Lecture 4 - Cognitive Theories of Autism Spectrum Disorder Flashcards
Outline stats on ASD
National Autistic Society: over 500,000 people in UK have ASD
1 in 100 children may have ASD
Spectrum mild to severe
Outline Asperger’s Syndrome
Autism without co-occurring language delay or learning disability
Outline ASD
Introduced 1992. Recently removed DSM-V still use ICD-10 in Europe.
Kenny et al 2016: autistic individual preferred by people on spectrum and person with autism preferred by professionals
Who are the key researchers for ASD
Hans Asperger 1944
Leo Kanner 1943
Independent research on children both gathered similar findings
What is the history of the Diagnosis of ASD
Innate ability form usual biologically provided affective contact with people. Difficulty forming and understanding relationships with others.
Poverty facial expression
Many stereotypical movements do not convey meaning
Impulsive and stimulus driven
Excellent logical and abstract thought
What is Kanner’s cardinal features of ASD
Autistic aloneness
Obsessive insistence of sameness
Anxiety key co-occurring symptom with autism
Who researched triad of impairments
Wing and Gould 1979
Outline Wing and Gould’s 1979 Triad of Impairments
SOCIALISATION, COMMUNICATION, IMAGINATION
Delay or atypical functioning in at least 1, with onset prior to age 3 years.
Outline Triad of Impairment number 1: Impairment of Social Interaction/Development
Issues Social Attachment, Understanding other’s minds/thoughts/feelings
Emotion regulation/coping with change
Outline issues Social Attachment in Triad of Impairment
Indifference other people; difficulty making friends
May seem independent as toddler, resists or does not seek affection
Can be affectionate and show attachment on simple level
Outline issues of Understanding other’s minds/thoughts/feelings in Triad of Impairment
Difficulty interpreting others thoughts and emotions
Irregular eye contact –> do not follow gaze –> seem to be in ‘world of their own’
Outline issues of Emotion regulation/coping with change in Triad of Impairment
Difficulty managing emotions –> expressed outbursts anger or aggression
Difficulties coping new situations
Difficult accept simple social rules, causing problems at school
Outline Triad of Impairment number 2: Impairment of Social Communication
Non-verbal
Verbal Issues
Outline Non-verbal Issues of Triad of Impairment
Difficulty read body language and facial expressions
Lack appreciation social uses and pleasure of communication
Do not develop usual non-verbal e.g. pointing skills or imitation skills
Outline Verbal Issues of Triad of Impairment
Don’t develop usual verbal skills
Trouble understanding meaning spoken or written language.
Not babble or point by age 1, not respond their name, not learn 2 words by age 2.
Repeat learned words over and over.
Unusual use language e.g. reversal pronouns, difficulty starting conversation
Unable understand jokes or sarcasm
Outline Triad of Impairment number 3: Impairment of Imagination
Narrowing interests and behaviour
Inability play imaginatively
Outward manifestation
Overly interested in repetitive activities
Take up special interest young age
Older children/adolescents may develop obsessions
Outline other symptoms
Sit up/walk later - sensory motor difficulty, feed in to later difficulties/developments
Oversensitive
Odd mannerisms - rocking back forth, hand flapping, walking tip-toes or head banging
Clumsy and struggle physical activity
Sticking same routines, upset if these are disturbed
Outline features of ASD
Non-social features: restricted area interest/preoccupation with parts of objects. Desire sameness/routine Excellent rote memory Savant abilities Islets of abilities
Co-occurrence of ASD
Attention/Motor difficulties - ADHD, DCD, DAMP
Cognitive Impairment 75-80%
Associated medical disorder/chromosomal disorder 10-25% and epilepsy
80% criteria least 1 psychiatric condition
Prevalence of ASD
1% children
Boys outnumber girls 10:1
How is ASD diagnosed through standard assessments?
Autism Diagnostic Interview ADI - more informal, someone child knows
Autism Diagnostic Observation Schedule ADOS: in-person assessment. Give social prompts test hypothesis and if individual does or does not have ability.
Outline understanding autism at cognitive level?
Early research on cognitive abilities argued autism arises from primary cognitive deficit. What makes good theory? 1. Specificity 2. Uniqueness 3. Universality
3 main theories
- ToM - failure acknowledge others have own thoughts and beliefs
- Executive Dysfunction - deficits inhibition, planning (perceptual, conceptual), executive memory
- Weak Central Coherence - preference local details over global or whole context
Often dependent on intellectual abilities. Mid 80s proposed autism might arise from primary cognitive deficit.
Outline ToM
Agent without mind = machine
Without understanding other minds
Outline Socialisation difficulties and FB tasks Baron-Cohen et al 1985
Sally Anne Task
Social and emotional problems secondary cognitive
Unexpected transfer task
80% ASD children failed, even those mental age above 4 –> deficient ToM
Not due learning difficulty as down syndrome children not fail.
Outline inferring mental states of Geometric figures
Klin et al 2000
Tested ability attribute and explain figures. Asked describe what see.
Autistic mind not attuned social world.
Outline Leslie and Frith 1988
Unexpected transfer task Ppt involved directly
Penny under one cup –> Where will Leslie look for his penny?
Outline Perner et al 1989 study
Deceptive box task. Smarties tube containing pencil. Asked what next child think is in tube? Verbal mental age above 4 but cant solve.
Autism linked deficit ToM
Outline Mitchell and Isaac 1994 study on communication impairment
Message desire task.
Mom 2 bags wool. One in drawer, One in cupboard. Jane swapped items other way round. Mom returns and wants wool from drawer. Get mom bag she really wants. ASD children fail.
Outline Mitchell et al 1997 task
Children judge:
1. Which item mom really wants (interpret)
2. Which item mom put in drawer (memory)
ASD more errors in interpreting desire than in judging bag of wool mom put in drawer is now in cupboard (memory).
ASD incorrectly interpreted utterances suggesting difficulty making non-literal interpretations
Outline imagination impairment Leslie 1987
Link cognitive impairment and lack pretend play.
Pretend play basic expression.
Engaging imagination requires acknowledging another person’s non-literal thoughts/beliefs
Positive evaluation of ToM hypothesis of autism
Good specificity for triad
Powerful convincing
Difficulties in relating, communicating
All related to understanding of mind
Negative evaluation of ToM hypothesis of autism
Not Universal
Happe 1994: still 20% passed FB task!
Solve differently - rule based system? Instead ToM?
Not autistic?
ToM hypothesis wrong?
Nor primary element ASD?
Some ASD give reliable correct judgements across different tasks
ToM hypothesis of Autism
Sparrevohn and Howie 1995 - ASD with higher verbal mental age more likely succeed
Happe 1995 - meta analysis ASD and ToM. Verbal mental age 12 able pass compared 4yrs in typically developing children.
Delay ToM development
Outline Second Order FB
I think that he thinks that she thinks
Not where John thinks the ice-cream van is, but where John thinks Mary thinks the ice-cream van is
Element memory
Baron-Cohen 1989 Second Order FB
ASD pass 1st order, fail 2nd order.
Tom delay rather deficit
90% average children pass 7.5yrs. 60% down syndrome pass.
Non of ASD pass (verbal age 12)
What is the Asperger’s response to Baron-Cohen Second Order FB
Asperger’s pass 2nd order
Bowler 1992: 73%
Deficit ToM not universal. Perhaps not primary. Even if not deficit, but delay. Impaired ToM not same ASD
Uniqueness of ASD
Visual impairment show difficulty FB. Hearing impairment have development delay FB
Sensory impairments show delays in FB task.
Verbal proficient allows access social world/interaction.
Verbal age increased –> pass FB attainable
Communication disadvantage early years leads delay understanding
Does ToM have good specificity?
Accounts for triad.
Insistence on sameness, routines, narrow interests, repetitive behaviour
ToM domain-specific deficit. BUT ToM does not explain mental inflexibility
Outline what Executive Control is
Account social and non-social (repetitive)
Ability maintain appropriate problem solving set for attainment future goal
Domain general.
Behaviours explain Executive Control
Planning Impulse control Inhibition of pre-potent but irrelevant responses Set maintenance Organised search Flexibility of search and action
How does Ozonoff et al 1991 systematically investigate mental inflexibility
Tower of Hanoi - Planning.
Wisconsin Card Sorting - Set Shifting.
Both tasks more accurate basis discriminating between who was and was not autistic compared FB
ToM - many passed 1st order, some passed 2nd order.
Executive Functioning reliable indicator rigidity autistic thought. More fundamental deficit.
Outline Tower of Hanoi Task for investigating inflexibility
Planning
Plan few stages possible, how move 3 layers 1 end to other
ASD - Acted impulsively, could not plan several moves ahead, shifted directly.
Outline Wisconsin Card Sorting Task for investigating inflexibility
Set Shifting.
Pile cards. Sort by colour or symbol based feedback. Change strategy some point. ASD unable switch to changing rule. Unable shift attentional focus.
Outline Windows Task for executive control explaining social/communication problems for FB?
Mirror FB. FB due to insufficient flexibility in imagination? e.g. Sally-Ann task not that don’t understand FB but difficulty inhibiting pointing
Outline Russell et al 1991 Window Task
Children under 4yrs and autistic unable inhibit pre-potent response.
1. Boxes without window - some learning trials
2. Box with window so ppts see where chocolate is.
Chocolate - if point to it experimenter eats it. Need point to empty box get reward.
Results of window task
Unexpected transfer task: point impulsively to where chocolate it: rigidity behaviour
Deceptive box: say impulsively what know in box. Repetitive
Windows: point chocolate, pattern behaviour ToM tests
EC difficulty explaining social aspects
EF leads acting impulsively on environment
Outline Sodian and Frith 1992 experiment on whether Executive Dysfunction is the primary cause of ASD?
Prevent burglar gain access to treasure box. Ppts can lock treasure box and not give key (sabotage) or lie that lox is locked (deception = ToM)
Results of Sodian and Frith 1992 experiment
ASD no problems with sabotage (withholding info) do not act impulsively but cannot withhold info (deception). Deficit not about EF but ToM specific.
Uniqueness of Sodian and Frith 1992 experiment
Adults onset ED not cause ASD
Children PKU showed ED but not ASD - Welsh et al 1990 - Tourette’s
Universality of Sodian and Frith 1992 experiment
No evidence for executive dysfunction in autistic pre-school children - Griffith et al 1999. Dawson et al 2002 - not universal
Can executive dysfunction be primary cause of ASD?
Specificity - can explain many deficits, but doesn’t always hold up
Universality - not all individuals with ASD show EF problems
Uniqueness - not unique to ASD
Criticism of Executive Dysfunction. What else does it need to explain?
Non-social features
Savant abilities
Anecdotal reports heightened perceptual abilities. Uneven intellectual profile.
ASD: do not automatically integrate info - fragmented. Less susceptible to capture by meaning. Analyse scenes more objectively.
Show advantages certain tasks.
Outline how Weak Central Coherence Frith 2003 attempts explain social and non-social features
Do not automatically process contextual meaning or use prior knowledge.
Bias piecemeal or local processing (stereotypes)
ASD tend not process info in context, many instances ignore overall meaning
What tasks is weak central coherence found in
Language processing
Perceptual judgement
Discrimination tasks
Outline Milbrath and Siegel 1996 study on ASD less inclined conceptually analyse visual material
Investigated whether drawings non-savant individuals with autism lack conceptual analysis subject matter
Perception autism less top-down, find relatively better drawing performance non-savant individuals with autism. Drawings be highly informative.
Outline Social difficulties in ASD experiment by Snowling and Frith 1986
Those autism fail use context when processing ambiguous homographs e.g. the actor took a bow.
Literal interpretation. Difficulties with sarcasm and irony.
Outline experiments of Perception
- Embedded figures test - Shah and Frith 1983
- Block Design - Shah and Frith 1993. ASD faster than matched controls.
Pring et al 1995: individuals with autism were fast at solving jigsaw upside-down as right-way-up
Inconsistent evidence for WCC
Happe 1996 - reduced susceptibility visual illusions. ASD perceive in parts.
BUT inconsistent Ropar and Mitchell 2001
Mottron et al 1993 - reduced global precedence in Navon task. But see plaisted.
Is WCC primary cause ASD?
Good specificity
Not universal.
Not unique - pragmatic language impairment have problems with processing context - Nobury et al 2002
Should we give up a single explanation of ASD?
3 main cog theories explain some symptoms but not all
Specificity - may be domain general or specific (multiple deficits?). 1 explanation social, different for non-social
Not universal or unique ASD
Cannot be explained by single cognitive deficit
What is Happe and Ronalds 2008 view on the single explanation of ASD
Fractionation of triad
Different genetic and neurological explanations each aspect of Triad
Is autism a unitary disorder?
Triad impairments do not correlate highly in normal population
Each component may have different cause
May be mixture conditions
Changes in Criteria
Triad > Dyad
Social communication and interaction
Restricted, repetitive patterns behaviour, interests/activities (include sensory abnormalities)
Outline changes in categories
New collective term ‘Autism Spectrum Disorder’
No more Asperger’s Syndrome
New emphasis on individual need: 3 levels severity
1. Requiring Support
2. Requiring Substantial Support
3. Requiring Very Substantial Support
Outline Alternative Theories of ASD
Mirror Neuron Theory - Williams et al 2001 - brain level explanation, not well supported
Extreme male brain - more descriptive than explanatory
Social Motivation Theory - Chevallier et al 2012 - not cog but motivational/reward deficit
Enhanced Perceptual Functioning - accounts inconsistencies in literature
Enlarged Temporal Binding Window - explains ASD symptoms at sensory level
Sensorimotor theory of autism - could be more parsimonious explanation of autism
