Autism

Age of Onset- ASD

1. ~2 years old (months preceding birthday) 2. Earliest point in development for reliable detection: 12-18 months 3. AAP recommends that all children be screened at 18-24 months

Proto-declarative

"3rd person" "pointing to convey" impaired

Proto-Imperative

"Give me" in tact

Genetic Influences on ASD (family and twin studies)

1. 3-7 % of siblings and extended family members of individuals with ASD have the disorder 2. 60-90 % in identical twins 3. Heritability of an underlying autism liability is 80 % VERY HIGH 4. Broader autism trait

Autism Intellectual Deficits:

1. 70% have co-occurring intellectual impairment (IQ) 2. Low verbal scores and high non-verbal scores 3. About 25% have splinter skills (ability to do something without needing general knowledge) or islets of ability 4. 5% (autistic savants) display isolated and remarkable talents

Three factors contribute to the spectrum nature of autism

1. Children may differ in level of intellectual ability, from profound disability (retardisity) to above average intelligence (savant) INTELLIGENCE 2. Children vary in the severity of their language problems SEVERITY 3. The behavior of children changes with age/ development BEHAVIOR

Persistent deficits in social communication and Social interaction across multiple contexts, as manifested by

1. Deficits in social-emotionl reciprocity, ranging from abnormal social approach and failure of normal back and forth conversation: SOCIAL-EMOTIONAL RECIPROCITY 2. Deficits in nonverbal communicative behaviors used for social interaction for example, from poorly integrated verbal and non-verbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures to a total lack of facial expressions and non verbal communication NONVERBAL COMMUNICATION 3. Deficits in developing, maintaining and understanding relationships, ranging from difficulties adjusting behavior to suit various social contexts; to difficulty in sharing imaginative play or in making friends; to absence of interest in peers RELATIONSHIPS

Treatment programs of Autism

1. Early intervention 2. Techniques to reduce self-injurious, self-stimulation, or other disruptive behaviors 3. Teaching social and communication skills 4. Interventions that involve the parents to the greatest degree possible 5. Interventions to help the parents cope with the demands of having a child with autism.

Autism: General deficits

1. Executive functions (higher-order planning and regulatory behaviors) (PREFRONTAL) 2. Weak drive for central coherence (strong human tendency to interpret stimuli in a relatively global way to account for broader context (Do well on tasks requiring focus on parts of stimulus)

Causes- ASD

1. Generally accepted that ASD is biologically based neurodevelopmental disorder with multiple causes 2. Problems in early development (pregnancy, birth, or immediately following birth) (possibly linked to vaccinations) 3.(rare) Genetic influences (chromosomal and gene disorders)

DSM-5 ASD

1. Impairments in social interaction 2. Impairments in communication 3. Restricted repetitive and stereotyped patterns of behavior, interests, and activities

Phenomenology of Autism; Behavior and interests

1. Inflexible adherence to daily routines NEED CONSISTANCY 2. Stereotyped movements 3. Pre-occupation w/ sensory qualities of objects

Phenomenology of Autism; Communication

1. Language Delay 2. Idiosyncratic language (eg. no reciprocity)

Accompanying Disorders and Symptoms- ASD

1. Most often associated with INTELLECTUAL DISABILITY 2. Symptoms: hyperactivity, learning disabilities, anxieties, mood problems, self-injurious behavior

Treatment of Autism

1. No known cure 3. Most benefit is likely to come from programs 4. Treatment strategies, goals, and expectations vary for different children with autism

Phenomenology of Autism; Social Relatedness

1. Non verbal behavior (avoid eye contact, facial expression) 2. Minimal interest in others (eg. sharing enjoyment, social-emotional reciprocity)

Course/Outcome: ASD

1. Often gradual improvements with age, likely to continue to experience many problems, with some symptoms worsening in adolescence 2. Complex OCD rituals may develop in late adolescence and adulthood 3. Usually a chronic and lifelong condition with continuing handicaps with moderate independence 4. Continued problems in communication, stereotyped behaviors and interests 5. IQ and language development are best predictors of adult outcomes

Deficits in Repetitive Behaviors and Interests-ASD

1. Perservation or abnormal preoccupations 2. Ritualistic behavior 3. Stereotyped body movements 4. Insistence of sameness 5. Self-stimulatory behavior

Deficits in Communicaction-ASD

1. Proto-imperative is intact, but impaired proto-declarative 2. May use instrumental but not expressive gestures 3. About 50% of children with AD do not develop any useful language 4. Use qualitatively deviant forms of communication (intonation, patterns of sound) 5. Impairments in the pragmatic use of language, (eg. literally force hand of others on to objects of interest) 6. Difficulty communicating emotion

Family Stress-ASD

1. Raising a child with autism is stressful 2. Frustrated and experience delays in receiving help 3. Parents may be socially ostracized by friends and strangers (marital discord)

Restricted, repetitive patterns of behavior, interests or activities as manifested by at least two of the following, currently or by history

1. STEREOTYPED OR REPETITIVE MOTOR MOVEMENTS use of objects, or speech (eg. simple motor stereotypes, lining up toys or flipped objects) 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or non verbal behavior (eg. extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take some route, etc) SAMENESS/RIGIDITY 3. Highly restricted, fixated interests that are abnormal in intensity or focus (eg. strong attachment or preoccupation with unusual objects, excessively circumscribed or perseverative interests) FIXATED INTEREST 4. HYPER-OR-HYPOACTIVITY TO SENSORY INPUT or unusual interest in sensory aspects of environment (eg. apparent indifferent pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement

Deficits in social interaction-ASD

1. Social imitation (motor or vocal) 2. (symbolic) Make-believe play (reciprocity) 3. Social expressiveness (facial expressions) 4. Orienting to social stimuli (need reward) 5. Responsiveness to others (empathy) 6. Processing of emotional information or sharing emotions with others 7. Joint social attention 8. Ability to see others as social agents

Theory of Mind deficits-Autism

1. What children know about the minds of others' (aspect of social intelligence; making inferences about cognition in others) --> Critical acquisition for social interaction: when is it literal interpretation 2. Autistics fail false -belief tasks: typically developing children solve around 4 years old 3. Not a function of IQ because children with Down's Syndrome can solve task 4. Higher function PDD children can eventually learn but still fail second order false belief task

Prevalence of ASD

1. Worldwide: 1/150 suffer from some form of autism; one million in US 2. Autistic Disorder: 22/10,000 3. PDD-NOS: 33/10,000 4. Asperger's disorder: 10/10,000 5. Occurs in all social classes and cultures 6. 3-4 times more common in boys. 7. When girls are affected, they tend to have more severe intellectual impairments Prevalence goes up, incidence stays same

Standard False Belief Test 2nd order False Belief Test

ASD fail test Typical children can solve at around years old perspective (2) perspectives

DSMIV

Aspergers or Pervasive developmental disorder included in ASD

Historical Background of Autism

Autism and Childhood-onset schizophrenia were previously lumped together as a single condition.

Social (pragmatic) communication disorder

Deficits in social communication, but does not meet the criteria for ASD.

Retraction

Illeal Lymphoid Nodular Hyperplasia, non-colitis and pervasive developmental disorder

False-belief task

Inability to place yourself in another's perspective

Instrumental vs Expressive gestures

Instrumental: STOP/ GIVE ME- Expressive: SADNESS/ EMBARASSMENT impaired

Broader Autism trait

Non-autistic relatives of individuals with autism display higher than normal rates of social, language, and cognitive deficits that are similar in quality to those found in autism, but are less severe

Narrative-ASD

Story Coherence: telling a story with a beginning, middle, or end with respect to the second partison

Pragmatics

Taking turn, 'checking in' with partner, conversational etiquette

Mental states-ASD

Theory of mind, intention

Prosody

acoustic protperties: pitch, rate, phrasing of speech

Kanner

coined the term "early infantile autism" Autism resulted from an inborn inability to form loving relationships with other people and described parents of these children as being cold/detached.

Goals of Autism treatment

minimize core problems, and maximize independence and quality of life, and help child/family cope more effectively

Meta-linguistics:

recognizing irony, sarcasm, teasing (tone)

Example of deficit in emotion and social repricocity

reduced sharing of interest: typical developing kids will share novel item with parents