Autism

Course Overview

  • Course title: Clinical Child and Adolescent Psychology

  • Topic focus: Autism Spectrum Disorders (ASD)

  • Instructor: Prof. Dr. Julian Schmitz

  • University: Universität Leipzig

Perception of Autism in Media

  • Question: Have you seen portrayals of autistic individuals in film or TV?

  • Discussion Point: Consider how autism was depicted in those portrayals.

Historical Roots of Autism

Leo Kanner (1943)

  • Described 11 children displaying:

    • Focus on objects over people

    • Avoidance of eye contact

    • Lack of speech and social awareness

    • Stereotypical motor movements

    • Reacting with anger or fear to routine changes

  • Term introduced: Early Childhood Autism

Hans Asperger (1944)

  • Observed children with:

    • Conspicuous behaviors labeled as "autistic psychopaths"

    • Signs of high intelligence, lack of empathy, and specialized skills

    • Referred to these children as "little professors"

Definitions of Autism Spectrum Disorders

  • WHO (2002) Definition of Pervasive Developmental Disorders:

    • Include qualitative impairments in interactions and communication

    • Restrictive and repetitive behaviors

    • Typically mild general cognitive impairment, with behaviors not correlating with intelligence level.

ICD-10 Classification

  • Categories Include:

    • F84.0 Childhood Autism

    • F84.1 Atypical Autism

    • F84.2 Rett Syndrome

    • F84.3 Other Childhood Disintegrative Disorder

    • F84.4 Overactive Disorder with Mental Retardation

    • F84.5 Asperger Syndrome

Childhood Autism Criteria (ICD-10)

Manifestation Features

  • Symptoms must appear before age 3 in:

    • Functional or symbolic play

    • Language use (receptive/expressive)

    • Social categorization

Core Areas of Impairment

  1. Mutual Interaction

  2. Social Communication

  3. Repetitive and Stereotypical Behaviors

Qualitative Abnormalities in Interaction

  • Inability to use communicative behaviors (e.g., eye contact, gestures)

  • Difficulty relating to peers, sharing interests or emotions

  • Impaired social-emotional reciprocity

  • Lack of enjoyment in shared activities

Qualitative Abnormalities in Communication

  • Delay or disruption in speech development

  • Difficulty initiating or maintaining conversation

  • Stereotyped language usage

  • Lack of spontaneous play or imitation games

Stereotyped Behaviors

  • Compulsive attachment to rituals or non-functional actions

  • Repetitive motor manners (e.g., flapping)

  • Preoccupation with the sensory aspects of play material

Asperger Autism (ICD-10)

Key Features

  • No delays in spoken language or cognitive development

  • Reciprocal social interaction impairments similar to early childhood autism

  • Uniquely intensive interests and higher-level repetitive behaviors

Future Classification Changes

  • Recognizing the overlap between childhood autism and Asperger's syndrome

  • ICD-11 establishes a unified category: Autism Spectrum Disorder.

    • Includes symptom clusters of social communication deficits and repetitive behaviors.

Severity Levels of Autism

Level 1 (Requires Support)

  • Reduced interest in social interactions; difficulty initiating contact.

  • Deficits in social communication; difficulty with changes.

Level 2 (Requires Substantial Support)

  • Noticeable social impairments despite help; significant communication deficits.

  • Fixed interests leading to stress when interrupted.

Level 3 (Requires Very Intensive Support)

  • Severe dysfunction with minimal social engagement; adheres to strict rituals.

Epidemiology of Autism

  • Increasing prevalence from 0.04% to 0.65% (Fombonne, 2005).

  • Improved assessment tools and increased awareness attributed to rise in cases.

  • Gender Ratio: Boys diagnosed 4.3 times more than girls.

Intelligence and Special Talents in Autism

  • 5% of children may display exceptional talents in specific areas.

  • 25-50% of children have intellectual disabilities; many have average intelligence.

Course Progression and Outcomes

  • Limited studies indicate slight symptom improvement in social interactions.

  • Low IQ and language skills are indicators of poorer outcomes.

  • Approximately 50% of those with Asperger’s Syndrome achieve independent living.

Etiology of Autism

  • Focus on biological and neurobiological factors:

    • Molecular biology, genetics, brain development.

    • Associated cognitive deficits in executive functions and Theory of Mind.

Diagnostic Procedures

  • Initial Screening: Social communication questionnaires and interviews.

  • Behavioral Observations: Autism Diagnostic Observation Schedule (ADOS).

Treatment Approaches

Symptom-Oriented Programs

  • Focus on improving communication, social skills, emotion regulation, and problem-solving.

Therapy Recommendations for Preschoolers

  • Begin with standardized assessments to inform targeted therapy.

  • Include parent training and promote child’s self-initiated communication.

Therapy Recommendations for School Age & Adolescents

  • Group therapy for social skills development; informed parents.

  • Focus on peer interactions, role-playing, and parent coaching.

Pharmacotherapy of Autism

  • Medications for symptoms such as hyperactivity, aggression, anxiety, etc.

Learning Theory Based Interventions

Applied Behavior Analysis (ABA)

  • Intensive, structured, 20-40 hours/week programs aimed at enhancing language and social skills.

  • Emphasis on reinforcement and long-term individual support.

Criticism of ABA

  • High costs linked to limited efficacy; experiencing negative effects reported.

Theory of Mind Training (TOMTASS)

  • Group interventions teaching aspects of social interactions and self-awareness for children aged 7-18 with high-functioning autism.

Further Evaluation and Research

  • Notable improvements in social responsiveness and quality of life measures.

  • Continued investigation needed for educational and treatment effectiveness.

References

  • Mash, E. & Wolfe, D. (2019). Abnormal Child Psychology. Cengage Learning: Boston.