Dr. Katrina Ostmeyer, BCBA, LBA, LP of
with present
A Three-Part Training Series on Autism, Mental
Health, and Working with Insurance
Companies
Objectives
Part 2: Differentiation & Overlap of Autism & Related Disorders
Autism: A Disorder of Comorbidity
Co-morbidity in Autism
Neurodevelopmental Disorders
- Onset in the early developmental period
- Etiology considered to be primarily biological
Neurodevelopmetal Disorders
Characteristics
Intellectual Disability & Global Developmental Delay
- Deficits in intellectual functioning and learning
- Deficits in adaptive functioning
- Conceptual
- Social
- Practical
Characteristics
ADHD
- Persistent inattention and/or hyperactivity/impulsivity
- Present before the age of 12
- Occur across settings
- https://www.cdc.gov/ncbddd/adhd/diagnosis.html
Characteristics
SLD
- Learning that is significantly delayed in comparison to intellectual ability and age
- Learning difficulties persist despite provision of targeted intervention
- Cannot be attributed to other factors
- Categorized by subject
- Reading
- Written expression
- Mathematics
- https://psychcentral.com/disorders/specific-learning-disorder/
OCD & Tic Disorders
- Tic Disorders
- Motor disorders
- Considered to be biologal
- OCD Disorders
- Considered to be biologically based unless associated with another disorder or drug induced
- Often associated with anxiety
Motor Disorders
Tic
Disorders
- Stereotypic Movement Disorder
- Tic Disorders
- Tourette's
- Multiple motor and at least one vocal tic
- Persistent Motor or Vocal Tic
- Motor or vocal tic only
- Provisional Tic
- Less than a year of tics
- https://www.cdc.gov/ncbddd/tourette/diagnosis.html
OC and Related
Obsessive
Compulsvie
Disorders
- OCD
- Body Dysmorphic Disorder
- Hoarding
- Trichotillomania
- Excoriation
- https://beyondocd.org/information-for-individuals/clinical-definition-of-ocd
Anxiety Disorders
- Etiology is a combination of biological sensitivity and environment
- Evolves over development
- Conceptualized a little differently in IDD
Separation Anxiety
Separation Anxiety Disorder
- Worry and distress about being separated from attachment figures
- Anticipatory and triggered anxiety
- More significant distress or anxiety than appropriate for developmental level
- https://thriveworks.com/blog/separation-anxiety-disorder/
Specific Phobia
- Animals
- Natural environment
- Blood-injury-injections/medical
- Situational
- Other (i.e. loud noises, choking, vomiting, clouds)
- https://www.verywellmind.com/diagnosing-a-specific-phobia-2671981
Social Anxiety
Social Anxiety Disorder
- Complicated in ASD due to real deficits in social skills/understanding
- Typically seen for individuals who have better Theory of Mind
- Rarely treated in ASD without some skills training
- https://www.theravive.com/therapedia/social-anxiety-disorder-(social-phobia)-dsm--5-300.23-(f40.10)
Panic Disorder
- Characterized by panic attacks that occur out-of-the-blue
- Must worry about attacks or change behavior to avoid attacks
- Cannot be in response to specific triggers
- https://thriveworks.com/blog/panic-disorder/
GAD
Generalized Anxiety Disorder
- Excessive, hard to control worry
- Associated with physical symptoms, irritability, and/or difficulty concentrating
- https://www.verywellmind.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147
Disruptive Behavior
Disruptive Behavior Disorders
- Associated with
- irritability
- defiance
- disregard for rules
- Often referred to as "junk" diagnoses
ODD
- Symptoms may occur in one or many environments
- Does not specify a function
- https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_OppositionalDefiantDisorder.pdf
Conduct Disorder
CD
- Persistent pattern of more severe behavior
- Behaviors seriously violate the rights of others
- Behaviors can cause significant property damage or risk to self/others
- http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ConductDisorder.pdf
Other Common DX
Grab Bag
- Mood disorders (depression, bipolar)
- PTSD
- Feeding and eating disorders
- Pica, rumunation, anorexia, bing-eating
- Elimination disorders
- Insomnia
Understanding Diagnosis
Differentiate Autism
& Related Disorders
- Diagnosis based on behavioral profiles
- If there is overlap, it's difficult to say "what disorder" is responsible
- Some disorders share biological basis
- Many are secondary to autism
Where is it coming from?
Think Functionally
- Anxiety = Escape/avoidance
- Disruptive behavior = access, escape/avoidance, automatic
- OCD/Tic = automatic, escape/avoidance
- Mood = motivation
- Consider
- Skill deficit
- Generalization
- Managing motivation operations
Lets practice
Defend and Redefine Goals with Overlap
Case Example
Example
Olivia is an adolescent with autism spectrum disorder and significant social anxiety. While she has made great progress is mastering several of her social skills goals with known peers and adults; however, she expresses that she is very nervous she will mess up or not know what to say when asked to engage outside of her inner circle. When she does engage with others, she is very quiet, mumbles, or relies on other to help accomodate and escape the situation.
Original Goal
Within 6 months, Olivia will independently utilize self-calming strategies of deep breathing, PMR, and/or imagery when feeling anxious or overwhelmed by self-report.
Issues from Funder
- Self-reported distress
- Not a core deficit of autism
- How will you measure progress?
Likely Issues
Rework - Considerations
Rework
- Is she fluent in the requisite skills?
- Are we inadvertently prompting?
- Is there a history of punishment in these situations?
- What situations or skills are failing to generalize?
- Should this be one or several goals?
New Goal
- Within 6 months, Olivia will generalize the social skills below to at least 8 different individuals/situations as defined by engaging in at least 3 interchanges with one (or more people) on at least 3 occasions per person or situation, in the absence of the other person asking Olivia to repeat herself.
- Ordering at a fast food restaurant
- Initiating a conversation with a peer who is not a friend
- Ordering at a table service restaurant
- Asking to find an item at a store
- Particiapting in a group discussion at girl scouts
- ........
Give me some examples!
Practice
Thank you for your time!
Finale
If you would like CEUs for tonight's event, please complete the form at: https://forms.gle/EQijUBAxMP2tnRiY8
Link will be provided on the Facebook page as well.