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Module 11: Autism Spectrum Disorder - ANSWER-
I. Core features of ASD - ANSWER--Deficits in Social Communication & Social
Interaction
-Restrictive, repetitive patterns of behavior, interests, or activities
Diagnosis•ASD is a spectrum disorder. Individuals with ASD can vary in terms of the
severity of their syndromic symptoms. •Severity Rating Scale: Amount of support and
environmental modifications•Level 3: Requiring very substantial support•Level 2:
Requiring substantial support•Level 1: Requiring support•Differential diagnosis is
important
Social Pragmatic Communication Disorder•Diagnostic criteria•Deficits in social use of
communication•Comprehension deficit
-1 in 68 for 8-year-old children
-1:42 boys vs. 1:189 girls
Associated Problems•Intellectual disabilities (ID)•Motor behavior deficits•Sensory
processing deficits•Hearing loss•Seizures•Developmental disorders
Communication in Children with ASD - ANSWER-Infants show deficits in eye contact,
failing to orient to their names, lacking a pointing gesture to gain attention and lack
showing a response.•Deficiencies in joint attention. •Deficits synchronizing vocal
patterns with caregivers, sharing emotional expressions with adults, and responding to
parents through gestures and vocalizations.•Lack theory of mind. •Adolescents with
ASD prefer to engage with things of interest rather than getting involved in activities with
peers that require social interactions.
Etiology•ASD is not a discrete disorder. Affects individuals differently. •ASD is a brain
disorder with abnormalities in brain structure and function. •Cause has not been
confirmed. Possibilities include heredity, genetics and environmental toxins.
Preserved Abilities - ANSWER-Nonsegmental Phonology•Also referred to as prosody.
•Stereotyped rhythmic pattern characterized by excessive sound prolongation•Overly
frequent and contextually inappropriate whispering•Unusual fluctuations in
loudness•Limited pitch range - monotonous•Inappropriate or disfluent
phrasing•Excessive nasal resonance•Tonal contrasts that are inconsistent with the
meanings expressed verbally. •Pronoun Difficulties•Confusion of gender or case
substitution (him/he) similar to TD children•Confusion of the person aspect of pronoun
usage (1st, 2nd, and 3rdperson forms)
Impaired abilities - ANSWER-Impaired Abilities•Echolalia, Formulaic Language and
Neologism•Immediate vs. delayed echolalia.
, •Communicative Functions•Children with ASD are much less competent at gaining and
directing the attention of the conversational partner.
Echolalia, Formulaic Language and Neologism•Immediate vs. delayed echolalia.
Communicative Functions•Children with ASD are much less competent at gaining and
directing the attention of the conversational partner.
II. Assessment concerns - ANSWER-Implications for Assessment & Intervention
•ASD is complex.
•Early Assessment and Intervention is crucial; however, it is difficult to identify in
children before 3 years.
•Known undesirable behaviors should place a child in an at-risk category.
•Checklist for Autism in Toddlers (CHAT) and the Modified CHAT.
•CHAT is used to screen for children with ASD at 18 months
•Assesses key factors such as eye contact, joint attention and pretend play.
•Gilliam Autism Rating Scale-3 (GARS-3)•Screening for children ages 3-22
•Childhood Autism Rating Scale - 2 (CARS-2)•15-item behavioral rating scale grouped
into 4 subtests
II. Assessment concerns (Continued) - ANSWER-Assessment in ASD
•Use of an interprofessional team is recommended.
•Children may lack the ability to attend to stimuli, may have no consistent verbal or
nonverbal means of responding, and responses may be contaminated by the intrusion
of echolalia or idiosyncratic responses. •Autism Diagnostic Observation Schedule - 2
(ADOS-2): Gold standard of diagnostic instruments. Consists of 4 modules
•Module 1: 31 months and older who don't consistently use phrases
•Module 2: any age who use phrases but are not verbally fluent
•Module 3: for verbally fluent children and young adolescents
•Module 4: for verbally fluent adolescents and adults
•Assesses communication, social interaction, play and restricted and repetitive
behaviors
Special Considerations - ANSWER-Elevated risk for seizures and hearing loss.
•Hypersensitivity •Might consider "priming" •Communicative functions may emerge in a
different sequence than TD children
•Effective communication in children with ASD requires interaction between three
systems:•Goodness of fit
•Ecological systems
•Culturally competent family centeredness
Intervention Approaches for ASD - ANSWER-Beware of claims or fads for intervention
that do not have an evidence base.
•Chelation, nutritional supplements, special diets, avoidance of certain vaccines,
hyperbaric oxygen treatment.
•Two theoretical frameworks
•Behaviorism
•Social Interaction Theory