Autism

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Autism





Common to be willing to interact with animals, emotionally, but not
humans.
Echolaic with animals and language, not to humans (normal use)
Difficulty in connecting with others.
Misuse of data – MMR vaccine, issues with what causes autism.

Autism was first diagnosed by a mother.
"Charles...brought to the clinic at 4 years old...[mother said] "the thing
that upsets me most is that I can't reach my baby". At one and a half
years of age , he began to spend hours spinning toys and lids of bottles
and jars..[his mother said] "he would not pay any attention to me. He
walks as if he is in a shadow, lives in a world of his own where he cannot
be reached. No sense of relationship to persons. He never offers anything
himself. His entire conversation is a replica of whatever has been said to
him. He speaks in the third person...he says "he wants" never "I want" " "
– Leo Kanner, 1943
 Distraction and comfort repetitive behaviours common.
Background
• 75% of children with autism have a learning disability - remainder
tend to have "borderline" learning disability,
• Roughly equally common across culture and social class
• Boys diagnosed more frequently - boys:girls 3-4:1
• 6 per 10,000 children are "clearly autistic'
• 20 per 10,000 have autistic characteristics
– ------> suggestion of "autistic continuum disorders“ with
Asperger’s syndrome being a variant
 Difficulty in categorisation of the spectrum.
Causes: Parental influences?
• Historically,
– a notion of cold, rejecting parents - especially mothers causing autism in their children
• Child and mother not bonding (attachment theory)
– This theory became quite widely known – “refrigerator
mother”
– Very damaging theory in many ways and no evidence for it
whatsoever.
• However:
– Nb. cold parenting, possible if parent had autism/asperger’s
MMR







vaccine
controversy over MMR?
“3 in 1” vaccine – measles, mumps, rubella
2-3 times 12-15 months/ 4-6 yrs and 11-13 yrs (US)
Wakefield (Lancet, 1998) advocated a link between MMR v and
autism
Other research has shown that there is NO link
Kaye (BMJ, 2001)

Incidence has increased from 0.3 per 10,000 since
1988 to 2.1 per 10,000 in 1999
• MR vaccination was at same level
• Not thought to be due to more awareness
• Increased risk “remains uncertain”
• Taylor (BMJ, 2002)
• Investiagted 278 chldren with autism and 195 with
atypical autism over period since 1979 & introduction
of MMR vaccine
• No evidence for causal link
 Number of children receiving vaccine dropped during this period.


DSM V: An overview
• People with ASD tend to have communication deficits, such as
responding inappropriately in conversations, misreading nonverbal
interactions, or having difficulty building friendships appropriate to
their age.
• In addition, people with ASD may be overly dependent on routines,
highly sensitive to changes in their environment, or intensely
focused on inappropriate items.
• Again, the symptoms of people with ASD will fall on a continuum,
with some individuals showing mild symptoms and others having
much more severe symptoms.
• This spectrum will allow clinicians to account for the variations in
symptoms and behaviors from person to person
Theory of Mind and Empathy
• “ToM is the ability to attribute mental states to others, to infer what
someone else is thinking or feeling. It is one of the two major
components of empathy, sometimes known as 'cognitive empathy'.
• The other major component is known as 'affective empathy', or the
drive to respond with an appropriate emotion to someone else's
mental states. Our work is showing that both components of
empathy may be impaired in autism and Asperger Syndrome.”
Simon Baron-Cohen
• http://www.autismresearchcentre.com/research/project.asp?id=1
“Normal” development & communication
• Most children have innate preferences for social attentiveness
which allows them to develop pre-verbal social skills
– (attend to "faces", follow gaze, communicative noises, facial
expressions)
• The use of gestures (e.g. pointing at objects) leads to shared
communication and shared perspective
• Normal communication allows the child to share in the perceptions
and thoughts of those around them - to make sense of the world
• They get to feel safe, knowing what others intentions are and what
their mood is (empathy).
Socio-affective processing:




Brain systems
and emotion
processing

AUTISM IS DEFINED BY
AN ABSENCE...
• Comparison with
normal, nondisabled
development
revealed a
characteristic
"Triad of
Impairment" in
individuals with
Autism
• A major point of
difference can be seen in the development of turn taking and
gesturing
And from a person with autism:
"I really didn't know there were people until I was seven years old. I
then suddenly realised that there were people. But not like you do. I
still have to remind myself that there are people...I never could have a
friend. I really do not know what other people do with other people,
really".
– Donald Cohen (1980 p.388)
• Principle thing in autism is panic through not knowing what people
expect of you .
• Intensive interaction – type of therapy. Differential reinforcement of
incompatible behavour.
And from someone who works with people with autistim:
• "...it is not uncommon to feel that one is faced with a strangeling
who moves on another plane of existence, a person with whom one
cannot connect"
– Hobson, (p.2, 1993)
Asperger’s syndrome…..
• “Prof. Temple Grandin is one of the few experts on animal welfare
who is categorically respected, from those affiliated with the animal




rights movement to government and corporate officials in industry
and agriculture.
Grandin, who is autistic, lectures regularly on the disability and is
the subject of "Anthropologist on Mars," … title of a book by Oliver
Sacks”
Works on systems for managing livestock –

Biological causes…
• Autism has major biological roots
• genetics: 91% concordance in MZ twins, nearly 0%
DZ twins and about 3% of siblings of people with
autism are also affected (= 60 - 100 fold more than
expected)
– OR
• Illness, rubella, meningitis, tuber sclerosis,
encephalitis as a direct cause in a significant number
of people and there are often signs of increased
neurological abnormality (EEG, MRI)
 Aspergers…what is the concordance rate for brothers, etc? from father?
 10,000 synapses in the human brain per neurone, 150,000,000,000
neurone cells
Synapses
• Development of synapses occurs at an astonishing rate during
children’s early years in response to experiences:
• At peak, cerebral cortex of toddler may create 2 milllion Synapses
per sec.(zero to three, 1999)

By time children
3years, brains will have
approx. 1,000 trillion synapses
(many more than they need).
• Some strengthened, but many
gradually discarded.
• This ‘pruning’ = normal part of
development (Shonkoff &
Phillips,2000). By adolescence,
approx. half
synapses have
been discarded.
Remainder exist throughout individual
life.
 Prefrontal cortex = reasoning.
 Phases of development.


“Two papers published online in Nature, by Hakon Hakonarson and
colleagues at the Centre for Applied Genomics at the Children's
Hospital of Philadelphia, show that mutations in genes that play
a role in establishing connections within a child's brain
increase his or her chances of developing autism. While a
single genetic variant may pose a small increased risk for a
child, the researchers claim to have identified variants that
may explain up to 15% of the prevalence of autism….

…Professor Tony Monaco, of the Wellcome Trust Centre for Human
Genetics at Oxford University….[reported that] … genes involved
in the growth and development of nerve cells in the brain
[might be implicated in increasing someone's susceptibility to
autism]. "This does seem to fit with what we know from brain scans
- that people with autism may show different or reduced
connectivity between different parts of the brain," said Monaco.”
15% variation/prevalence maybe due to genetic variation/mutations
Possibly caused by de-coupling by certain brain ‘cones’.
Autism less rare than thought, triad of autism impairments.
‘Nature never draws a line without smudging it’.







“Abnormalities in the cerebellum, frontal cortex, hippocampus, and
amygdala. …functional Magnetic Resonance Imagery (fMRI) suggests that
the fusiform “face area” in the temporal lobe may be impaired in people
with autistic disorder. This is interesting, because this area of the brain is
associated with face recognition (or emotional expression) – autistic
individuals often have profound difficulties in recognizing even very basic
facial expressions”
Developmental deficit/delay in communication
• People with autistic characteristics are disadvantaged
• seem not to have the abilities to "attend" to others to begin the
development of social and communicative skills
– Brain development – of synapses and connectivity systems,
may be affected
– Dawson “impairment of face recognition may turn out to be
one of the earliest indicators of abnormal brain development”
• leaves them at risk of not understanding the “social world”
• Puts at risk of anxiety and idiosyncratic "coping" behaviours
• Leads to the “Triad” of disorders of Autism
(1) Social Impairment
• Signs:
– Absent/impaired imitation
• (does not wave bye-bye; mechanical imitation of
others' actions out of context)
– Absent/abnormal social play
• (e.g preference for solitary play)
– Impaired ability to make friendships
• (e.g. can range from someone lacking understanding
of conventions of social interactions to complete
withdrawal)
– No or lack of wanting to seek comfort from others at times of
distress
 Emotional delay, physical social behaviour display
 Impaired social interactions.
 Not seeming to want to seek comfort, however often they do feel the
need for it, but can’t ask for it from humans. (Temple Grande ‘hug
machine’ (deep pressure)).
• Due to:
– People with autism lack a "Theory of Mind” (TOM)

An in-ability to think about their own and others'
mental states
– This underlies their difficulties in social relationships
• Evidence from “Sally Anne” Experiments suggests that
people with autism are severely delayed in developing
this ability, if ever able to at all
– "Sally Anne" task (Frith, 1989):
» This is Sally. Sally has a basket. This is
Anne. Anne has a box. Sally has a marble.
She puts the marble into her basket. Sally
goes out for a walk. Anne takes the
marble out of the basket, and puts it into
the box. Now Sally comes back. She
wants to play with her marble. Where will
Sally look for her marble?
 Lacking theory of mind – not being able to understand different
perspectives and other peoples beliefs.


(2) Language Impairment
Signs:
– No developmentally appropriate mode of communication
(e.g. babbling, mime or speech)
– Absent or abnormal nonverbal communication (eye-gaze,
facial expression or gestures)
– Abnormalities in form of speech e.g. stereotyped and
repetitive use of speech (echolalia)
– Pronominal reversals (use of "he" instead of "I", "He wants
tea“)
– Abnormalities in production of speech (volume, stress,
rhythm etc. eg. asking question)
– Lack of understanding about symbolic (abstract) nature of
language, stuck on concrete (eg. "Just give me a hand.....“)
– Possibly due to < people with autism not having the insight
into communication (motivated) to learn language skills
– And/or
• Lack language-learning experiences
 Not babbling and ‘talk’ as children in autism.
 Problem with pronominal reversals, not understanding the self as ‘I’.
 Not understanding the abstract aspect of speech, sayings eg. give me a
hand.





– (3) Restricted Behavioural Repertoire
Signs:
– Stereotyped body movements (e.g. hand flicking, rocking,
head banging etc)
– Preoccupation with parts of objects or attachment to unusual
objects (e.g. spinning wheels on toy car, carrying particular
tin around)
– Marked distress over changes made in trivial aspects of
environment (e.g. vase moved out of position)- also known as
'neophobia': fear of new things
– Insistence on following routines in detail
– Absence of imaginative activity

Stereotyped and restricted patterns of interest (e.g.
preoccupation with lining things up, preoccupation with bus
timetables)
• ? these are the autistic person's attempt to control a frightening and
unpredictable world
• If you can't organise your internal world it makes sense to impose
order on your external world.
 Likes routines a lot, if change gets very anxious.
 Need for sameness.
 Wanting to control external world as they can’t control their internal
world.


Goals of Intervention
• Provide with adaptive skills for engaging and making sense of
greater part of the world and promote independence
• Relieve symptoms of anxiety, frustration, and possibly, difficult
behaviour
– Especial emphasis on communication skills
– Difficulties for interventions
• ….The very things you hope to change….
– Rigidity with routines: educational approaches rely on
changing routines
– Usual rewards not rewarding, e.g. social praise etc., for
encouraging participation: the search for rewards is difficult
 Earlier intervention will be most effective in creating slight change in
the disorder.
 Age 3 or 4, critical
 Advise for parents is critical, to show what the best cause of action is.
 Issue with finding rewards.
 Evidence that there are links between autism and schizophrenia!
Summary
• Autism <-> Asperger’s constitutes a biologically based cognitive
disability
• manifest in disorders in social and language development and in
rigidity in thought and behaviour patterns
• puts people at risk of being learning disabled
• in contrast with other learning disability conditions, there is not
necessarily a "global" deficit of skills
• Each individual has her/his own pattern of abilities and may have
more or less "autistic features" and hence more or less difficulties
in coping with the ever so social world
 Definitely possible relationships with autism being possible
schizophrenia in childhood.
 Cultural differences can find autism difficult, not known in some
countries.
 Aspergers syndrome, condition affecting people with average or above
average ‘intelligence’.
 Alan Turing, Aspergers syndrome?
 Lack of appreciation of social cues.
 ‘Shades into eccentric normality’.

 Connection between autism and criminal offenses – Hughes, Williams et
al, 2012, indicates society isn’t doing a good enough job at finding
people with autism and helping deal with, rather than stigmatising.

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