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Overview Of Autism Spectrum Disorder And Intellectual ...

Nov 12, 2021

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Page 1: Overview Of Autism Spectrum Disorder And Intellectual ...

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Overview Of Autism

Spectrum Disorder And

Intellectual Disability

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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

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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

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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.

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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

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DSM-5 Criteria for ASD

A- Persistent deficits in social communication and

social interaction in:

- Social reciprocity

- Nonverbal communication

- Deficits in relationships

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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

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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

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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

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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.

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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

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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

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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

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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

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Intellectual Disability Severity Prevalence

ID

Mild ID Moderate ID Severe - Profound ID

85%

10%

5%

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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.)

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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

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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)

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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.

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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

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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)

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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