Autism Spectrum Disorder

DSM-IV definition A “Triad of Impairments”:1. Impaired communication2. Impaired social interaction

3. Restricted, repetitive, and stereotyped patterns of behaviors, interests, and activities

• Difficulties fall along a spectrum ranging from very mild to very severe

DSM-V (combines 1 & 2)

David, 7, and Jason, 5, with their mops of brown hair, look physically healthy. But both boys suffer from a devastating developmental disorder: autism. David speaks only 10 words, still wears diapers at night and sucks on a pacifier. Jason drinks from a baby bottle. Neither one can vocalize his glee as he plays…

Since their sons were diagnosed, both at age 2, Barry and Dana Craven have tried a dizzying array of therapies: neurofeedback, music therapy, swimming with dolphins, social-skills therapy, gluten-free diets, vitamins, anti-anxiety pills, and steroids…To reduce the boys’ exposure to environmental chemical, they replaced their carpeting with toxin-free wood floors and bought a special water-purifying system. They even installed a sauna which they think will help remove metals like mercury and arsenic from the boys’ bodies. Warm and loving parents, the Cravens spend $75,000 in treatments last year alone…

…autism, a vexing brain disorder, remains largely a mystery. Researchers still don’t know what causes it, nor do they know how best to treat a condition that prompts one child to stop speaking and another to memorize movie scripts.Newsweek, Feb. 2005

Autism

Kanner’s (1943) Descriptions• He seems almost to draw into his shell and live within himself....• When taken into a room, he completely disregarded the people and instantly went for

objects....• When a hand was held out to him so that he could not possibly ignore it, he played with it

briefly as if it were a detached object....• He did not respond to being called, and did not look at his mother when she spoke to him....• He never looked up at people's faces. When he had any dealings with persons at all, he treated

them, or rather parts of them, as if they were objects. He would use a hand to lead him. He would, in playing, butt his head against his mother as at other times he did against a pillow. He allowed his boarding mother's hand to dress him, paying not the slightest attention to her....

• ... on a crowded beach he would walk straight toward his goal irrespective of whether this involved walking over newspapers, hands, feet, or torsos, much to the discomfiture of their owners. His mother was careful to point out that he did not intentionally deviate from his course in order to walk on others, but neither did he make the slightest attempt to avoid them. It was as if he did not distinguish people from things, or at least did not concern himself about the distinction.

Facts about Autism• Prevalence: Estimates range: ~1/4000 to 1/88 (CDC, 2008)• Increases in rates: 1/150 in 2000; 1/88 in 2008 (CDC)• 5 times more common in males• 40% also have cognitive delay• Today, diagnosis can be reliably made at 2 years, ~20% diagnosed

by 3 years; on average between ages 4-6• Affects every race and SES• 10% are autistic savants

*In Asperger’s Syndrome, there are no clinically significant delays in language or cognition (Deficits seem specific to social interaction)

1. Impaired Communication• ~ up to 40% are mute• Those who speak show unusual patterns:

Echolalia = repeating words or phrasesPronoun ReversalMonotonic voicePragmatic deficits (e.g. sarcasm)Misuse of words (e.g. “hot” for stove and only stove)

Not just due to cognitive impairment

2. Impaired Social Functioning• Little eye-contact• Low social-emotional reciprocity: Not as “cozy,

cuddly” as other children• Less awareness of social norms (e.g. acceptable

behavior)• Typically prefer playing by self

The MOST reliable sign of autism is a problem with social functioning!

3. Restricted Behavior• Unusual behavior patterns (e.g. emotional

outbursts or very passive)• Repetitive actions and insistence on routines• Sensory sensitivities (enhanced and/or reduced)• Stereotyped movements (e.g., flapping, rocking)• Special interests and preoccupations• Attachment to unusual objects• Lack pretend play

What causes autism?• Psychodynamic theory: bad parenting—NO!

• Nature AND Nurture!Genetics– ~60% concordance in monozygotic twins– Higher rate in siblings (2-18% also autistic)– Multiple chromosomes involved (polygenic)– 10% have other genetic conditions

• + Environmental trigger(s)• some evidence that 3rd week of pregnancy is critical (e.g.,

ear placement)• Exposure to Microbes? Toxins? Some Unknown factors?

Common Theories of Mechanisms underlying Autism Characteristics

(regardless of the causes of the condition)

• Central Coherence (Frith)• Extreme Male Brain (Baron-Cohen) • Theory of Mind Module (Leslie; Baron-Cohen)

* Not necessarily mutually exclusive (i.e. 1 or other)

1. Central Coherence?Embedded Figures Task, Upside down puzzles

Global vs. local focus

2. Extreme Male Brain?

• Levels of testosterone, early puberty• Morphology (e.g., finger)• Better at skills that males tend to do better

on (‘systemizing’ skills: math, science, computers) and worse at skills that females tend to do better on (‘empathizing’ skills: verbal, social-emotional, ‘reading’ others)

3. Theory of Mind Impairment?recall ‘triad of impairments’

communicationSocial interaction

Behavior

theory of mind

Well-established deficit in Theory of MindTypically fail false belief tasks

No social referencingNo gaze following

Poor ‘mind-reading’e.g., Reading the mind in the eyes

Theory of Mind and the Triad1. Social Interaction

Reading the Eyes

e.g. Individuals with autism tend to not monitor gaze when watching social interactions (show preference formouth and other moving parts)

Theory of Mind and the TriadSocial Interaction

Theory of Mind and the TriadSocial Interaction

Moving Triangles Task

Normal adolescent:What happened was that the larger triangle- which was like a bigger kid or a bully-

and he had isolated himself from everything else until two new kids came along and the little one was a bit more shy, scared, and the smaller triangle more like stood up for himself and protected the little one. The big triangle got jealous of them, came out, and started to pick on the smaller triangle. The little triangle got upset and said like “What’s up? Why are you doing this?”

Adolescent with autism:The big triangle went into the rectangle. There were a small triangle and a circle.

The big triangle went out. The shapes bounce off each other. The small circle went inside the rectangle. The big triangle was in the box with the circle. The small triangle and the circle went around each other a few times. They were kind of oscillating around each other, maybe because of a magnetic field. After that, they go off the screen. The big triangle turned like a star- like a Star of David- and broke the rectangle.

Theory of Mind and the TriadSocial Interaction

• Lack Joint Attention/Gaze Following• Can result in mislabeling• Difficulty reasoning about intentions• Pragmatic aspects of language are difficult (e.g.,

sarcasm; tend to interpret literally)• Understanding of nonverbal communication is

impaired

Theory of Mind and the Triad2. Communication

• Theory: inability to reason about mental states of others makes the social world incredibly difficult to predict

• Results in – preference for social isolation– preference for routines (b/c predictable) and interests in

non-social objects that can be understood (e.g., fascination with numbers, math, and physical ‘systems’)

• Poor attachments• No pretend play

Theory of Mind and the Triad3. Unusual Behavior

Theory of Mind Theory of Autismrecall ‘triad of impairments’

communicationSocial interaction

Behavior

theory of mind

If you are interested in learning more about autism…

http://www.grandin.com/inc/visual.thinking.html

Chapter 1 available on-line:

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