5c. Autism (neuropsychiatry)

Question 1

DSM-5 criteria ASD

1. All 3
2. 2 of 4
3. …
4. …

Answer 1

1. Persistent deficits in communication and interaction
   - Social-emotional reciprocity
   - Nonverbal communicative behaviors used for social interaction
   - Developing/maintaining/understanding relationships
2. Restricted, repetitive behaviors
   - Stereotyped or repetitive motor movements
   - Inflexible adherence to routines (rigidity)
   - Highly restricted, fixated interests that are abnormal in intensity or focus
   - Hyper- or hyporeactivity to sensory input: so some things they are extremely sensitive to (for example tactile stimuli) and other things can be under detected (like pain, heat)
3. Symptoms must be present in the early developmental period
4. Symptoms cause clinically significant impairment in daily functioning

Question 2

Severity level ASD, which levels can be distinguished?

Answer 2

Besides the diagnosis, you assign a sign of severity to the patient.

• Level 1: lowest severity level, patient requires some support.
• Level 2: medium severity level, patient requires substantial support.
• Level 3: highest severity level, patient requires very substantial support.

Question 3

Cognitive deficit profile ASD

Which domain most salient?

Answer 3

Cognitive flexibility

Question 4

Signs during (adult) NPA of ASD (4x)

Answer 4

1. Literal interpretation of speech
2. Gets upset when something unexpected happens or when things are unclear
3. Perseverance errors: the deficit in cognitive flexibility / using the same strategy over and over
4. Focus on details, not seeing the whole picture

Question 5

What is ToM?

Answer 5

The ability to attribute mental states to ourselves and others, serving as one of the foundational elements for social interaction.

Question 6

Which 2 types of ToM are there?

Answer 6

1. Social cognition: cognitive understanding of other people’s mental states > you can interpret and predict the behavior of others
2. Social performance: competence in applying ToM skills in real life

Question 7

To which cognitive domain is ToM linked to?

Answer 7

EF: reduced WM moderates social communication skills.

Social interaction also requires other EF: self-monitoring, sustained attention, cognitive flexibility to adapt to someone else’s behavior.

Question 8

What is context blindness?

Answer 8

A decreased ability to spontaneously use context in attributing meaning to stimuli, especially when ambiguous, vague, new, or incomplete. A lot of things do not have an absolute meaning (only because of their context), but autistic people are not flexibly able to consider that here are different options. This causes uncertainty and anxiety (‘the world doesn’t make sense anymore’).

Question 9

What is the central coherence theory?

Answer 9

Suggests that the limited ability to understand context or “see the big picture” underlies the central disturbance in autism.

When you detect a stimuli, the input will be processed as a whole and matched with a certain expectation you already have. This expectation is based on context. Someone with ASD will, however, not look at the context as a whole, but rather at the details.