as shaping, prompting, and extinction are used to
promote the desired behavioral alternative, which is then reinforced by increasingly mature rewards. Behavior therapy is
also used for the facilitation of learning, including the promotion of early cognitive skills such as categorization and
elicitation of vocalization and speech. It is clear that many children, although not all, will significantly benefit from
behavior therapy; other forms of teaching can also be used particularly for more intellectually able children.
- Psychotherapy: With the shift from a psychogenic to a biological understanding of autism, it became clear that
psychodynamic psychotherapy and unstructured play therapies, in general, were not appropriate in the treatment of young
children. Individual psychotherapy may be appropriate for higher-functioning individuals who may present with anxiety
and depressive symptoms as they grow older and become more aware of their differences and difficulties relating to others.
In these cases, psychotherapy should focus on rather explicit problem-solving skills rather than being insight oriented, with
the goal to promote better adjustment and self-satisfaction. New approaches that include modified CBT specific to
individuals with ASD should be considered.
3. Echolalia, circumlocutions, cluttering, prosopagnosia, dyscalculia
- Echolalia (Sadock Chp 44): Leo Kanner noted unusual responses to the environment seen in autism such as echoing
language.
- Circumlocutions (DSM pg 46): Childhood-onset fluency disorder (stuttering) word substitutions to avoid problematic
words.
- Cluttering: is another disorder of fluency characterized by rapid speech, reduced intelligibility, and frequent telescoping of
words. Cluttering is often marked by grammatical and syntactic errors and is not typically associated with any specific
sound or word fears or even limited awareness of the speech disorder. Cluttering has often been associated with a central
language imbalance, and some authors have suggested that cluttering exists when an individual presents with one or more
impairments in each of five broad communicative dimensions reflecting cognitive, linguistic, pragmatic, speech, and motor
abilities. One of the features differentiating cluttering from developmental stuttering is self-monitoring and general
awareness. Whereas the person with developmental stuttering is usually hypersensitive to the sound of his or her own
speech, the person who clutters is often only vaguely aware of the aberrant speech pattern. Prognosis for improvement with
treatment for cluttering is usually guarded, in large part because of the individual’s general lack of awareness of the speech
pattern.
3
, - Prosopagnosia: variety of disorders of higher visual function has already been mentioned in describing the complex
structure of visual association cortices. Prosopagnosia is a defect in recognition of faces. Such a defect may be obvious
from the history or may be a more subtle abnormality; it can be spotted at the bedside, albeit insensitively, with the use of a
few pictures of famous people.
- Dyscalculia: The term “dyscalculia” (from the Greek dys and Latin calculia) was used by Cohn (1968) to refer to a “failure
to recognize numbers or manipulate them in an advanced culture,” Seen in Specific Learning Disorder specifically in
mathematics, Dyscalculia is an alternative term used to refer to a pattern of difficulties characterized by problems
processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. If dyscalculia
is used to specify this particular pattern of mathematic difficulties, it is important also to specify any additional difficulties
that are present, such as difficulties with math reasoning or word reasoning accuracy.
4. Complex symbolic play
Table 36.1-6 Structure of play Pg 3393
- Play
Play is a primary mode of information gathering for all sections of the Infant and Toddler Mental Status Examination. In
young children, play is especially useful in the evaluation of the child’s cognitive and symbolic functioning, relatedness, and
expression of affect.
Themes of play are helpful in assessing older toddlers.
The management and expression of aggression are assessed in play as in other areas of behavior. Play may be with toys or with the
child’s own or another’s body (e.g., peek-a-boo, roughhousing), verbal (e.g., sound imitation games between mother and infant), or
interactional or solitary. It is important to note how the child’s play varies with different familiar caregivers and with parents versus
the examiner.
A. Structure of play (ages are approximate).
1. Sensorimotor play
a. 0–12 months of age: Mouthing, banging, dropping and throwing toys or other objects.
b. 6–12 months of age: Exploring characteristics of objects (e.g., moving parts, poking, and pulling).
2. Functional play
a. 12–18 months of age: Child’s use of objects shows understanding and exploration of their use or function (e.g., pushes
car, touches comb to hair, and puts telephone to ear).
Early symbolic play
b. 18 months of age and older: Child pretends with increasing complexity; pretends with own body to eat or to sleep; child
pretends with objects or other people (e.g., “feeds” mother); child uses one object to represent another (e.g., a block
becomes a car); child pretends a sequence of activities (e.g., cooking and eating).
3. Complex symbolic play
a. 30 months of age and older: Child plans and acts out dramatic play sequences, uses imaginary objects. Later, child
incorporates others into play with assigned roles.
4. Imitation, turn taking, and problem solving as part of play.
5. Piaget – concrete operations
- Piaget’s Cognitive Development Stages
• Sensorimotor
¨ Ages birth - 2: the infant uses his senses and motor abilities to understand the world.
• Preoperational
¨ Ages 2-7: the child uses metal representations of objects and is able to use symbolic thought and language.
• Concrete operations
¨ Ages 7-11; the child uses logical operations or principles when solving problems.
• Formal operations
¨ Ages 12 up; the use of logical operations in a systematic fashion and with the ability to use abstractions
4
