CMN 554 – FINAL EXAM 1,2,3,4 STUDY GUIDE WITH
COMPLETE SOLUTION
MODULE 1 – Child and Adolescent Psychiatric Mental Health
Autism Spectrum Disorder: Diagnostic Criteria
A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by all of the following, currently
or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from
abnormal social approach and failure of normal back-and-forth
conversation; to reduced sharing of interests, emotions, or affect; to failure
to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in eye contact and body
language or deficits in understanding and use of gestures; to a total lack
of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships,
ranging, for example, from difficulties adjusting behavior to suit various social
contexts; to difficulties in sharing imaginative play or in making friends; to
absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as
manifested by at least two of the following, currently or by history
(examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech
(e.g., simple motor stereotypies, lining up toys or flipping objects,
echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or
ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at
small changes, difficulties with transitions, rigid thinking patterns, greeting
rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or
focus (e.g., strong attachment to or preoccupation with unusual objects,
excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in
sensory aspects of the environment (e.g., apparent indifference to
pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or
movement).
1 | Page
, C. Symptoms must be present in the early developmental period (but
may not become fully manifest until social demands exceed limited
capacities, or may be masked by learned strategies in later life).
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, D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual developmental
disorder (intellectual disability) or global developmental delay. Intellectual
developmental disorder and autism spectrum disorder frequently co-occur;
to make comorbid diagnoses of autism spectrum disorder and intellectual
developmental disorder, social communication should be below that
expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic
disorder, Asperger’s disorder, or pervasive developmental disorder not
otherwise specified should be given the diagnosis of autism spectrum
disorder. Individuals who have marked deficits in social communication,
but whose symptoms do not otherwise meet criteria for autism spectrum
disorder, should be evaluated for social (pragmatic) communication
disorder.
Age of onset:
Autism Spectrum Disorder: Development and Course
Because social (pragmatic) communication depends on adequate developmental
progress in speech and language, diagnosis of social (pragmatic) communication
disorder is rare among children younger than 4 years. By age 4 or 5 years, most
children should possess adequate speech and language abilities to permit
identification of specific deficits in social communication. Milder forms of the disorder
may not become apparent until early adolescence, when language and social
interactions become more complex. The outcome of social (pragmatic)
communication disorder is variable, with some children improving substantially over
time and others continuing to have difficulties persisting into adulthood. Even among
those who have significant improvements, the early deficits in pragmatics may cause
lasting impairments in social relationships and behavior and also low performance of
other related skills, such as written expression, reading comprehension, and oral
reading.
1. Non-pharmacological treatment of autism spectrum
disorder-Treatment
The goals of treatment for children with autism are to reduce disruptive behaviors and
promote learning, particularly in the areas of language acquisition, communication, and
self-help skills. These goals are best achieved based on a comprehensive assessment to
determine a profile of strengths and needs, and an individualized and structured program is
implemented by professionals experienced in working with
children who are autistic
3 | Page
, - Educational Approaches: Autistic children require intensive and highly structured special
education from as early as the child is able to tolerate a school routine. Given the
challenges involved in teaching children with autism, a classroom setting with a low
student to teacher ratio is usually essential. For the more impaired children, a typical
hierarchy of priorities should include the ability to:
(1) tolerate individual adult guidance in performing tasks; (2) consistently follow a daily
routine; (3)
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COMPLETE SOLUTION
MODULE 1 – Child and Adolescent Psychiatric Mental Health
Autism Spectrum Disorder: Diagnostic Criteria
A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by all of the following, currently
or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from
abnormal social approach and failure of normal back-and-forth
conversation; to reduced sharing of interests, emotions, or affect; to failure
to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in eye contact and body
language or deficits in understanding and use of gestures; to a total lack
of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships,
ranging, for example, from difficulties adjusting behavior to suit various social
contexts; to difficulties in sharing imaginative play or in making friends; to
absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as
manifested by at least two of the following, currently or by history
(examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech
(e.g., simple motor stereotypies, lining up toys or flipping objects,
echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or
ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at
small changes, difficulties with transitions, rigid thinking patterns, greeting
rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or
focus (e.g., strong attachment to or preoccupation with unusual objects,
excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in
sensory aspects of the environment (e.g., apparent indifference to
pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or
movement).
1 | Page
, C. Symptoms must be present in the early developmental period (but
may not become fully manifest until social demands exceed limited
capacities, or may be masked by learned strategies in later life).
2 | Page
, D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual developmental
disorder (intellectual disability) or global developmental delay. Intellectual
developmental disorder and autism spectrum disorder frequently co-occur;
to make comorbid diagnoses of autism spectrum disorder and intellectual
developmental disorder, social communication should be below that
expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic
disorder, Asperger’s disorder, or pervasive developmental disorder not
otherwise specified should be given the diagnosis of autism spectrum
disorder. Individuals who have marked deficits in social communication,
but whose symptoms do not otherwise meet criteria for autism spectrum
disorder, should be evaluated for social (pragmatic) communication
disorder.
Age of onset:
Autism Spectrum Disorder: Development and Course
Because social (pragmatic) communication depends on adequate developmental
progress in speech and language, diagnosis of social (pragmatic) communication
disorder is rare among children younger than 4 years. By age 4 or 5 years, most
children should possess adequate speech and language abilities to permit
identification of specific deficits in social communication. Milder forms of the disorder
may not become apparent until early adolescence, when language and social
interactions become more complex. The outcome of social (pragmatic)
communication disorder is variable, with some children improving substantially over
time and others continuing to have difficulties persisting into adulthood. Even among
those who have significant improvements, the early deficits in pragmatics may cause
lasting impairments in social relationships and behavior and also low performance of
other related skills, such as written expression, reading comprehension, and oral
reading.
1. Non-pharmacological treatment of autism spectrum
disorder-Treatment
The goals of treatment for children with autism are to reduce disruptive behaviors and
promote learning, particularly in the areas of language acquisition, communication, and
self-help skills. These goals are best achieved based on a comprehensive assessment to
determine a profile of strengths and needs, and an individualized and structured program is
implemented by professionals experienced in working with
children who are autistic
3 | Page
, - Educational Approaches: Autistic children require intensive and highly structured special
education from as early as the child is able to tolerate a school routine. Given the
challenges involved in teaching children with autism, a classroom setting with a low
student to teacher ratio is usually essential. For the more impaired children, a typical
hierarchy of priorities should include the ability to:
(1) tolerate individual adult guidance in performing tasks; (2) consistently follow a daily
routine; (3)
4 | Page
