THE BIG PICTURE OF AUTISM: SCIENCE AND THEORY IN PLAIN ENGLISH

1. THE BIG PICTURE OF AUTISM:SCIENCE AND THEORY IN PLAIN ENGLISH Lars Perner, Ph.D. San Diego State University Presentation at the ANCATM Foundation Annual Conference and Fundraiser Vancouver, B.C. July 19, 2004

2. Purposes of This Talk • Understand the many factors that influence autism in individuals • Recognize individual variations and unique needs • Build empathy with autistic individuals • Get ideas on what to try and consider to help specific individuals

3. “If It [Were] Easy” • Problems we face are often superficially similar to those faced by “neurotypicals” • Relationships • Understanding others • Conflict • Budgeting • Limited sensory abilities • How we handle these problems

4. Sensitivity to Noise Coarse materials Food tastes Poor handwriting Difficulty maintaining eye contact Frustration with “spontaneous coordination” Difficulty imitating others Impaired spatial ability Difficulty driving Following maps Difficulty with sensory integration Difficulty doing arithmetic despite intelligence Depression Why Do These Symptoms Go Together?

5. The Role of Theory THEORY INTERVENTIONS VALUES AND DECISIONS UNDERSTANDING ANALYSIS EXPERIENCE WITH INDIVIDUAL

6. Diagnosis • Diagnostic criteria are somewhat arbitrary • May be needed for insurance and eligibility standards • Frequently “fudged” to meet eligibility • Future discoveries may help us better identify clusters of vulnerabilities

7. Categories Autism Asperger’s Syndrome Rett’s Pervasive Developmental Disorder—Not Otherwise Specified (PDD-NOS) Childhood Degenerative Disorder Differences Within-group Between-group Meaningfulness of diagnostic distinctions Rigidity of criteria Arbitrary nature of standards Pervasive Developmental Disorders (PDDs)

8. Causes of and Influences on Autism GENETICS GENETIC PROTECTION VULNERABILITY TO ENVIRONMENT COMPENSATING ABILITIES EXHAUST SYMPTOMS SECONDARY SYMPTOMS

9. Genetics • Varying estimates of the numbers of genes involved • Interaction of multiple genes • Fraternal vs. identical twins • Genetic redundancy and protection

10. El Niñofication • The tendency to move to one extreme or the other on performance or behavior • Examples • Sensitivity • Confrontation • Math or verbal abilities

11. Brain Structure • Specialization of brain areas (e.g., amygdala) • Brain scan studies • “White” vs. “gray” matter • Neural connections • Learning • Survival and “pruning” • Structure of neurons and dendrites

12. Neurotransmitters • Total of 52 known • Especially important in autism: • Dopamine • Norepinephrine • Serotonin • Oxytocin • Interaction of transmitters

13. Two Competing Objectives for Computers and Brains ASSUMPTIONS GENERALIZATION SPECIALIZATION FILTERING PRIORITIZATION INTUITION (HUMANS) SPEED (EFFICIENCY) QUESTIONING ASSUMPTIONS REDUNDANCY VERIFICATION FOCUS OF ATTENTION LOGICAL EXAMINATION RELIABILITY

14. A FIVE FUNCTION MODEL OF THE PERFORMANCE OF INDIVIDUALS ON THE AUTISTIC SPECTRUM PERF0RMANCE INHIBITORY INSTINCTIVE FUNCTION INTUITIVE FUNCTION EXECUTIVE FUNCTION COMPENSATORY FUNCTION ACTIVE INTELLECTUAL FUNCTION

15. Abstraction and Generalization • Individuals with autism often have difficulty in • Generalizing from one situation to another • Understanding and/or accepting “exceptions” • Understanding certain non-concrete ideas (BUT…) • Understanding non-literal language • Deciphering symbolic (graphical) representation

16. LITERAL TERM LITERAL MEANING Literal Detour Contingent Redirection or “Bounceoff” Direct Route SOCIALLY ESTABLISHED MEANING ACTIVATION OF ASSOCIATIONS ANALYSIS OF METAPHOR The Literal Detour

17. Specialists and medical practitioners Teachers Parents Individuals on the Spectrum Biomedical researchers Psychologists and Counselors Theoreticians “It Takes Every Kinda’ Perspective to Go Around the Autistic Spectrum”with apologies to Robert Palmer

18. Comorbidity DEPRESSION/ BIPOLAR DISORDER ANXIETY OBSESSIVE- COMPULSIVE DISORDER AUTISTIC SPECTRUM CONDITIONS ATTENTION DEFICIT/ HYPER- ACTIVITY OPPOSITIONAL DEFIANCE DISORDER LEARNING DISABILITIES SEIZURES/ TOURETTE’S

19. Medical Treatments (In Addition to “Talk” Therapy) SOCIAL ISOLATION “FLAT” AFFECT ANTI- DEPRESSANTS VITAMINS AND NUTRIENTS REPETITIVE BEHAVIOR/ OCB ANTI-ANXIETY MEDICATIONS DEPRESSION NEUROLEPTICS ANXIETY SENSORY OVERLOAD STIMULANTS SELF INJURURIOUS BEHAVIOR ATTENTIONAL PROBLEMS

20. Very large individual variations in Needs Effectiveness Side effects Interactions Frequent side effects Paradoxical effects—may have opposite of expected effects Individuals with autism often respond to minute quantities Tolerance Loss of effectiveness Notes on Medications

21. Medical Studies • Test vs. placebo groups • Criteria • Average improvement • Improvement within a subgroup • Trial size and random variations

22. MEASLES ANTIBODIES IN GUT AVOIDANCE OF DISEASES MEASLES REACTION TO IMMUNIZATION CONTENTS VACCINATIONS SUSCEPTIBILITY TO HEAVY METALS AUTISM LEAKY GUT SYNDROME HEAVY METAL INTOXIATION EXACERBATION OF AUTISM SYMPTOMS AUTISM DIAGNOSIS TIMING OF VACCINATION SUSCEPTIBILITY TO AUTISM