Lecture 2 - Autism

Question 1

How does the medical model define autism?

Answer 1

A neurodevelopmental disability that results in people experiencing difficulties in a range of areas.

Question 2

How does the social model define autism?

Answer 2

A neurodevelopmental difference.
Autism is only disabling as autistic people are required to live in a neurotypical world that isn’t set up well to accommodate their profile and needs.

Question 3

How has the logo for the National Autistic Society changed and why?

Answer 3

1963-2002 = it was a puzzle piece with a picture of a weeping child in. This was controversial because it describes the child as being isolated and not ‘fitting in’. It also suggests the people with autism are puzzles and uses dark colours which suggests unhappiness.
2002-2018 = They changed it to a brighter logo of a person helping another person. This was better as it represents unity, togetherness and friendship and includes brighter colours. However does still seem slightly patronising as it suggests people with autism need help from others.
2018 - present = Changed to a bright circle made up of rainbow colours. This suggests a brighter and cheerful mood and optimism. Using a circle highlights diversity by showing it’s not a linear spectrum and the circle also represents unity and togetherness.

Question 4

How has the logo for Cure Autism Now Foundation changed and why?

Answer 4

1995-2007 = It was just the foundation name for the logo. This suggests we need to remove autism and the idea of a cure can be seen as insulting and hurtful.
2007-present = They changed the name to Autism Speaks and presents their goal to enhance lives. However it still uses the puzzle piece which can be seen as controversial.

Question 5

What happened in 1943?

Answer 5

Leo Kanner first wrote about autism. He wrote about a small set of children who had the same features: Extreme aloneness, preservation of sameness, delayed/deviant language.

Question 6

What happened in 1944?

Answer 6

Hans Asperger published about a set of more abled children but described them as having difficulties in the areas proposed by Kanner.

Question 7

What happened in 1980?

Answer 7

Lorna Wing proposed the Wing Triad of Impairments - proposed autistic children had a triad of impairment including: Communication, socialisation and imagination.
In 1980 autism was also included in the DSM as ‘infantile autism’ - it was only recognised in young children (not adults or older children).

Question 8

What happened in 1994?

Answer 8

Autism was included in ICD-10, DSM-VI and ADI-R.
It was also the first time Asperger’s Syndrome was used.

Question 9

What happened in 2013?

Answer 9

Autism was included in DSM-5 and Asperger’s Syndrome was dropped from the classification criteria.

Question 10

What happened in 2018?

Answer 10

ICD-11 came out and caught up with the new set of criteria.

Question 11

What are the diagnostic classifications of ASD in the DSM-5?

Answer 11

Autistic disorder.
Asperger’s syndrome.
Childhood degenerative disorder.
Pervasive developmental disorder - not otherwise specified (PDD-NOS).
These were all amalgamated into one umbrella term.

Question 12

What were the symptoms needed to receive a diagnosis of ASD according to DSM-5?

Answer 12

Persistent deficits in social communication and social interaction:
- Deficits in socioemotional reciprocity.
- Deficits in nonverbal communicative behaviours.
- Deficits in developing and maintaining relationships.
Restricted, repetitive patterns of behaviour, interests or activities:
- Highly restricted, fixated interests.
- Stereotyped or repetitive speech, motor movements or use of objects.
- Hyper- or hypo-reactivity to sensory input.
- Excessive adherence to routines.

Question 13

What is the clinical assessment like for autism?

Answer 13

It is often a semi-structured behavioural assessment of communication, social interaction and restricted and repetitive behaviour/play.
There is a prescriptive set of activities that are led by the clinician and the clinician would then score them up on the different activities and see if they are scored above or below the threshold.

Question 14

What is the male:female ratio for autism diagnosis?

Answer 14

Autism = 4:1
Asperger’s = 10:1
The true male-to-female ratio for autism is closer to 3:1 but there is a diagnostic gender bias and girls are at a disproportionate risk for not receiving a clinical diagnosis.

Question 15

What is CAT-Q?

Answer 15

It was proposed by Hull et al. (2009).
It’s a questionnaire on camouflaging autistic traits and looks at different types of camouflaging:
- Compensation = finding ways around social and communication difficulties e.g. not attending events.
- Masking = hiding aspects of one’s autistic presentation.
- Assimilation = strategies used to fit in with others in uncomfortable social situations.

Question 16

What are the uses of CAT-Q?

Answer 16

Used in research settings to quantify camouflaging behaviours and compare between groups (see how many people are camouflaging).
In clinical settings as a potential screening tool for individuals who may be missed under current autism diagnosis because they camouflage.
By autistic and non-autistic people to aid identification of beneficial or harmful behaviours they use in social situations.

Question 17

Why is it important to know about the experiences of females diagnosed with autism in mid-late adulthood?

Answer 17

Models of autism understanding and diagnostic process are largely based on males.
Diagnosis typically occurs later for females compared to males (Begeer et al., 2013).
Diagnosis is an ‘important milestone’ but the process can be ‘challenging’ and ‘arduous’ (Crane et al., 2018).
There is currently little research that specifically focuses on older females.

Question 18

What is the diagnostic process for females like?

Answer 18

Ratio of diagnosis (Rutherford et al., 2016):
- Childhood = 5 males : 1 female.
- Adulthood = 2 males : 1 female.
The ratio being more similar in adulthood suggests they are being misdiagnosed or not diagnosed at all.
Females are more likely to be misdiagnosed/missed completely (Eaton., 2018).

Question 19

What did Leedham et al. (2020) do and what did they find?

Answer 19

Interviewed 11 females who had been diagnosed with autism age 40+.
Used one-to-one semi-structured interview analysed using IPA.
Were asked questions such as what was the exact diagnosis given, what was your experience of receiving the diagnosis, has anything changed etc.
Found 4 main themes:
- Autism is a hidden condition = people didn’t feel like they fitted in and hated who they were pretending to be, doctors wouldn’t listen to them when they said their diagnosis was wrong.
- The process of acceptance = some started to think they were just those symptoms and doubted their abilities, some felt relieved they now understood why they felt how they felt.
- Post-diagnostic impact of others = some family/friends researched a lot into it, whereas others refused to accept the individual had this diagnosis. Made it so people couldn’t talk to their loved one or sometimes improved relationships.
- A new identity on the autism spectrum = feeling like they fit in somewhere and are able to understand why they feel the way they do.

Question 20

What are the clinical implications of the Leedham et al. (2020) study?

Answer 20

Accurate and timely diagnosis is important.
Undertrained professionals can cause distress.
Clinicians should not rely on reports of others.
Coming to terms with diagnosis is an extensive process.
Ways to support self-compassion should be considered.

Question 21

What are the pros of potential universal screening for autism?

Answer 21

It can be freeing and give people a sense of relief.
Makes intervention easier and can put it in place at early age.
May diminish gender bias.
Mean age of diagnosis would be lower.

Question 22

What are the cons of potential universal screening for autism?

Answer 22

There is a lot of stigma around autism.
They may miss other comorbid disorders.
It is costly and time consuming.
A diagnosis may have a negative impact if people are coping well with it.

Question 23

What work has been done on genetic testing for autism?

Answer 23

A lot of work on this has started by taking the genotype first route. They are looking at individuals with genetic characteristics e.g. individuals with 16p11.2 and trying to assess the cognitive and behavioural profile of these genes e.g. Arnett et al. (2019), Jeste & Geschwind (2014).

Question 24

What is grey matter?

Answer 24

Grey matter is a type of tissue that contains the cell bodies, dendrites and axon terminals of neurons so it is where all the synapses are.

Question 25

What is white matter?

Answer 25

White matter is the tissue which messages pass between different areas of grey matter. It contains the axons connecting different parts of grey matter to each other.

Question 26

What did Wass (2011) suggest?

Answer 26

People with autism have local over-connectivity and long-distance under-connectivity.
They have ‘more severe’ disruptions in later developing cortical regions (regions in the frontal lobe).
Within regions there might be a lot of connectivity (in grey matter) but the communication within regions are lower (white matter) - these might reinforce each other and make it harder for people with autism to differentiate signal and noise which links to over sensitivity.
The differences in connectivity results in a cognitive style bias towards local (detailed focus processing) rather than global (widespread processing).

Question 27

How do people with autism differ in their Theory of Mind?

Answer 27

Baron-Cohen et al. (1985) looked at how children did on false belief tasks and found autistic children performed poorer than non-autistic children.
This sparked a huge field of research on what autistic children might be doing differently.

Question 28

How do people with autism differ in their executive function?

Answer 28

Ozonoff et al. (1991) looked at planning and impulse control in children with autism and found significant group differences between autism and non-autism groups.

Question 29

How do people with autism differ in their central coherence?

Answer 29

Happé and Frith (2006) found autistic people have a weaker central coherence and they segment information. The process of integrating information doesn’t happen naturally like it does with non-autistic people. This means they don’t look at the big picture as much.
Shah and Frith (1993) found autistic people are good at segmentation tasks compared to other tasks - suggests they don’t look at the big picture but rather look at it in segments.
Booth and Happe (2018) also found autistic participants are slower to identify figures in pictures and do not show global pop-out effect suggesting they have reduced global integration. They also are less able to identify an impossible image with a possible image.

Question 30

How do people with autism differ in their perceptual function?

Answer 30

Mottron et al. (2006) found they have enhanced perceptual function (better primary perceptual function) which is associated with reduced neural complexity (long-range connections). They have a drive for perceptual input in early years e.g. fixated on specific objects or the way light passes through objects. Due to this people with autism can ignore higher-order processing (evaluating and analysing rather than memorising) whereas people without autism cannot ignore this.

Question 31

What did Kimhi et al. (2014) do and what did they find?

Answer 31

Participants = 29 autistic individuals (intellectually able) 3-6 year olds and 30 neurotypical (intellectually able) 3-6 year olds.
Got them to perform 2 executive function tasks (looks at cognitive shifting and planning) and 2 ToM tasks (predicting and explaining others’ knowledge and emotions).
Found participants in the autism group did not perform as well as the neurotypical group across all 4 tasks.
EF planning and cognitive shifting contributed to better ToM explanation and prediction abilities.
Suggests EF training in pre-schoolers will likely support later ToM development.
Also found language plays an important role in supporting ToM ability.

Question 32

Why should we focus on considering autism through the lens of neurodiversity?

Answer 32

The conventional medical paradigm approaches autism as a disability and tries to change them to fit the accepted norm. It also brings away attention from their strengths e.g. a number of studies show people with autism outperform non-autistic people e.g. on the block design task.
The medical approach has bad effects on children e.g. they label themselves as ‘freak’ and ‘having a bad brain’.
It also tends to detract attention from autistic people’s own understanding of autism and their own lives which makes them question their own experiences.

Question 33

What are the 2 assumptions of neurodiversity?

Answer 33

Typical neurodevelopment is neither superior nor inferior to divergent neurodevelopment.
Even if diversity were not to serve the collective purpose, all people deserve to be treated with dignity and respect.

Question 34

What is Milton’s Double Empathy Problem (2012)?

Answer 34

This idea proposes a misalignment between the minds of autistic people and non-autistic people, highlighting a lack of reciprocity in cross-neurotypical interactions as the source of social communication difficulties.
Non-autistic people have trouble understanding the minds and behaviours of autistic people as well as vice versa. Autistic people have been found to communicate more effectively and develop stronger rapport with other autistic people compared to non-autistic people.