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Lecture 5

PSY341H1 Lecture 5 (including all autism & temple grandin video notes)

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Hywel Morgan

PSY341H1S L5; July 22, 2013  Asperger’s Syndrome Autism Spectrum Disorder (not disorders) – DSM V o Low level autistic-like symptoms  Inability to interact w other ppl o Typically very high fn’ing  Not everyone agrees on what the concept of autism is, what o Sheldon Cooper: Socially, verbally – not adept causes it, and how to treat it  Could argue socially & verbally retarded  High cognitive fn’ing  Term “autism” coined in 1950s  Many researchers & clinicians that find themselves unable to o Ppl who are “nerdy” – could be a mild form of autism, distinguish btwn autism & mental retardation (intellectual not dysfunctional difficulties) since hallmark is profound inability to socially connect w other ppl, of which the main medium is language  Childhood Disintegrative Disorder (verbal communication) o More severe form of autism o Very hard to intellectually assess a child that won’t o Looks more psychotic than the other forms o In the past, on DSM I, was referred to as Childhood communicate w you o Extreme: no eye contact Schizophrenia o Often mistaken for deafness Category: “Childhood Psychoses” (DSM I - 1954)  Many ppl think autism & mental retardation occur comorbidly st  Dif levels of functioning in dif ppl w ASD  Temple Grandin 1 diagnosed w mental retardation  High fn’ing ppl  can go to college, but still have a lot of  DSM I calls autism Childhood Psychosis  Can’t still definitively say what the label should be difficulty interacting verbally & emotionally w other ppl, hard time understanding affective components (sarcasm), not  Original reason: social deprivation – leads to similar good at interpreting affect & language symptoms  Severe is indistinguishable from mental retardation o Initially research suggested aloof, bookish parents (not  Facilitated communication – takes their hand, punches letters interacting w their children) & #s on a pad o Envt blamed (parents) o Debunked since the communication was coming from Category: Neurodevelopmental Disorders (DSM V) the facilitator  Diagnoses: Autism Spectrum Disorder and Intellectual aka Pervasive Developmental Disorders (DSM IV) Disorder  Evidence that neurological  Autism o Hallmark symptoms:  Brains look differently, fn differently  profound inability to socially interact w other pp) Connections btwn lobes (white matter) is dysfunctional   somewhat aware of what’s going on around them lobes can’t communicate w each other as well but interpreting the sensory in a dif way  Not the parents, prob the biology  like schizophrenia, considered to be a  Genetic markers – predisposition, don’t guarantee symptom psychotic condition – lost touch w reality, display not experiencing same things in same way as others) Childhood Schizophrenia  cognitive perspective: suggested they might  Not used much anymore be hypersensitive, sensory register decays  Sometimes used when child seems psychotic quickly; it seems to be that they are unable to effectively filter stuff out (pathology) Childhood Psychoses overwhelmed by incoming sensory info  shut it all out – fn’al neuroimaging support1) Infantile Autism this  Different affect  what Leo Kanner (USA) & Aspergers (Austria) described Leo Kanner: o potentially lifelong unless treated  not simple treatments  infants that didn’t interact w caregivers  not all children treated will improve to normal  infants that are removed from their caregivers normally cry o autistic infants – don’t do that, appear concerned but fn’ing don’t react “murderously” llike normal infants o if untreated  can’t hold down jobs, go to college, have spouses o don’t react w pleasure o remain stiff & rigid when picked up  definitions of abnormality o generally unable to tolerate ppl & wanted to be left o looks a lot like mental retardation – don’t score high on cognitive tests since not interacting alone o can’t do simple things o likely to respond angrily to an adult that reached out to them o lack of eye contact  Retts o Very much like autism but manifestation of symptoms o sitting motionless for hours o smiling to themselves momentarily tend to be later – in toddlerhood instead of infancy o looked like deafness of mental retardation  so hard to o Primary characteristic is “hand-wringing” o Autistic-like categorize o fondness for simple inanimate objects that they will o Varying degrees manipulate for hours on end  will self-stimulate (ex. look at own hand) if no objects available Causes of Autism o excellent motor coordination  Genetics o Hypenesia – seem to observe everything that goes on o Genetic vulnerability for autistic-like bhvrs – not clear- around; will react (-)vely & even violently to even small cut, not 1 gene (the case for multiple disorders) changes o Twin studies: if autism was a genetic disorder,  No attention filter genetically identical twins would have a 100% concordance rate – but this isn’t the cause  Speech therapy (bhvr’al in origin)  helped Grandin be verbal  However it is higher than avg  Speech acquired in only 50% of those diagnosed w Autism  Have identified specific genes (mapping) that o however, even within those 50%, it tends to be parrot- seem to be attached to this disorder  genetic like (Echolalia) – non-communicative speech vulnerability – no guarantee  if literal – concrete (ex. if they have learned they’ll  Other evidence suggests it isn’t 100% genetic – get medical attention when they hurt their head, can be treated by bhvr therapy (most effective they’ll say “I hurt my head”) treatment) which isn’t biological  Self-injuries bhvr  Biochemistry Diagnostic Criteria (DSM IV) o Dif biochemistry a. Total of 6 or more items from 3 grps o Biochemical markers o Grp 1: qualitative impairment in social fn’ing must o Abnormal levels of serotonin & other mono-amines be manifested by:  Ex. Grandin treated w SSRIs – pharmacological  A: an impairment in non-verbal bhvrs (eye component contact, body posture etc) o Affective component – anxiety, depression  B: Failure to develop peer relationships at an  Overwhelmed by incoming sensory info, no filter appropriate age   treat pharmacologically  C: Lack of spontaneousy to share enjoyment w others  Neurobiology – most important  D: Lack of soial or emotional reciprocity o Functional imaging o Grp 2: qualitative impairment in communication o Bhvr’al reaction (ex. to a bang) is different in autistic manifested by: children (do nothing), but see Neurological reaction  A: delay or lack of language  Dif parts of brain light up in dif degrees  B: an impairment to initiate conversation o Less efficient mitochondria  C: repetitive language or stereotypical language  D: lack of make-belief or social play Treatments o Grp 3: restrictive patterns of bhvr manifested by:  Bhvr Modification  A: preoccupation w a bhvr o Psychoanalysis not useful for autism  B: inflexible bhvrs o Most useful technique  C: stereotypical mannerisms o Works rly well  D: preoccupation w parts of an object o In order to occur, specifically w regards to operant b. Delays in fn’ing in 1 of these areas (social interaction, conditioning, need communication – on a very language, play) prior to age 3 superficial level  reinforce, takes a lot of time o GONE – now 2 categories of: Social communication &  Conditioning requires an interaction Restrictive repetitive bhvrs o Ex. (+)ve reinforcement for things as simple as eye c. Disturbance does not fit another disorder in this category contact  Imitation  Play  Social responses o GONE in DSM V (since no other disorders in this o Punishment (mild electric shock): self-harm category)  Useful, unpleasant  Used effectively in controlled circumstances  Diagnosis in DSM V has not changed significantly  Structured Envt o Social bhvrs, communication bhvrs, social interactions o Therapy gets best result in a structured controlled envt in repetitive & play bhvrs o In the past was mainly in institutionalized settings  Ex. bang heads against wall for hours (severe,  Now not completely necessary possibly unable to filter incoming sensory info),  Mainstreamed special education envts are just as flapping hands effective (ex. in schools)  ECT Associated Characteristics o In past  tend to come from middle class homes o Electrodes to head o in past has suggested an envt’al cause – remains o Abandoned since relatively invasive controversial but research has supported it  Drug therapies  only (+)ve prognostic factor is development of speech o Anti-anxiety drugs, antidepressants o ex. Temple Grandin o Large scale study on use of hallucinogens &  prevalence is hard to say, since large degree of diagnostic antipsychotic drugs on autistic bvrs, antipsychotic unreliability drugs o but seems to be 10/10,000 children  Mixed results o however more prevalent in boys than girls – 4:1  Some research showing anti-psychotic drugs help – but don’t know if was autism or another Quantitative Autism Childhood Differences Schizophrenia disorder  Sensory deprivation Onset Almost from the beginning Btwn 2-11 o Used by Temple Grandin of life, early infancy Much more gradual o Take sensory input away o Considered unethical to sensorily deprive children Physical Good, healthy complexion Light o Sensory deprivation chamber Appearance complexion, o Typical symptoms of sensory deprivation  pale skin hallucinate (brain fills in what isn’t there anymore) EEG Generally normal Abnormal  Thought the opposite would happen in autistic children Anticipatory Absent, stiff, rigid Present,  Moderately successful but abandoned Body Movements conform to (to parental body of holder 2) Childhood Schizophrenia pick-up)  On DSM IV was relabelled as Childhood Disintegrative Motor Gross motor & fine Poor Disorder Performance dexterity good coordination,  DSM V: on the more severe end of Autism Spectrum Disorder awkward, o Complete cut from reality clumsy o Qualitatively looks different Special Abilities Can be present Never o Very low fn’ing Usually in a particular  Near next to impossible to call delusions & hallucinations domain of cognitive fn’ing abnormal in children  abandoned this term Rare  Childhood Psychoses – used to described all weird severe Ex. Savant syndrome – bhvr in children (ex. children reactivity disorder) indiv w autism will  Still not clear what it is develop very specific  Basically, the term “Childhood Schizophrenia” was used as special ability (ex. playing music, come up w day of an umbrella term for all other disorders that were psychotic- like in children that didn’t fit the diagnosis of autism year, math) Not well understood Possibility they are Differences from Autism  Quantitative difference (not qualitative) focussing cognitive capacity on a very specific cognitive fn Possible Causes Conditionability Difficult to establish Occurs easily  Suggestion that it is result of brain damage o The rest mostly have Echolalia – repeat what others  Research showing children that have historically been diagnosed w childhood schizophrenia did have previous birth says complications  Lack use of language, emotional attachment to other ppl, attention, toy play, peer plat, self-help skills Characteristics  Excessive aggression, self-stimulation, tantrums  Predominant: Profound decrease of interest in ppl, events,  Many need custodial care activities  Bhvr’al treatment approach influence by BF Skinner o Cannot play w toys o Operant conditioning  Preoccupation w bizarre matters o Broad application to human bhvrs o Reinforcers (increase probability of bhvr)  Tend to show periods of hypo- & hyper-activity o Punishers (decrease probability of bhvr) Video: Bhvr’al Treatment of Autistic Children  Ivar Lovaas – 1 research of this  Lisa (3yrs old) – plays w small set of objects o Extremely controversial o Reinforce sitting bhvr of sitting w food, praise, clapping  Very important film in treatment of autism  Immediate o Effectiveness of bhvr’al modification of severely autistic  Gradually learned to sit w/o a prompt child, affectively labile (up & down) o Lisa tantrums when anyone tries to teach her – screams  Usually st
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