diagnosis the pros and cons of the changes made.

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Please choose 1 diagnosis and discuss the pros and cons of the changes madeAutism Spectrum
Disorder
From PDD to ASD: A Focus on Autism
Spectrum Disorders
◼ Characterized by impairments in:
◼ Social interaction
◼ Communication/Language
◼ Behavior and interests
Associated Problems in Autism
◼ Deficits in joint attention behavior
◼ Poor eye contact
◼ Lack of social reciprocity
◼ Mutism or echolalia and pronoun reversals
◼ Poor pragmatics
◼ Stereotyped behaviors
◼ Unusual preoccupations/obsessions
◼ Oversensitivity or undersensitivity

Intellectual problems

Splinter skills

Savant skills

Adaptive behavior deficits

Motor problems

Behavioral problems
From PDD to ASD
DSM-IV-TR
Pervasive Developmental
Disorders
◼Autistic Disorder
◼Asperger’s Disorder
◼Pervasive developmental
Disorder, NOS
◼Childhood Disintegrative
Disorder
◼Rett’s Disorder
DSM-V
◼ Autism Spectrum
Disorders (ASD)
Changes in Diagnostic Criteria
DSM-IV-TR
DSM-V






Qualitative impairment in social
interaction (2 out of 4)
Qualitative impairments in
communication (2 out of 4)
Restricted repetitive and stereotyped
patterns of behavior, interests, and
activities (1 out of 4)
Delays or abnormal functioning in at
least one of the following areas, with
onset prior to age 3 years: (1) social
interaction, (2) language as used in
social communication, or (3) symbolic
or imaginative play.
The disturbance is not better
accounted for by Rett’s Disorder or
Childhood Disintegrative Disorder.




Persistent deficits in social communication
and social interaction across multiple
contexts, (3 out of 3)
Restricted, repetitive patterns of behavior,
interests, or activities (2 out of 4)
Symptoms must be present in early
childhood (but may not become fully
manifest until social demands exceed
limited capacities, or may be masked by
learned strategies later in life)
Symptoms cause clinically significant
impairment in social, occupational, or
other important areas of current
functioning
Not better explained by intellectual
disability or global developmental delay.
Severity Level
Requiring Support
Level One
Requiring Substantial Support
Level Two
Requiring Very Substantial Support
Level Three
New Diagnosis:
Social Communication Disorder
◼ Similar to Autism without the interest or
engagement in unusual behaviours, unusual
interests, or an unusual degree of interest in
something.
◼ Suggested that it may be where some of the
individuals previously diagnosed with PDD
Nos or Asperger’s may fall in this category
Social (Pragmatic)
Communication Disorder
◼ Primary difficulty in pragmatics, the social use of
language and communication
◼ Deficits in understanding and following rules of verbal
and nonverbal communication in naturalistic situations
◼ Difficulty changing language according to the needs of
the listener
◼ Difficulty following rules of conversation and storytelling
◼ May have language impairments
◼ Often avoid social interactions
Epidemiology
◼ Prevalence rate has been increasing
◼ 1/600 to 1/88
◼ More prevalent in males
◼ 80 % are boys
◼ 90% are considered disabled into adulthood
◼ Unrelated to social class
◼ Developmental course quite variable
◼ Better prognosis with higher IQ, better verbal skills and
early intervention
Incidence of Autism (USA)
http://www.cdc.gov/ncbddd/autism/data.html
Theories of Etiology
Psychological Deficits
◼ Theory of Mind

Neurobiological Abnormalities
◼ Temporal lobe-limbic system,
frontal lobes, cerebellum
Genetic Disorder
◼ Chromosome 11 – 11p 12-p13
and neurexin 1
(Autism Genome Project)
Etiology Cont’d
Genetics
◼ Twin (identical 36-95 %, fraternal 0-31%)
◼ Family (if have one child with ASD, 2-18% likelihood of
second child with ASD)
Factors Believed to Contribute to Autism
◼ Parental age
◼ Exposure to toxins
◼ Postnatal challenges
◼ Diet and nutrition
◼ Prenatal factors
Old Theories
◼ Refrigerator mother-debunked
◼ Vaccines-CDC has not found support
for the theory that the MMR vaccine
causes the disorder
Assessment
◼ Developmental History
◼ Observations
◼ Standardized checklists for autistic behaviors
◼ Social Communication Questionnaire
◼ CARS
◼ ADOS
◼ ADI-R
◼ Intellectual assessment
◼ Adaptive behavior Assessment
Treatment
◼ Pharmacological treatment
◼ Behavioral Interventions
◼ Pivotal Response Training
◼ IBI and ABA http://youtu.be/SLBLnNxzftM
◼ TEACCH http://youtu.be/ddGLJ2r4rcw
◼ Video Modelling
◼ Programs should:
◼ Be intensive, start early, be carefully
controlled/systematic, promote generalization, involve
parents, be flexible.
Ethical/Social Cultural Concerns
◼ Over diagnosing specific populations.
◼ Changes in DSM may exclude children
previously diagnosed.
◼ Testing may only occur if resources exist to
modify programs.
◼ Accessibility to assessment and treatment.
◼ Depending on province, services may be paid
for by government.
Videos for this class
◼ What is autism
◼ http://youtu.be/bG0vko7GHDQ
◼ Interview with Temple Grandin
◼ http://youtu.be/4Mu5qlQBP50
Intellectual Disability (IDD)*
DSM V
◼ Deficits in general mental abilities (more about clinical judgment
than before)
◼ Impairment in adaptive functioning for the individual’s age and
sociocultural background
◼ All symptoms must have an onset during the developmental period
◼ Severity: Mild, Moderate, Severe, based on Adaptive Behavior
Most individuals will fall within the Mild Range
Assessing Intelligence/Cognition
◼ Based on norms and scored against similar group of
children of a similar age. Thus scores are presented
as percentiles.
◼ Predominantly measure both crystallized and fluid
intelligence. In layman’s terms: what you already
know and your ability to learn and reason.
◼ Typically focuses on verbal and visual abilities to
create a global ability score
◼ Stable over time once a child is 6-7 years of age.*
Intellectual Testing
• Image of testing
Ethical Considerations in Intelligence Testing
◼ Language
◼ Cultural bias**
◼ Specifically linked with school success
does not speak to other abilities
◼ Historically was used to provide support then became
about exclusionary criteria
◼ Currently, is used primarily to determine level of
support required and special placements and funding
◼ The government now requires psychologists to provide
evidence that someone meets the criteria for a
diagnosis of IDD.
*IQ tests in DSM-5. Assessment procedures and diagnosis must take
into account factors other that may limit performance (e.g.,
sociocultural background, native language, associated
communication/language disorder, motor or sensory handicap).
Adaptive Functioning
◼ Areas often assessed:
◼ Sensorimotor
◼ Communication
◼ Self help
◼ Socialization
◼ Community living
◼ Behavior can vary across cultures
◼ Children with IDD can experience varying
levels of adaptive functioning
Adaptive Functioning: Diagnostic Areas
Mild, Moderate, Severe Severity Levels based on:
◼Conceptual

language, reading, writing, math, reasoning, knowledge, and memory,
among others, used to solve problems.
◼Social
◼ awareness of others’ experiences, empathy, interpersonal
communication skills, friendship abilities, social judgment, and selfregulation, among others.
◼Practical
◼ self management across life settings, including personal care, job
responsibilities, money management, recreation, managing one’s
behavior, and organizing school and work tasks, among others.
Assessing Adaptive Functioning
◼ Informants
◼ Parent
◼ Caregiver
◼ Teacher
◼ Daycare worker
❖ Challenge in getting an accurate picture of
child’s adaptive functioning.
Epidemiology
◼ 1-3% of the general population
◼ More severe cases noticed earlier
◼ Childhood peak time for identification
◼ More prevalent in males
◼ Mild cases more prevalent in low SES group
◼ For Mild IDD early intervention and training
can result in a child no longer meeting the
criteria for diagnosis
Diagnosis…..now what
Main questions I get asked
1. Why did this happen?
2. What does this mean for my child’s future?
3. What can we do to help our child?
4. What services are available?
The Why
◼ One of the hardest questions to answer
◼ Many are of unknown etiology
◼ Of those we know, typically genetic disorders,
infectious disease, metabolic disorders
◼ Non”biological” or normal variation

Not considered acquired: would be an acquired brain injury
rather than MR even if the cognitive scores are the same. If
scores are the same, the services are likely similar from a
public health perspective
Now what?
◼ Children will continue to develop albeit in a
slower manner.
◼ All will have some sort of learning curve,
except in very severe cases.
◼ My main goal in talking to parents is how to
help their child grow and develop so that they
are as independent as they can be.
What can we do?
◼ Early intervention
◼ Can be OT
◼ Speech
◼ Behavioural
◼ Social
What services are available?
◼ School: special education (mainstream
movement so child is included as much as
possible.)
◼ Community: special resources for children
and their families and for adults with MR
Educational Interventions

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