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Pauline Narciso
Philip Lai
Henry Kang
– General Survey of Autism
– Neural/Chemical Correlates
– Comparison of Consciousness
– Treatments
General Notes
Autism as a Syndrome: multiple disease
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
Severe abnormality of communication
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
Is child’s eye-to-eye contact normal?
Is he/she comforted by proximity/body
Does he/she often smile or laugh
Does he/she prefer to be left alone?
Systematic Feature
Hand stereotypies (strange looking or
Stiff gaze, avoidance of
Little reaction to strong, unexpected noise
Passive, obvious lack of interest
Disease Entities within Autism
Zapella Dysmaturational subgroup
Purine Autism
Asperger’s and Autistic Savants
All share common Autistic behaviors
Infantile Autistic Bipolar
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
 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
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
Unfavorable pre, peri,
post-natal factors
 Cellular and structural
changes in Limbic
System (amygdala,
cerebellum, and
 L-hemi neural substrates
fail to develop (loss
lang., consciousness,
motor planning
input from sensesunderdeveloped
 Low mercury levels
Who’s affected?
1% of general public under the Autism
 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.
 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.
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
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.
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.
 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
 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
– Understand the world
– Picture exchange
Social Stories
– Theory of Mind
Sensory Integration
Biomedical Treatments
– Serotonin Re-uptake Inhibitors
– Anti-Psychotic Medications
Vitamins and Minerals
Dietary Interventions
 Two double-blind, placebo-controlled responses of
– 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
Vitamins & Minerals
Vitamin B
– Most common vitamin supplement
Vitamins A and D
– Eye contact and behavior
Vitamin C
– Improve symptom severity
Dietary Interventions
– Disruption in biochemical and neuroregulatory
– 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
Autism is a spectrum
Autistics lack an essential element of
consciousness-Theory of Mind
Autism Society of America. <http://>.
Bauman, Margaret L. and Kemper, Thomas L., eds. The Neurobiology of Autism.
Baltimore: John Hopkins UP, 1994.
Centers for Disease Control. <>.
Coates, Sheila and Richer, John, eds. Autism The Search for Coherence. Philadelphia:
Jessica Kingsley Publishers, 2001.
Gabriels, Robin L. and Hill, Dina E., eds. Autism-From Research to Individualized
Practice. Philadelphia: Jessica Kingsley Publishers, 2002.
Gilberg, Christopher. Diagnosis and Treatment of Autism. New York: Plenum Press,
Gilberg,Christopher and Coleman, Mary. The Biology of the Autistic Syndromes.
London: MacKeith Press, 2000.
Happe, F. “Theory of Mind and Self.” Ann. N.Y. Acad. Sci 1001 (2003): 134144.
Harris, J.C. “Social neuroscience, empathy, brain integration, and neurodevelopmental
disorders.” Physiology & Behavior 79 (2003): 525-532.
McCraken, James T. et al. “Risperidone in Children With Autism and Serious
Behavioral Problems.” The New England Journal of Medicine 347
(2002): 314-321.
References Cont.
McDougle, Christopher J., et al. “A Double-blind, Placebo-Controlled Study of
Risperidone in Adults With Autistic Disorder and Other Pervasive
Developmental Disorders.” Arch Gen Psychiatry 55 (1998): 633-641.
McQueen, JM and Heck, AM. “Secretin for the treatment of Autism.” Ann
Pharmacother. 36 (2002): 1294-1295.
Millward, C., et al. “Gluten- and casein-free diets for autistic spectrum disorder.”
Cochrane Database Syst Rev. 2 (2004): CD003498.
Pineda, Jamie. Home page.
Pfeiffer, SI, et al. “Efficacy of vitamin B6and magnesium in the treatment of
autism: a methodology review and summary of outcomes.” J Autism
Dev Disord 28 (1998): 580-581.
Schopler, Eric and Mesibav, Gary. High-Functioning Individuals With Autism. New
York: Plenum Press, 1992.
Sterling, Lisa. Home page. 2002 <>.
Strock, Margaret (2004). Autism Spectrum Disorders (Pervasive
Developmental Disorders). NIH Publication No. NIH-04-5511, National
Institute of Mental Health, National Institutes of Health, U.S. Department of
Health and Human Services, Bethesda, MD, 40 pp.