Chapter 6 – autism spectrum disorder (ASD)
ASD: complex neurodevelopmental disorder characterized by abnormalities in social communication
and unusual behaviors and interests. Children with ASD behave in unusual and frequently puzzling
ways focus on minuscule things over the whole environment.
- Bad relationships/communication
- Bad talking
- No facial expressions
Leads to isolation. Biologically based lifelong neurodevelopmental (first few years of life) disorder.
Preservation of sameness: anxious and obsessive insistence on the maintenance which no one but
the child may disrupt.
DSM-5 defining features of ASD:
- Represented in 2 symptoms both domains, early development, multiple settings and
persistent:
o Social communication and interaction. Only this symptom? social community
disorder (Chapter 7).
Deficits in social emotional reciprocity
Deficits in nonverbal communication behaviors used by social interaction
Deficits in developing, maintaining and understanding relationships
o Restricted repetitive patterns of behavior, interest or activities. At least two types for
ASD.
Stereotyped or repetitive motor movements, use of objects or speech
Insistence on sameness, inflexible adherence to routines, or ritualized
patterns of verbal or nonverbal behavior
Highly restricted, fixated interests that are abnormal in intensity of focus
Hyperactivity or hyper reactivity to sensory input or unusual interest in
sensory aspects of the environment.
Severity levels of rating the currents symptoms interfere with the child’s functioning:
o Level 1: requiring support
o Level 2: substantial support
o Level 3: very substantial support
o low validity, because every situation for an individual is different
Changes in DSM-4 to DSM-5:
- Social interaction and social communication where two different domains, now we have two
domains
- DSM-5 eliminated all previous subtypes of ASD Asperger, pervasive developmental
disorder, autistic. To increase the consistency of diagnosing ASD, but there is heterogeneity
within the disorder.
Classification:
- Use of specifiers: is ASD associated with a known medical or genetic condition?
- Use of modifiers: indicate when other important conditions are present and/or when ASD is
associated with another neurodevelopmental, mental or behavioral disorder
- more detailed description.
Maybe that children with less severe symptoms could be disadvantaged by changes in DSM-5. In
terms of eligibility (verkiesbaarheid) for services.
, ASD across the spectrum:
Spectrum disorder: it is symptoms abilities and characteristics are expressed in many different
combinations and in any degree of severity (ASD).
Core deficits of ASD:
- Social interaction deficits:
o Lack of monitoring of the social activities of others
o Lack of social and emotional reciprocity
o Atypical facial expressions
o Lack of interest and/or difficulty relating to others
o Failure to share enjoyment and interest with others
Direct eye contact is hard mouth associated with fear. Impairments with joint attention:
ability to coordinate attention to a social partner and an object or event of mutual interest.
- Social communication deficits:
Most children has passed the predictable milestones by 3 years old.
o Proto imperative gestures: gestures or vocalizations that are used to express needs+
o Proto declarative gestures: gestures or vocalizations that direct the visual attention
of other people to objects of shared interest requires interaction, shared social
attention and understanding what other people think -
o Showing gestures: showing new discover objects to others -
o Instrumental gestures: primitive forms of communication (pulling arms into
direction) +
o Expressive gestures: to convey feelings/emotions -
Pronoun reversal: is a common language impairment in children with ASD, which occurs
when the child repeats personal pronouns exactly as heard. No matter in which situation.
Impairments with pragmatics: appropriate use of language in social and communicative
contexts. Being unable to interpret the context of what is spoken to him or her.
- Restricted and repetitive behaviors and interests:
Are characterized by their high frequency, repetition in a fixed manner and desire for
sameness in the environment.
Type of repetitive speech (learn how to talk) (DSM-5):
o Echolalia: which is the child’s parrot-like repetition of words or word combinations
that is heard first step op language acquisition for children with ASD.
o Perseverative speech: incessant (onophoudelijk) talking about one topic and
incessant questioning desire to talk and communicate
Two dimensions of restricted and repetitive behaviors:
1. Repetitive sensory and motor behaviors
2. Insistence on sameness behaviors
Self-stimulatory behaviors: stereotypes as well as repetitive body movements or movements
op objects. May be linked to genetic disorders, such as fragile-X syndrome, reason is not
known.
Sensory over responsivity: involves a negative response to avoidance of sensory stimuli
(touching and cuddling)
ASD: complex neurodevelopmental disorder characterized by abnormalities in social communication
and unusual behaviors and interests. Children with ASD behave in unusual and frequently puzzling
ways focus on minuscule things over the whole environment.
- Bad relationships/communication
- Bad talking
- No facial expressions
Leads to isolation. Biologically based lifelong neurodevelopmental (first few years of life) disorder.
Preservation of sameness: anxious and obsessive insistence on the maintenance which no one but
the child may disrupt.
DSM-5 defining features of ASD:
- Represented in 2 symptoms both domains, early development, multiple settings and
persistent:
o Social communication and interaction. Only this symptom? social community
disorder (Chapter 7).
Deficits in social emotional reciprocity
Deficits in nonverbal communication behaviors used by social interaction
Deficits in developing, maintaining and understanding relationships
o Restricted repetitive patterns of behavior, interest or activities. At least two types for
ASD.
Stereotyped or repetitive motor movements, use of objects or speech
Insistence on sameness, inflexible adherence to routines, or ritualized
patterns of verbal or nonverbal behavior
Highly restricted, fixated interests that are abnormal in intensity of focus
Hyperactivity or hyper reactivity to sensory input or unusual interest in
sensory aspects of the environment.
Severity levels of rating the currents symptoms interfere with the child’s functioning:
o Level 1: requiring support
o Level 2: substantial support
o Level 3: very substantial support
o low validity, because every situation for an individual is different
Changes in DSM-4 to DSM-5:
- Social interaction and social communication where two different domains, now we have two
domains
- DSM-5 eliminated all previous subtypes of ASD Asperger, pervasive developmental
disorder, autistic. To increase the consistency of diagnosing ASD, but there is heterogeneity
within the disorder.
Classification:
- Use of specifiers: is ASD associated with a known medical or genetic condition?
- Use of modifiers: indicate when other important conditions are present and/or when ASD is
associated with another neurodevelopmental, mental or behavioral disorder
- more detailed description.
Maybe that children with less severe symptoms could be disadvantaged by changes in DSM-5. In
terms of eligibility (verkiesbaarheid) for services.
, ASD across the spectrum:
Spectrum disorder: it is symptoms abilities and characteristics are expressed in many different
combinations and in any degree of severity (ASD).
Core deficits of ASD:
- Social interaction deficits:
o Lack of monitoring of the social activities of others
o Lack of social and emotional reciprocity
o Atypical facial expressions
o Lack of interest and/or difficulty relating to others
o Failure to share enjoyment and interest with others
Direct eye contact is hard mouth associated with fear. Impairments with joint attention:
ability to coordinate attention to a social partner and an object or event of mutual interest.
- Social communication deficits:
Most children has passed the predictable milestones by 3 years old.
o Proto imperative gestures: gestures or vocalizations that are used to express needs+
o Proto declarative gestures: gestures or vocalizations that direct the visual attention
of other people to objects of shared interest requires interaction, shared social
attention and understanding what other people think -
o Showing gestures: showing new discover objects to others -
o Instrumental gestures: primitive forms of communication (pulling arms into
direction) +
o Expressive gestures: to convey feelings/emotions -
Pronoun reversal: is a common language impairment in children with ASD, which occurs
when the child repeats personal pronouns exactly as heard. No matter in which situation.
Impairments with pragmatics: appropriate use of language in social and communicative
contexts. Being unable to interpret the context of what is spoken to him or her.
- Restricted and repetitive behaviors and interests:
Are characterized by their high frequency, repetition in a fixed manner and desire for
sameness in the environment.
Type of repetitive speech (learn how to talk) (DSM-5):
o Echolalia: which is the child’s parrot-like repetition of words or word combinations
that is heard first step op language acquisition for children with ASD.
o Perseverative speech: incessant (onophoudelijk) talking about one topic and
incessant questioning desire to talk and communicate
Two dimensions of restricted and repetitive behaviors:
1. Repetitive sensory and motor behaviors
2. Insistence on sameness behaviors
Self-stimulatory behaviors: stereotypes as well as repetitive body movements or movements
op objects. May be linked to genetic disorders, such as fragile-X syndrome, reason is not
known.
Sensory over responsivity: involves a negative response to avoidance of sensory stimuli
(touching and cuddling)
