overview of autism spectrum disorder and intellectual
TRANSCRIPT
11
Overview Of Autism
Spectrum Disorder And
Intellectual Disability
22
Training Webinar Series for MCI Teams
1. Introduction to MCPAP for ASD-ID for MCI Teams
2. Questions you will be asked during a consult and how they
relate to Applied Behavior Analysis
3. Overview of Autism Spectrum Disorder and Intellectual
Disabilities
4. De-escalation strategies for working with youth with ASD
5. Psychiatric issues and medical issues that can contribute to
behavior change in youth with ASD or ID
6. Why so many meds? Understanding psychopharmacology in ASD
7. Supporting Emotional Regulation: Language and Sensory
Processing Considerations
33
Outline for this Webinar
• Diagnostic features and clinical characteristics of Autism Spectrum
Disorder (ASD)
• Diagnostic features and clinical characteristics of Intellectual
Disability (ID)
• Brief overview of assessments
44
Autism Spectrum Disorder (ASD)
• Autism, or autism spectrum disorder, refers to a broad range of
conditions characterized by challenges with social skills, repetitive
behaviors, speech and nonverbal communication.
• About ½ of individuals with ASD have average intellectual abilities and
each person with autism can have unique strengths and challenges.
• A combination of genetic and environmental factors influences the
development of ASD.
• ASD often is accompanied by medical issues such as GI disorders,
seizures, sleep disturbances, as well as psychiatric comorbidities.
55
66
Emerging Risk Factors for ASD
• Advanced paternal/maternal age
• Family members with autistic features, sibling, identical twins with ASD
• Critical infections during pregnancy
• Too brief birth spacing
• Folate deficiency
• Valproate
• Environmental contributors
77
DSM-5 Criteria for ASD
A- Persistent deficits in social communication and
social interaction in:
- Social reciprocity
- Nonverbal communication
- Deficits in relationships
88
DSM-5 Criteria for ASD
B- Restricted, Repetitive Patterns of Behavior, Interests or Activities
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized
patterns or verbal nonverbal behavior
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory
aspects of the environment
• Symptoms must be present in early childhood
• Symptoms must impair functioning
• Not better explained by intellectual disability and global developmental
delay
99
DSM-5 Diagnostic Specifiers
• Accompanying intellectual impairment – 45%
• Accompanying language impairment (i.e., fewer than 5 single
words)
• Known genetic risk factor – 25%
• Highly comorbid with other DSM-5 diagnoses
• Comorbid with other medical factors
• With or without catatonia
1010
ASD Severity Level
• A severity level for each ASD domain – Social Communication and
Restricted Interests/Repetitive Behaviors
• Severity levels based on a scale of 1-3:
- Level 1: requiring support
- Level 2: requiring substantial support
- Level 3: requiring very substantial support
1111
Intellectual Disability
• Prevalence: ~ 1-3% of the population in the United States
• Risk Factors (Prenatal, Perinatal and Postnatal):
-Genetic (Fragile X syndrome, Tuberous Sclerosis, Down syndrome
etc.)
-Medical conditions
-Prenatal infections
-Toxins
-Birth trauma etc.
1212
DSM-5: Intellectual Disability (Intellectual
Developmental Disorder)
A. Deficits in intellectual functions
• reasoning, problem solving, planning, abstract thinking, judgment,
academic learning, and learning from experience
• confirmed by both clinical assessment and individualized, standardized
intelligence testing
B. Deficits in adaptive functioning
• failure to meet developmental and sociocultural standards for personal
independence and social responsibility
• limit functioning in one or more activities of daily life, such as
communication, social participation, and independent living, across
multiple environments
C. Onset of intellectual and adaptive deficits during the developmental
period
1313
Specifiers and Severity Level
• Associated with known medical or genetic condition or environmental
exposure
• Severity: Mild, Moderate, Severe, Profound
- Levels of severity defined on basis of adaptive functioning and not IQ
scores, because it is adaptive functioning that determines the level of
support required.
- Moreover, IQ measures are less valid on the lower end of IQ range
1414
Criteria for Adaptive Behavior
• Deficits in adaptive functioning: refers to how well a person meets
community standards of personal independence and social responsibility,
in comparison to others of similar age and sociocultural background
• Involves adaptive reasoning in 3 domains: conceptual, social and
practical
1515
Severity Levels of ID
Intellectual Disability Approximated Developmental Age
Mild 9-12 years old
Skills for some self-support, needs
assistance under stress
Moderate 6-9 years old
Needs sheltered conditions, can reach
~2nd grade academic levels
Severe 3-6 years old
Minimal self-care, poor motor/language
development, full supervision needed, may
form attachments to caregivers
Profound <3 years old
Needs 24/7 supervision, may form
attachments to caregivers
1616
Intellectual Disability Severity Prevalence
ID
Mild ID Moderate ID Severe - Profound ID
85%
10%
5%
1717
1818
1919
2020
2121
Common Presenting Symptoms of ASD, ID
• Social difficulties
• Over focused interests
• Repetitive behaviors
• Hyperactivity
• Irritability and tantrums
• Aggression towards self/others/objects
• Self-injury
• Social withdrawal
• Sleep/feeding disturbances
• Repetitive behaviors
• Non-adherence and increased oppositionality
• Other DSM-5 disorders (anxiety, ADHD, major depressive disorder,
schizophrenia etc.)
2222
Overview of Assessments for ASD and ID
• Child
- Observation of behaviors, emotional expression, social
interactions with clinician and family, communication
- Assess functional ability (ADLs)
• Parent interview and history
• Collaborative information from school, providers and prior records
• Physical examination
• Psychological testing (IQ, Vineland, neuropsychological testing)
• Genetics
• Neuroimaging if indicated
• Other medical and developmental referrals
2323
Additional Assessments for ASD
• ADOS (Autism Diagnostic Observation Schedule)
• ADI-R (Autism Diagnostic Interview – Revised)
• Autism Mental Status Exam
• SCQ (Social Communication Questionnaire)
• M-CHAT (Modified – Checklist for Autism in Toddlers) – for pediatrician
(very brief)
2424
The Family & Caregivers
• Partners in care
• Family-centered collaborative care
-Focus on the family
-Navigate resources
-Cultural competence
-Parent’s perspective
• Appreciate caregiver stress
• Provide accurate and appropriate information and resources to families that
will help bring them relief:
-Respite, supports, financial aid and benefits.
2525
Goals of Intervention
“Goals are to maximize an individual’s
functional independence and quality of
life through development and learning,
improvements in social skills and
communication, reductions in disability
and comorbidity, promotion of
independence, and provision of support
to families.”
- AACAP Autism and Intellectual Disability Training
Workgroup
2626
How to Reach MCPAP for ASD-IDMCPAP for ASD-ID is available seven days a week, 11 a.m. - 7 p.m. The number to call depends on your MCI regional team.
Western/Central MCI teams: 1-844-926-2727• The Brien Center for Mental Health and Substance Abuse (Pittsfield, North Adams, Great
Barrington) • Clinical & Support Options (Greenfield, Athol, Florence) • Behavioral Health Network (Springfield, Westfield, Holyoke) • Community Healthlink, Inc. (Leominster, Worcester) • Riverside Community Care (Milford, Upton, Southbridge)
Eastern Massachusetts/Boston and South MCI teams: 1-844-636-2727• Child and Family Services (New Bedford, Plymouth) • Community Counseling of Bristol County (Brockton, Norton) • Bay Cove/Cape Cod and the Islands Emergency Services (Hyannis, Martha’s Vineyard, Nantucket) • Boston Medical Center/Fall River Emergency Services (Fall River) • Riverside Community Care (Norwood)/Aspire Health Alliance (Quincy)
Eastern Massachusetts/Boston and North MCI Teams: 1-855-627-2763• Beth Israel Lahey Behavioral Health Services (Haverhill, Salem, Lawrence, Lowell) • Eliot Community Services (Lynn and Everett) • Boston Medical Center/Boston Emergency Services Team (B.E.S.T.) (Boston, Cambridge,
Somerville)• Advocates/Wayside (Framingham, Waltham, Marlboro)
2727
Thank You
Contact Us
Thank You
Please Contact Us
Western/Central MCI teams call 1-844-926-2727
Eastern Massachusetts/Boston and South MCI teams
call 1-844-636-2727
Eastern Massachusetts/Boston and North MCI Teams
call 1-855-627-2763