DEVELOPMENT, AUTISM SPECTRUM DISORDER, Amy W y Weir, Psy. y.D . - PowerPoint PPT Presentation

DEVELOPMENT, AUTISM SPECTRUM DISORDER, Amy W y Weir, Psy. y.D . AND TRAUMA: 17 th Annual PCIT Conference University of IDENTIFICATION AND California, Los Angeles Sept. 28, 2017 TREATMENT RECOMMENDATIONS

OBJECTIVES FOR TODAY:  The experience of trauma complicates behavioral symptom presentations.  Understanding the overlap and distinct features of different disorders in children (ASD and trauma)  Available screeners for identifying possible trauma and ASD  Use of comprehensive strategies for screening, assessment and diagnosis  Best practices for trauma, ASD, and dual diagnosis

POSTTRAUMATIC STRESS DISORDER (DSM-5)  Crit iterio ion A n A: stresso sor  Crit iterio ion n B: i intrusi sion s n sympt ptoms ms  Crit iterio ion n C: C: a avoid idanc ance  Crit iterio ion n D: n negative al alterat ations in in c cognitions an and mo mood  Crit iterio ion E n E: a alterations i ns in a arousal usal a and d reactiv ivit ity  Crit iterio ion n F: d : dura uration  Crit iterio ion n G: f functio ional s nal signif nific icanc nce  Crit iterio ion n H: e exclus usio ion  Specify fy if: Wi f: With d h dissociative sy sympt ptoms  Specify fy if: Wi f: With d h dela layed expr press ssio ion (American Psychiatric Association, 2013)

MULTIPLE DIMENSIONS OF TRAUMA  Child’s symptoms of trauma understood within the context of multiple factors  Traumatic events

EFFECTS OF TRAUMA EXPOSURE  Ne Neurological al / / Bi Biolo logical  Se Self-Regu gulation  Atta tach chment  Developmen pmental  So Social ial r relatedn dness  Beha Behavi vioral l con contr trol  Co Cogni gnition from Rambeau and Lukasik

AUTISM SPECTRUM DISORDER (DSM-5) SOCIAL-COMMUNICATION Range of expression and examples (all 3) Deficits in social-emotional • abnormal social approach and failure of normal back and forth conversation reciprocity • reduced sharing of interests, emotions, affect, and response • failure to initiate or respond to social interactions • poorly integrated verbal and nonverbal Deficits in nonverbal communication communicative behaviors used for • abnormalities in eye contact and body social interaction language or deficits in understanding and use of nonverbal communication • total lack of facial expression or gestures Deficits in developing and • difficulties adjusting behavior to suit different social contexts maintaining developmentally • difficulties in sharing imaginative play and appropriate relationships making friends • absence of interest in people (American Psychiatric Association, 2013)

AUTISM SPECTRUM DISORDER (DSM-5) RESTRICTED AND REPETITIVE Range of expression and examples BEHAVIORS OR INTERESTS (at least 2)  motor stereotypies Stereotyped or repetitive motor  lining up or flipping objects movements, use of objects or  echolalia speech  idiosyncratic speech  extreme distress at small changes Insistence on sameness,  difficulty with transitions inflexible adherence to routines,  rigid thinking patterns or ritualized patterns of behavior  greeting rituals  insistence on same route or food  strong attachment to/preoccupation with Highly restricted fixated interests unusual objects abnormal in intensity or focus  excessively circumscribed or perseverative interests  indifference to pain/temperature Hyper- or hypo-reactivity to  adverse response to sounds/textures sensory input or unusual interest  excessive smelling/touching objects in sensory aspects of  visual fascination with lights/movement/objects environment (American Psychiatric Association, 2013)

AUTISM SPECTRUM DISORDER CONSIDERATIONS

WHERE ARE WE NOW? Wha What W We Kno now Wha What W We Don Don’t K Kno now

LENS COMPARISONS DEVELOPMENTAL LENS TRAUMA LENS

OVERLAPPING SYMPTOMS from Rambeau and Lukasik

OVERLAPPING SYMPTOMS (CONTINUED) TRAUMA ASD  Withdrawal/lack of eye contact, no  Lack of eye contact, no initiation of social initiation, no interest in social conversation, no pleasure shown in interaction social interactions due t to mistrust o of others  due ue t to o inh nherent nt d difficulties w with s soci ocial-emotio ional  reci ciprocity/engaging m meani ningfully w with ot others  Issues with trust, fears adults,  No response to name, reduced sharing avoids adults of interests  due ue t to o past traum umatic e experienc nce w where trus ust of o others was v violated  due ue t to o inh nherent nt d difficulties w with s soci ocial-emotio ional recip iprocit ity  Depression/anxiety: difficulty  Reduced sharing of emotions/affect, identifying, expressing, and no social initiation managing emotions  due ue t to o inh nherent nt d difficulties w with s soci ocial-emotio ional  due ue to o int nternalization on of of t traum uma e experienc nce recip iprocit ity  Impact of traumatic experience on  Difficulty with relationships and taking empathy, social relatedness, trust, another’s perspective turn-taking due ue t to o deficits i in n theor ory of of mind s skills   due to violation o of t trust i in r rela lationships  Tantrums, head banging/self-injurious  Tantrums, unpredictable emotional behaviors responses, anger, overreactivity  due ue t to o deficits i in n com commun unica cation s on skills, problems  due t to emotiona nal l dysregula ulation on with ch chang nges in n rout outine nes, s sens nsory-seeking ng behaviors ( be (self-injurious-beh behaviors rs) from Jacob and Graham, 2016

OVERLAPPING SYMPTOMS (CONTINUED) TRAUMA ASD  Nightmares, fears of going to sleep  Sleep problems  due ue t to o revisiting m memor ories of of traum uma  due t to problematic sleep c cycle (prob oble lems f fall lling ng asle leep, mu mult ltiple wakin ings dur uring t the ni night, early  Changes in appetite morning w g wak aking) g) due t to mood dysregulation   Eating problems- rituals, pickiness  Hypersensitivity to sounds, smells, due t to senso sory i interest sts a s and p proble lems w s with th c chang nges i s in  touch, light- unaware of pain or routines es (res estricted a ed and r repetitive e beh ehaviors) internal physical sensations  Under- or overreactivity to sensory input due ue t to o hyperarous ousal/reminders of of t traum uma   due ue to o sens nsor ory s sens nsitivities  Dissociation  “lives in their own world”  malad adapt aptive c coping m g mechanism  due ue t to o inh nherent nt d difficulties w with s soci ocial-emotio ional recip iprocit ity  Deficits in language development and  Difficulties with pragmatic/social use of abstract reasoning language  Due ue to o early t traum uma a and nd br brain d development nt, regression i n in s n skills due ue t to o prob oblems with th socia ial-emotion onal r reci ciprocity  and nd com commonl only co co-occur urring ng l language dela lays  Difficulties with changes and  Insistence on following routines, lining transitions, rigid repetitive behaviors, up toys or objects, repetitive behaviors, repeated play themes, fixated fixated interests interests  due ue t to o restricted and nd r repetitive be behaviors ( (cor core  due ue t to o anx nxious us r react ction t n to o cont control unp unpredictable symp symptom of ASD ASD) natur na ure of of traum uma from Jacob and Graham, 2016

DISTINCT SYMPTOMS ASD TRAUMA  Symptoms must be present in  Exposure to trauma early childhood (before age 3)  Re-experiencing (e.g. flashbacks)  Hyperarousal (i.e. hypervigliance)  Social concerns may not be  Hypoarousal (i.e. dissociation) evident until a child is older  Acting in or acting out (aggression) and social demands increase  Disorganized attachment style  Consistency of symptoms (approach/withdrawal)  Scripted speech  Increasingly restricted range with displays of affect post trauma  Fascination with movement or exposure parts of objects (spinning,  Sensory based trauma associations sighting)  Exacerbation of typical  Stereotypical movements developmental fears from Rambeau and Lukasik

ASSESSMENT AND TREATMENT

IMPORTANCE OF CAREGIVER PERCEPTIONS from Rambeau and Lukasik

SCREENERS TRAUMA ASD  Ages and Stages Questionnaire,  Brief measures: Third Edition/Social-Emotional Questionnaire (ASQ-3 and  Trauma Symptom Checklist ASQ:SE), looks more directly at for Young Children (TSCYC); development overall Trauma Symptom Checklist  Modified Checklist for Autism in Toddlers, Revised and Follow-Up for Children (TSCC) Interview (M-CHAT-R/F)  UCLA PTSD Reaction Index  Social Communication Questionnaire (SCQ for DSM-5 Lifetime/Current) is a brief measure that can assist in assessing for ASD in preschool and school-age children

TRAUMA SYMPTOM CHECKLIST FOR CHILDREN (TSCC/TSCYC)

UCLA PTSD REACTION INDEX FOR DSM-5

AGES AND STAGES QUESTIONNAIRE, THIRD EDITION (ASQ-3 AND ASQ:SE)

MODIFIED CHECKLIST FOR AUTISM IN TODDLERS, REVISED AND FOLLOW-UP INTERVIEW (M-CHAT-R/F)

SOCIAL COMMUNICATION QUESTIONNAIRE (SCQ)

ASSESSMENT COMPONENTS