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2. Outline. Autism basicsModel for understanding social interactions in autismPsychiatric comorbidity TemperamentAutism specific deficitsInterventionsConclusions / Questions. 3. Autism Spectrum Disorders. DSM-IV defines autism as (1) impairments in social interaction(2) impairments in commun
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1. 1 Understanding Behavior & Social Interactions in Children with Autism Spectrum Disorders Kevin M. Antshel, Ph.D.
Assistant Professor of Psychiatry / Licensed Psychologist
Department of Psychiatry & Behavioral Sciences
SUNY – Upstate Medical University
2. 2 Outline Autism basics
Model for understanding social interactions in autism
Psychiatric comorbidity
Temperament
Autism specific deficits
Interventions
Conclusions / Questions
3. 3 Autism Spectrum Disorders DSM-IV defines autism as
(1) impairments in social interaction
(2) impairments in communication
(3) restricted, repetitive and stereotyped patterns of behavior and interests
Grouped under Pervasive Developmental Disorders with:
Asperger disorder
impairment in social interaction
restricted interest/repetitive behaviors
PDD NOS
impairment in reciprocal social interaction
impairment in communication skills OR restricted interest / repetitive behaviors
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5. 5 Prevalence / Etiologies 1 : 166 – 500
Substantial genetic component (~ 90%)
Genetic syndrome in 10 – 20% of cases
30 – 50 % of ASD cases have mental retardation
Males are substantially more likely to be diagnosed with ASD
sex ratio is larger among children with higher IQ
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9. 9 Consider comorbidity…
1. When signs of problems outside the autism spectrum are apparent
Hyperactivity, distractible inattention
Sad or irritable mood, decreased pleasure in activities, increased withdrawal
Vegetative signs
Increased anxiety
Affective instability
Cognitive disorganization
2. When there is an abrupt change in behavior from “baseline”
First rule out a medical problem (seizures, migraine, medication side effect)
3. When there is a severe and incapacitating problem behavior
Aggression
Self-injury
Agitation
Sleep disturbance
4. When there is a worsening of symptoms already present
Decreased communication
Increased hand flapping or motor stereotypies
Decreased adaptive behavior and daily living skills
5. When child does not respond as expected to treatment
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12. 12 ASD Deficits – Theory of Mind The ability to construct representations of others, oneself, and interactions between oneself and others
Knowledge that others “have minds”
Requires the use of social cues to make inferences about individuals, such as their status, motivation, mood state, trustworthiness, etc.
Contributes to perspective taking
13. 13 ASD Deficits – Executive Functions Set-Shifting Deficits
inability to shift cognitive strategy to changing contingencies
correlated with autism symptomatology within the ritualistic/repetitive behavior domain
Preference for Detail Over Global
processing on detail at the expense of global configurations – poor central coherence
missing the overarching meaning of a situation
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17. 17 ASD Behavioral Rigidity Rigidity in behavior is interpersonally oriented
Most intrusive feature by parents
Insistence on Sameness in ASD
multiple areas of functioning
aversion to novelty
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20. 20 ASD Deficits – Emotion Awareness & Recognition
21. 21 Emotion Awareness & Recognition – Neurological Substrates Amygdala
Superior Temporal Sulcus
Fusiform Gyrus
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23. 23 Amygdala
integrative center of highly processed sensory information, emotional circuits, and outputs that influence somatomotor and autonomic activity
key region for processing information of motivational salience
involved in directing the visual system to seek out and attend to the eyes as a socially salient stimulus
strong positive correlation in individuals with ASD between the level of amygdala activity and gaze fixation on the eye region
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25. 25 Superior Temporal Sulcus higher-order processing region for the integration of multisensory stimuli and motion perception
sensitive to subtle changes in facial movement associated with facial affect
active when auditory stimuli is associated with socially relevant features
greater activation in response to angry prosody of human voices relative to neutral prosody
integration of visual and auditory stimuli with their affective salience
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27. 27 Fusiform Gyrus
processing of static facial stimuli
interconnectivity between the fusiform gyrus, superior temporal sulcus & amygdala
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29. 29 Integrating Affective & Social Processing fusiform gyrus and superior temporal sulcus encode the visual properties of socially relevant stimuli
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neurons within the amygdala that associate the visual percept with its emotional meaning
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amygdala can simultaneously influence the perceptual representation of the stimulus in the fusiform gyrus and the superior temporal sulcus region
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regions are anatomically connected to prefrontal cortex, where social evaluative processes become associated with motivational goals and executive control of behavior
30. 30 ASD Socioemotional Heterogeneity Subtypes
Aloof, low-functioning individuals notable for total disengagement from social interaction and failure to engage in interpersonal reciprocity
Loner subtype characterized by individuals with high or superior functioning who may navigate the social realm by gravitating toward occupations that condone an isolated style and by mastering social nuances by rote.
An active but odd cluster characterized by individuals with ASD who actively seek social interaction but do so in an inappropriate and one-sided fashion
Passive subgroup comprises individuals who fail to initiate social interaction but who accept the advances of others and potentially enjoy such advances
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33. 33 Conclusions ASD’s are a significant public health issue
Psychiatric comorbidity is the rule, not the exception
ASD specific deficits
Theory of mind
Executive function
Emotion awareness & recognition
Interventions
Treat psychiatric comorbidity
Individual / group social skills therapy