Autism

1. Autism • Autism is a lifelong complex neurobiological disorder • Most severe childhood psychiatric condition • First identified in 1943 by Dr. Leo Kanner • Dr. Hans Asperger noted a milder form of the spectrum that is now called Asperger’s Syndrome

2. Pervasive Developmental Disorders Autism Rett Syndrome Childhood Disintegrative Disorder Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) Asperger’s Disorder

3. DSM IV Criteria for Autism: • Qualitative impairments in social interaction • Lack of eye contact and appropriate facial expressions and gestures • Failure to develop normal peer relationships • Lack of joint attention and emotional reciprocity • Impairments in communication • Language delays • Impairment in the ability to initiate or sustain a conversation with others • Stereotyped and repetitive use of language • Lack of imaginary play and imitation

4. Restricted repetitive and stereotyped patterns of behavior, interests and activities • Preoccupation with stereotyped and restricted patterns of interest • Adherence to specific routines or rituals • Stereotyped and repetitive motor movements (e.g hand flapping) • Preoccupation with parts of objects

5. Diagnosing Autism: • At least 1 DSM IV criterion before age 3 • Most children assessed at 2.5-5 years • Concerned when child has not developed language • Parents report that child was “strange” as an infant • Early onset: symptoms from birth • Late-onset: symptoms at 16-20 months

6. Incidence of Autism: • Used to be 4-5 out of 10, 000 people. • CDC now says it is about 1 in 150 individuals • More common than pediatric cancer, diabetes, and AIDS combined. • Occurs in all racial, ethnic, and social groups • Affects boys 4-5 X more than girls • 20% have splinter skills (above average in 1 area) • Less than 10% are ‘autistic savants’ • extraordinary skills: e.g. math, memory, artistic abilities, music

7. Sensory motor delays • Hearing: hypersensitive to certain noises • Vision: staring into space, flapping objects before their eyes, looking out of corner of eyes, peering close to objects • Vestibular sensations: spinning, staring • Temperature regulation • Pain: lack of appropriate pain response • Smell: oblivious to foul odors • Position: difficulty maintaining postures • Taste: specific food preferences • Textures: rubbing rough surfaces, preference for certain textures

8. Causes of Autism Genetics: • predisposition to autism is inherited • high concordance rates in identical twins • increased chance of affected family member Brain Abnormalities: • brain stem dysfunction • Epilepsy, and EEG abnormalities • ventricle enlargement & hydrocephalus • abnormal serotonin and dopamine levels • cerebellum abnormalities

9. Theories Executive Function (EF): • Individuals with autism are impaired on EF tasks • EF are mediated by frontal lobe, people with frontal lobe damage show similar behaviors  Theory of Mind (ToM): • ToM – ability to comprehend mental states of others, and make inferences and predictions about what others will do or believe • Understand that our own perspective may differ from the perspective of someone else

10. Baron-Cohen, Leslie, Frith (1985) • Compared autism (11-11), downs syndrome (10-11), and normal children (4-5) on a ToM test •  matched for VMA (5 years) • Why two comparison groups?

12. Results: • 85% normal passed • 86% downs syndrome passed • 80% autism failed • children with autism fail to employ a ToM Holroyd & Baron-Cohen (1993) • follow up study with same children at 19.8 years • Sally-Anne test, Ice Cream Van test (harder) • 82% failed Sally-Anne test • all failed Ice Cream Van test • as teenagers still fail to employ a ToM