AUTISM By: Pauline Narciso Philip Lai Henry Kang Overview Pauline – General Survey of Autism – Neural/Chemical Correlates Philip – Comparison of Consciousness Henry – Treatments General Notes Autism as a Syndrome: multiple disease entities Autism is a developmental syndrome: Common deficit: theory of mind Bit of History 1943- Kanner “extreme aloneness from the beginning of life and anxiously obsessive desire for the preservation of sameness.” Initial cause: Bad parents Diagnostic Criteria Severe abnormality of reciprocal social relatedness Severe abnormality of communication development Restricted, repetitive behavior, patterns of behavior, interests, imagination Early onset (before 3-5 years) Other observed behaviors Lack of awareness of feelings of others Bizarre speech patterns Lack of spontaneous and make-believe play Preoccupation with parts of objects Repetitive motor movements Marked distress over changes Begins when… 80% of cases began as “Infantile Autism” Screening Model for Infantile Autism Is child’s eye-to-eye contact normal? Is he/she comforted by proximity/body contact? Does he/she often smile or laugh unexpectedly? Does he/she prefer to be left alone? Systematic Feature Examination Hand stereotypies (strange looking or posturing) Stiff gaze, avoidance of Little reaction to strong, unexpected noise Passive, obvious lack of interest Disease Entities within Autism IABD Zapella Dysmaturational subgroup Purine Autism Asperger’s and Autistic Savants All share common Autistic behaviors Infantile Autistic Bipolar Disorder Regression after initial normal development Meets classical criteria for Autism Autistic symptoms have a cyclical pattern Positive family history of BD or Depression Different from Autistic who later has onset of BD Zapella Dysmaturational subgroup Loss of language after initial normal dev Meets classical criteria Complex tics present Normal neurological exam, normal lab exams Rapid improvement following therapy Reach quasi-normal abilities by age 5-6 After age 6, usually fall into other psychopathological category, ADHD Purine Autism Classical criteria met Too high/too low levels of uric acid Constipation Gout in family members Seizures and self-injury in majority “Purine”:abnormal levels of end product (uric acid) of all purine pathways Quote on Purine Autistic “the boy was an irritable baby who resisted any change in routine and never looked at people around him. By 2 years of age, the few words he had were rapidly disappearing. He lined up his toys in long straight lines instead of playing with them. He developed pica, teeth-grinding, compulsive biting to the point of bleeding.” On the functioning end.. Asperger’s: meet criteria, but have normal IQ functioning Autistic Savants: special skills in memory, music, math, calendar calc, drawing, and hyperalexia reading. Theories on contributing factors Unfavorable pre, peri, post-natal factors Cellular and structural changes in Limbic System (amygdala, cerebellum, and hippocampus) L-hemi neural substrates fail to develop (loss lang., consciousness, motor planning Locus Coerulus:Mediates input from sensesunderdeveloped Low mercury levels Who’s affected? 1% of general public under the Autism Spectrum Most often tend to be males Altered States Compared to Normal Resistance to change, Insist on sameness Strong attachments to objects; Spins objects Difficulty in mixing with others Throw Temper Tantrums Tend not to want to cuddle or be cuddled Over-sensitivity or under-sensitivity to pain No fears of danger Sensory Processing Painfully sensitive to certain sounds, textures, tastes, and smells. Either too sensitive or less sensitive than normal. Some autistic have difficulty interpreting sensory information. Like normal these experiences are not hallucinations but based on real experiences. Some avoid being touched, a gentle touch for most, will hurt or shock autistics. Some are insensitive to pain, and fail to notice injuries. Emotions Take major emergencies in stride but become upset over minor disruption. Unemotional, but can be very emotional when things are important to them. More candid and expressive with their emotions than normal people. Small amount will have difficulty regulating their emotions. Individual will have verbal outburst, usually in strange or overwhelming environment. Communications Problem with semantic-pragmatic component, take a statement or question in a literal way. Ex.) "I'd like coffee with my cereal“ Repeating things that have been heard (echolalia) Inability to understand body language, tone of voice Some autistics are mute Communication Cont. Difficult in sustaining a conversation. No normal "give and take" in a conversation Autistics tend to go on with their favorite subjects and do not give the other person a chance to talk. People with autism might stand too close to the other person. Body language, facial expressions, and gestures do not match what they are saying. Attention Trouble handling multiple stimuli of attention. Very narrow focused attention, can not keep up with more than one thing at a time. Shifting attention is a slow process, usually involves pauses or moments of delay. Productivity Great deal of variety among autistics. Some autistic may never learn to talk and be dependent throughout their lives. Others may do well in special supportive settings, working in a sheltered environment. There are autistics that are fully independent and function fairly well. Theory of Mind TOM is absent in autistics, can not attribute mental states. Autistic can not reflect on their own mental states. Cause abnormalities in social interactions, communications, and imagination. Understanding mental states of others can allows individuals to make sense of past behavior, allows influence on present behavior and permits prediction of future behavior. Normal 3 year olds no TOM, but 4 year olds tend to have a TOM. Mirror Neurons Tested controls and autistics on 4 different tasks. Researchers compared mu rhythms. At baseline, mu rhythms will fire in synchrony, large amplitude mu oscillations. Normal when seeing an action perform will cause mu rhythms to fire asynchronously, therefore resulting in mu suppression. Mirror Neurons Cont. So mu wave suppression will reflect activity of the mirror neuron system. In autistics, there was mu suppression in their own hand movements, but no mu suppression to the observed hand movements. Autism Treatment Behavioral modification and communication approaches Dietary and biomedical approaches Complementary approaches Behavioral & Communication Applied Behavior Analysis – Rewarded behavior TEACCH – Understand the world PECS – Picture exchange Social Stories – Theory of Mind Sensory Integration Biomedical Treatments Medications – Serotonin Re-uptake Inhibitors – Anti-Psychotic Medications Risperidone Vitamins and Minerals Dietary Interventions Risperidone Two double-blind, placebo-controlled responses of risperidone – Adults and Children Serotonin-Dopamine antagonist Effective as a short-term treatment – Tantrums, Aggression, Self-Injurious Behavior – Interfering repetitive behavior, self-injurious behavior, sensory motor behaviors, affectual reactions, overall behavioral symptoms Risperidone Cont. Figure 1: Mean Scores for Irritability Risperidone Cont. Figure 2: Change in Severity of Overall Symptoms Vitamins & Minerals Vitamin B – Most common vitamin supplement Vitamins A and D – Eye contact and behavior Vitamin C – Improve symptom severity Dietary Interventions Gluten – Disruption in biochemical and neuroregulatory processes Yeast – Behavioral and medical problems Complementary Approaches Improving Communication Skills – Music Therapy Speech Development – Art Therapy Non-verbal, Symbolic Expression – Animal Therapy Physical and Emotional Benefits Conclusion Autism is a spectrum Autistics lack an essential element of consciousness-Theory of Mind References Autism Society of America. <http:// www.autism-society.org>. Bauman, Margaret L. and Kemper, Thomas L., eds. The Neurobiology of Autism. Baltimore: John Hopkins UP, 1994. Centers for Disease Control. <http://www.cdc.gov>. Coates, Sheila and Richer, John, eds. Autism The Search for Coherence. Philadelphia: Jessica Kingsley Publishers, 2001. 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