Autism Flashcards
What is autism?
perspectives (2)
medical model:
-suggests it is a neurodevelopmental disability
-suggests the disorder needs to be diagnosed. Autism is a disability and results in people experiencing difficulties in a range of areas (a neurodevelopmental disability?)
social model
-suggests it’s a neurodevelopmental difference
- autism is only disabling as autistic people are required to live in a neurotypical world
neurotypical population is much larger
variability in neurotypical population and autism population
Autism spectrum
we should celebrate people’s differences, rather than trying to make them more neurotypical (Rosie King)]
autism is not always expressed in the same way due to varying types/ intensities
Perception of autism
- puzzle piece
- national autistic society
- ‘cure autism now’
- autism speaks
puzzle piece as logo = dark colours, weeping child - trying to represent the handicap being a puzzling condition, and that it can cause suffering
- national autistic society have now changed the logo and slogan to be more positive: “our goal is to help transform lives, change attitudes and create a society that works for autistic people” (aiming to be more nurturing and positive with the new logo)
- cure autism now = American company. autistic people found this to be insulting
- ‘autism speaks’ = American. also uses puzzle piece. goal: to enhance lives
overall, charities appear to be moving away from more offensive symbols (eg. puzzle pieces) showing autism as a handicap, and more towards an inclusive, thoughtful symbol to help show a more accurate representation of the disorder that those with the disorder are more happy with
Understanding the history
discovered?
Wings triad
DSM
-discovering autism = 1843 Kramer noticed extreme aloneness, preservation of sameness, delayed/deviant language
1944 - Asperger
1980 - wing = researcher and mother of autistic child. She proposed autism is a triad
‘Wing’s triad of impairments’:
- communication
-imagination
- socialisation
1980 = first included ‘infantile autism’ in DSM
1994 = ‘Asperger syndrome’ in DSM-IV and ICD-10
= more standardised tests for diagnosing autism
2000 = ADOS-G (autism diagnostic observation schedule)
2013 = no longer thought of as a triad of impairments
2018 - ICD11 = reconceptualization where aspergers is no longer seen as a separate diagnosis
Diagnosing ASD
2 categories
1) persistent deficits in social communication and social interaction
- deficits in social-emotional reciprocity
- deficits in developing and maintaining relationships
-deficits in nonverbal communicative behaviours
(all 3 required for diagnosis)
2) restricted, repetitive patterns of behaviour interests or activities
-highly restricted, fixated interests eg. cars/ specific TV show
-stereotyped or repetitive speech, motor movements or use of objects (seen in those who are less able)
-excessive adherence to routines
-hyper or hypo reactivity to sensory input –> easily distracted (Attention problems) - only brought to light in 2013, BUT many autistic people say this is a major part of their autism (eg. bright lights/ noises)
(only 2/4 of these required for diagnosis)
Clinical assessment
semi-structured behavioural assessment of:
- communication
- social interaction
- restricted and repetitive behaviour/ play
DSM-5 Autism spectrum disorder
other diagnoses within this = 4
1) autistic disorder
2) aspergers syndrome
3) childhood degenerative disorder
4) pervasive development disorder - not otherwise specified
Earlier diagnosis?
is there other way than behavioural assessment with diagnostic boundaries?
certain markers in the way brain works/ behaviour that would help early diagnosis?
Eye tracking (Jones & Klin, 2013) (early diagnosis method)
- study with infants (2 months old –> later life) looking at gaze
found: - those who went on to gain a diagnosis of autism had eye movements that showed they lost interest in stimuli faster than those infants who are neurotypical
- neurotypical spent more time (about 50%) on caregivers eye region, rather than exploring the rest of the stimuli
(We can see this difference over the first few years)
Preference for geometric patterns in early life (Pierre et al)
(early diagnosis method)
toddlers 14-42 months old
found some systematic differences:
- in autistic group, there was a subgroup who had a very strong preference for moving geometric shapes
- neurotypical or developmentally delayed didn’t display this preference for geometric shapes
- if child spends more than 69% of time looking at geometric patterns = this suggests they can be accurately classified as autistic
EEG to look at neural sensitivity to dynamic eye gaze (Elsabbagh et al, 2012)
(early diagnosis method)
- it has been suggested this eye gaze is associated with later emerging autism
6 -10 month olds
-electrophysiological response to gaze shifts over occipitotemporal channels - ASD assessment at 36 months
2 categories: towards or away (non-verbal communication)
found: - neurotypical = v different activity for each
- groups that developed ASD = no difference in activity for each group, nor did the subgroup that developed early and persistent symptoms
shows: neurotypical process these 2 communicative social signals differently
Autism diagnosis
positives
negatives
positives:
- current approach to diagnosis has worked reasonably well in terms of facilitating research and clinical service
negatives:
- hazy diagnostic boundaries
- diagnosis is a ticket to services = clinicians may feel pressured to give diagnosis
- the combo of genetic heterogeneity and diagnostic uncertainty complicates efforts to identify autism genes (Gupta & State, 2007)
Autism spectrum
- intellectual disability?
people can be any ability and be diagnosed autistic
- 2 things are independent, but around 50% of people who are autistic have an associated intellectual disability (more common than in general population)
Male and female ratios?
Autism: 4M : 1F
Aspergers: 10M : 1F
- true male to female ratio is closer to 3:1 in UK
There is a diagnostic gender bias, as girl who meet criteria are at a disproportionate risk for not receiving clinical diagnosis
BECAUSE?
- clinicians not fully aware of symptoms?
- females tend to camoflague symptoms more eg. may be trying to fit in more
Differences in the brain?
-connectivity
- local over connectivity
- global/ long distance under connectivity
This could be causing difficulty with information integration =results in cognitive style biased towards local rather than global info
Disruptions more severe in later develoing cortical regions (eg. frontal regions = problems with exec function and planning)
Cognitive profile of autism and impact on behaviour
- theory of mind difficulties (Baron-Cohen et al)
- executive function difficulties (Ozonoff et al) - inhibition, planning, logic
- weak central coherence (Happe + Frith) - local to global info
- enhanced perceptual function (mottron,2006)
Theory of mind and exec function in preschoolers
- 3-6 yrs olds
- 29 autistic intellectually able
- 30 neurotypical intellectually able
tasks: - cognitive shifting + planning (exec function)
- prediticing and explaining other knowledge AND predicting and explaining others emotions (ToM)
- verbal ability
found: - p’s in autism group didn’t perform as well on all tasks
- EF and cognitive shifting (and Verbal IQ) combined to better ToM explanation and prediction abilities
- language ability explained variance in ToM explanation ability
Conclusions: - EF planning skills and language are important for ToM performance and understanding
-EF training in pre-schoolers will likely support later ToM development: cog shifting, inhibition, planning - Language pays an important role in supporting ToM ability
Perception (weak central coherence in ASD)
autistic people better at segmenting and spotting smaller detail
autistic:
- reduced global integration–> autistic people found it more difficult to recognise complete objects compared to incomplete (Booth and Happe)
-enhanced perceptual functioning theory –> key principles:
- perception plays a different and superior role in autistic cognition
-autistic perception is locally oriented
- better low-level perceptual ability is associated with reduced neural complexity
-drive for perceptual input in early years
- higher-order processing is optional In autistic and mandatory in non-autistic
-atypical perception underlies savant syndrome
