AUTISMAUTISM

By:Pauline Narciso

Philip LaiHenry Kang

OverviewOverview

Pauline– General Survey of Autism– Neural/Chemical Correlates

Philip– Comparison of Consciousness

Henry– Treatments

General NotesGeneral Notes

Autism as a Syndrome: multiple disease entities

Autism is a developmental syndrome:

Common deficit: theory of mind

Bit of HistoryBit of History

1943- Kanner

“extreme aloneness from the beginning of life and anxiously obsessive desire for the preservation of sameness.”

Initial cause: Bad parents

Diagnostic CriteriaDiagnostic Criteria

Severe abnormality of reciprocal social relatedness

Severe abnormality of communication development

Restricted, repetitive behavior, patterns of behavior, interests, imagination

Early onset (before 3-5 years)

Other observed behaviorsOther observed behaviors

Lack of awareness of feelings of othersBizarre speech patternsLack of spontaneous and make-believe playPreoccupation with parts of objectsRepetitive motor movementsMarked distress over changes

Begins when…Begins when…

80% of cases began as “Infantile Autism”

Screening Model for Infantile Screening Model for Infantile AutismAutism

Is child’s eye-to-eye contact normal?Is he/she comforted by proximity/body

contact?Does he/she often smile or laugh

unexpectedly?Does he/she prefer to be left alone?

Systematic Feature Systematic Feature ExaminationExamination

Hand stereotypies (strange looking or posturing)

Stiff gaze, avoidance ofLittle reaction to strong, unexpected noisePassive, obvious lack of interest

Disease Entities within AutismDisease Entities within Autism

IABDZapella Dysmaturational subgroupPurine AutismAsperger’s and Autistic Savants

All share common Autistic behaviors

Infantile Autistic Bipolar Infantile Autistic Bipolar DisorderDisorder

Regression after initial normal developmentMeets classical criteria for AutismAutistic symptoms have a cyclical patternPositive family history of BD or Depression

Different from Autistic who later has onset of BD

Zapella Dysmaturational Zapella Dysmaturational subgroupsubgroup

Loss of language after initial normal dev Meets classical criteria Complex tics present Normal neurological exam, normal lab exams Rapid improvement following therapy Reach quasi-normal abilities by age 5-6 After age 6, usually fall into other psycho-

pathological category, ADHD

Purine AutismPurine Autism

Classical criteria metToo high/too low levels of uric acidConstipationGout in family membersSeizures and self-injury in majority“Purine”:abnormal levels of end product

(uric acid) of all purine pathways

Quote on Purine AutisticQuote on Purine Autistic

“the boy was an irritable baby who resisted any change in routine and never looked at people around him. By 2 years of age, the few words he had were rapidly disappearing. He lined up his toys in long straight lines instead of playing with them. He developed pica, teeth-grinding, compulsive biting to the point of bleeding.”

On the functioning end..On the functioning end..

Asperger’s: meet criteria, but have normal IQ functioning

Autistic Savants: special skills in memory, music, math, calendar calc, drawing, and hyperalexia reading.

Theories on contributing Theories on contributing factorsfactors

Unfavorable pre, peri, post-natal factors

Cellular and structural changes in Limbic System (amygdala, cerebellum, and hippocampus)

L-hemi neural substrates fail to develop (loss lang., consciousness, motor planning

Locus Coerulus:Mediates input from senses-underdeveloped

Low mercury levels

Who’s affected?Who’s affected?

1% of general public under the Autism Spectrum

Most often tend to be males

Altered States Compared to NormalAltered States Compared to Normal Resistance to change, Insist on sameness Strong attachments to objects; Spins objects Difficulty in mixing with others Throw Temper Tantrums Tend not to want to cuddle or be cuddled Over-sensitivity or under-sensitivity to pain

No fears of danger

Sensory ProcessingSensory Processing Painfully sensitive to certain sounds, textures, tastes,

and smells.

Either too sensitive or less sensitive than normal. Some autistic have difficulty interpreting sensory information.

Like normal these experiences are not hallucinations but based on real experiences.

Some avoid being touched, a gentle touch for most, will hurt or shock autistics.

Some are insensitive to pain, and fail to notice injuries.

EmotionsEmotions Take major emergencies in stride but become upset over

minor disruption.

Unemotional, but can be very emotional when things are important to them.

More candid and expressive with their emotions than normal people.

Small amount will have difficulty regulating their emotions. Individual will have verbal outburst, usually in strange or overwhelming environment.

CommunicationsCommunications

Problem with semantic-pragmatic component, take a statement or question in a literal way.

Ex.) "I'd like coffee with my cereal“

Repeating things that have been heard (echolalia)Inability to understand body language, tone of

voiceSome autistics are mute

Communication Cont.Communication Cont.Difficult in sustaining a conversation. No

normal "give and take" in a conversation

Autistics tend to go on with their favorite subjects and do not give the other person a chance to talk.

People with autism might stand too close to the other person.

Body language, facial expressions, and gestures do not match what they are saying.

AttentionAttentionTrouble handling multiple stimuli of attention. Very narrow focused attention, can not keep

up with more than one thing at a time.

Shifting attention is a slow process, usually involves pauses or moments of delay.

ProductivityProductivity Great deal of variety among autistics.

Some autistic may never learn to talk and be dependent throughout their lives.

Others may do well in special supportive settings, working in a sheltered environment.

There are autistics that are fully independent and function fairly well.

Theory of MindTheory of Mind TOM is absent in autistics, can not attribute mental states.

Autistic can not reflect on their own mental states.

Cause abnormalities in social interactions, communications, and imagination.

Understanding mental states of others can allows individuals to make sense of past behavior, allows influence on present behavior and permits prediction of future behavior.

Normal 3 year olds no TOM, but 4 year olds tend to have a TOM.

Mirror NeuronsMirror Neurons

Tested controls and autistics on 4 different tasks. Researchers compared mu rhythms. At baseline, mu

rhythms will fire in synchrony, large amplitude mu oscillations.

Normal when seeing an action perform will cause mu rhythms to fire asynchronously, therefore resulting in mu suppression.

Mirror Neurons Cont.Mirror Neurons Cont. So mu wave suppression will reflect activity of the

mirror neuron system. In autistics, there was mu suppression in their own

hand movements, but no mu suppression to the observed hand movements.

Autism TreatmentAutism Treatment

Behavioral modification and communication approaches

Dietary and biomedical approaches

Complementary approaches

Behavioral & CommunicationBehavioral & Communication Applied Behavior Analysis

– Rewarded behavior TEACCH

– Understand the world PECS

– Picture exchange Social Stories

– Theory of Mind Sensory Integration

Biomedical TreatmentsBiomedical TreatmentsMedications

– Serotonin Re-uptake Inhibitors– Anti-Psychotic Medications

Risperidone

Vitamins and Minerals

Dietary Interventions

RisperidoneRisperidone

Two double-blind, placebo-controlled responses of risperidone– Adults and Children

Serotonin-Dopamine antagonist Effective as a short-term treatment

– Tantrums, Aggression, Self-Injurious Behavior– Interfering repetitive behavior, self-injurious behavior,

sensory motor behaviors, affectual reactions, overall behavioral symptoms

Risperidone Cont.Risperidone Cont.Figure 1: Mean Scores for Irritability

Risperidone Cont.Risperidone Cont.Figure 2: Change in Severity of Overall

Symptoms

Vitamins & MineralsVitamins & Minerals

Vitamin B– Most common vitamin supplement

Vitamins A and D– Eye contact and behavior

Vitamin C– Improve symptom severity

Dietary InterventionsDietary Interventions

Gluten– Disruption in biochemical and neuroregulatory

processes

Yeast– Behavioral and medical problems

Complementary ApproachesComplementary Approaches

Improving Communication Skills– Music Therapy

Speech Development– Art Therapy

Non-verbal, Symbolic Expression– Animal Therapy

Physical and Emotional Benefits

ConclusionConclusion

Autism is a spectrum

Autistics lack an essential element of consciousness-Theory of Mind

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References Cont.References Cont. McDougle, Christopher J., et al. “A Double-blind, Placebo-Controlled Study of

Risperidone in Adults With Autistic Disorder and Other Pervasive Developmental Disorders.” Arch Gen Psychiatry 55 (1998): 633-641.

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