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Terms in this set (31)

• Etiology and Neurologic Basis for Autism; Early studies of neurologic functioning in autism were generally exploratory and theorized:
o Enlarged lateral ventricles (3rd and 4th ventricles)
o Increased heart rate variability and increased respiration - disruption of the autonomic nervous system and brain stem function
o Abnormal nystagmus responses
o Arousal state irregularities and unusual response to novel stimuli during evoked potential studies
• Anatomy and Physiology: There are alterations in the cortex, cerebellum, and brain stem that can explain many symptoms of autism, although they do not clarify the etiology of autism
o People with autism demonstrate an increase in total brain weight, brain volume, or both; the abnormal brain weight does not seem to be present at birth, but develops during the first few year, perhaps because of abnormal neural connectivity and lack of pruning
o Several areas of the brain show signs of gray and white matter hyperplasia in 2 and 3 year old patients
• The frontal lobe showed greatest enlargement, as well as changes in the temporal and parietal while matter sections of the brain
• EEG results show reduced activity in both the frontal and temporal sections of the brain. These structural deficits could be involved with the language and social processing deficits seen in children with autism
o Children with autism may have a delay in frontal lob maturation and temporal-lob dysfunction that could be related to an autistic child's tendency to demonstrate exaggerated reactions and abnormal behaviors in responses to auditory stimuli
• Corpus Callosum:
o Irregularities have been found in the corpus callosum of subjects with autism, including a smaller size of body and posterior subregions of the corpus callosum
o 51 persons with autism showed size reduction of the corpus callosum (concentrated in posterior subregions)
• Limbic System:
o Children with autism have been show to have irregularities in the limbic system, which is important for learning and memory. The amygdala is important for emotion, behavior, and social play
o Cells in the limbic system are 1/3 smaller than normal in people with autism and are found in excessive numbers. Particularly in the hippocampus, amygdala, mammillary bodies, anterior cingulated cortex, and medial septal nuclei
• Cerebellum:
o Researchers have found a decreased number of Purkinje cells in the cerebellums of people with autism, the cells present are also smaller
o The motor deficits that characterize children with autism can be related to abnormalities of the cerebellum and the frontal lobe
• These neurologic differences are also common in other diagnoses:
o Fetal alcohol syndrome
o Congenital rubella
o Fragile X
o Epilepsy (20-35% of children with autism exhibit a seizure disorder)
-SUPPORTED:
• Genetic Basis for Autism: Many genetic studies into the etiology of autism include examination of chromosomal evidence from family and twin studies and analysis of information from the Human Genome Project
o Autism affects 2% to 6% of the siblings
o There is a greater concordance rate for autism in identical twins than fraternal twins
o The concordance rate for identical twins was higher than 90%, for fraternal twins less than 10%
o The preponderance of males with the disorder suggests an x-linked, dominant condition (mom passing affected X chromosome to male child), but this needs further study
o Specific gene research has focused on the following autosomes (Ashley-Koch et al, 1999):
• Chromosome 7
• Chromosome 15
• There are indicators on other genes: 2, 4, and 19
• Other current areas being studied for possible links to autism:
o Perinatal factors
• Abnormal presentation at labor, low birth weight, low APGAR scores
o Toxin Exposure
• Thalidomide, valporic acid (anti-seizure medication)
o Hormone disruption
• Pesticide DDT, other chemicals that disrupt the action of estrogen and hormones
• Immunization Reactions: Is there a link between childhood immunizations and autism?
o Early studies about the measles, mumps, and rubella vaccination (MMR) reported a relationship between autism and the vaccination (Wakefield, 1998); not one study has been able to have the same findings as Wakefield
• Wakefield study retracted from the journal Lancet (BIG deal) in 2010
• More current research has no found causal link between the MMR vaccination and autism (Fombonne & Chakrabarti, 2001, Miller, 2003). Other researchers concurred (Dales et al, 2001, Wilson et al, 2003, Deer, 2011)
• Studies of autism rates in 3rd world countries where the MMR vaccine was NOT administered did not show a significant difference in the prevalence or rate of autism (you would expect this rate to be lower if autism was related to the vaccination and the vaccination was not given in these countries
-UNSUPPORTED: Other Causes? Commonly found on the internet... the research is inconclusive...
o Environmental
o Yeast infections
o Intolerance to specific food substances
• Gluten intolerance (found in the seeds of various cereal plants such as wheat, oat, rye, and barley) and Casein intolerance (Casein is the principal protein in milk) causes intestinal permeability and allows improperly digested peptides to enter the bloodstream and cross the blood-brain barrier which may mimic neurotransmitters and result in the disorganization of sensory input
• Food allergies cause symptoms of autism or an insufficiency of a specific vitamin or mineral may cause some autistic symptoms
• Diets have reported to be helpful for children with autism, but their efficacy or safety have not been proven in any randomized, double-blind, clinical trials, mostly case studies
o Phenolsulphertransferase (PST) deficiency--theory that some with autism are low on sulphate or an enzyme that uses this, called phenol-sulphotransferase-P. This means that they will be unable to get rid of amines and phenolic compounds once they no longer have any use for them. These then stay in their body and may cause adverse effects, even in the brain. Treatment is dietary as well as epsom salts baths
o Intractable seizures
Communication forms the basis for social and emotional connections to other people. Language is a system in which abstract and arbitrarily assigned symbols represent concepts. For communication to be effective within a child's social and cultural group, a shared language is needed. Deficits in communication seen in children with autism:
-Deficits in joint attention (cannot shift eye gaze between people and objects during play)
-The timing and reason for looking at others and making eye contact is atypical
-Child may not use the gesture of pointing
-Child does not vocalize, babble, or engage in verbal jargon
-Unusual speech tone and rhythm
-Difficulty attending to others facial expressions
-Infrequent crying, cooing, smiling
-Does not respond to own name
-Limited understanding of object labels
-Limited understanding of novel information
-Limited understanding of direction or instruction
-Pronoun confusion (speaks in the 1st person)
-Echolalia - child reproduces sounds that are identical to the model in both tone and rate of speech
-Delayed echolalia - when utterances are repeated from past experience, could be an attempt to relate a need or want. (ie. the child states, "chocolate milk is good vs. I want some milk)
-Immediate echolalia - when a child repeats what was just said. This can reflect the child's inability to comprehend what was said or to manage social demands.
-Limited use of words
-Use of unconventional means to request something (ie. biting, rocking, spinning)
-Crying not related to obvious needs or laughing not related to situation
1. Provide a safe environment, allow for exploration within safe boundaries
2. Provide an optimal sensory environment and level of stimulation
3. Watch the child closely, respond to child's wants, desires, and attempts at subtle communication
4. Observe and respond appropriately to the child's comfort level with your physical play proximity
5. Be appropriately playful and animated
6. Be interested in what the child is doing, "get into his/her world"
7. Attempt to motivate the child to engage or interact at some level
8. All the child to have control in initiating and ending activity, follow the child's lead whenever possible, allow choices
9. Sing and use music, exaggerate vocalizations
10. Provide appropriate assistance to allow success, use nonverbal hand-over-hand guiding
11. Provide opportunities for turn-taking
12. Imitate the child and allow opportunities to imitate you, expand on what the child is doing (ie. if the child rips a piece of paper, you rip a piece of paper , the child repeats the action, then you rip the paper and throw it into a trash can)
13. Playfully block repetitive play to create new play (ie. add obstacles to negotiate for a child who is running walking in circles around an area or put something in the way of a child who is repetitively pushing blocks like a train).
14. Use familiar themes to begin pretending (ie. favorite movie or cartoon characters)
15. Use peer groups, "circle of friends" pairing autistic child with non-disabled peer in small group (dyads, triads - whatever the child can handle)
16. Use play to develop praxis skills, find a "hook" or a toy that holds particular interest to the child
Structured teaching via the TEACCH method was developed by Professor Eric Schopler and many of his colleagues at the University of North Carolina at Chapel Hill. The TEACCH method is not considered an actual therapy but rather a therapeutic tool to help autistic individuals understand their surroundings and is widely used in school settings.
• Physical structure
Physical structure refers to the actual layout or surroundings of a person's environment, such as a classroom, home, or group home. The physical boundaries are clearly defined and usually include activities like: work, play, snack, music, and transitioning.
• Scheduling
A schedule or planner is set up which indicates what the person is supposed to do and when it is supposed to happen. The person's entire day, week, and possibly month, are clearly shown to the person through words, photographs, drawings, or whatever medium is easiest for the person to comprehend.
• Work system
The work system tells the person what is expected of him/her during an activity, how much is supposed to be accomplished, and what happens after the activity is completed. The goal is to teach the person to work independently. The work system is also organized in such a way that the person has little or no difficulty figuring out what to do. For example, the activity or task should be performed from top to bottom and from left to right.
• Routine
According to the TEACCH method, the most functional skill for autistic individuals is a routine which involves checking one's schedule and following the established work system. This routine can then be used throughout the person's lifetime and in multiple situations.
• Visual structure
Visual structure refers to visually-based cues regarding organization, clarification, and instructions to assist the person in understanding what is expected of him/her. For example, a visual structure may involve using colored containers to assist the person in sorting colored materials into various groups or displaying an example of a stamped envelope when the person is asked to place stamps on envelopes.
Social impairment (extreme egocentricity)
-Inability to interact with peers
-Lack of desire to interact with peers
-Lack of appreciation of social cues
-Socially and emotionally inappropriate behavior
-Comes too close to others - "treats others like furniture"
-Approaches others only to have own needs met
-A clumsy social approach
-One-sided responses to peers
-Difficulty sensing feelings of others
-Detached from feelings of others
Narrow interests
-Exclusion of other activities (due to preoccupation in one activity/topic)
-Repetitive adherence to routines
-Excel at rote memory - learning information without meaning (don't assume a child understands information that may be "parroted" back to you)
preoccupation with part-objects or nonfunctional elements of play materials (such as their odor, the feel of their surface, or the noise/vibration that they generate); preoccupations may change over time, but not in intensity themes of transportation; trains, airplanes, dinosaurs, maps
Repetitive routines
-Unusual behaviors towards others
-Distress over changes in small, nonfunctional, details of the environment
-Speech and language peculiarities
-No clinically significant general delay in language single words used by age 2 phrases used by age 3
-Superficially perfect expressive language; overly formal; speak in a monotonous tone
-Hyperverbal - speak incessantly on a topic of interest only to themselves
-Odd prosody, peculiar voice characteristics
-Impairment of comprehension including misinterpretation of literal/implied meanings
-Often appear to talk "at" you rather than "to you"
-Repetitive patterns of speech
-Abnormalities in inflection - speak too loud
Nonverbal communication problems
-Limited use of gestures
-Clumsy/gauche body language
-Limited facial expression
-Inappropriate expression
-Peculiar, stiff eye gaze, stare
OT Treatment Goals:
• Improve attention, learning and flexibility through sensory based interventions
• Improve motor planning
• Improve social and play skills
• Improve pre-vocational skills

Keep all your speech simple - to a level they understand.
Keep instructions simple ... for complicated jobs use lists or pictures. The visual sense is usually a strength for these kids.
Try to get confirmation that they understand what you are talking about/or asking - don't rely on a stock yes or no - that they like to answer with.
Explain why they should look at you when you speak to them.... encourage them; give lots of praise for any achievement - especially when they use a social skill without prompting.
In some young children who appear not to listen - the act of 'singing' your words can have a beneficial effect.
Limit any choices to two or three items.
Limit their 'special interest' time to set amounts of time each day if you can. (Social Story)
Use turn taking activities as much as possible, not only in games but at home too.
Try to identify stress triggers - avoid them if possible -can a sensory diet be used to diffuse the issue? Anger and tantrums may become an issue, especially in school settings.
Find a way of coping with behavior problems
Teach them some strategies for coping - telling people who are teasing perhaps to 'go away' or to breathe deeply and count to 20 if they feel the urge to cry in public.
Begin early to teach the difference between private and public places and actions, so that they can develop ways of coping with more complex social rules later in life.
-Asperger's syndrome will be subsumed into Autism Disorder (Autism Spectrum Disorder)
-'Asperger syndrome' is used loosely with little agreement: Williams et al. (2008) survey of 466 professionals reporting on 348 relevant cases, showed 44% of children given Asperger, PDD-NOS, atypical autism, or 'other ASD' label actually fulfilled criteria for Autistic Disorder

1st View: That Asperger disorder is not substantially different from other forms of 'high functioning' autism (HFA); i.e. Asperger's is the part of the autism spectrum with good formal language skills and good (at least Verbal) IQ. Note that 'HFA' is itself a vague term, with under specification of the area of 'high functioning' (performance IQ, verbal IQ, adaptation, or symptom severity).
2nd View: That Asperger disorder is distinct from other subgroups within the autism spectrum (see Matson & Wilkins, 2008, review): e.g. Klin, et al. (2005) suggest the lack of differentiating findings reflects the need for a more stringent approach, with a more nuanced view of onset patterns and early language (e.g. one-sided verbosity, unusual circumscribed interests).
Witwer and Lecavalier's (2008) perhaps more comprehensive review concludes there is little evidence that Aspergers is distinct, and that current IQ is the main differentiating factor.
Bennett et al's (2008) follow-up study suggests that language impairment at 6-8 years might have greater prognostic value than early language milestones, and Szatmari et al (2009) argue (on the basis of later developmental trajectory) for a distinction between ASD with (autism) versus without (Aspergers) structural language impairment at 6-8 years.