Asperger’s Syndrome, Anxiety, and Neurophysiology

1. Asperger’s Syndrome, Anxiety, and Neurophysiology Prepared by Robert S. Lagos For the Kiwanis Club October 21, 2011 Dexter, ME

2. Introduction: What is Asperger’s Syndrome? • Defined as an autism spectrum disorder (ASD), characterized by difficulties in social interaction and restricted, stereotyped patterns of behavior and interests.

3. Introduction: What is Asperger’s Syndrome? • Named after the Austrian pediatrician Hans Asperger, who, in 1944 described children in his practice with similar traits.

4. Introduction: What is Asperger’s Syndrome? • In 1994, AS is standardized as a diagnosis in the DSM IV • Will likely be subsumed into Autism disorder in DSM V (2012 or 2013).

5. Introduction: What is Asperger’s? • Lots of information nowadays! • Books written by people with autism/AS and also specialists in the field • Internet • Other Media

6. Frequency of Asperger’s? • About 1 in 100 diagnosed • Why the increase? Could be: • Increase in attention and education of autism • Effects of a changing society and culture over last 50 years: greater anonymity, erosion of community and family, spread of solitary pursuits like TV, internet.

7. Frequency of Asperger’s? • More males than females (about 3:1 or 4:1) – “true” ratio probably less. • Tony Attwood speculates 2:1 • Lack of diagnosis of women: probably due to societal roles expected of women vs. men • May also be due to the gender differences

8. Pioneers of Asperger’s Syndrome Research Hans Asperger (Well known for pioneer research work with early infantile autism) Modern Day: Tony Attwood World famous researcher and author (and others)

9. Common Themes, Symptoms, and Issues of Asperger’s/HFA • Inability to connect socially with others in outside world. Shyness, as well as a different interest focus. Inability to read and pick up non-verbal cues.

10. Common Themes, Symptoms, and Issues of Asperger’s/HFA • Cultural divide, difference to that of outside world. General feeling of lack of understanding and compatibility with it. Difference in perception. • Isolation. ? ? ?

11. Common Themes, Symptoms, and Issues of Asperger’s/HFA • Specialized range of interests • Often over-focused on a single topic • Can be vocationally beneficial, and at least of entertaining value. • Many technological contributions are attributed to intense focus in a particular area. • Some degree of repetitive aspects/behaviors within interests.

12. Other frequent themes/issues • Obsessive thinking • Sensory overload • Anxiety and hyper-reactivity • Language and mental processing delay • Motor and directional skills: some difficulties • Delays in learning physical activities

13. Other frequent themes/issues • Lack of social interest: internalization • Inability to respond emotionally • No small talk • May not understand sarcasm – things taken literally

14. Other frequent themes/issues • Awkward body language • Problems with eye contact • Repetitive movements • Not flexible about routines/rituals • May be singled out by peers as “strange”

15. Other frequent themes/issues • Common Comorbidities: • OCD • Attention deficit • Depression/mood shifts • High Functioning Autism: • More language delay • May be more withdrawn

16. Some common positive characteristics • Gifted in select areas • Thinking “outside the box” • Uniqueness – personality and abilities • Reliability and truthfulness • Attention to detail • Intense dedication and focus on different areas of interest.

17. Neurophysiological attributes of persons with autism / A.S. • Brains of autistic persons have been found to differ in several ways from a “neurotypical” brain. • Associated with “male-like” brain: systematizing skills over empathizing • Tend to use different areas of the brain • But many facts not yet tied together.

18. Neurophysiological attributes of persons with autism / A.S. • Brain cells are linked by axons, long cables insulated with myelin, which form the white matter. • In autistic people, there seem to be too many cables within local areas, but not enough links from one region to another. • This problem may be developmental – the development of the white matter has been found to be delayed in autistic persons.

19. Neurophysiological attributes of persons with autism / A.S. • Imbalances have been found in neurotransmitters (i.e. chemicals helping nerve cells communicate with one another): • Serotonin (affecting emotion and behavior) • Glutamate (plays a role in neuron activity)

20. Regions of the Brain Important in Autism • Frontal Lobes 2. Corpus Callosum 3. Amygdala 4. Hippocampus 5. Cerebellum Back of Head Front of Head (Time Magazine, May 15, 2006, p.44-45)

21. Neurophysiological attributes of persons with autism / A.S. • Frontral lobes • Important in reasoning, emotion, personality. • Found to be enlarged in autistic persons, due mainly to excess white matter, the brain’s connector cables. • Often found to grow at an unusual rate by age 2.

22. Neurophysiological attributes of persons with autism / A.S. • Cerebellum • Important in motor activity, coordination, and motor/sensory planning. • Like frontal lobes, overloaded with white matter. • The above skills can all be weak for people with autism.

23. Neurophysiological attributes of persons with autism / A.S. • Corpus Callosum • Facilitates communication between the left and right hemispheres of the brain. • Found to be undersized. • Activity across regions of the brain are poorly coordinated.

24. Neurophysiological attributes of persons with autism / A.S. • Hippocampus • Vital to memory. • Found to be about 10% larger than normal for autistic persons. • May, however, be because autistic persons rely on memory to interpret situations that most people process elsewhere.

25. Neurophysiological attributes of persons with autism / A.S. • Amygdala • Important in emotion and social behavior. • Also found to be enlarged for autistic persons. • Size may be related to the high level of anxiety in autistic people.

26. Neurophysiological attributes of persons with autism / A.S. • Genetics • No single gene has been isolated. But different gene combinations have been associated. • Lately it has been found that autistic persons tend to have fewer copies of certain genes (due to depletion in chromosome #16). • Asperger’s and autism tend to run in families, i.e., higher chance if relative such as sibling or parent has it.

27. Neurophysiological attributes of persons with autism / A.S. • Still uncertain as to whether many structural differences are the cause or the result. • Some physiological differences not as pronounced in person’s with Asperger’s • Although differences evident, it is all very much a puzzle yet to be pieced together!

28. Anxiety and A.S. • Anxiety is normal – but likely to be significantly more disabling in AS than in general population. • Important AS symptom: excessively overwhelmed by stimuli: May be highly correlation with anxiety.

29. Anxiety and A.S. • Could other A.S. symptoms be a form of this hyper-reactivity toward stimuli? • Could this hyper-response toward stimuli, in fact, even define A.S./autism? • But harder to observe than more obvious symptoms.

30. How anxiety may affect persons with A.S. • For many, the biggest obstacle in life – can interfere with quality of life. • Can severely affect human relationships, business dealings, and ability in general to deal with people. • Often painful as well as disabling. • May be impossible to reason out even if reasoning seems obvious.

31. Experiences of persons with A.S. surveyed regarding anxiety • Gets in the way of getting things done. • Paralyzing. • Many situations uncomfortable and terrifying. • Feeling of being overwhelmed; sometimes leads to depression and meltdowns (breakdowns). • Affects confidence in being able to connect and interact with others.

32. Experiences of persons with A.S. surveyed regarding anxiety • Awkward/erratic eye contact another manifestation – social discomfort. • Hard to say “no” or assert needs. • Tension of socializing expends much energy; need to lie down to relax after social event to recoup energy.

33. Situations which particularly trigger anxiety (A.S. group survey): • Meeting somebody for the first time • Not knowing how to interpret signals from other people • feeling clueless as to how to go about approaching people • fear of alienating the other person • Confrontation or even anticipation of anxiety

34. Situations which particularly trigger anxiety (A.S. group survey): • New place, routine, situation • Job interviews (***) • Social climate in school • Anticipation of school work and homework

35. Situations which particularly trigger anxiety (A.S. group survey): • Tasks needing to be done which may seem huge or forbidding, creating feeling of being overwhelmed • Attempting to apply the same principles and advice given to clients or others to oneself • Performances, competitions.

36. Coping Remedies • Possible to find areas in which to excel or enjoy which are less anxiety dependent. • Can tap into certain special interests and talents. • Drug therapy sometimes helpful, but may not justify side-effects, effort, and cost. Effectiveness can vary according to the person. • Cognitive therapy (see later) is a helpful tool. But can require repeated applications.

37. Coping Remedies • Peer support and empathy particularly helpful. • Parental empathy and support very important in development.

38. Comorbidities tying in with anxiety • OCD (Obsessive Compulsive Disorder) • Depression • Acute sensory sensitivity

39. What are the common connections?

40. Research and Diagnosis • Diagnostic criteria for AS do not include mood disorders such as anxiety, depression, OCD. • But many with AS are overwhelmed by: • Life experiences • Social rejection/bullying/not being understood • Isolation • Vulnerability • Sensory overloads

41. Research and Diagnosis (continued) • It has been found that anxiety symptoms cannot be explained by increased stress alone • Environment and biology may be interrelated. • The amygdala (part of the brain) • Involved with regulation of emotions • Some evidence of it being different for those with A.S. • Important in anxiety problem

42. Comments on Research and Diagnosis Thomas Edison

43. Comments on Research and Diagnosis • ASD Not an exact diagnosis. However, the symptoms are very real: marked differences, both from standpoint of person’s life history as well as behavior, as well as physical development.

44. Comments on Research and Diagnosis • Still many medical professionals uninformed about Asperger’s. • But information is on the rise.

45. Comments on Research and Diagnosis • Maybe in the future, people within the AS umbrella may be grouped differently? Will diagnosis acquire a different name? ex: “basal ganglia” problem?

46. Therapies • Medications which may be used: • Anti-anxiety, anti-depressants: Tricyclics, SSRI Inhibitors; Prozac, Imipramine, Celexa, Zoloft, many others. • Effectiveness varies widely according to the individual. Some see a significant improvement due to medication, others do not.

47. Therapies (continued) • Cognitive Therapy • This addresses thought distortions and obsessive thinking. • A time-limited approach which allows one to view more objectively distortions in thought patterns and emotions. • “Thought stoppers”

48. Therapies (continued) • Peer and other support • Peer group support • Asperger Chat lines • Internet, other media • Parents, spouses, friends who know about and empathize with Asperger’s

49. Family: Raising / Dealing with a Child with ASC

50. Family: Raising / Dealing with a Child with ASC • Probably won’t be easy.