Week 3 Flashcards
Name the DSM-5 criteria of ASD
A. Persistent deficits in social communication or social interaction across multiple contexts
B. Restricted, repetitive patterns of behaviour, interests or activities
C. Present in early development
D. Distress and reduced functioning
E. Not better explained by other disorder
Explain what criteria is in criteria A of the DSM-5 criteria of ASD
A. Persistent deficits in social communication or social interaction across multiple contexts.
1. deficits in social-emotional reciprocity
- Strange way of making eye contact
- Reduced sharing of interests, pleasure, emotions or affect
- Inability to initiate and respond to interactions
- Untuned: on its own track, ignoring others in the room
2. Deficits in nonverbal communicative behaviours used for social interaction
- Limited eye contact
- Body language: turning away
- Limited facial expression (and understanding)
- Less gestures (and understanding)
3. Deficits in developing, maintaining, and understanding relationships
- difficulty playing together
- not much fantasy play
Explain what criteria is in criteria B of the DSM-5 criteria of ASD
B. Restricted, repetitive patterns of behaviour, interests or activities, 2 or more of the following:
1. Stereotyped or repetitive motor movements, use of objects, or speech
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
What is asperger disorder from the DSM-IV?
- Introduced in DSM-IV, removed in DSM-5
- Social impairment (but: presence of social skills, but it didn’t feel natural), restricted behaviour
- No speech delay, No cognitive delay
- often specialized knowledge in restricted domains
- formal speech
- difficulty in comprehending non-literal use of language (taking language very literal)
Name the important differences between ASD and asperger disorder
DSM-IV: Hanteerde drie domeinen: sociale interactie, communicatie en repetitief gedrag. Bij Asperger werd specifiek opgemerkt dat er geen significante taalachterstanden waren.
DSM-V: Combineert sociale interactie en communicatie in één domein en voegt een tweede domein toe voor beperkte en repetitieve gedragingen. Dit leidt tot een meer uniforme en gestandaardiseerde benadering.
Taal- en cognitieve ontwikkeling:
In de DSM-IV werd bij het Asperger-syndroom benadrukt dat er geen significante vertraging was in taal- of cognitieve ontwikkeling. Dit vormde een belangrijk onderscheid met andere autismespectrumstoornissen. In de DSM-V is deze voorwaarde niet langer vereist, wat betekent dat het spectrum nu ook mensen met bepaalde taalontwikkelingsachterstanden kan omvatten.
In de DSM-V is er expliciet aandacht voor sensorische gevoeligheid, zoals over- of onderreactiviteit op sensorische prikkels, wat in de DSM-IV minder prominent aanwezig was.
De DSM-IV kende aparte domeinen voor sociale interactie, communicatie en repetitief gedrag. Bij Asperger-syndroom lag de nadruk vooral op sociale interactie en beperkte interesses. In de DSM-V zijn de criteria herschikt in twee hoofdgebieden:
1. Problemen in sociale communicatie en sociale interactie
2. Beperkte, repetitieve patronen van gedrag, interesses of activiteiten
Deze herstructurering zorgt voor een meer uniforme en bredere beschrijving van het autismespectrum.
Are language difficulties associated with ASD?
In the DSM-5, language difficulties are not a criterion anymore. Because some individuals with social impairments do develop fluent speech. But, deficits in receptive language prove to be good predictors of ASD. And, social interactions contribute to language development. So, we still need to assess language abilities in ASD-assessment.
Name 3 underlying mechanisms of ASD
- Theory of Mind (ToM)
- Executive functions (EFs)
- Central Coherence (CC)
Explain the mechanism of Theory of Mind.
Theory of mind is the failure in the ability to (meta)represent mental states in oneself and others is the cognitive cause of the characteristic autistic behavioural difficulties in social interaction and reciprocal communication.
Theory of Mind (ToM) refers to the cognitive ability to understand that other people have their own thoughts, beliefs, intentions, and emotions that are separate from one’s own. In the context of Autism Spectrum Disorder (ASD), differences in ToM are thought to arise from several interrelated mechanisms:
- Neurobiological Differences
Research suggests that individuals with ASD often show atypical functioning in brain regions crucial for social cognition—such as the medial prefrontal cortex, the temporoparietal junction, and the superior temporal sulcus. These areas normally work together to process social information and infer others’ mental states. In ASD, reduced connectivity or altered activation in this “social brain” network may contribute to difficulties in intuitively grasping what others are thinking or feeling. - Cognitive Processing Styles
While neurotypical individuals tend to use an implicit, automatic process to infer others’ mental states, many individuals with ASD might rely on more explicit, rule-based reasoning. This means that rather than automatically “reading” social cues, they may consciously analyze behavior to guess what someone might be thinking—a process that can be slower and less flexible, especially in rapidly changing social situations. - Early Developmental Factors
Early in life, typical infants learn about mental states through joint attention (sharing focus with another person) and by observing social interactions. In ASD, reduced attention to social cues (such as facial expressions or eye contact) during infancy may lead to fewer opportunities to develop these foundational social-cognitive skills. Over time, this reduced social engagement can contribute to a less intuitive understanding of other people’s inner experiences. - The Role of the Mirror Neuron System
Some theories have proposed that dysfunction in the mirror neuron system—networks that are activated both when performing an action and when observing others do the same—could underlie difficulties with empathy and ToM in ASD. Although evidence is mixed, the idea is that impairments in this system might reduce the natural, embodied simulation of others’ actions and emotions, making it harder to infer their mental states.
Which criteria of ASD explains ToM and why and why not?
ToM does explain criteria A (about social communication and social interaction).
Explaining Social Communication and Interaction:
- Understanding Others’ Mental States:
—ToM involves the ability to infer and understand the thoughts, emotions, and intentions of others. This capacity is crucial for navigating social interactions, interpreting nonverbal cues, and responding appropriately in social situations.
- Social Deficits in ASD:
—Many individuals with ASD experience difficulties in social reciprocity, such as recognizing when someone is confused or needs help, understanding sarcasm, or interpreting facial expressions. These challenges can largely be attributed to impairments in ToM, which makes it harder for them to grasp others’ perspectives or predict social behavior.
Not Explaining Restricted and Repetitive Behaviors:
- Different Underlying Mechanisms:
—The restricted and repetitive behaviors (RRBs) characteristic of ASD—such as insistence on sameness, repetitive motor movements, or highly focused interests—are not directly related to the ability to infer mental states. These behaviors are thought to arise from other factors, including differences in executive functioning, cognitive flexibility, sensory processing, or neural circuitry (such as in the basal ganglia).
- Separate Neural Pathways:
—While ToM deficits impact social cognition, RRBs are associated with other neural and cognitive systems. This dissociation suggests that while both sets of symptoms are part of ASD, they may have distinct underlying neurobiological and developmental origins.
Explain the current vision of ToM in ASD
- Individuals with ASD also differ from one another in ToM task performance.
- ToM task performance can change with age, also that of individuals with ASD
- Traditional ToM tasks often measure “cognitive empathy” (the ability to understand another’s perspective). However, “emotional empathy” (the ability to share or resonate with another’s feelings) and “social motivation” (the drive to engage with others) are also important for understanding the full social profile of a person with ASD. These factors can affect how well ToM skills are applied in real-life contexts.
- perhaps, ASD is characterized by lack of implicit ToM and not explicit ToM: Research suggests that some individuals with ASD can do relatively well on structured, “explicit” ToM tasks—where they are asked directly to reason about someone’s mental state—but may struggle with “implicit” ToM. Implicit ToM is the spontaneous, automatic ability to track and respond to others’ mental states in everyday interactions.
This difference might explain why some people with ASD pass standard ToM tests yet still encounter significant social difficulties in natural settings, where social cues are rapid, subtle, and unstructured.
Which executive functions play a important role in autism?
- Inhibition: - Definition: The capacity to suppress or delay a response, ignore irrelevant information, and manage impulses.
- Relevance to ASD: Challenges in inhibiting certain behaviors or reactions can manifest in repetitive actions or difficulties regulating emotional responses. This may also affect social interactions when it comes to taking turns or following conversational rules. - Switching: switching between your own mental states and what other thinks.
- Working memory: - Definition: The ability to hold and manipulate information in mind over short periods.
- Relevance to ASD: Weaker working memory can make it harder to follow multi-step instructions, track social cues, or keep up with the flow of conversation. It can also affect problem-solving and academic tasks that require keeping multiple pieces of information in mind. - Cognitive Flexibility (Set-Shifting)
- Definition: The ability to shift thinking or behavior in response to changing goals, rules, or environmental demands.
- Relevance to ASD: Individuals on the autism spectrum often show a preference for sameness and can struggle with unexpected changes. Difficulty with cognitive flexibility may contribute to the insistence on routine and resistance to change frequently seen in ASD. - Planning and Organization
- Definition: The ability to formulate goals, create a plan of action, and carry it out effectively, as well as manage multiple tasks or ideas.
- Relevance to ASD: Some individuals may find it hard to break down tasks, anticipate next steps, or organize materials and information, leading to frustration and difficulties in both academic and daily living tasks.
Explain executive functioning as a mechanism for ASD.
Restricted and Repetitive Behaviors:
- Cognitive inflexibility, difficulty with planning, and reduced inhibitory control can make novel or changing environments feel overwhelming. Sticking to repetitive routines and interests provides predictability.
Social Communication Challenges:
- Working memory and self-monitoring deficits can make it difficult to keep track of social cues, topics, and rules of conversation, leading to miscommunications or social withdrawal.
Overlap with Other Mechanisms:
- Executive functioning is not the only factor in ASD. For instance, Theory of Mind differences and sensory processing issues also play major roles. However, EF differences can amplify or interact with these other mechanisms, shaping the overall presentation of ASD.
Neural Underpinnings:
- Executive functions are primarily associated with frontal lobe networks (including the prefrontal cortex) and fronto-striatal circuitry. Neuroimaging studies often find atypical connectivity or activation in these regions in ASD, suggesting that structural or functional differences in these networks may underlie EF-related challenges.
Conclusion:
Executive functioning differences can serve as a core mechanism that helps explain several key features of ASD, especially the insistence on sameness, difficulties adapting to change, and challenges in social interaction. By recognizing the role of EF, interventions (e.g., structured supports, visual schedules, cognitive flexibility training) can be designed to help individuals on the spectrum build strategies that mitigate these challenges and enhance daily functioning.
Which critetia of the DSM does the mechanism of EF explain and which doesn’t and why?
“Perhaps no, but high EF can compensate for ASD symptoms.” Here’s what that means:
- Partial Explanation:
Some aspects of ASD—particularly insistence on sameness, difficulty with transitions, and certain repetitive behaviors—can be linked to cognitive inflexibility (an EF component). This suggests that EF challenges may underlie or worsen these traits.
- Not a Complete Explanation:
Social communication and interaction difficulties (like reading nonverbal cues or reciprocating in conversation) are only partially explained by EF. They also involve other factors, such as Theory of Mind, social motivation, and sensory processing differences. - Compensation Through EF:
Individuals with ASD who have relatively strong EF skills might develop coping strategies—like using explicit “social scripts” or self-monitoring techniques—to navigate social situations and reduce the impact of repetitive behaviors. Essentially, robust EF can help compensate for or mask some ASD-related challenges, even though it does not eliminate them.
In other words, the slide emphasizes that while EF differences are important in understanding ASD (especially the need for sameness and difficulties with flexibility), they do not fully account for all the core social and behavioral features. However, having stronger EF abilities can help some people with ASD manage or adapt to those features more effectively.
What is central coherence?
our ability to integrate individual pieces of information into a coherent whole. See the big picture vs. focused on details
Explain central coherence as a mechanism for ASD
Many individuals on the autism spectrum show a tendency to focus on details at the expense of the broader context. They might excel at noticing small discrepancies or patterns, yet find it more challenging to see how these details fit together into a larger whole.
Consequences of weak central coherence:
- more time and energy needed to process information
- difficulty with cause-and-effect relationships
- difficulty in distinguishing between main and secondary issues
- a situation is no longer the same when a detail changes
Impact on Social Understanding
- Social interactions rely heavily on integrating facial expressions, tone of voice, body language, and contextual cues into a coherent interpretation of someone’s intentions or feelings.
- With WCC, an individual may fixate on a specific detail (e.g., a single phrase someone used) rather than the broader emotional tone, resulting in misunderstandings or literal interpretations.
Relationship to Restricted and Repetitive Behaviors
- A detail-oriented style can reinforce repetitive behaviors or narrow interests, as these activities allow the individual to focus on familiar details and avoid complex or unpredictable contexts.
- Difficulty “zooming out” and adapting to new information can also underlie the insistence on sameness commonly observed in ASD.
Interaction with Other Cognitive Mechanisms
- Theory of Mind: Even if a person has intact perspective-taking skills, difficulties in synthesizing social cues (due to WCC) can still lead to social misunderstandings.
- Executive Functions: If cognitive flexibility is also impaired, switching attention between details and global context becomes even more challenging, amplifying the effects of WCC.
Does explain WCC mechanism the criteria of ASD?
Explaining Social Communication Challenges:
- If someone is more tuned in to specific details (like a particular word or a tiny change in someone’s expression) but less attuned to the broader context (like the overall emotional tone of a conversation), it can make social interaction more confusing.
- Difficulties in “seeing the big picture” of a social situation may contribute to challenges with social-emotional reciprocity and nonverbal communication.
Explaining Restricted and Repetitive Behaviors:
- A focus on details can reinforce strong interests in specific topics or repetitive routines that feel predictable.
- Insistence on sameness might be partly related to difficulty shifting away from detail-oriented thinking to adapt to new contexts or changing routines.
Does WCC fully explain ASD symptoms?
- It can help us understand certain features, like why some individuals with ASD might be drawn to repetitive patterns or have trouble with social context.
- However, WCC does not necessarily account for every aspect of ASD—other factors (e.g., Theory of Mind, executive functioning, sensory processing) also play important roles.
Takeaway:
- Weak central coherence offers a partial lens to interpret ASD traits:
—Social domain: Difficulty integrating social cues, focusing on specific details over the overall flow of conversation.
—-Restricted behaviors: Strong detail-focus can fuel special interests, repetitive patterns, or insistence on sameness.
- Nevertheless, it is just one piece of the broader puzzle that defines autism.
Which mechanism exlpains ASD best?
- No Single Cause or Mechanism: ASD is highly heterogeneous; individuals vary widely in their traits, strengths, and challenges. Because of this diversity, no single theory (ToM, EF, or CC) fully accounts for every manifestation of ASD.
- Subtyping Is Difficult:
Researchers have not yet succeeded in creating clear subtypes of ASD that map neatly onto any one of these cognitive theories. In reality, different individuals may exhibit varying combinations or degrees of ToM, EF, and CC differences. - Multiple Mechanisms May Coexist:
In a single individual, multiple factors (e.g., social cognition, executive functioning, sensory processing, weak central coherence) can all interact. Thus, ASD is viewed as a “compound condition” rather than a single, uniform entity. - No Unique Explanation for Heterogeneity:
Given the spectrum’s complexity, there is currently no unifying explanation that covers all ASD presentations. Each theory offers valuable insights, but taken alone, they do not capture the full range of experiences and behaviors seen in ASD.
In short, the slide underscores that ASD is best understood as multifaceted, involving an interplay of various cognitive, neurological, and environmental factors—rather than one simple, overarching mechanism.
Which disorders have a high comorbidity with ASD?
- ADHD (33%)
- overlapping neurobiology
- shared genetic factors - Anxiety (23%)
- social challenges
- cognitive styles: a preference for sameness and routine can make sudden changes stressful
- sensory sensitivities - Depression (12%)
- social isolation
- chronis stress: coping with sensory overload, EF - OCD (10%)
- repetitive behaviours
- cognitive rigidity - Conduct disorder (10%)
- Schizophrenia spectrum (5%)
- Bipolar (5%)
How do repetitive behaviours in autism and OCD differ from eachother?
- Underlying motivation:
- OCD:
—Driven by obsessions (intrusive thoughts, fears, or images) that cause significant anxiety or distress.
—The compulsions (repetitive behaviors) are performed to reduce or neutralize the anxiety stemming from these obsessions.
—There is often an internal sense of being “compelled” or “forced” to perform the behavior to prevent a feared outcome.
- ASD:
—Repetitive behaviors (e.g., stimming, routines, or intense interests) are less about preventing a feared outcome and more about self-regulation, sensory stimulation, or enjoyment.
—These behaviors may provide comfort, help with emotional regulation, or simply reflect a preference for predictable patterns.
- Level of distress and insight:
- OCD:
— The individual typically recognizes their obsessions or compulsions as excessive or irrational (at least to some degree), which can lead to frustration and shame.
— The repetitive behavior itself causes distress or is seen as burdensome; individuals often want to stop but feel unable to.
- ASD:
— The repetitive behaviors may not be viewed as irrational or distressing by the person themselves. In fact, they can be comforting or pleasurable.
— If distress occurs, it is more likely due to external pressure (e.g., being told to stop stimming) or because the routine is disrupted, rather than from the behavior itself.
- Emotional Function:
- OCD:
— Compulsions often momentarily relieve intense anxiety but can perpetuate a cycle of obsession-anxiety-compulsion-relief.
— The relief is usually temporary, and anxiety returns, driving the compulsive cycle again.
- ASD:
— Repetitive behaviors may serve a regulatory function, helping the individual cope with overwhelming sensory input or strong emotions.
— They can also be a source of joy, focus, or self-expression rather than a response to intrusive thoughts.
- Response to treatment:
- OCD:
— Treatments like Exposure and Response Prevention (ERP) target the anxiety-obsession-compulsion cycle, helping individuals resist compulsive behaviors despite anxiety.
— Medications (SSRIs) can also reduce the intensity of obsessions and compulsions.
- ASD:
— Interventions often focus on managing or redirecting repetitive behaviors that interfere with daily life or cause distress.
— The goal is not always to eliminate the behavior but to ensure it serves a helpful function (e.g., self-regulation) rather than creating barriers (e.g., social isolation, disruption to routines).
- Personal Perspective:
- OCD:
— The person is often aware that their behavior is out of the ordinary and may feel embarrassed or distressed by it.
— They perform the behavior primarily to alleviate fear or anxiety.
- ASD:
— Individuals may not view their repetitive actions as problematic unless others impose that view.
— Behaviors often have a soothing or intrinsically rewarding quality, not necessarily tied to anxiety about a specific obsession.
Explain the challenges that come with determining comorbidity with ASD
- Overlapping symptoms, e.g. repetitive behaviour: Many disorders have features that look similar to ASD symptoms—like repetitive behaviors, fixations, or social difficulties. This overlap can make it hard to determine whether a behavior is part of the individual’s ASD presentation or a separate condition (e.g., OCD, ADHD).
- Diagnostic overshadowing: 1 disorder is dominant: ASD can be overshadowed by another disorder
- Symptoms of ASD are heterogeneous: ASD itself varies widely from person to person in terms of social, communicative, and behavioral characteristics.
Because of this variability, what might be a typical trait of one individual’s ASD could be a sign of a co-occurring disorder in another individual, complicating diagnosis. - Possible impairments in Verbal & intellectual abilities complicate assessment: Some individuals with ASD have limited verbal skills or co-occurring intellectual disability, making it challenging to use standard diagnostic tools or self-report questionnaires.
- Disorders may manifest differently in children with ASD vs. children without ASD: Certain comorbid conditions (like ADHD, anxiety, or depression) can present with unique or atypical symptom profiles when occurring alongside ASD.
- Diagnostic tools are lacking: Many existing assessments were not developed or normed for individuals on the autism spectrum.
This can lead to false negatives (missing a real comorbidity) or misinterpretations of ASD traits as separate disorders—or vice versa
Why is there a high comorbidity in ASD?
- Selection bias: individuals with mental health difficulties seek help and research on individuals with only ASD symptoms is limited
- ASD may cause co-occuring conditions
- underlying deficit (e.g. low EF, SES disadvantage) may make it difficult to cope with ASD symptoms, making other problems more likely
- Shared aetiology (e.g. EF is impaired in both ASD and ADHD)
- People with ASD have difficulties in identifying, sharing and talking about feelings
- Shared neurobiological and genetic factors
What is the prevalence ratio of boys and girls with autism?
- Clinical population: 4:1
- Recent diagnoses: 3:1
- 2:1 in intellectual disability individuals
- the gender gap in autism-related behavior is smaller in non-clinical population than in clinical samples
Give some explanations for the gender gap
- Girls get a diagnosis later in life
- Standard diagnostic tools are biased toward male presentations, meaning many autistic girls do not meet the traditional criteria.
- They say females are genetically protected for getting autism
- Female Autism Phenotype (FAP): the underlying characteristics of autism are differently expressed in women and they have some extra behaviors they show.
Explain what is meant by the Female Autism Phenotype
- Different Social communication & interaction
- Females have stronger social motivation
- But they struggle with maintaining this friendships on the long-term and conflicts in the relationships
- So in comparison to autistic boys, autistic girls experience less social difficulties, but in comparison to TD girls, autistic girls experience sign. more social difficulties
- they also struggle with understanding social hierarchy and indirect communication - Different restricted, repetitive interests and behavior
- While autistic boys often have stereotypical “narrow interests” (e.g., trains, numbers, technology), autistic girls may develop deep interests in literature, animals, celebrities, psychology, or social justice.
These interests often go unnoticed because they align more closely with gender norms. - More internalizing co-occuring problems i.p.v. externalizing
- Autistic females often internalize their struggles, leading to mental health issues like anxiety, depression, and eating disorders.
- This leads often to a diagnosis for the internalizing problems instead for autism
- Boys show more externalizing problems, this is more striking for teachers and parents which lead to earlier request for help - Camouflaging
- Use of conscious or unconscious strategies (explicitly learned or implicitly developed) to minimise the appearance of autistic characteristics during a social setting
- this involves:
— imitating others
— avoid standing out, be the ideal girl in class: (keep to the rules, sweet, adapt)
— show socially desirable behaviour
- But camouflaging can be exhausting:
— mood swings
— identity issues
— physical exhaustion, often need time to recover
