PSYC443: Autism Session 1

1. PSYC443: Autism Session 1 Dr Jason Low School of Psychology Victoria University of Wellington

2. Case 1 • JN at 18 months, did not take delight in engaging in pretend play and had communication difficulties. He had a large collection of calculators (he was interested in numbers). With his collection of toy cars, he was interested only in placing them in long straight lines in a particular pattern and was mesmerised with the spinning of wheels. He often echoed what people said and most of the time it seemed as if he was looking through people, not at them.

3. Case 2 • Stephen Wiltshire born in London. As a child, was mute and did not relate to other human beings. Even by age 3, he had no language, uncontrolled tantrums and lived entirely in his own world. At the age of five, noticed that the only pastime he enjoyed was drawing (esp. buildings). Once, he was taken on a helicopter ride over the city of London. After a brief ride, he returns to the ground where, in three hours, he completes a stunningly detailed and remarkably accurate drawing of London from the air which spans four square miles with 12 major landmarks and 200 other buildings drawn to perfect perspective and scale • http://www.youtube.com/watch?v=AxAR9dnSuQM • http://www.autismspeaks.org/sponsoredevents/autism_every_day.php

4. Reasons to study atypical development? • for PSYC443: as a window through which to view normal development • elucidating cognitive processes key to normal development

5. Historical perspective • Autism was first described in 1943 by psychiatrist Leo Kanner. Applied the term to children who were socially withdrawn and preoccupied with routine, who struggled to acquire spoken language. • Autistic loneliness • Desire for sameness • Islets of abilities

6. Kanner’s main conclusion • These children have come into the world with an innate inability to form the usual biologically provided affective contact with people.

7. Historical Perspective: Hans Asperger • Autism was again described in 1944 by Austrian paediatrician Hans Asperger. Applied term to children who were socially maladroit, developed bizarre obsessions and yet were highly verbal and seemingly quite bright.

8. Hans Asperger: Case of Fritz • When somebody was talking to him he did not enter into eye contact fundamental to conversation • Normal speech melody was missing • Stereotypic body movements (e.g., beating rhythmically on thighs) • From very early on he had shown an interest in numbers and calculations • Disturbance of contact existed at some deep level of affect and / or instinct

9. Asperger Syndrome • Diagnosis in late childhood or even adulthood • No language delay as children • Social interaction difficulties & usually focused preoccupations (“little professor”) • Variants of the same underlying disorder Neurotypical Aspergers Autism

10. Lessons from history • Case of the Wild Boy of Aveyron (named Victor) (found in 1797 near Toulouse) • His affections are limited; cares for no one, and is attached to no one. • He reflects on nothing. His imbecility is evident in his gaze. • The most harmonious sounds make no impression on his ear (but is sensitive to opening of the cupboard containing walnuts). • Indifferent to all childish amusements.

11. Educating Victor • Jean-Marc Itard in 1801 took on the task of Victor’s education • Showed some acquisition of sign language and a few words (milk, oh god) • Never learned the meaning of social values (“a true idiot”)

12. Victor and autistic loneliness • “Mme Recamier seated Victor at her side, thinking perhaps that the same beauty that had captivated civilised men would receive similar homage from the child of nature, who seemed not yet 15 years old. Too occupied with the abundant things to eat, which he devoured with startling greed as soon as his plate was filled. When dessert was served, and he had filled his pockets with all the delicacies that he could fetch, he calmly left the table. Suddenly a noise came from the garden. We soon glimpsed Victor running across the lawn with the speed of a rabbit. To give himself more freedom of movement, he had stripped to his undershirt. Reaching the main avenue of the park, climbing the nearest tree with the ease of a squirrel, he perched in the middle of the branches.”

13. The Mother’s dilemma

14. Autism Triad Social deficits Imaginative Deficits Communication deficits Yes

15. Epidemiology • Rates in studies between 1966 and 1991: 4.4 cases per 10,000 (Wing & Potter, 2002) • Rates between 1992 and 2001: 12.7 per 10,000 (Fombonne, 2003) • Epidemic of autism? • Changes in diagnostic practice? • Increased awareness? • Earlier diagnosis • Issues of study design & case ascertainment

16. Epidemiology • Boys disproportionately affected (ratio 3.4 or 4.0 to 1; Frombonne, 2003; Volkmar et al., 1993) • Possible that males have lower threshold • More severe neurodevelopmental abnormalities needed in girls

17. Organic Context • Concordance rates for MZ twins (36%-91%) higher than compared to DZ twins (0%) (Bailey et al., 1996) • Elevated level of serotonin (chemical messengers) in 25% of individuals with autism (Klinger & Dawson, 1996) • Structural abnormalities in limbic system (emotion), amygdala (social cognition), and areas of cerebellum (sensori-motor integration) (Bauman, 1996) • Dawson (2001): 3- and 4-year-olds reactions to neutral and fear depicting photos. Brain activity of autistic children didn’t change in response to the different images. • Need to ask whether it is specific brain damage or a disorder of development

18. The Great Vaccination Scare • Sudden increase, blame novel environmental agent (e.g., vaccination) • First signs of autism noticed at 2nd year • Proportion of cases show regression • Proportion of cases have severe gastric conditions • So MMR vaccination = autism? • Evidence? • Meaning of increasing number of cases • Number of cases diagnosed in relation to introduction of MMR in various countries? • Difficulties in diagnosing in first year of life

19. Difficulties in Diagnosis • DSM-IV (1994) – Autism • A total of six (or more) items from impaired social interaction, and one each from impaired communication and impaired imagination, and onset prior to 3 years of age • Often, earliest signs go unnoticed • Problems arise with borderline cases • Additional problems that may overshadow autistic features

20. Difficulties in diagnosis • Knobloch & Pasamanick (1975): 50 children identified with “failure to regard people as persons” – compared to 50 controls • Followed up 3 to 10 years later • Those seen before 12 months – failure to regard people as persons disappeared • Those seen in the second or third year were definitely diagnosed as autistic later on • What facts can be learned from the above example?

21. What happens in adulthood? • The disability does not go away • But through treatments (e.g., behavioural learning, language training, physical props to mental states), improvements in adaptation and behaviour can be observed • Can be guided into a niche where skills are put to good use • But future of any child with autism remains uncertain, as with any child

22. a disorder of unknown cause Hazard (e.g., faulty genes, chromosome abnormality, viral agents, anoxia) Havoc (to neural development) Harm (to development of brain systems)

23. From here on … • Theoretical (and associated methodological) approaches to studying the autism triad • Theory of Mind (Mindblindness) • Executive (Dys)Functioning • (Weak) Central Coherence • Do these approaches highlight domain specificity issues, or are they interacting? • Where and how does language fit in?