Autism Spectrum Disorder
What is Autism Spectrum Disorder a combination of?
Autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder
Strengths with having ASD
- being able to learn things in detail and remember information for long periods of time
- being strong visual and auditory learners
- excelling in math, science, music, or art
DSM-5 definition of ADHD
- inattention: not focusing, careless, doesn't seem to listen; sustained attention; alerting
-hyperactive and impulsive: constantly in motion, fidgets, talks excessively; blurts out answers, doesn't wait turn
Risk factors for developmental course
- family relationships
- goodness of fit model
- peer relationships
- achievement
- cascade of effects (internal & external obstacles)
- prognosis
DSM-5 definition of ODD
- age inappropriate display of angry mood, defiant behaviours, vindictiveness
- symptoms are grouped into negative affect and defiance and hurtful behaviour
- vindictiveness (at least 2x in past 6 months)
- distress or impairment
- <5 most days in 6 months, 5+ 1/week in 6 months
Early recognition of ASD
6-12 months:
- less preference for social stimuli, less social orienting, less anticipatory pleasure associated with social stimuli (ex. smiling faces
12-18 months:
- joint attention, social imitation, face processing
Characteristics associated with ASD
- self-injurious behaviours
- sleep disturbances
- gastrointestinal symptoms
- epilepsy
- co-morbid mental health concerns
DSM-5 revisions of ADHD
- developmental sensitivity
- age of onset raised
- not solely oppositional behaviour, failure to understand task, etc.
Strength-based approaches
- deficit approach: keeps focus on what's wrong and how to fix it
- need attention to strengths or to the factors that help cope and work effectively: identify what going right and building on strengths and protective resources
- embrace divergent thinking
- value of understanding role of ADHD in life
DSM-5 definition of CD
- more serious list of antisocial and aggressive behaviours (e.g., inflicting pain on others, denying the basic rights of others, violating social norms or rules)
What are some of the restricted/repetitive patterns of behaviour?
motor stereotypies: repetitive motor movements and speech
insistence on sameness: inflexible adherence to routines and rituals, changes cause distress
restricted fixated interests: restricted range of interest, line up objects over and over
reactivity to sensory input: over-react to specific sounds/texture, difficulty shifting attention to sensory input, under-react to pain/temperature
Risks for developing ASD
- parental rejection
- psychosocial causes
- genetic & biological factors
- environmental risk factors (compromised fetal/neonatal development, parental age, environmental toxins)
- genetic-environment interactions
- abnormalities in brain development
What are the 3 different presentations of ADHD and can they change over time?
- ADHD-PI: predominantly inattentive (slow processing, selective attention)
- ADHD-HI: predominantly hyperactive-impulsive (inhibiting behaviour, aggressive, defiant, rejected by peers)
- ADHD-C: combined type
Evidence based treatments
multi-modal treatment:
1. learning about ADHD (parents, teacher, child)
2. medication (stimulants 1st line treatment)
3. parent training programs (< age 12)
4. classroom support/accomodations
5. organizational skills interventions (> age 8)
Risk factors/associate problems
- biological: difficult temperament, parent pathology, tendency to seek rewards, impulsivity, insensitivity to punishment, low arousal, regulatory processes such as anterior cingulate cortex (ACC) & prefrontal cortex
- individual/psychological: lower verbal skills, executive functioning deficits, ADHD
- social-cognitive deficits & distortions: encode, interpret, search for a response option, evaluate response options, enact a response
- hostile attributional bias
- relational/social: difficulties with peers, ineffective parenting (ineffective discipline, harsh discipline, low involvement, poor supervision, coercive cycles), family disturbance
- sociocultural: social disadvantage, policies that systemically harm youth who are already marginalized, systemic racism, prejudice, profiling, the weight of low expectations
What are some of the social behaviours of a child with ASD?
joint attention and spontaneous sharing
social awareness: understanding of other people's emotions
inconsistent use of preverbal gestures
delay or lack of spoken language
unusual use of language (social chatter, pronoun reversal, pragmatic aspects of language)
Support approaches to ASD
- naturalistic developmental behavioural interventions (NBDI): parent coaching
- symptom-based: needs vary with developmental stage
- family needs
Emotional challenges with ADHD
- flash emotions
- low frustration tolerance
- sensitive to rejection
- overreaction
- reactive aggression
- impatience
Cultural considerations with ADHD
- ADHD occurs among all socioecononic groups, slightly higher in lower SES
- functional impairment is more universal and less culturally-driven than interpretation of symptoms
- disparities in access to assessment and intervention
Psychological treatments
- parenting interventions
- parent child interaction therapy
- child: emotion regulation, problem solving, social competence
family interventions, including multi-systemic family therapy
DSM-5 definition of ASD
- significant and persistent deficits in a social interaction and communication skills
- restricted, and repetitive patterns of interests and behaviours
- symptoms must be present in early developmental period
-symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
Symptoms of ASD in girls
- overly rehearsed social scripts
- imaginative play: more scripted/obsessive
- masking symptoms: camouflage hypothesis
- socially acceptable interests (e.g., horses, princesses, cats)
Risk factors for ADHD
- neurobiological influences: decreased blood flow to prefrontal regions, brain abnormalities, neurotransmitters (especially dopamine and norepinephrine), pregnancy/birth complications
- gene-environment interactions
ADHD co-morbidity
- disruptive behaviours disorders : ~50%
- anxiety disorders: ~25-50%
- depression: 20-30%
- learning disabilities: up to 45%
- speech and language: 30-60%
- motor coordination difficulties: 30-50%
- tic disorder: 20%
- 3x more like to get accidental injury
The two subtypes of CD in DSM-5
- childhood onset: early onset and persists, more aggressive symptoms, correlates with neuropsychological deficits, academic failure and family externalizing and discord
- adolescent onset: antisocial behaviour begins around puberty and ends in young adulthood (covert behaviours, less extreme behaviours, less likely to drop out, stronger family ties, peer influence), "late" starter (not a benign outcome, perpetuated by "snares" - the further obstacles it creates)