Download AUTISM

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
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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.
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,
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Gilberg,Christopher and Coleman, Mary. The Biology of the Autistic Syndromes.
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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
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McCraken, James T. et al. “Risperidone in Children With Autism and Serious
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References Cont.
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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.
<http://www.bci.ucsd.edu/~pineda/CNL_WEBPAGE/index.html>.
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 <http://darkwing.uoregon.edu/~sterling>.
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.
<http://www.nimh.nih.gov/publicat/autism.cfm>.