Traumatic Brain Injury School Re-entry Program Renée Lavelle, MS CCC/SLP Lindsay Wilson, MS CCC/SLP.
Autism Spectrum Disorders: Core Symptoms and their Development Rhea Paul, Ph.D., CCC-SLP
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Transcript of Autism Spectrum Disorders: Core Symptoms and their Development Rhea Paul, Ph.D., CCC-SLP
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Autism Spectrum Disorders: Core Symptoms and their Development
Rhea Paul, Ph.D., CCC-SLPSouthern Connecticut State University
Yale Child Study CenterFeb. 11-15, 2008
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Triad of symptoms
Severe, qualitative impairment in social interaction
Qualitative impairment in communication
Restrictive, repetitive or stereotyped behaviors interests or activities
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Social Interaction Gaze
Attentional patterns Eye contact
Joint Attention Imitation Emotion and attachment Reciprocity Play Peer Relations
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Eye Contact/Using Gaze to Share
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Eye Contact
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Toddler with autism Typically-developing toddler
2-year-olds with autism and typical development viewing video of child playing
Gaze Patterns
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Gaze development in ASD Newborns show preference for faces
prefer eyes by 2 mo. Can detect direction of other’s gaze by 4
mo. Children with ASD fail to develop
these patterns Problems in gaze persist throughout
the life span, even in HFA Are resistant to intervention
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Joint Attention (Intersubjectivity) Dyadic: infant looks at adult Triadic: Begins w/ gaze following (6 mo.) Progresses to following point (8-10 mo.) Then to initiation w/ smiling and pointing at
objects of interest (12 mo.) Lays basis for conversation Very low frequency in ASD, appears later
than TD Can increase with age
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Joint Attention Video examples:
JA DD JA Autism Imitate JA
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Imitation Emerges in infancy Basis of learning Fades in typical development Role of mirror neurons Less spontaneous imitation and less
in elicitation settings for children with ASD
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Imitation In normal developmenthttp://www.youtube.com/watch?v=-rWKSTtM6Ys In ASDHaddia example
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Emotion and attachment Social referencing Comfort seeking Sharing emotion with
gaze Children with ASD
Do show attachment Have difficulty recognizing
emotions: may be related to difficulties in face perception
Less likely to coordinate expression of emotion (smile) with gaze
Difficulties in empathy (hurt examiner experiment)
Decreased social referencing (robot experiment)
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Sharing emotions
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Sharing emotions
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Reciprocity Turn-taking emerges before language Back-and-forth nature of social
interaction Deficits in reciprocity can be seen
in both verbal and nonverbal individuals
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Reciprocity: Preverbal
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Reciprocity: Verbal
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PlayNormal development: 0-8 mo. All schemes to all objects 8-12 mo. Functional play 12-18 mo. Autosymbolic play 18-24 mo. Single scheme symbolic play 24-36 mo. Multischeme symbolic 3-5 Pretend, role play 5-12 games with rules
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Play in ASD Favor exploratory, means-ends,
construction, stereotypical play over pretend play
Even symbolic play can be repetitive and stereotypic
May prefer solitary play May have difficulty w/ flexibility in
games w/ rules
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Play
http://www.youtube.com/watch?v=zAu6ehEGMQc&feature=related
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Peer Relations TD children move from family-centered to
peer-centered social relations Children with ASD may
Prefer to remain solitary Be ineffective in approaching and engaging peers
Make fewer approaches to peers Respond less often to peer bids
Those w/ HFA may prefer adults to peers Expand interest in peers during adolescence Become depressed over loneliness and lack of
friendships
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Communication: Definitions
Communication Message Sender Receiver
Language Rule-governed Conventional Symbolic Culturally Determined Communication
Speech Vocal expression Sounds of language
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Language Domains
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Communication is a primary deficit in autism Of the triad of symptoms, communication is
directly involved in two Communication deficits are a primary
means of identifying and diagnosing autism Communication in autism involves both
delaydelay and deviancedeviance. Primary area of difficulty is in pragmaticspragmatics
BUT deficits in other areas can also be seen; sometimes are similar to those of children with specific language impairments (SLI).
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Communication in Typical Development
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Communication Development: Capacities at birth Vision best at face-to-face range Infants show preferences for
Faces over other visual stimuli Speech over other sounds Female voices over other voices Own mother’s voice over other female voices Motherese speech-style over adult directed style
Can discriminate phonemes of native and non-native languages
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Typical Communication Development: Preverbal & Early Language
Perlocutionary Stage: 0-8 mo. 0-4 mo.: Preference for faces,
speech 4-8 mo.: Development of
vocal communication 6-10 mo.:
Emergence of preference for ambient language patterns
Emergence of speech-like sounds
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Communication Development: Preverbal Form
Production 0-2 mo.: Vegetative
sounds 2-4: Cooing &
laughing 4-8 mo.: vocal play 6-10 mo.: canonical
babble 8-18 mo.: jargon
babble with prosodic contours of ambient language
Perception 0-6 mo.: general speech general speech
processing abilitiesprocessing abilities that are biologically determined and “generic;” can apply to any linguistic input (Eimas et al., 1971.)
7-12 mo.: Change in preferences from those that would apply to anyany language toward ones those closely tuned to the sound patterns of the environmentenvironment
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Perlocutionary Communication
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Illocutionary Stage: 8-12 mo.Use
• Development of intentional communication expressed through • Gestures, e.g., pointing• Vocalization• Gaze
• Small range of functions expressed• Proto-imperative• Proto-declarative
• 2.5 communicative acts/minute• Emergence of prosodic
patterns of ambient language.
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Illocutionary Stage: Content and Form Expressive vocabulary starts slowly
12 mo: 1-3 words 15 mo.: 10 words 18 mo. 50-100 words; first word combinations
First 50 words include proper and common nouns, adjectives, verbs, social terms
Receptive vocabulary is larger: 50 words at 15 mo.
Most words have CV shape, one syllable Sounds used are same as those found in
babble: /b/, /p/ /m/, /n/, /d/, /h/, /w/.
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Illocutionary Stage: Gestures used to express intents: Contact Point
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Illocutionary Stage: Gestures used to express intents: Reach
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Illocutionary Stage: Gestures used to express intents: Distal Point
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Illocutionary Stage: Gestures used to express intents: Show
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Illocutionary Stage: Other Conventional Gestures
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Illocutionary Communication
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Locutionary Communication: 12-18 mo.
First words spoken
First words comprehended outside of routines
Rapid increase in spoken vocabulary:
–15 mo: 3 words
–18 mo.: 50-100 words (+/-100)
–24 mo.: 300 words (+/-150)
Word combinations begin when vocabulary=50
Same intents expressed with gestures, vocalization now expressed with words
New discourse-related intentions expressed
•request information•answer•acknowledge
5-7 communicative acts/minute on average
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Locutionary Development: Content
Early two-word utterances express a small range of meanings Agent, action, object combinations Possession Location Attributes Meanings related to
object permanence
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Locutionary Communication
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Communication Development: 18-24 mo.
Repertoire of speech sounds increase CVC and multisyllabic words increase; many still single syllable Average child is 50% intelligible Average expressive vocabulary size at 18 mo. Is 100 words
(+/- 100)• Multiword utterances increase in frequency; vocabulary grows• Understanding of sentences is not far ahead of production• Pragmatic developments:
New discourse-related communicative functions: Discourse management
Turns: increasing awareness of conversational obligation
Topics: 1-2 turns/topic Register variation
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18-24 mo. Communication
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Limitations in Communication is ASD: Prelinguistic Level
Delayed onset of speech (Stone et al., 1994) Atypical preverbal vocalizations (Sheinkopf et al., 2000) Depressed rate of preverbal communication (Wetherby,
Prizant & Hutchinson, 1998) Restricted range of communicative behaviours, limited
primarily to regulatory functions (Mundy & Stella, 2000) Low responsiveness to speech (Osterling & Dawson,
1994) Delayed and deviant use of gestures (Dawson et al.,
1998; Stone, et al., 1997) Dearth of pretend and imaginative play (Stone et al.,
1994) Laci of imitation orally, vocally, and verbally (Volkmar
et al., 1997)
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TD: Comment
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ASD: Comment
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Developing Language
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Communication Development: 24-36 mo. Form and Content Average expressive vocabulary size at 24 mo. Is
300 words (+/-150); word classes include Object & action words Kinship terms Spatial terms Question words Color, shape words
Grammatical morphemes, verb phrase marking emerges; some overgeneralization
Grammatical forms for sentences such as questions, negatives are emerging
Sentence length is 3-5 words Intelligibility increases from 50% to 70%
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Communication Development: 48-60 mo.: Form & Content Vocabulary at school entry=6000 words Basic grammatical forms mastered
expressively and receptively; few grammatical errors are heard Overgeneralization may persist
Average 4 year is 100% intelligible Speech errors may persist, but speech
can be understood Residual errors in /s/, /l/, and /r are last
to resolve
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Background: Pragmatics of Language
Pragmatic domains: Communicative functions Discourse management Register variation Presupposition Prosody
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Communication Development: 48-60 mo.: UseCommunicative functions• Increase in range of functions• New genre: narration• Increase in decontextualized talkDiscourse management• Requires less support from
adults; still needs some• Longer turns; more turns/topic
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Communication Development: 48-60 mo.: Use Register variation
• New polite forms: • permission requests, permission
directives, some indirect requests• 4-7: hints
• Ability to use ‘motherese’
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Preschool Conversation
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Early Verbal Communication in ASD
Pronoun reversals Idiosyncratic word use Use of immediate and delayed
echolalia (communication strategy) Perseverative conversation Atypical voice and prosodic features
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Echolalia
http://www.youtube.com/watch?v=sniGZoVB0R4&feature=related
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Conversation in ASD
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Communication Development in Later Childhood and Adolescence Syntax/Semantics
Increases in oral and written forms Increases in figurative, nonliteral
language Pragmatics
Discourse Genres Narration Persuasion/negotiation Exposition Ambiguity/sarcasm
Register variation Slang Figurative language
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Communication in Youth
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Impairments in Higher Level Language Skills in ASD
Reduced topic management skills appropriate topic termination Responding to cues to change topic Commenting contingently; say something
relevant Reduced presuppositional skills due to “theory of
mind” (ToM) deficits Poor ability to share topics infer other’s informational state
Obsessive, circumscribed interests Sparse conversation OR overly
talkative about special interests Gaze and prosodic deficits persist
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Discourse Management Example
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Presupposition Example
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Prosody Example
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Circumscribed Interest Example
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Repetitive behaviors http://www.youtu
be.com/watch?v=-6blmKiPe9c&feature=related
http://www.youtube.com/watch?v=MB9UDDLJfKM&feature=related
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Controversial Treatments
Promise to cure the core symptoms of ASD Definition of the core deficits often lacks
solid empirical evidence (e.g., metabolic problems, exposures, ‘visual processing’)
Offer vague benefit (e.g., improve focus) Lack of empirical evidence
Reliance on uncontrolled studies, single-case testimonials
Claim that ‘they cannot be studied ‘ Often claim persecution form the scientific
establishment Staying open-minded
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Gluten- Free & Cassien-Free Diet (GFCF) “Leaky gut” -> peptides crossing blood-
brain barrier -> disrupted neurotransmitter breakdown -> increase of opiotoids -> activity-autism.
“Leaky gut” could be caused by: yeast overgrowth, gastrointestinal disease due to immunization, etc.
No evidence for these causal relationships
Systematic study of GFCF diet initiated at University of Rochester
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Ethyl Mercury (Thimerosal) Exposure
1. Danish “Natural Experiment”• 1970 – 1992 petrussis vaccine contained
Thimerosal• 1992-1997: same vaccine w/o Thimerosal• 1997: different petrussis vaccine w/o Thimerosal
2. Danish Psychiatric Register Data: contrary to prediction, no difference in rates of autism was found between groups who received Thimeraosal and those who did not
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Chelation Therapy
Hypothesized toxic effects of mercury exposure, mercury accumulates in internal organs (hair trace analysis)
Chelation: introduction into the blood stream agents that bond with specific metals in the body
Purely hypothetical connection between mercury poisoning and autism
No empirical evidence supporting the claim, no reports of curing autism or improving symptoms following chelation
Possible side-effects of chelation: washes out valuable minerals, very costly diagnostic process
Two children have died following chelation.
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Supplements
Assumption that developmental disabilities may be caused by innate biochemical errors
E.g., B6+magnesium supplements
Lack of well-controlled, long-term follow up studies
Possible side effects: high dose of B6: possible neuromotor side effects in adults, magnesium: potentially toxic metal in high doses
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Secretin Pancreatic hormone assisting digestion “Cure” of autism (Horvath et al., 1998)
after single injection of the hormone Controlled studies: secretin has the same
effect as placebo (Carey et al., 2002; Chez et al., 2000; Owley et al., 1999)
Positive effect on children with autism and diarrhea, but no reduction in aberrant behaviors; no effect on those w/o diarrhea (Kern et al., 2002)