Psy4270 Assessment Of Autism

Front 1

Who first described autism in 1943?

Back 1

Leo Kanner

Front 2

Autism is a developmental disorder which affects what 5 key areas?

Back 2

1. Communication
2. Reciprocal social interaction
3. Play
4. Interests
5. Behaviour

Front 3

At what age do symptoms of autism usually present?

Back 3

3 years

Front 4

Describe the circular nature of developmental disorders, specifically autism?

Back 4

Autism changes with development and development is affected by having autism

Front 5

Finish this sentence “autism is defined completely on the basis of…”

Back 5

behaviour

Front 6

What are the five main pervasive developmental disorders as described by the DSM-IV?

Back 6

1. Austistic Disorder
2. Asperger’s Disorder
3. PDD – NOS
4. Childhood disintegrative disorder
5. Rett’s Syndrome

Front 7

Describe the key diagnostic criteria of Autistic Disorder according to the DSM-IV?

Back 7

6 or more symptoms
A: Qualitative abnormalities in Reciprocal Social Interaction (at least 2)
B: Qualitative abnormalities in Communication (at least one)
C: Restricted, Repetitive, and Stereotyped Patterns of Behaviour (at least 1)
D: Abnormality of Development at or before 36 months

Front 8

Describe the abnormalities associated with social interaction in autistic disorder.

Back 8

1. Impairment in non-verbal behaviour e.g. eye gaze, facial expression, body posture, gestures to regulate social interaction
2. Failure to develop peer relationship appropriate to developmental level
3. Lack of spontaneous seeking enjoyment, interests, achievements with other people e.g. lack of showing, bringing or pointing out objects of interest
4. Lack of social or emotional reciprocity

Front 9

Describe the abnormalities associated with Communication in autistic disorder.

Back 9

1. Delay in/total lack of the development of spoken language (with no attempt to compensate)
2. In children with adequate speech, marked impairment in ability to initiate or sustain a conversation with others
3. Stereotyped & repetitive use of language or idiosyncratic language e.g. echolalia
4. Lack of varied, spontaneous make believe play or social imitative play appropriate to developmental level

Front 10

Describe the abnormalities associated with Restrictive, Repetitive & Stereotyped Patterns of Behaviours in autistic disorder.

Back 10

1. Proccupation with one or more stereotyped and restricted patterns of interest that is abnormal in intensity or focus
2. Inflexible adherence to specific non-functional routines or rituals e.g. positioning certain items
3. Stereotyped & repetitive motor mannerisms e.g. hand or finger flapping or twisting, or complex whole body movements
4. Persistent preoccupation with parts of objects

Front 11

What is the prevalence of autism?

Back 11

Just under 1%

Front 12

Does autism occur more frequently in males or females? What is the ratio?

Back 12

Males 5:1

Front 13

What reported percentage of children with autism have an ID?

Back 13

75 to 80%

Front 14

What are some of the issues which complicate the autism prevalence statistics?

Back 14

– methodologies across studies
– whether children with ID’s were included in the sample
– whether only autism is measured, or included other PDD’s
– use of differing diagnostic and case inclusion criteria
– increased public awareness

Front 15

Briefly describe the main similarities of aspergers disorder and the three criteria which must be excluded before a diagnosis is made?

Back 15

Similarities
– social deficits
– narrow/unusual interests and sometimes other repetitive behaviours like autism
Exclusions
– no autism
– no language delay
– no ID

Front 16

Briefly describe the main similarities of PDD-NOS with autism and the three criteria which must be excluded before a diagnosis is made?

Back 16

Similarities
– must have social deficits
– must have either communication of repetitive behaviour like autism
Exclusions
– must have social deficits
– may have late onset
– may not have communication deficits OR not have restricted, repetitive behaviours

Front 17

Briefly describe Childhood Disintegrative Dirsorder.

Back 17

– features like autism across the 3 domains
– very rare
– normal development until age 2
– Must lose receptive language and social skills
– May lose motor and adaptive skills

Front 18

Briefly describer Rett’s Syndrome

Back 18

– Child appears to grow and develop normally for first 2 years
– normal psychomotor development in the first 5 mths
– Normal head circumference at birth
– Caused by spontaneous mutation in the MPEC2 gene, on the X chromosome
– one in every 10,000 to 15,000 (female births)

Front 19

What key change is made to the classification of Rett’s Syndrome in the DSM-5 and why?

Back 19

It was been reclassified from ASD to degenerative disorder because a biological marker has been identified

Front 20

What are six main symptoms which indicate the onset of Rett’s Syndrome?

Back 20

1. Deceleration of head growth btw 5-48 months
2. Loss of purposive hand skills 3-30 mths
3. Stereotyped hand movements (hand writing, washing etc)
4. Loss of social engagement
5. Poorly coordinated gait or trunk movements
6. Severely impaired expressive and receptive language

Front 21

What does it mean that both positive (abnormal) and negative (the absence of normal) behaviours are required to make a diagnosis of autism?

Back 21

Positive – e.g. flapping and eye gaze abnormalities and Negative – e.g. language and social development

Front 22

In the DMS-5 what DSM-IV disorders are now included in the DSM-5 ASD?

Back 22

1. Early infantile syndrome
2. Childhood autism / Kanner’s autism
3. High functioning autism, atypical autism
4. PDD-NOS
5. Childhood Disintegrative Disorder
6. Asperger’s Disorder

Front 23

What new communication disorder is being included in the DSM-5?

Back 23

Social (pragmatic) Communication Disorder

Front 24

Describer the DSM-5 criteria for ASD.

Back 24

Criterion A: Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays (All three criteria, currently or by history)
Criterion B: Restricted, repetitive patterns of behaviour, interests or activities (at least 2 of the 4, currently or by history)
Criterion C: Symptoms must be present in early childhood and may not fully manifest until social demands exceed limited capacities Criterion D: Symptoms together limit and impair everyday functioning

Front 25

What is the new symptom included in the DSM-5 under Criterion B (restricted, repetitive behaviours)?

Back 25

Hyper or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment, such as
– apparent indifference to pain/temperature
– adverse response to specific sounds or textures
– excessive smelling or touching of objects
– visual fascination with lights or movement

Front 26

Describe the severity specifiers for ASD in the DSM-5 for criterion A and B.

Back 26

Level 1 – Requiring support
Level 2 – Requiring substantial support
Level 3 – Requiring very substantial support

Front 27

What are 5 specifiers for ASD in the DSM-5?

Back 27

1. Without or without accompanying ID
2. without or without accompanying language impairment
3. Associated with known medical or genetic condition or environmental factor (ie down’s syndrome, fragile X syndrome, epilepsy, FAS)
4. Associated with another neurodevelopmental, mental, or behavioural disorder
5. With catatonia

Front 28

Why are the changes in DSM-5 for the presentation of ASD described as having more of a developmental approach?

Back 28

Because includes specific examples of behaviours in each domain and it provides clinicians with better guidelines for the changing manifestations of symtomology across the lifespan (toddler to adults)

Front 29

What is the DSM-5 criteria for Social (Pragmatic) Communication Disorder?

Back 29

A: Persistent difficulties in the social use of verbal and non-verbal communication (need to meet all 4 symptoms)
1. Deficits in using communication for social purposes
2. Impairments in ability to change communication to match context or needs of the listener
3. Difficulties following rules for conversation and storytelling
4. Difficulties in understanding what is not explicitly stated ( e.g. inferences, humour, metaphor)
B: Deficits in functional limitations
C: Onset in early developmental period
D: Symptoms not attributable to another medical or neurological condition or to low abilities in the domain of word structure and grammar along with no other differential diagnosis for developmental or mental disorder

Front 30

Social (pragmatic) communication disorder is characterized by what?

Back 30

Primary difficulty with pragmatics (social use of language and deficits in understanding and following social rules of verbal and non-verbal communication)

Front 31

What are the main differential diagnosis which must be ruled out before a diagnosis of Social Communication Disorder can be made?

Back 31

ASD, ADHD, SAD, ID, Global Developmental Delay

Front 32

What are some of the issues with Social (pragmatic) Communication Disorder?

Back 32

– intended to fill a gap?
– symptoms of ASd or new disorder
– lack of clinical measures for assessing pragmatic impairments
– lack of evidence for reliability and validity of SCD as an independent disorder!

Front 33

Finish this sentence “Assessment and diagnosis of ASD requires a ….“

Back 33

multidisciplinary approach

Front 34

Identify some of the professionals involved in the assessment and treatment of ASD.

Back 34

– paediatrician
– psychologist
– speech pathologist
– psychiatrist
– neurologist
– geneticist
– occupational therapist
– physiotherapist

Front 35

Describe 5 measures, including ages, used to screen for ASD?

Back 35

1. DBC – autism screening algorithm (4-18 yo with ID)
2. SRS - Social Responsiveness Scale (4-18 yo)
3. SCQ – Social Communication Questionnaire (age 4+ with mental age 2+)
4. CHAT, M-CHAT, Q-CHAT - Checklist for Autism in Toddlers (originally as an 18mth screen Q-CHAT used for 18-24 mths)
5. DBC-ES (Early screen 18 to 48 mths)

Front 36

What should take place prior to assessing for ASD?

Back 36

Formal screening

Front 37

Finish this sentence “ASD screening measures vary in both their….”

Back 37

Specificity and sensitivity

Front 38

What are the 5 important elements of diagnostic information in an ASD assessment?

Back 38

1. Interview with parents (key)
2. Assessment of child
3. Observation in relevant environments
4. Reports form teachers
5. Medical (paediatric and genetic)

Front 39

Developmental/cognitive assessment is important for assessing what?

Back 39

- Determining the childs overall level of functioning
- Assist with differential diagnosis
- Provides a frame for interpretation of the assessment
- Education planning - Access to services and support
- Intervention planning - Evaluating intervention/treatment effects
- Evaluate need for neuropsychological assessment

Front 40

What are the 7 main components of an ASD assessment?

Back 40

1. Developmental history
2. Intervention history
3. Developmental/cognitive assessment
4. Adaptive behaviour skills
5. Autism symptomology
6. Family and psychosocial factors
7. Behaviour and emotional problems

Front 41

What type of information regarding developmental history is gathered when assessing for autism?

Back 41

- motor milestones
- onset/recognition of problems (when, why and unusual aspects of development)
- Communication milestones
- Developmental regression
- Social relatedness in the first few years of life
- Unusual behaviours or environmental responses
- Family history (psychopathology and developmental disorders)

Front 42

What information is gathered when interviewing parent during an assessment for autism?

Back 42

1. developmental history (mandatory)
2. Social, communication, repetitive and stereotyped behaviors (Core)
3. Other problem behaviours
4. Pervasiveness of behaviours (cross context)

Front 43

What information is gathered when assessing the child for autism?

Back 43

1. Child observation
2. Cognitive/developmental assessment
3. Adaptive behaviour assessment
4. Language assessment
5. OT assessment

Front 44

What information is gathered about intervention history when conducting an assessment for autism?

Back 44

1. Education programmes
2. Behavioural interventions
3. Speech-language therapy
4. Occupational therapy
5. Medication
6. Child’s response to past/current interventions

Front 45

What information is gathered about family and psychosocial factors when conducting an assessment for autism?

Back 45

1. Support system (family and community)
2. Stressors
3. Parental mental health
4. Parents skills training – behaviour management
5. Parent support groups

Front 46

What are 5 criteria for a selecting a test for a development/cognitive assessment for autism?

Back 46

1. Appropriate for both mental and chronological age
2. Provides a full range of standard scores
3. Assesses, measures and scores verbal and non-verbal skills separately
4. Provides an overall index of ability
5. Has norms that are current and relatively independent of social functioning

Front 47

What are 8 main developmental/cognitive measures used with children?

Back 47

1. Bayley scales of Infant Development
2. Mullen Scales of Early Learning
3. Wechsler tests – WPPSI, WISC, WAIS
4. Stanford Binet
5. Leiter (non verbal test)
6. Non Verbal Wechsler
7. Differential Abilities Scale (DAS) (less verbally demanding)
8. Psycheducational Profile (PEP)

Front 48

What is the main measure used to assess adaptive functioning in children?

Back 48

Vineland Adaptive Behaviour Scales

Front 49

What are adaptive behaviour skills?

Back 49

The capability for self-sufficiency in ADL’s

Front 50

Along with cognitive assessment, what is an important component in the assessment of intellectual disability?

Back 50

Adaptive Behaviour Skills

Front 51

What three areas of autism symptomology are evaluated during and autism assessment?

Back 51

1. Reciprocal social interaction
2. Communication
3. Restricted, repetitive and stereotyped patterns of behaviour

Front 52

What are the 6 main parent/teacher interviews/questionnaires used to assess for autism symptomology?

Back 52

1. ADI – Autism Diagnostic Interview
2. DISCO – Diagnostic Interview for Social and communication Disorders
3. PIA – Parent Interview for Autism
4. 3Di – Developmental, Dimensional and Diagnostic interview
5. GARS – Gilliam Autism Rating Scale
6. SRS – Social Responsiveness Scale

Front 53

Describe the ADI.

Back 53

- Autism Diagnostic Interview
- Parent interview measuring autism symptomology
- Used from age 24 months
- Toddler version from 10 months
- Strong psychometric properties

Front 54

Describe the DISCO.

Back 54

- Diagnostic Interview for Social and Communication Disorders
- Parent interview measuring autism symptomology
- Used from age 3 years
- Further evaluation of psychometric properties needed

Front 55

Describe the PIA

Back 55

- Parent Interview for Autism
- Measuring autism symptomology
- Structured interview for young children

Front 56

Describe the 3Di.

Back 56

- Development, Dimensional and Diagnostic Interview
- Parent interview measuring autism symptomology
- Broader in scope than the ADI as it also assesses for other psychiatric diagnosis
- Very little published psychometric validation

Front 57

Describe the GARS

Back 57

- Gilliam Autism Rating Scale
- Parent questionnaire measuring autism symptomology
- Reported problems with psychometric properties

Front 58

Describe the SRS

Back 58

- Social Responsiveness Scale
- Parent and teacher report measuring autism symptomology
- For ages 4 to 18 years
- Assesses social awareness, social information processing, capacity for reciprocal social communication, social anxiety/avoidance, and autistic preoccupations and traits

Front 59

What are the three main clinician administered observation measure for assessing autism symptomology in children?

Back 59

1. ADOS – Autism Diagnostic Observation Schedule
2. CARS – Childhood Autism Rating Scale
3. STAT – Screening Tool for Autism in Two-Year-Olds

Front 60

Describe the ADOS.

Back 60

- Autism Diagnostic Observation Schedule
- Clinician administered observation measure for autism symptomology
- More recently developed version for toddlers which has improved psychometric properties for the very young

Front 61

Describe the CARS

Back 61

- Childhood Autism Rating Scale
- Clinician administered observation measure for autism symptomology
- For ages 24 months and older
- Revised version released in 2010

Front 62

Describe the STAT

Back 62

- Screening Tool for Autism in Two-Year-Olds
- Level 2 tool (clinician completed assessment for autism symptomology)

Front 63

What are the main challenges in assessing very young children for autism?

Back 63

1. Symptoms at an early age are more subtle
2. Can be difficult to distinguish between autism and other developmental difficulties at an early age
3. Stability of diagnosis in children under 2 years but not before 12 months however there is still some uncertainty regarding this stability
4. Often difficult to obtain a cross context assessment

Front 64

Finish this sentence “assessment measures and tool are an important…”

Back 64

PART of a comprehensive autism evaluation

Front 65

Finish this sentence “instruments such as the ADI-R, ADOS, and DISCO result in a…..”

Back 65

classification not a diagnosis by itself

Front 66

Psychological assessment for autism is part of a multidisciplinary assessment broadly covering what 4 main areas?

Back 66

1. Development/Cognitive Assessment
2. Adaptive Behaviour
3. Symptomology (behaviour)
4. Family support and stressors