Autism?

DSM-IV definition:

1. Impaired social interaction

2. Impaired communication

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

A “Triad of Impairments”:1) Social Functioning 2) Language and Communication 3) Behavior

It’s a winter night in Northbrook, Illinois and brothers David and Jason Craven are on the move. They’re watching a “Baby Beethoven” video. They’re bouncing on a mattress in their basement playroom. They’re climbing up their dad’s legs. 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 memory 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

• Rate: 1 in 3000 to 1 in 500• 75-90% males• 70% also have mental retardation• Diagnosis between 18 months and 3+ years• Affects every race and SES• 10% are autistic savants

*In Asperger’s Syndrome, there are no clinically significant delays in language or cognition

1. Language and Communication

• 40-50% are mute• Those who speak show unusual patterns:

Echolalia = repeating words or phrases

Pronoun Reversal

Monotonic voice

Pragmatic deficits (e.g. sarcasm)

Misuse of words (e.g. “hot” for stove and only stove)

Not just due to mental retardation

2. Behavior

• Unusual responses to environment• Insistence on sameness• Stereotyped movements• Special interests/preoccupations• Attachment to unusual objects• Lack of pretend play

3. Social Functioning• Little eye-contact• Not as “cozy, cuddly” as my other children

(poor attachment?)• Unaware of social norms, (acceptable behavior)• Typically prefer social isolation/playing by self

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

What causes autism?• Psychodynamic theory - bad parenting

– “Refrigerator moms”

• Genetics– 60% concordance in monozygotic twins– Higher rate in siblings (2% also autistic)– Multiple chromosomes involved

• + Unknown????

Theories of what underlies Autism

• Emotional impairment (Hobson)

• Central Coherence (Frith)

• Theory of Mind Module (Leslie; Baron-Cohen)

• Extreme Male Brain (Baron-Cohen)

Embedded Figures Task

‘Triad of impairments’: a failure in theory of mind?

communicationsocialization

Behavior

theory of mind

Theory of Mind & AutismWell established deficit in theory of mind:

– ‘Higher Level’ Theory of mind (ok with non-belief state emotions like sad/happy and desires, very poor at knowledge and belief attribution) Fail False belief, appearance reality

– No social referencing – Joint attention—e.g. gaze following and

protodeclarative pointing (only instrumental), showing gestures

• E.g. Discrepant Looking - Baldwin (1993)

Reading the Eyes

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

Reading the mind in the eyes

Monitoring of Referential Intent: Gaze Following Experiment

• Use the gaze of an adult speaker to discern appropriate referent of novel word

• Experimenter holds one novel toy and child looks at and holds a different novel toy; Experimenter utters novel word (e.g. “peri”)

Baldwin, 1993; Baron-Cohen, Baldwin & Crowson (1997)

Monitoring Referential Intent (Gaze Following) Results

85

6780

38

0

10

20

30

40

50

60

70

80

90

Follow-in Discrepant

ToddlersAutism

*

Theory of Mind

• Social Attribution Task (Klin, 2000)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?

Theory of Mind

• Social Attribution Task (Klin, 2000)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.

How is autism treated?There is no cure for autism (though symptoms tend to get milder

with age and intervention can help them lead more normal lives)• Medication - treats specific symptoms• Applied Behavioral Analysis (ABA) therapy

– Behaviors that are positively reinforced likely to be repeated, negative behaviors denied reinforcements --> shapes behavior

– Systematic and structured (completely objective data, everything same )– Goals are to work on every area of development and to eliminate autistic

behaviors at same time

• Others? (special diet, increase focus on eye-gaze)

Outcomes for Autism

• Symptoms tend to get milder with age• In 1980 survey, 1-2% are “normal” (live alone

and hold a job)• 1/3 have some degree of independence• 2/3 need a lot of support

Video Diary of Autism from “Planet Parent”!

If you are interested in learning more about autism…

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

Chapter 1 available on-line:

Book Recommendations

Book Recommendation:Mindblindness

Book Recommendation:Let Me Hear your Voice