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Chapter 10

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Lauren Hetherington

Chapter 10- Autism Spectrum Disorders and Childhood-Onset Schizophrenia AUTISM SPECTRUM DISORDERS [ASD]  ASD: complex, neurodevelopmental disorder characterized by abnormalities in social behavior, language and communication skills, and unusual behaviors and interests Description and History  First few years of life, isolated, caught up in personal rituals and interests and when interrupted extremely upset  Questions – When should I be concerned? How can I understand what is happening? Treatments? Where can I turn for services? Future?  ASD refers to 3 DSM-IV-TR pervasive developmental disorders [PDD: significant impairments in social and communication skills, stereotyped patterns of behavior]  Autistic Disorder, Asperger‘s Disorder and Pervasive Developmental Disorder Not Otherwise Specified  Historically thought of schizophrenia and autism as a single disorder  Factual history begins in 1943  Dr. Leo Kanner- 11 children who displayed more attention to objects than people, avoided eye contact, lacked social awareness, limited language,  Preservation of sameness [anxious and obsessive insistence on maintaining sameness in daily routines and activities]  Early infantine autism: extreme aloneness, shut out and disregards anything coming to the child from outside  Their parents were Refrigerator parents: highly intelligent, obsessive, mechanical and cold  Autism as child‘s defensive withdrawal from cold environment – found no support, now known as biologically based  @ Same time- Dr. Hans Asperger found milder version  Unusual interests, some have extraordinary perceptual abilities  May spend hours doing stereotyped repetitive motor activities, or focus on minor details instead of whole environment DSM-IV-TR: DEFINING FEATURES OF AUTISM  A. Total of six [or more] items from (1), (2), and (3), with at least 2 from (1) and one each from (2) and (3)  (1): Qualitative impairment in social interaction as manifested by at least 2 of the following  (a): marked impairment in use of multiple nonverbal behaviors such as eye-to- eye gaze, facial expressions, body postures, gestures to regulate social interaction  (b): failure to develop peer relationships appropriate to developmental level  (c): a lack of spontaneous seeking to share enjoyment, interests, or achievements w/ other people  (d): lack of social or emotional reciprocity 1  (2): Qualitative impairment in communication as manifested by at least on of the following:  (a) delay in, or total lack of, the development of spoken language  (b) in individuals w/ adequate speech, marked impairment in the ability to initiate or sustain a conversation with others  (c) stereotyped and repetitive use of language or idiosyncratic language  (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level  (3): restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following  (a) encompassing preoccupation w/ on or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus  (b): apparently inflexible adherence to specific, nonfunctional routines or rituals  (c): stereotyped and repetitive motor mannerisms [hand/finger flapping etc]  (d): persistent preoccupation with parts or objects  B. delays of abnormal functioning in at least one of the following areas, with onset prior to age 3 years: 1) Social interaction, 2) language as used in social communication, or 3) symbolic or imaginative play  C. the disturbance is not accounted for by Rett‘s Disorder or Childhood Disintegrative Disorder Autism Across the Spectrum  Spectrum disorder: symptoms, abilities and characteristics are expressed in many different combinations and in any degree of severity  Vary widely in IQ, age, SES, gender and race but the majority of them display most of the core features  Might also, in varying degrees, show features not specific to ASD – commonly intellectual disability and epilepsy  Lucy & John  Both failed to develop normal two-way social relationships and communication in first few years, and displayed repetitive interests and preoccupations  Lucy- developmental deficits, seriously lacking in communicative ability and silent most of the time  John- more socially outgoing, but efforts at social communication are unnatural and repetitive  Three critical factors contribute to differences among ASD children  1. Level of intellectual ability: from profound disability to above average intelligence, [John= normal and Lucy=severe disability]  2. Severity of their Language problems: from speaking a lot to mute [John= a lot and Lucy =mute]  3. Behavior Changes with Age: some make little progress and some develop speech and become more outgoing [Children like John w/ normal intelligence or above average are the ones who make significant gains] CORE DEFICITS OF ASD 2 Social impairments  Lack of monitoring of the social activities of others, lack of social and emotional reciprocity, unusual nonverbal behaviors and gestures to regulate social interaction, lack of interest or difficulty relating to others  Can‘t imitate others‘ social behavior or share focus  Social expressiveness and sensitivity to social cues = limited, recognition of complex emotions and mental states in everyday life is impaired  Can‘t integrate the social, communicative and emotional behaviors needed to greet familiar person  Treat people like objects  Atypical processing of faces and facial expression  May overemphasize one part of the face [ex mouth] rather than whole face  Problems detecting fear b/c fear is heavily concentrated on eyes  Impairments in joint attention [ability to coordinate attention to a social partner and an object or event of mutual interest]  JA typically emerges at 9-14 months  Impedes language developments in children w/ ASD @ 20 months, greater problems in language, communication and social behavior @ 42 months  More responsive to caregivers  Quality of infant-mother attachment in young children w/ ASD contributes substantially to development of play behavior  development of social skills  In contrast to other children, they might sort pictures of people according to type of hat they are wearing instead of facial expression – preschool years Communication Impairments  By first birthday, typical toddler would turn when he hears his name, points when he wants a toy, says words  ASD- Atypical early vocalizations  Protoimperative gestures: gestures or vocalizations that are used to express needs  Protodeclarative gestures: gestures or vocalizations that direct visual attention of other people to objects of shared interest  ASD typically fail to do this one  Requires shared social attention and an implicit understanding of what other people are thinking  As many as ½ of ASD children do not develop useful language  Those with no speech do not use gestures [motor skills underlie both spoken and nonverbal communication]  Use instrumental gestures to get someone to do something for them immediately but fail to use expressive gestures  Those who do develop language usually do so before 5 years  Lack of spontaneity and use of qualitatively deviant forms of communication  Rhythm and intonation is often unusual  Lack of social chatter- most noticeable  Communication described as nonsensical, silly, incoherent and irrelevant  Pronoun reversals and echolalia – 3  PR: child repeats personal pronoun exactly as heard, w/out changing them to suit the situation  Echolalia: either immediate or delayed and is child‘s parrot-like repetition of words or word combinations heard before  Problem is not so much with the computational [sounds, words, grammar] or semantic [meaning] –its with pragmatics [appropriate use of language in social and communicative contexts]  Leads to difficulty understanding nonliteral statements or adjusting language to fit the situation  Monotone voice and lack of gestures, problems with narrative discourse, little use of language for social convention Restricted and Repetitive Behaviors and Interests  Characterized by high frequency, repetition in a fixed manner and desire for sameness in the environment  Two dimensions – ―repetitive sensory and motor behaviors‖ [frequency remains high over time] and ―insistence or sameness behaviors‖ [starts low and increases or worse over time]  Self stimulatory behaviors stereotyped as well as repetitive body movements or movements of objects  May involve one or more senses  One theory- children crave stimulation, self-stimulation excites their nervous system  Another is that they environment may be too stimulating, use self-stimulation to block out and control unwanted stimulation ASSOCIATED CHARACTERISTICS OF ASD Intellectual Deficits and Strengths  40% have severe to profound impairments w/ IQs less than 50  30% have mild to moderate impairments w/ IQ b/w 50-70  30% average or above average intelligence  typically assessed using WISC-IV  performance of children with ASD tends to be uneven across different WISC subtests  relatively low score on verbal subtests such as comprehension  relatively high scores on nonverbal subtests involving short-term memory for a string of numbers, or arranging blocks  found that ASD children score higher on other tests of intellectual functioning than they do on the WISC-IV  low intellectual ability – particularly low verbal IQ  more severe symptoms and poorer long-term outcomes  only average or above average intelligence have potential to achieve relatively independent living status as adults  small but significant number develop splinter skills  25% have a special cognitive skill that is above average for general population as well above their own general level of intellect 4  5% develop an isolated and remarkable talent that far exceeds normally developing children of the same age--- autistic savants  calculation, memory, jigsaw puzzles, music or drawing  seen as a side effect of abnormal brain functioning,  one theory---tend to segment info in to parts which leads to exceptional performance in certain domains  another theory---ASD think in images not abstract ideas Sensory and Perceptual Impairments  90% have problems in two or three sensory domains that continue well into adulthood  oversensitive or under sensitive to certain stimuli, over selective and impaired shifting of attention to sensory input  sensory dominance- tendency to focus on certain type of sensory input over others  stimulus over selectivity- tendency to focus on one feature of an object or event in the environment while ignoring other equally important features Cognitive and Motivational Deficits 1. Deficits in Processing Social-Emotional Information  young children with ASD don‘t understand pretense or engage in imaginative play  mentalization, Theory of Mind- awareness of mental states in themselves and in others  ability to read the intentions, beliefs and feelings and desires of others from their external behavior has adaptive significance in human evolution  automatic, little conscious effort  ASD – suffer in varying degrees from ‗mindblindness‘ – they fail to develop the capacity to mind read in a normal way  ―brain is what makes people move‖- nothing about mental activity  Sally-Anne Test- original test to see if children can detect mental states  15-60% of ASD demonstrate some knowledge of Tom[insightfully interactive behavior and better verbal communication abilities]  understand metaphors, irony and a range of speaker emotions  ability to mentalize is associated with a specific region of the brain that is connected to a widespread network of brain regions 2. General Deficits  executive functions – effective problem solving, engaging in thoughtful actions, sustaining task performance, using feedback  ASD- diffi
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