Understanding Behavior Social Interactions in Children with Autism Spectrum Disorders

1. 1 Understanding Behavior & Social Interactions in Children with Autism Spectrum Disorders Kevin M. Antshel, Ph.D. Assistant Professor of Psychiatry / Licensed Psychologist Department of Psychiatry & Behavioral Sciences SUNY � Upstate Medical University

2. 2 Outline Autism basics Model for understanding social interactions in autism Psychiatric comorbidity Temperament Autism specific deficits Interventions Conclusions / Questions

3. 3 Autism Spectrum Disorders DSM-IV defines autism as (1) impairments in social interaction (2) impairments in communication (3) restricted, repetitive and stereotyped patterns of behavior and interests Grouped under Pervasive Developmental Disorders with: Asperger disorder impairment in social interaction restricted interest/repetitive behaviors PDD NOS impairment in reciprocal social interaction impairment in communication skills OR restricted interest / repetitive behaviors

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5. 5 Prevalence / Etiologies 1 : 166 � 500 Substantial genetic component (~ 90%) Genetic syndrome in 10 � 20% of cases 30 � 50 % of ASD cases have mental retardation Males are substantially more likely to be diagnosed with ASD sex ratio is larger among children with higher IQ

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9. 9 Consider comorbidity� 1. When signs of problems outside the autism spectrum are apparent Hyperactivity, distractible inattention Sad or irritable mood, decreased pleasure in activities, increased withdrawal Vegetative signs Increased anxiety Affective instability Cognitive disorganization 2. When there is an abrupt change in behavior from �baseline� First rule out a medical problem (seizures, migraine, medication side effect) 3. When there is a severe and incapacitating problem behavior Aggression Self-injury Agitation Sleep disturbance 4. When there is a worsening of symptoms already present Decreased communication Increased hand flapping or motor stereotypies Decreased adaptive behavior and daily living skills 5. When child does not respond as expected to treatment

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12. 12 ASD Deficits � Theory of Mind The ability to construct representations of others, oneself, and interactions between oneself and others Knowledge that others �have minds� Requires the use of social cues to make inferences about individuals, such as their status, motivation, mood state, trustworthiness, etc. Contributes to perspective taking

13. 13 ASD Deficits � Executive Functions Set-Shifting Deficits inability to shift cognitive strategy to changing contingencies correlated with autism symptomatology within the ritualistic/repetitive behavior domain Preference for Detail Over Global processing on detail at the expense of global configurations � poor central coherence missing the overarching meaning of a situation

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17. 17 ASD Behavioral Rigidity Rigidity in behavior is interpersonally oriented Most intrusive feature by parents Insistence on Sameness in ASD multiple areas of functioning aversion to novelty

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20. 20 ASD Deficits � Emotion Awareness & Recognition

21. 21 Emotion Awareness & Recognition � Neurological Substrates Amygdala Superior Temporal Sulcus Fusiform Gyrus

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23. 23 Amygdala integrative center of highly processed sensory information, emotional circuits, and outputs that influence somatomotor and autonomic activity key region for processing information of motivational salience involved in directing the visual system to seek out and attend to the eyes as a socially salient stimulus strong positive correlation in individuals with ASD between the level of amygdala activity and gaze fixation on the eye region

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25. 25 Superior Temporal Sulcus higher-order processing region for the integration of multisensory stimuli and motion perception sensitive to subtle changes in facial movement associated with facial affect active when auditory stimuli is associated with socially relevant features greater activation in response to angry prosody of human voices relative to neutral prosody integration of visual and auditory stimuli with their affective salience

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27. 27 Fusiform Gyrus processing of static facial stimuli interconnectivity between the fusiform gyrus, superior temporal sulcus & amygdala

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29. 29 Integrating Affective & Social Processing fusiform gyrus and superior temporal sulcus encode the visual properties of socially relevant stimuli ? neurons within the amygdala that associate the visual percept with its emotional meaning ? amygdala can simultaneously influence the perceptual representation of the stimulus in the fusiform gyrus and the superior temporal sulcus region ? regions are anatomically connected to prefrontal cortex, where social evaluative processes become associated with motivational goals and executive control of behavior

30. 30 ASD Socioemotional Heterogeneity Subtypes Aloof, low-functioning individuals notable for total disengagement from social interaction and failure to engage in interpersonal reciprocity Loner subtype characterized by individuals with high or superior functioning who may navigate the social realm by gravitating toward occupations that condone an isolated style and by mastering social nuances by rote. An active but odd cluster characterized by individuals with ASD who actively seek social interaction but do so in an inappropriate and one-sided fashion Passive subgroup comprises individuals who fail to initiate social interaction but who accept the advances of others and potentially enjoy such advances

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33. 33 Conclusions ASD�s are a significant public health issue Psychiatric comorbidity is the rule, not the exception ASD specific deficits Theory of mind Executive function Emotion awareness & recognition Interventions Treat psychiatric comorbidity Individual / group social skills therapy