Autism

What are the 4 attributes that described a group of Kanner’s (autistic) patients

• autistic aloneness

• desire for sameness

• language problems

• islets of ability

  • overall poorer functioning but preserved or enhanced skills in some areas

What did Kanner believe before and after changing his mind about the aetiology (cause) of autism

• originally thought autism as a biological disorder

  • innate inability to form affective relationships

• moved to a psychodynamic understanding of autism caused by maladaptive parenting

  • e.g. ‘refrigerator mothers’

How does the ICD-11 describe the autism spectrum disorder

• ongoing difficulties with social communication and social interaction that are greater than what is typical for someone’s age and level of intellectual development

• ongoing restricted, repetitive, or inflexible behaviours or interests that are not typical for the person’s age or cultural context

The ICD-11 diagnosis of autism is made in reference to…

• presence or not of disorder of intellectual development

• presence or not of impaired functional language

  • functional language: “capacity of individual to use language for instrumental purposes (e.g. express personal needs and desires)”

When does the onset of autism occur

occurs during the developmental period

• typically in early childhood

• characteristic symptoms may not fully manifest until later, when social demands exceed limited capacities

What is the DSM-5 criteria for autism

• deficits in social-emotional reciprocity

  • e.g. abnormal social approach and difficulty sustaining back and forth conversation

• deficits in nonverbal communication behaviours

  • e.g. poor eye contact, lack of facial expressions and understanding, use of body language

• deficits in developing, maintaining, and understanding relationships

What behavioural/sensory symptoms of autism is there

• stereotyped or repetitive motor movements, use of objects or speech

• insistence on sameness, inflexible routines, ritualised behaviour, or speech

• abnormal intensity of fixated interests

• hyper or hypo sensitivity to sensory input

When must symptoms of autism be present DSM-5

must be present in early childhood periods

• symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

What is the comorbid diagnosis of autism

can only be given when social communication below expected developmental level

According to the NICE guidelines autism assessment what is included

• detailed questions about parents or carers concerns

• details of the child's or young person's experiences of home life, education and social care

• a developmental history

  • focusing on developmental and behavioural features consistent with ICD-10 or DSM-IV criteria

• assessment (through interaction with and observation of the child or young person) of social and communication skills and behaviours

  • focusing on features consistent with ICD-10 or DSM-IV criteria

What is the prevalence rate of autism spectrum disorder

• average prevalence of ASD in Europe, Asia and North America is between 1-2%

• more common in boys (1 in 42) than girls (1 in 189), Christensen et al., (2016)

Is the incidence of ASD increasing - ‘yes’ answer

• data from US registry report increase in prevalence in ASD since 2002

• increase to 116 in 10,000 children aged 9-10 years in South Thames region, UK, Baird et al., (2006)

Is the incidence of ASD increasing - ‘no’ answer

UK community survey of adults, prevalence rates in younger cohorts consistent with that of older cohorts, Brugha et al., (2011)

What are the other issues to consider in the incidence of ASD increasing

• changes in practices of autism diagnosis account for up to 24% of the increase in prevalence rates in California between 1992 and 2005 (King & Bearman, 2009)

• broader criteria than that originally put forward by Kanner (Lenoir, 2009)

• relying solely on clinical diagnoses

What are the biological causes of ASD

• larger cerebral volume - excess of white matter (Filipek, 1999)

• abnormalities in lateral occipital lobe (motion processing)

• pericentral region (sensorimotor processing)

• basal ganglia (associated with poor motor performance and repetitive/stereotyped behaviour)

• medial temporal lobe (face recognition),

• right parietal operculum (sensory integration) (Nickl-Jockschat et al, 2012)

How does the brain function with a person with ASD

decreased activation in amygdala and prefrontal cortex - brain areas involved in processing intentions of others (Casteeli et al., 2002)

What is the perinatal factor with a person with ASD

extremely preterm birth < 26 weeks gestation (Johnson et al., 2010)

• up to 8% prevalence of ASD

What are the genetic factors of a person with ASD

• heritability:

  • 60-91% concordance rate between monozygotic (identical) twins

  • 0-9% between dizygotic twins

• many different genes implicated in ASD genetic heritability

  • heritability involves interaction of multiple genes

What is the possibility of siblings of children with ASD to have it themselves

siblings of children with ASD 20-25 fold higher incidence of autism than general population

What is the Theory of Mind deficit

individuals with ASD have Theory of Mind deficits

• difficulty understanding others' internal mental states (beliefs, desires, intentions, emotions), leading to challenges in social interaction, communication, and predicting behaviour

  • it impacts interpreting cues, recognising different perspectives, and expressing empathy

Describe the findings go the Seminal Theory of Mind Study, Baron-Cohen et al., (1985)

typically developing children pass false belief task by age 5

• children with an intellectual disability with a mental-age of 5 were also able to pass the false belief task

• some children with ASD able to pass fall belief task by age 10

What is the compensatory mechanism

children can be taught to pass false belief tasks but social competence is not improved

What are some criticisms of the Theory of Mind hypothesis

• doesn’t fully explain all features of ASD, such as stereotyped and repetitive behaviours

• weak central coherence - bias for features or local information rather than global meaning

• open-ended tasks indicate that individuals with ASD have a processing bias for local versus global information

  • tend to focus more on small details (local information) rather than the overall picture or whole (global information)

What are the executive function skills

• inhibition

• working memory

• cognitive flexibility

• planning

• weak central coherence

• theory of mind

What are the correlations between inhibition, working memory, planning, flexibility, and theory of mind

no significant correlations

Children with … have poorer inhibition skills than children with ASD

ADHD

The executive dysfunction model doesn’t explain …

what is unique about autism phenotype - no evidence for a ‘primary deficit’

Why do individuals with autism engage in repetitive and restricted behaviours and interests

• behavioural manifestation of anxiety

  • strong correlation between anxiety and frequency of repetitive behaviours

• provides some degree of control, unlike in social situations

  • social situations present a high amount of uncertainty for individuals with autism as they struggle to understand others’ mental states and predict their behaviour

• a high level of attention to detail might result in an insistence on sameness

  • as individuals can more easily detect small changes in the environment

What is the relationship between restricted interests and age

reduction of restricted pattern of interests and related behaviours after the age of 10 and for children with higher language ability

• older children might have more typical interests, but are still higher in intensity

• being older and having better language skills might reflect better inhibition and set-shifting skills, associated with lower restricted interest scores