Autism Flashcards
Early observation
Many symptoms only seen when developmentally expected.
Early diagnosis is critical.
Early concern observations at 18 months:
Joint attention
Gaze following
Pretend play
Original definition
Kanner (1943) and Asperger (1944):
Autistic aloneness (lack of sociability)
Desire for sameness (liking of repetitive routines)
Low intellectual ability (IQ)
Poor use of language
Implication: you have or do not have autism - no spectrum.
Monothetic & Polythetic
DSM III : Monothetic - all criteria is essential for definition.
DSM IV & V: Polythetic - a broad set of criteria of which a number are essential but not all e.g. 3 out of 5.
DSM-IV to DSM-V
DSM-IV
Pervasive Developmental Disorders (4 categories)
Autism
(Wing & Gould) Triad of Impairments:
1. Severe impairment in social interaction
2. Severe impairment in communication
3. Restricted, repetitive and stereotyped behaviour
Aspergers
Deficits in social interaction and in activities and interests, but not in language or (basic) cognitive skills
Rett’s Disorder & Childhood Disintegrative Disorder.
DSM-V
All in one category - ASD.
Acknowledges need to include sensory issues.
Reduced comparability in prevalence figures.
Reduced comparability of research findings
Loss of diagnostic specificity.
Loss of identity/status/funding for some who may in the past be diagnosed e.g. Aspergers and now diagnosed as ASD or not at all.
Prof. Temple Grandin
Emphasised a further ASD impairment: perceptual distortions
(hyper/hypo perception sensitivities/synaesthesia)
Craving of routine understandable.
Advocates sensory integration therapy.
Prevalence and funding
1% of births, 0.7 million diagnosable in UK
B:G 4:1 (Autism); B:G 9:1 (Asperger)
No ethnicity, and social economic class bias
UK funding £4 Million
UK societal costs £32 Billion
DSM-V
Dyad of impairments:
- Impaired social communication & interaction
- Repetitive restricted behaviour (RRB)
If RRBs not present, then diagnosis Social Communication Disorder.
The different impairment types are rated on severity.
Frequently co-morbid with other diagnoses (cerebral palsy, ADHD)
DSM-V criteria - social communication
Not all symptoms of three elements need to be present (polythetic)
Deficits in social-emotional reciprocity: ranging from abnormal social approach to failure to initiate or respond to social interactions.
Deficits in NV communicative behaviours: ranging from poorly integrated communication to a total lack of facial expressions and NV communication.
Deficits in developing, maintaining, and understanding relationships: ranging from difficulties adjusting behavior to suit various social contexts to difficulties in sharing imaginative play or in making friends to absence of interest in peers.
DSM-V criteria - RRBs
Stereotyped or repetitive motor movements, use of objects, or speech (e.g. motor stereotypies, lining up toys, echopraxia).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns (e.g., extreme distress at small changes, rigid thinking patterns, need to take same route or eat same food).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g. strong attachment to or preoccupation with unusual objects; interests very limited in scope and are repeated).
Hyper/Hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g. indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching, fascination with lights or movement).
Prognosis
Indicators of a good prognosis when intellectual and language ability spared before 5 years.
But 80% of ASD retaining an IQ
Savant abilities
High/low functioning independent of savant abilities.
Unusual skills in highly specialist domains
Arithmetical, musical, drawing, language learning.
Spontaneous acquired savantism - Derek Amato (piano)
5-10% ASD have savantism.
Autism Quotient
Baron Cohen et al. (2001)
50-items measure ASD traits in otherwise neurotypical population.
Scores >32 = high systemising (not on clinical spectrum). Useful for some careers.
Research tool to support extreme male brain theory.
Not used for diagnosis.
Prone to systematising or empathising :
Systemising - drive to analyse, control and construct rule-based systems.
Empathising - drive to analyse other person’s emotions and thoughts, and respond with an appropriate emotion.
S>E (more typical of Autistic thinking)
S
Psychodynamic theories (Bettelheim, 1987)
“Refrigerator Mother” (emotionally unavailable)
Based on observations on limited sample of children of working mothers.
At time of study not the cultural norm for women to be financially independent
Theory dismissed based on more recent scientific evidence.
Behavioural approaches
Ferster and DeMyer (1961)
Techniques to remediate behavioural manifestations (e. g. aggression, redirect attention.
Effective use of positive reinforcement (and sometimes punishment) schedules.
Supposed to address ‘compliancy’ & ‘receptiveness to learning’.
Little theoretical depth and controversy around effectiveness.
Used in The Loddon School, Basingstoke to develop whatever potential is available.
Judge Rotenberg Centre vs. Loddon School
Students with low end spectrum ASD sent from pillar to post.
Similar age students.
Both funded by the taxpayer.
Treatment types: Adverse (incl extreme adverse) therapy as well as reward therapy in the case of JRC.
No or mild adverse treatment (restraining) at Lodden.
Professional judgements and detailed knowledge of each individual student helps avoid triggers of undesirable behaviour.
Relaxation rooms; minimal drug use; emphasis on education.
