Autism Spectrum Disorder

(ASD)

Subject: Students with developmental disorders: Psychoeducational intervention

Profesor: Francesc Sidera
Date: 13/012022
Student: Núria Aiguabella Casals
 INDEX

1. Introduction…………………………………………………………..2
2. Diagnostic of ASD……………………………………………………3
3. Role of psychologist………………………………………………….6
4. Treatment: Parent-child interaction therapy (PCIT)......................8
5. Case…………………………………………………………………..10
6. Bibliography…………………………………………………………13

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 1. INTRODUCTION

Definition
Autism spectrum disorder (ASD) is a developmental disability that can cause significant
social, communication and behavioral challenges.
To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent
deficits in each of three areas of social communication and interaction plus at least two of
four types of restricted, repetitive behaviors.
The behaviors are the following ones:
1. Persistent deficits in social communication and social interaction across multiple
contexts, as manifested by the following, currently or by history:
a) 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.
b) 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.
c) 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.

2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at

least two of the following, currently or by history:
a) Stereotyped or repetitive motor movements, use of objects, or speech (e.g.,
simple motor stereotypes, lining up toys or flipping objects, echolalia,
idiosyncratic phrases).
b) 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 the same route or eat the same food every day).

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 c) 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).
d) 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).

3. 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).
4. Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning.
5. These disturbances are not better explained by intellectual disability (intellectual
developmental disorder) or global developmental delay. Intellectual disability and
autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism
spectrum disorder and intellectual disability, social communication should be below
that expected for general developmental level.

As it is mentioned before, people with ASD often have problems with social, emotional, and
communication skills. They might repeat certain behaviors and might not want change in
their daily activities. Many people with ASD also have different ways of learning, paying
attention, or reacting to things.

These behaviors are observed in the majority of cases at an early age, and that's because the
schools and educators have the responsibility to give support and satisfy their needs.

2. DIAGNOSIS

Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose
the disorders. Doctors look at the child’s behavior and development to make a diagnosis.

ASD can sometimes be detected at 18 months or younger. However, many children do not
receive a final diagnosis until much older. This delay means that children with ASD might
not get the early help they need.

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According to the article “Examining the Efficacy of Parent–Child Interaction Therapy with
Children on the Autism Spectrum” The diagnosis of autism is based on three symptomatic
pillars

a) Social interaction;

The areas that are affected are: Non-verbal communication, such as eye contact, facial
expression, and regulatory gestures of social interaction, may be severely affected, with slow
improvement during process evolution. The patients have the incapacity to develop
relationships with other children.

They don’t have the spontaneous inclination to share their interests and hobbies. The absence
of social or emotional reciprocity is evident, when the child doesn’t actively participate in
social games, and prefers to have activities alone and use inappropriate utensils for the game.

b) Communication

Communication impairment impacts verbal and non-verbal skills. Autistic children may have
a significant delay in acquiring language or a complete absence of it. Talking patients do not
have the ability to initiate or maintain a conversation with other people, or they have
stereotyped language, use repetitive words, or speak idiosyncratic. When language develops,
prosody is abnormal, with inappropriate intonation, speed, volume, and rhythm for the age of
development

c) Behavior, interests, and activities

Children with autistic disorder use to have patterns of restricted, stereotyped and repetitive
behavior, activities and interests. The interests are very limited, and the patients are
stubbornly worried with activities very restricted: they can line up toys over and over again
the same way, or repeatedly imitate a type of behavior.

They can show inflexible activities, in the form of non-functional routines and rituals, such as
always following the same routine at home or to go to school.

They may also have body stereotypes, such as flapping their hands or repeatedly hitting the
table with a finger.

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Other characteristics of people with autism:

The children with autism used to have these symptoms;

● Epilepsy: Patients with autism are at risk of suffering epileptic seizures, which ranges
between 30 and 40%.
● Motor problems: Motor control abnormalities are not common in autism; however,
when they reach adulthood, some patients may develop gait disorders, ataxic
movements, and coarseness of movements, which increase with age.
● Sensory deficit (Sensory hypersensitivity, sensory hyposensitivity): Patients with
autism usually have a more or less inability to respond to sensory stimuli; but this
difficulty appears as a response to the perceptual deficit; that is, it is secondary to
attention, cognitive or motivation defects, rather than the sensory problem itself.
● Self-stimulatory behaviors: are repetitive body movements or repetitive movements of
objects. Many individuals on the autism spectrum engage in routine stimming.
● Physical abnormalities: Individuals with autism often have a number of unusual
physical characteristics, called dysmorphologies, such as wide-set eyes or broad
foreheads.
● Hyperactivity: Autism spectrum disorder and ADHD are related in several ways.
ADHD is not included in the autism spectrum, but some symptoms are very similar,
for example, children with autism and hyperactivity used to have difficulties paying
attention, and their social skills are affected, having one of them increases the risk of
having the other.
● Social anxiety: commonly co-occurs with autism spectrum disorders. It is conceivable
that inherent socio-communication impairments, or their impact on social
experiences, contribute to the development of SA.
● Disruptive behaviors: Disruptive behaviors such as aggression, irritability, and
noncompliance are common in children with autism, and are among the main reasons
for psychiatric treatment and even hospitalization, said Denis Sukhodolsky, senior
author and associate professor in the Yale Child Study Center.
● Possible intellectual disability: Children with autistic disorder have highly irregular
cognitive abilities, ranging from profound mental retardation to superior abilities.
Anyway, autistic children with intact intellectual capacity are unable to imagine what
a person thinks or experiences, and how their behavior is perceived by another person.

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3. ROLE OF PSYCHOLOGIST: According to the article“The role of the school
psychologist in the inclusive education of school-age children with autism spectrum
disorders”

The interventions covered fall into three broad areas: strategies to manage disruptive
behaviors, strategies to promote academic competencies, and strategies to encourage
social integration

1. Strategies to manage disruptive behaviors

● Applied behavior analysis and functional assessment:

A functional assessment involves multiple components, which can be conducted in a series of

steps. The first step is to conduct a functional assessment interview with teachers, parents.
Another step, can be observation of the child in the classroom where and when the target
behavior(s) is most likely to occur. The functional assessment can be used to analyze the
target behavior even further

● Managing antecedents

Environmental adaptations are often made in the classrooms of children with ASDs,
including modification of lighting and sound, and physical re-arrangement of materials and
furniture.

● Functional communication

“If children with autism are taught more appropriate and functional means of communicating
their needs, it may decrease the need for maladaptive behavior” (Koegel, Koegel, & Surratt,
1992; Wacker et al., 1998).

● Errorless compliance training and reinforcement

This approach involves beginning with high-probability commands (i.e., those that are likely
to be complied with) and gradually introducing more demanding commands so that the child
experiences success and reinforcement.

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 2. Strategies to promote academic competencies

There are some activities that psychologists can use to improve language and communication
(academic competencies) of the children:

● Share objects and activities (focus on their interests)

● Attract gaze to objects and interlocutor
● (exaggerated cues + reinforcement)
● Use simple language to describe activities
● Give practical value to his words
● Simplify class commands and use direct requests
● Make sure how they interpret ambiguous utterances and metaphors
● Avoid vague concepts

Another language and communication problem that autism children suffer is echolalia; which
means they repeat others' words or sentences.

Strategies to encourage social integration (Social skills)

● Modeling Social Skills: for example,; teaching peers, plan social situations with
teacher and family, breaking down complex social behaviors, “priming” (e.g.,
rehearse expected behaviors in upcoming activities)
● Teaching social rules (e.g. Discriminate appropriate and inappropriate social
behaviors)
● Fostering self-management of social skills (e.g., rewarding through a wrist counter)
● Conversational skills: Asking appropriate repair questions like “What do you mean
with…?”, and feedback
● Increasing social motivation (e.g., chose an activity motivating for the child like for
example chess )
● Use of social scripts to teach social behaviors.

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4. TREATMENT: Parent-child interaction therapy (PCIT)

There is currently no cure for ASD. However, research shows that early intervention
treatment services can improve a child’s development. Early intervention services help
children from birth to 3 years old (36 months) learn important skills. Services can include
therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk
to your child’s doctor as soon as possible if you think your child has ASD or other
developmental problems.
According to the article “Examining the Efficacy of Parent–Child Interaction Therapy with Children
on the Autism Spectrum” Behavioral Parent Training has long been recognized as an
evidence-based treatment for disruptive behavior disorders (Eyberg et al. 2008)

The parents are the figure most important for these children with ASD, and that’s because
the selected treatment is the efficacy of Parent–Child Interaction Therapy, because this
therapy includes the figure of the family, the child, and the therapist. This therapy is
designed to help improve the parent-child relationship through interaction.

The main purpose of this therapy is to improve parent–child relationships, reduce problem
behavior, and increase child compliance.

Parent–child interaction therapy (PCIT; McNeil and Hembree-Kigin 2010) is an

empirically-supported, short term parent training program designed for young children ages
2–7 with disruptive behavior problems. PCIT is derived from Hanf’s two-stage treatment
model, social learning theory, and attachment theory. Was created to promote fidelity in the
practice of Parent-Child Interaction Therapy through well-conducted research, training, and
continuing education of therapists and trainers.

PCIT consists of two phases;

1. A relationship enhancement phase [child directed interaction (CDI)] :

In this phase parents engage in playtime with their children by following their child’s lead
and utilizing core ‘‘do’’ skills (i.e., behavior descriptions, labeled praises, reflections,
imitation). Therapists coach parents to increase the use of these positive skills and to reduce
the use of the ‘‘avoid skills’’during the interactions to enhance the parent–child relationship.
Importantly, parents engage in selective attention by responding to appropriate behaviors
using the positive skills while ignoring inappropriate behaviors (e.g., whining).

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These skills are represented with the acronym PRIDE:

● Praise: The child is praised for good or appropriate behavior.

● Reflection: The child's words are repeated and expanded upon by parents,
which encourages communication.
● Imitation: Parents teach and show approval by mimicking what their child is
doing.
● Description: Parents describe what the child is doing in order to help their child
build vocabulary and show that they (the parents) are paying attention to the
child's activities.
● Enjoyment: Parents have to demonstrate enthusiasm for the child's activities

2. Discipline phase [parent directed interaction (PDI)].

In this second phase families continue to utilize the skills learned in CDI, however the
teaching and implementation of effective commands are incorporated to work on child
compliance. As part of the process, parents learn to provide direct, easy-to-understand
instructions to the child, with clear, consistent repercussions for obedience and disobedience.
If the child is compliant, the parent provides specific praise such as "Thank you for picking
up your toys." If the child is non-compliant then the parent issues a time-out warning such as:
"Pick up your toys or you will take a time-out." Further non-compliance results in the
time-out procedure being carried out.

The effectiveness of this therapy is comprovated in a lot of studies. One group participated in
PCIT, and the other group was put on a waiting list. After a 12-week period, the mothers
participating in PCIT were observed to have better parent-child interactions, and they
reported improved child behavior and less stress.

Is an effective method to improve problematic behaviors like agressions, definace, short

temper, and non-compliance.

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5. CASE

This case has been taken from the study “Examining the Efficacy of Parent–Child Interaction
Therapy with Children on the Autism Spectrum” written by Joshua J. Masse, Cheryl B.
McNeil, Stephanie Wagner, Lauren B. Quetsch in 2016.
Participants were recruited from community referrals in a rural university town. Inclusion
criteria for the study were as follows: child was between the ages of 2 and 7, participating
caregiver was the primary caregiver and legal guardian of the child, child was previously
diagnosed with ASD, and a child had receptive language skills greater than 24 months.
The study was approved by a university’s Institutional Review Board.

Cristopher
“Christopher was a 4-year-old Caucasian male who participated in the study with his
25-year-old biological mother. Christopher was referred by a specialized educational
program at a community school. He was diagnosed with autism at 18 months at a
university-based medical center for developmental disabilities. At the time of study, he was
receiving in-home occupational and physical therapy which continued throughout treatment.
He exhibited significant expressive language delays, immediate echolalia, and several
self-stimulatory behaviors (e.g., rocking, hand flapping). Christopher lived with his
biological parents. Behaviorally, Christopher’s mother reported that he was defiant and often
would not comply with demands at home, in school, and with interventionists. He often
refused to eat food presented. In addition, he frequently cried and yelled and would become
physically aggressive toward his parents and other objects (e.g., the wall). During the
baseline sessions, Christopher often wandered around the room and was generally
non-compliant with his mother’s requests. He was frequently off-task, engaging in other
activities of his preference (e.g., playing with stuffed animals by himself).”

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The aim of this study is to examine the efficiency of PCIT treatment with ASD children.
Although I don’t implement the treatment with this child, the research in other similar cases
with this treatment have worked, and the improvement is relevant, for this reason, it's
important to describe how the intervention could be conducted specifically for this case, this
description is inspired by the “Examining the Efficacy of Parent–Child Interaction Therapy
with Children on the Autism Spectrum” study because they had implement PCIT treatment in
Christopher :
The two phases of PCIT, child-directed interaction (CDI) and parent-directed interaction
(PDI), the schedule will be one hour a session twice a week, and there’s didactic and
experiential components.
Each phase begins with didactic and role-played activities with parents and Christopher. The
following time of the session, starts with a brief check-in with the parent regarding the
previous week’s homework and learned skills. After that, the psychologist will explain to the
parent how to help to improve their skills while the parent and Chrisitian will be playing
together.

First phase: CDI

As I mentioned before, the role of the psychologist is to coach the parents on how to increase
the use of these positive skills and reduce the use of the ‘‘avoid skills’’. These interactions are
also used to enhance the parent’s relationship with christian.
Importantly, Chritopher’s parents will engage in selective attention by responding to
appropriate behaviors using the positive reinforcements while ignoring inappropriate
behaviors.
In this phase Christopher’s parents will always be paying attention to PRIDE skills.

This are some steps that Christopher’s parents with help of the therapist have to follow:
(MCNEIL Y HEMBRE-KIGIN, 2012)
1. Review homework
2. Describe the objectives for CDI
3. Discuss the 5 minutes of daily practice at home
4. Explain and present models of behaviors to avoid
5. Explain and present models of the skills to be performed
6. Discuss the use of strategic attention
7. Discuss the use of selectively ignore

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8. Model all skills combined
9. Train through role-play
10. Discuss the logic of home play therapy
11. Assign new jobs for home

Second phase: PDI

This are the steps that Christopher’s parents have to follow in this phase: (MCNEIL Y
HEMBRE-KIGIN, 2012)
1. Explain the use of obedience exercises
2. Discuss how to give effective instructions.
3. Determine when the child obeys
4. Discuss the consequences of obedience.
5. Discuss the consequences of disobedience
6. Explain how to do an effective Time Out.
7. Train parents in discipline skills

During the intervention, the sessions are recorded with a fixed video camera placed in the
game room and, in addition, these technical equipment described are used above to observe,
praise, shape and correct in real time to parents throughout the intervention.
The number of therapeutic sessions needed will depend on how quickly Christopher’s parents
will learn the skills.
The treatment is applied between 8 and 12 sessions, with extra sessions if necessary,
The sessions will follow this steps:
Step 1: Evaluation pre-treatment of the functioning of the Christopher’s family(1 or 2
sessions).
Step 2: Teach Behavioral Play Therapy Skills (1 session).
Step 3: Train behavioral play therapy skills (2-4 sessions).
Step 4: Teach discipline techniques (1 session).
Step 5: Training of discipline techniques (4 to 6 sessions).
Step 6: Post-treatment evaluation of the functioning of the Christopher’s family (1 or 2
sessions).
Step 7: Extraordinary sessions if necessary and follow-up.

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6. BIBLIOGRAPHY

Masse, J. J., McNeil, C. B., Wagner, S., & Quetsch, L. B. (2016). Examining the efficacy of
parent–child interaction therapy with children on the autism spectrum. Journal of Child and Family
Studies, 25(8), 2508-2525. Available at:
https://link.springer.com/content/pdf/10.1007/s10826-016-0424-7.pdf

Centers of Disease Control and Prevention June 29, 2020. Diagnostic Criteria. Autism Spectrum
Disorder. Available at:
https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

Rodríguez-Barrionuevo, A. C., & Rodríguez-Vives, M. A. (2002). Diagnóstico clínico del autismo.

Revista de Neurología, 34(1), 72-77. Available at:
http://files.usal-psicopatoinfanto.webnode.com.ar/200000291-1b5061c4e5/Rodriguez_Diagnostico%2
0Clinico%20del%20Autista.pdf

Akshoomoff, N., Corsello, C., & Schmidt, H. (2006). The role of the autism diagnostic observation
schedule in the assessment of autism spectrum disorders in school and community settings. The
California School Psychologist, 11(1), 7-19. Available at:
https://link.springer.com/content/pdf/10.1007/BF03341111.pdf

García, R. F., & Velasco, L. A. (2014). Terapia de interacción padres-hijos (PCIT). Papeles del
psicólogo, 35(3), 169-180. Available at:
http://www.papelesdelpsicologo.es/pdf/2437.pdf

Sidera F. (2021). Topic 3 ASD.(Slide 17, 18, 19, 24, ) Available at:
https://moodle2.udg.edu/mod/resource/view.php?id=1111337&redirect=1

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