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THE BIG PICTURE OF
AUTISM:
SCIENCE AND THEORY
IN PLAIN ENGLISH
Lars Perner, Ph.D.
San Diego State University
Presentation at the
ANCA® Foundation Special Fall Conference and
Fundraiser
Vancouver, B.C.
November 19-20, 2004
“If It [Were] Easy”
 Problems
we face are often superficially
similar to those faced by “neurotypicals”
–
–
–
–
–
Relationships
Understanding others
Conflict
Budgeting
Limited sensory abilities
 How
we handle these problems
Copyright © 2004 Lars Perner, Ph.D.
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Purposes of This Talk
 Understand
the many factors that
influence autism in individuals
 Recognize individual variations and
unique needs
 Build empathy with autistic individuals
 Get ideas on what to try and consider to
help specific individuals
Copyright © 2004 Lars Perner, Ph.D.
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The Role of Theory (or Seeing
“The Big Picture”)
THEORY
UNDERSTANDING
EXPERIENCE
WITH INDIVIDUAL
INTERVENTIONS
VALUES
AND
DECISIONS
ANALYSIS
Copyright © 2004 Lars Perner, Ph.D.
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“It Takes Every Kinda’ Perspective to Go
Around the Autistic Spectrum” with apologies to
Robert Palmer
Specialists and
medical practitioners
 Teachers
 Parents
 Individuals on the
Spectrum
 Biomedical
researchers

Psychologists and
Counselors
 Theoreticians
 General population
 Other(?)

Copyright © 2004 Lars Perner, Ph.D.
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Why Do These Symptoms Go
Together?

Sensitivity to
– Noise
– Coarse materials
– Food tastes



Poor handwriting
Difficulty maintaining
eye contact
Frustration with
“spontaneous
coordination”


Difficulty imitating
others
Impaired spatial ability
– Difficulty driving
– Following maps



Difficulty with sensory
integration
Difficulty doing
arithmetic despite
intelligence
Depression
Copyright © 2004 Lars Perner, Ph.D.
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Diagnosis
 Diagnostic
criteria are somewhat
arbitrary
 May be needed for insurance and
eligibility standards
 Frequently “fudged” to meet eligibility
 Future discoveries may help us better
identify clusters of vulnerabilities
Copyright © 2004 Lars Perner, Ph.D.
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Arbitrary Medical Standards
 Schizophrenia
takes precedence over
autism/AS/PDD-NOS
 Autism/AS/PDD-NOS take precedence
over ADD/ADHD
 Symptoms of depression may be
“secondary” and may or may not be
diagnosed separately
Copyright © 2004 Lars Perner, Ph.D.
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Diagnosis, Misdiagnosis, and
“Undiagnosis”
Diagnosed
Has Autism
Correctly
Diagnosed
Autism
Misdiagnosed
As Autism
Undiagnosed
Autism
Copyright © 2004 Lars Perner, Ph.D.
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Complicating Things…
Autism
Only
Autism
And
Other
Other
Only
Copyright © 2004 Lars Perner, Ph.D.
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Comorbidity
DEPRESSION/
BIPOLAR
DISORDER
ANXIETY
ATTENTION
DEFICIT/
HYPERACTIVITY
AUTISTIC
SPECTRUM
CONDITIONS
LEARNING
DISABILITIES
OBSESSIVECOMPULSIVE
DISORDER
OPPOSITIONAL
DEFIANCE
DISORDER
SEIZURES/
TOURETTE’S
Copyright © 2004 Lars Perner, Ph.D.
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Autism and Other Conditions:
Seeing the Whole Picture
HAS
AUTISM
Auon
HAS
OTHER
CONDITION
AuOu
adOu
ADOu
aMOu
ADon
ADOD
AUTISM
DIAGNOSED
aMoD
anOD
ADoM
aMon
aMoM
A Has autism
a Does not have autism
D Condition has been diagnosed
n Condition has not been diagnosed
M Misdiagnosis (False positive)
u Undiagnosed condition (False negative)
O Has other condition
o Does not have other condition
anoM
OTHER
CONDITION
DIAGNOSED
Copyright © 2004 Lars Perner, Ph.D.
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Pervasive Developmental
Disorders (PDDs)

Categories
–
–
–
–
Autism
Asperger’s Syndrome
Rett’s
Pervasive Developmental
Disorder—Not Otherwise
Specified (PDD-NOS)



Meaningfulness of
diagnostic distinctions
Rigidity of criteria
Arbitrary nature of
standards
– Childhood Degenerative
Disorder

Differences
– Within-group
– Between-group
Copyright © 2004 Lars Perner, Ph.D.
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Causes of and Influences on Autism
ENVIRONMENT
GENETICS
COMPENSATING
ABILITIES
SYMPTOMS
GENETIC
PROTECTION
VULNERABILITY
TO ENVIRONMENT
EXHAUST
SECONDARY
SYMPTOMS
Copyright © 2004 Lars Perner, Ph.D.
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Non-Action
If lacking
INSTINCT
MOVITATION
Inefficient
EXHAUST
Efficient
ACTION
ABILITY/
INHIBITION
REINFORCEMENT/
LEARNING
SHUTDOWN
“MELTDOWN”
INAPPROPRIATE
ACTION
POSSIBLE
ADAPTATION
LIKELY
ADAPTATION
Low ability or inadequate inhibition
Copyright © 2004 Lars Perner, Ph.D.
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Genetics
Varying estimates of the numbers of genes
involved
 Models

– Various genes individually cause specific problems
leading to autism symptoms
– Multi-gene Threshold: Must have a certain number
of genes (e.g., 3-20) to exhibit symptoms

Interaction of multiple genes
– Fraternal vs. identical twins

Genetic redundancy and protection
Copyright © 2004 Lars Perner, Ph.D.
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Question from Participants
Likelihood of Children Inheriting
Autism from Autistic Parents
Question: “Speak to the issue of autistic people having children given genetic
component.”
 Inheriting
“autism” vs. specific traits
 Family history of both parents
– Autism characteristics
– Other characteristics (e.g., ADHD, depression, anxiety)
 Gender
of child
 Dr. Ami Klin: [No definitive research but]
“15% might be a reasonable estimate.]
MAAP Newsletter, 2004, Volume II.
Copyright © 2004 Lars Perner, Ph.D.
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El Niñofication

The tendency to
move to one extreme
or the other on
performance or
behavior
– Examples
 Sensitivity
 Confrontation
 Math
or verbal abilities
Copyright © 2004 Lars Perner, Ph.D.
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Brain Structure
 Specialization
of brain areas (e.g.,
amygdala)
 Brain scan studies
 “White” vs. “gray” matter
 Neural connections
– Learning
– Survival and “pruning”
– Structure of neurons and dendrites
Copyright © 2004 Lars Perner, Ph.D.
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Neurotransmitters
 Total
of 52 known
 Especially important in autism:
–
–
–
–
Dopamine
Norepinephrine
Serotonin
Oxytocin
 Interaction
of transmitters
Copyright © 2004 Lars Perner, Ph.D.
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Question from Participants
“Fight or Flight” Response
“Question: Can you add more fight-or-flight information in terms of brain chemistry and body
reactions?”



“Fight or Flight” response—evolutionary advantage
Or: “Fight, Flight, Shutdown, or Meltdown”
Causes
– Activation of Sympathetic Nervous System
– Release of adrenaline and cortisol

Role of amygdala within autism
– Some research suggests that the amygdala is, on the average,
enlarged in people on the spectrum (large variation)
– Amygdala may be overworked due to non-specialization in
other brain areas

Role of anxiety and depression
Copyright © 2004 Lars Perner, Ph.D.
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Flight or Fight Responses:
A Simplified Model POST TRAUSENSORY
INPUT
THALAMUS
LONG
DETOUR
PRE-FRONTAL
CORTEX
FRONTAL
CORTEX
LIMBIC
SYSTEM
MATIC STRESS
DISORDER MAY
RESULT FROM
EXCESSIVE USE
OF THIS
CHANNEL
AUTOMIC
NERVOUS
SYSTEM
STRESS
RESPONSE
CANCEL
UNNEEDED
STRESS
RESPONSE
THIS CHANNEL
IS STRENGTHENED
THROUGH
MATURATION
Copyright © 2004 Lars Perner, Ph.D.
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Two Competing Objectives for
Computers and Brains
SPEED
(EFFICIENCY)
RELIABILITY
ASSUMPTIONS
GENERALIZATION
SPECIALIZATION
FILTERING
PRIORITIZATION
INTUITION (HUMANS)
QUESTIONING ASSUMPTIONS
REDUNDANCY
VERIFICATION
FOCUS OF ATTENTION
LOGICAL EXAMINATION
Copyright © 2004 Lars Perner, Ph.D.
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Hierarchy of Information and
Thinking
Decision making
Thinking
Awareness
Pre-conscious
awareness
Non-conscious handling of
stimuli
Non-perceived stimuli
Copyright © 2004 Lars Perner, Ph.D.
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A FIVE FUNCTION MODEL OF THE PERFORMANCE OF
INDIVIDUALS ON THE AUTISTIC SPECTRUM
PERF0RMANCE
INHIBITORY
INSTINCTIVE
FUNCTION
INTUITIVE
FUNCTION
EXECUTIVE
FUNCTION
COMPENSATORY
FUNCTION
ACTIVE
INTELLECTUAL
FUNCTION
Copyright © 2004 Lars Perner, Ph.D.
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Abstraction and Generalization

Individuals with autism often have difficulty in
–
–
–
–
–
Generalizing from one situation to another
Understanding and/or accepting “exceptions”
Understanding certain non-concrete ideas (BUT…)
Understanding non-literal language
Deciphering symbolic (graphical) representation
Copyright © 2004 Lars Perner, Ph.D.
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Question From the Audience
What Teachers Can Do
Question: “The early teen years are very difficult for all children. As a
school, what would you like to see us teachers make happen? What would
make life easier for the autistic child? How can they grow socially,
emotionally without disaster?”

Recognizing individual differences
– Talking about options rather than giving “command”
advice
Working with special interests and motivations
 Time to “process”
 Help with reasoning on other people’s thoughts
and feelings (“Theory of Mind”)

Copyright © 2004 Lars Perner, Ph.D.
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