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36 Cards in this Set
- Front
- Back
ASD as a cluster of neurodevelopmental disorders: |
- Represents a deviance from the normal developmental course; a different way of developing, not just a delay in the pace of normal development - Highly heterogeneous; probably a cluster of conditions with different causes and siliar behavioural representation - No definitive genetic/biological test |
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Assessment: |
Procedure of gathering information about a person's skills and weaknesses - Thorough assessments are needed for accurate diagnosis and need to be able to indicate a treatment/management plan |
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Diagnosis: |
Deciding that a particular classification fits that person's presentation - Can be difficult because symptoms vary considerably in different people and symptoms are expressed differently at different chronological/mental ages |
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Who is involved in an assessment and diagnosis? |
Multidisciplinary team with ASD expertise: - Medical practitioner: Paediatrician, Psychiatrist.- Allied health workers: Speech Pathologist & Psychologist. - Others may include: Occupational Therapist, Social Workers & Educators. |
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How are assessments conducted? |
- Specialist team/clinic (sent to an ASD clinic at the Royal Children's Hospital) - Oversight by medical practitioner with referral to allied health workers. |
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What tools are used during an assessment? |
- Standardised assessments (different tests) & other forms of information gathering (informal observation at school). - Combined with clinical judgement – toward a DSM-5 Diagnostic Classification. |
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Steps to and through an ASD diagnosis: |
1. Concerns raised 2. Referral for assessment/monitoring 3. Diagnosis given 4. Intervention/Support accessed These steps may overlap, go back and forth, or be out of order |
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"Concerns Raised" |
Either: - The parent becomes concerned. - Someone else raises concerns to parent (relative; friend; child minder) - Concerns identified through standard community screening: - Maternal & Child Health (MCH) nurse or similar - Triggers referral to GP; Paediatrician; Speech Therapist; Specialist service |
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Community Based Screening for ASD - Level 1 |
Screening tools to ‘flag’ potential early ASD: - Targets all children during standard wellness checks, there is often low specificity in tests Checklist for Autism in Toddlers (CHAT; Baron-Cohen et al., 1992; 1996): ̶ Administered at 18-months: Excellent specificity (98%); poor sensitivity (38%). Modified-CHAT (Robins et al., 2001): ̶ Administered at 24 months: Identifies many children who do not have ASD. Early Screening of Autistic Traits Questionnaire (ESAT; Swinkelset al., 2006): ̶ Well-baby clinic at 14 months: again, low sensitivity |
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Community Based Screening for ASD - Level 2 |
- For those flagged 'at risk' on the basis of level 1 screening - Referred for level 2 screen (cheap&quick) and diagnostic assessment (expensive&lengthy) - Aims to specifically identify children with ASD vs. other developmental difficulties. - Social Communication Questionnaire (SCQ; Rutter et al., 2003) - Parent questionnaire. Childhood Autism Rating Scales (CARS; Schopleret al., 1988) |
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Developmental Surveillance |
- There are multiple time points where children are able to be assessed - This is a level 1 tool with a different procedure |
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There are multiple opportunities/ages to 'catch' children showing early signs for Developmental Surveillance: |
--> 12 months --> 18 months --> 24 months --> 36 months |
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Specificity |
Proportion of children without ASD, correctly identified as such (how specific the test is - ability to rule out non-ASD) |
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Sensitivity |
Proportion of children with ASD, correctly identified as such (how sensitive the test is at correctly detecting children with ASD) |
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Positive Predictive Value (PPV) |
Test "accuracy" - case ascertainment rate |
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Negative Predictive Value (NPV) |
Correctly identifying that a child is "not at risk" |
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Social Attention and Communication Study |
- 241 MCH Nurses were trained - Surveillance on 20,770 children in Melbourne - Those at risk were referred - Then followed up every 6 months until they were 24 months old - Total children showing ASD: 89/110 Positive Predictive Value: 81% Estimated Sensitivity: 83.4% Estimated Specificity: 99.9% |
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From the Social Attention and Communication study, what was the estimated prevalence of ASD? |
1 in 119 children (~1%) |
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Autism Diagnostic Observation Schedule (ADOS) (Lord et al., 2000-2013) |
• Focus of observation is on key diagnostic features. - Social motivation and communication skills. - Restricted, repetitive and stereotyped behaviours & interests. • Assessor does specific things and observes child’s response. - Various aspects of behaviour scored. - Key items transferred to ‘diagnostic algorithm’. - Cut-off scores facilitate interpretation |
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Autism Diagnostic Interview - Revised (ADI-R) (Lord et al., 1994) |
- Semi-structured interview assessment with parent/caregiver reports > Social motivation and communication skills. > Restricted, repetitive and stereotyped behaviours & interests. > Allows checking of ‘onset’ criterion and regression. - Interviewer scores various aspects of parent/caregiver response |
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Mullen Scales of Early Learning (1995) |
Tests: • Visuo-Spatial Skills • Motor Skills: Gross Motor & Fine Motor • Language Skills: Receptive (comprehension) & Expressive (production) |
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What is the atypical profile common in ASD? |
They have visuo-spatial strengths and language weaknesses (especially receptive language) - There is an atypical profile of different strengths and weaknesses in cognitive skills - What we see in autism is often a strange profile where some skills are abnormally good and otherskills are abnormally poor for that particular person's age - Performance is normally in a straight line on average, across the different domains |
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If it is not ASD then it could be (and not to be confused with): |
- Acquired brain injury - Speech/language impairment (SLI); Attention-deficit/hyperactivity disorder (ADHD); Obsessive compulsive disorder (OCD); Psychopathy; Schizophrenia. |
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What occurs after an ASD diagnosis? |
- Intervention - Management - Support |
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What percentage of parents reported suspecting a problem with then child at <12 months? |
~ 50% The interval between first concerns and seeking professional help M = 6 months |
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What was the average time between parental first concerns & ASD diagnosis? |
2 - 4 years Diagnosis is usually between 3 & 5 years (Bent, Dissanayake & Barbaro, 2015), with the average age of diagnosis being 4.1 years |
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What are the four broad methods for identifying the early signs of ASD? |
1. Retrospective parent report 2. Retrospective analysis of home video footage 3. Prospective high-risk sibling studies. 4. Prospective community-based screening/surveillance studies |
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What is the definition of retrospective? |
Looking back in time |
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What is the definition of prospective? |
Looking forward in time |
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Method 1: Retrospective Parent Report |
Done through an interview or questionnaire - Problems may be present < 3 years - Problems may always be there or may have a regressive onset - Parent-report can be subject to recall/response biases - Behaviours of interest may be too subtle to notice |
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Method 2: Retrospective Home Video Studies |
Objective observation of natural behaviour in real life contexts through using technology (video cameras) This allows to show for any irregular behaviours/ symptoms of ASD |
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Method 3: Prospective High-Risk Sibling Studies |
- There is a ~1% population prevalence - But there is high heritability ~20% sibling recurrence - Recruit participants in toddler-hood; infancy; (pre-natally!?) - Track over early developmental period and assess for ASD |
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Method 4: Prospective Identification in the Community |
• Large sample sizes required: e.g. if 1% population prevalence & you want 100 children with ASD, need to screen at least 10,000 children – and only if your test has Tim (Godber)’s “perfect d”... ;) • Can only ‘catch’ children as early as the screening tool ‘works’. • Long follow-up time required. |
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When does ASD first appear? |
Three different modes of onset: 1. Innate: Born with it and presents right away. 2. Plateau: Starts fine but rate of development slows (still acquiring new skills but not as quickly) 3. Regression: Starts fine with sudden skills loss (child ‘becomes’ autistic) |
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Canalisation: |
Restored ‘normative’ development in many high-risk siblings |
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What are "simplex" and "multiplex" families? |
“Multiplex” refers to families in which multiple individuals are affected by a specific disease, while “simplex” refers to families in which only a single individual has a specific disease. |