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University of Toronto Scarborough
R Song

ANTC68: Deconstructing Epidemics Lecture 10: Autism Spectrum Disorders  Problem because it exists now in higher prevalence now than 20 years ago  Conditions that are commonly in the news ...listed below  Epidemic term is used so openly  Things important to western society  The perception of autism... it is epidemic affects children and it's visible due to its high rates in western societies ..that is possible to be recognized  Address the autism as a visible disease ...perception that it affects a lot of kids “Epidemics” of …  Bipolar spectrum disorder  Psychosocial disorders (anxiety, eating, affective / mood, schizophrenia)  ADD/ADHD  Depression  Suicide  Autism spectrum disorders Spectrum of Disorders  Affect different aspects of 1 social learning, 2 communication abilities, 3 imaginative development among children  Neurological impairment  Severe form of autism linked to neurological impairment  Asperger syndrome (like autism, but milder, with normal language development)  Rett syndrome (very different from autism, and only occurs in females)  Childhood disintegrative disorder (rare condition where a child learns skills, but loses them by age 10)  Pervasive developmental disorder - not otherwise specified (PDD-NOS), also called atypical autism o Affects so many aspects of child's life o See figure .....autistic disorder is more severe o PDD ...not as severe ..more mild  Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behaviour (National Institute of Neurological Disorders and Stroke).  Autistic disorder, sometimes called autism or classical ASD, is the most severe form of ASD; a developmental disorder that appears in the first 3 years of life (often recognize symptoms by 18 months), and affects the brain's normal development of social and communication skills.  First recognized and labeled in 1948 by Kanner  ASD varies significantly in character and severity  It occurs in all ethnic and socioeconomic groups and affects every age group  Experts estimate that 3 to 6 children out of every 1,000 will have ASD  Males are 4x more likely to have ASD than females (gender biased)  Genetic factors seem important, i.e., identical twins o runs in the family o but seen in all ethnic groups o generally occurs in infancy  Similarly, language abnormalities are more common in relatives of autistic children  Chromosomal abnormalities and other nervous system (neurological) problems are also more common in families with autism o More common in family with autism  Children with autism typically have difficulties in: o Pretend play o Social interactions (friends, families, teachers, etc.) o Verbal and nonverbal communication  Some children with autism appear normal before age 1 or 2 and then suddenly "regress" and lose language or social skills they previously had. This is called the regressive type of autism. o Able to do things before the age of 1-2 ...then regress them and lose these abilities How to diagnose children who may have autism ...subjective way to define the conditions ....the so called symptoms are pretty normal in children growing up ....think about autism ...these symptoms are subjective and can be over- emphasized ...over focused ....these traits are individual variations ...autism children have a combinations of these issues which make it complex and results in this disease  Communication problems may include: o Cannot start or maintain a social conversation o Communicates with gestures instead of words o Develops language slowly or not at all o Does not adjust gaze to look at objects that others are looking at o Does not refer to self correctly (e.g., says "you want water" when they mean "I want water") o Does not point to direct others' attention to objects (occurs in the first 14 months of life) o Repeats words or memorized passages, such as commercials o Uses nonsense rhyming  Social interaction: o Does not make friends o Does not play interactive games o Is withdrawn o May not respond to eye contact or smiles, or avoids eye contact o May treat others as if they are objects o Prefers to spend time alone, rather than with others o Shows a lack of empathy  Response to sensory information: o Does not startle at loud noises o Has heightened or low senses of sight, hearing, touch, smell, or taste o May find normal noises painful and hold hands over ears o May withdraw from physical contact because it is over-stimulating or overwhelming o Rubs surfaces, mouths or licks objects o Seems to have a heightened or low response to pain  Play: o Doesn't imitate the actions of others o Prefers solitary or ritualistic play o Shows little pretend or imaginative play  Behaviours: o "Acts up" with intense tantrums o Gets stuck on a single topic or task (perseveration) o Has a short attention span o Has very narrow interests o Is overactive or very passive o Shows aggression to others or self o Shows a strong need for sameness o Uses repetitive body movements Major Approaches to Defining/Treating Autism (Baker 2008) 1. Psychoanalytic model (rejection, poor parenting) o Autism result of poor parenting o Children acting out cause parents aren't good o Idea thrown out and not used anymore 2. “Mainline” Biological - neuro-developmental o Impairment to neurological ...affects socialization o See the reasons below 3. “Alternative” Biological - biomedical Four tenets have characterized most approaches emphasizing (mainline) biological origins: 1. The cause of autism is fundamentally biological, not due to parental behaviour. Nature of the cause remains unknown, but variety of studies have highlighted the importance of genetics. 2. Autism is conceptualized as a spectrum of disorders. In the 1970s, investigators modified Kanner's original (1948) diagnosis to encompass children with greater intellectual and language impairment and also expanded it to encompass higher-functioning kids with labels such as "pervasive developmental disorders" and "autistic spectrum disorders“ 3. If autism represents a spectrum disorder rooted in biology, its treatment must be largely rehabilitative, rather than curative (crucial part of autism) 4. As with other developmental disorders, early referral and intervention offer the greatest hope for a positive outcome (screening, educational programs, support, etc.) .. (crucial part of autism) “Alternative” biological perspective  Views autism in biomedical terms. Rather than viewing autism as a continuum of disability, it characterized the condition as a heterogeneous collection of discrete entities with different etiologies sharing a common presentation. Most importantly, this viewpoint offered hope that at least some forms of autism are not simply treatable, but curable. o Can be cured o dietary are responsible  Most popular: those focusing on special diets, based on studies suggesting that an abnormality in intestinal permeability may admit intestinal toxins or opioids affecting the nervous system at an early age.  These theories recast autism as biomedical in origin and potentially curable in ways that reflect late 20th century hopes in the power of medical technology  Autism Research Institute in San Diego, CA ..leading centre of this perspective ..found readily on the internet Possible Causes (of Autism)  Diet  Digestive tract changes (changes in permeability..more absorption of toxins that affect nervous system)  Mercury poisoning  Body's inability to properly use vitamins and minerals  Vaccine sensitivity (lead to genetic predisposition, some kids more sensitive to vaccine than other children) Explaining Autism’s Rise… 1. Links to vaccines and other environmental toxins 2. Changes in definition, measurement, and identification of ASD - its expanded diagnostic continuum in widely used clinical manuals such as the Diagnostic and Statistical Manual of Mental Disorders IV and IV-TR (APA 1994, 2000) may be a source of increase in prevalence of childhood ASD - as diagnoses include a broader range of conditions than they did in the past - which was facilitated by an increasing cultural preoccupation with medicalizing childhood
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