AUTISM By: Pauline Narciso Philip Lai Henry Kang
Overview • Pauline • General Survey of Autism • Neural/Chemical Correlates • Philip • Comparison of Consciousness • Henry • Treatments
General Notes • Autism as a Syndrome: multiple disease entities • Autism is a developmental syndrome: • Common deficit: theory of mind
Bit of History • 1943- Kanner • “extreme aloneness from the beginning of life and anxiously obsessive desire for the preservation of sameness.” • Initial cause: Bad parents
Diagnostic Criteria • Severe abnormality of reciprocal social relatedness • Severe abnormality of communication development • Restricted, repetitive behavior, patterns of behavior, interests, imagination • Early onset (before 3-5 years)
Other observed behaviors • Lack of awareness of feelings of others • Bizarre speech patterns • Lack of spontaneous and make-believe play • Preoccupation with parts of objects • Repetitive motor movements • Marked distress over changes
Begins when… • 80% of cases began as “Infantile Autism”
Screening Model for Infantile Autism • Is child’s eye-to-eye contact normal? • Is he/she comforted by proximity/body contact? • Does he/she often smile or laugh unexpectedly? • Does he/she prefer to be left alone?
Systematic Feature Examination • Hand stereotypies (strange looking or posturing) • Stiff gaze, avoidance of • Little reaction to strong, unexpected noise • Passive, obvious lack of interest
Disease Entities within Autism • IABD • Zapella Dysmaturational subgroup • Purine Autism • Asperger’s and Autistic Savants • All share common Autistic behaviors
Infantile Autistic Bipolar Disorder • Regression after initial normal development • Meets classical criteria for Autism • Autistic symptoms have a cyclical pattern • Positive family history of BD or Depression • Different from Autistic who later has onset of BD
Zapella Dysmaturational subgroup • Loss of language after initial normal dev • Meets classical criteria • Complex tics present • Normal neurological exam, normal lab exams • Rapid improvement following therapy • Reach quasi-normal abilities by age 5-6 • After age 6, usually fall into other psycho-pathological category, ADHD
Purine Autism • Classical criteria met • Too high/too low levels of uric acid • Constipation • Gout in family members • Seizures and self-injury in majority • “Purine”:abnormal levels of end product (uric acid) of all purine pathways
Quote on Purine Autistic • “the boy was an irritable baby who resisted any change in routine and never looked at people around him. By 2 years of age, the few words he had were rapidly disappearing. He lined up his toys in long straight lines instead of playing with them. He developed pica, teeth-grinding, compulsive biting to the point of bleeding.”
On the functioning end.. • Asperger’s: meet criteria, but have normal IQ functioning • Autistic Savants: special skills in memory, music, math, calendar calc, drawing, and hyperalexia reading.
Unfavorable pre, peri, post-natal factors Cellular and structural changes in Limbic System (amygdala, cerebellum, and hippocampus) L-hemi neural substrates fail to develop (loss lang., consciousness, motor planning Locus Coerulus:Mediates input from senses-underdeveloped Low mercury levels Theories on contributing factors
Who’s affected? • 1% of general public under the Autism Spectrum • Most often tend to be males
Altered States Compared to Normal • Resistance to change, Insist on sameness • Strong attachments to objects; Spins objects • Difficulty in mixing with others • Throw Temper Tantrums • Tend not to want to cuddle or be cuddled • Over-sensitivity or under-sensitivity to pain • No fears of danger
Sensory Processing • Painfully sensitive to certain sounds, textures, tastes, and smells. • Either too sensitive or less sensitive than normal. Some autistic have difficulty interpreting sensory information. • Like normal these experiences are not hallucinations but based on real experiences. • Some avoid being touched, a gentle touch for most, will hurt or shock autistics. • Some are insensitive to pain, and fail to notice injuries.
Emotions • Take major emergencies in stride but become upset over minor disruption. • Unemotional, but can be very emotional when things are important to them. • More candid and expressive with their emotions than normal people. • Small amount will have difficulty regulating their emotions. Individual will have verbal outburst, usually in strange or overwhelming environment.
Communications • Problem with semantic-pragmatic component, take a statement or question in a literal way. Ex.) "I'd like coffee with my cereal“ • Repeating things that have been heard (echolalia) • Inability to understand body language, tone of voice • Some autistics are mute
Communication Cont. • Difficult in sustaining a conversation. No normal "give and take" in a conversation • Autistics tend to go on with their favorite subjects and do not give the other person a chance to talk. • People with autism might stand too close to the other person. • Body language, facial expressions, and gestures do not match what they are saying.
Attention • Trouble handling multiple stimuli of attention. • Very narrow focused attention, can not keep up with more than one thing at a time. • Shifting attention is a slow process, usually involves pauses or moments of delay.
Productivity • Great deal of variety among autistics. • Some autistic may never learn to talk and be dependent throughout their lives. • Others may do well in special supportive settings, working in a sheltered environment. • There are autistics that are fully independent and function fairly well.
Theory of Mind • TOM is absent in autistics, can not attribute mental states. • Autistic can not reflect on their own mental states. • Cause abnormalities in social interactions, communications, and imagination. • Understanding mental states of others can allows individuals to make sense of past behavior, allows influence on present behavior and permits prediction of future behavior. • Normal 3 year olds no TOM, but 4 year olds tend to have a TOM.
Mirror Neurons • Tested controls and autistics on 4 different tasks. • Researchers compared mu rhythms. At baseline, mu rhythms will fire in synchrony, large amplitude mu oscillations. • Normal when seeing an action perform will cause mu rhythms to fire asynchronously, therefore resulting in mu suppression.
Mirror Neurons Cont. • So mu wave suppression will reflect activity of the mirror neuron system. • In autistics, there was mu suppression in their own hand movements, but no mu suppression to the observed hand movements.
Autism Treatment • Behavioral modification and communication approaches • Dietary and biomedical approaches • Complementary approaches
Behavioral & Communication • Applied Behavior Analysis • Rewarded behavior • TEACCH • Understand the world • PECS • Picture exchange • Social Stories • Theory of Mind • Sensory Integration
Biomedical Treatments • Medications • Serotonin Re-uptake Inhibitors • Anti-Psychotic Medications • Risperidone • Vitamins and Minerals • Dietary Interventions
Risperidone • Two double-blind, placebo-controlled responses of risperidone • Adults and Children • Serotonin-Dopamine antagonist • Effective as a short-term treatment • Tantrums, Aggression, Self-Injurious Behavior • Interfering repetitive behavior, self-injurious behavior, sensory motor behaviors, affectual reactions, overall behavioral symptoms
Risperidone Cont. • Figure 1: Mean Scores for Irritability
Risperidone Cont. • Figure 2: Change in Severity of Overall Symptoms
Vitamins & Minerals • Vitamin B • Most common vitamin supplement • Vitamins A and D • Eye contact and behavior • Vitamin C • Improve symptom severity
Dietary Interventions • Gluten • Disruption in biochemical and neuroregulatory processes • Yeast • Behavioral and medical problems
Complementary Approaches • Improving Communication Skills • Music Therapy • Speech Development • Art Therapy • Non-verbal, Symbolic Expression • Animal Therapy • Physical and Emotional Benefits
Conclusion • Autism is a spectrum • Autistics lack an essential element of consciousness-Theory of Mind
References • Autism Society of America. <http:// www.autism-society.org>. • Bauman, Margaret L. and Kemper, Thomas L., eds. The Neurobiology of Autism. Baltimore: John Hopkins UP, 1994. • Centers for Disease Control. <http://www.cdc.gov>. • Coates, Sheila and Richer, John, eds. Autism The Search for Coherence. Philadelphia: Jessica Kingsley Publishers, 2001. • Gabriels, Robin L. and Hill, Dina E., eds. Autism-From Research to Individualized Practice. Philadelphia: Jessica Kingsley Publishers, 2002. • Gilberg, Christopher. Diagnosis and Treatment of Autism. New York: Plenum Press, 1989. • Gilberg,Christopher and Coleman, Mary. The Biology of the Autistic Syndromes. London: MacKeith Press, 2000. • Happe, F. “Theory of Mind and Self.” Ann. N.Y. Acad. Sci 1001 (2003): 134- 144. • Harris, J.C. “Social neuroscience, empathy, brain integration, and neurodevelopmental disorders.” Physiology & Behavior 79 (2003): 525-532. • McCraken, James T. et al. “Risperidone in Children With Autism and Serious Behavioral Problems.” The New England Journal of Medicine 347 (2002): 314-321.
References Cont. • McDougle, Christopher J., et al. “A Double-blind, Placebo-Controlled Study of Risperidone in Adults With Autistic Disorder and Other Pervasive Developmental Disorders.” Arch Gen Psychiatry 55 (1998): 633-641. • McQueen, JM and Heck, AM. “Secretin for the treatment of Autism.” Ann Pharmacother. 36 (2002): 1294-1295. • Millward, C., et al. “Gluten- and casein-free diets for autistic spectrum disorder.” Cochrane Database Syst Rev. 2 (2004): CD003498. • Pineda, Jamie. Home page. <http://www.bci.ucsd.edu/~pineda/CNL_WEBPAGE/index.html>. • Pfeiffer, SI, et al. “Efficacy of vitamin B6and magnesium in the treatment of autism: a methodology review and summary of outcomes.” J Autism Dev Disord 28 (1998): 580-581. • Schopler, Eric and Mesibav, Gary. High-Functioning Individuals With Autism. New York: Plenum Press, 1992. • Sterling, Lisa. Home page. 2002 <http://darkwing.uoregon.edu/~sterling>. • Strock, Margaret (2004). Autism Spectrum Disorders (Pervasive Developmental Disorders). NIH Publication No. NIH-04-5511, National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, 40 pp. <http://www.nimh.nih.gov/publicat/autism.cfm>.