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 Aspergers 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/aspergers

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, non- disabled 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)

Aspergers 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) Aspergerswhat 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 childrens 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 expressionsDevelopmental 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 cant 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 cant 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 Aspergers 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 isnt doing a good enough job at finding people with autism and helping deal with, rather than stigmatising.