Autism Spectrum Disorder

DSM-IV definition A Triad of Impairments:

1. Impaired communication
2. Impaired social interaction
3. Restricted, repetitive, and stereotyped patterns
of behaviors, interests, and activities
Difficulties fall along a spectrum ranging from
very mild to very severe

DSM-V (combines 1 & 2)

David, 7, and Jason, 5, with their mops of brown hair, look physically healthy. But both
boys suffer from a devastating developmental disorder: autism. David speaks only 10
words, still wears diapers at night and sucks on a pacifier. Jason drinks from a baby
bottle. Neither one can vocalize his glee as he plays

Since their sons were diagnosed, both at age 2, Barry and Dana Craven have tried a
dizzying array of therapies: neurofeedback, music therapy, swimming with dolphins,
social-skills therapy, gluten-free diets, vitamins, anti-anxiety pills, and steroidsTo
reduce the boys exposure to environmental chemical, they replaced their carpeting
with toxin-free wood floors and bought a special water-purifying system. They even
installed a sauna which they think will help remove metals like mercury and arsenic
from the boys bodies. Warm and loving parents, the Cravens spend $75,000 in
treatments last year alone

autism, a vexing brain disorder, remains largely a mystery. Researchers still dont
know what causes it, nor do they know how best to treat a condition that prompts one
child to stop speaking and another to memorize movie scripts.
Newsweek, Feb. 2005
Autism
Kanners (1943) Descriptions
He seems almost to draw into his shell and live within himself....
When taken into a room, he completely disregarded the people and instantly
went for objects....
When a hand was held out to him so that he could not possibly ignore it, he
played with it briefly as if it were a detached object....
He did not respond to being called, and did not look at his mother when she
spoke to him....
He never looked up at people's faces. When he had any dealings with persons at
all, he treated them, or rather parts of them, as if they were objects. He would
use a hand to lead him. He would, in playing, butt his head against his mother
as at other times he did against a pillow. He allowed his boarding mother's hand
to dress him, paying not the slightest attention to her....
... on a crowded beach he would walk straight toward his goal irrespective of
whether this involved walking over newspapers, hands, feet, or torsos, much to
the discomfiture of their owners. His mother was careful to point out that he did
not intentionally deviate from his course in order to walk on others, but neither
did he make the slightest attempt to avoid them. It was as if he did not
distinguish people from things, or at least did not concern himself about the
distinction.

Facts about Autism
Prevalence: Estimates range: ~1/4000 to 1/88 (CDC,
2008)
Increases in rates: 1/150 in 2000; 1/88 in 2008 (CDC)
5 times more common in males
40% also have cognitive delay
Today, diagnosis can be reliably made at 2 years, ~20%
diagnosed by 3 years; on average between ages 4-6
Affects every race and SES
10% are autistic savants

*In Aspergers Syndrome, there are no clinically significant delays in language or
cognition (Deficits seem specific to social interaction)

1. Impaired Communication
~ up to 40% are mute
Those who speak show unusual patterns:
Echolalia = repeating words or phrases
Pronoun Reversal
Monotonic voice
Pragmatic deficits (e.g. sarcasm)
Misuse of words (e.g. hot for stove and only
stove)
Not just due to cognitive impairment
2. Impaired Social Functioning
Little eye-contact
Low social-emotional reciprocity: Not as cozy,
cuddly as other children
Less awareness of social norms (e.g. acceptable
behavior)
Typically prefer playing by self

The MOST reliable sign of autism is a problem with social
functioning!
3. Restricted Behavior
Unusual behavior patterns (e.g. emotional
outbursts or very passive)
Repetitive actions and insistence on routines
Sensory sensitivities (enhanced and/or
reduced)
Stereotyped movements (e.g., flapping,
rocking)
Special interests and preoccupations
Attachment to unusual objects
Lack pretend play

What causes autism?
Psychodynamic theory: bad parentingNO!

Nature AND Nurture!
Genetics
~60% concordance in monozygotic twins
Higher rate in siblings (2-18% also autistic)
Multiple chromosomes involved (polygenic)
10% have other genetic conditions

+ Environmental trigger(s)
some evidence that 3
rd
week of pregnancy is critical (e.g.,
ear placement)
Exposure to Microbes? Toxins? Some Unknown factors?

Common Theories of Mechanisms
underlying Autism Characteristics
(regardless of the causes of the condition)
Central Coherence (Frith)
Extreme Male Brain (Baron-Cohen)
Theory of Mind Module (Leslie; Baron-Cohen)

* Not necessarily mutually exclusive (i.e. 1 or other)
1. Central Coherence?
Embedded Figures Task, Upside down puzzles
Global vs. local focus
2. Extreme Male Brain?
Levels of testosterone, early puberty
Morphology (e.g., finger)
Better at skills that males tend to do better
on (systemizing skills: math, science,
computers) and worse at skills that females
tend to do better on (empathizing skills:
verbal, social-emotional, reading others)
3. Theory of Mind Impairment?
recall triad of impairments

communication
Social interaction
Behavior
theory of mind
Well-established deficit in Theory of Mind
Typically fail false belief tasks
No social referencing
No gaze following
Poor mind-reading
e.g., Reading the mind in the eyes
Theory of Mind and the Triad
1. Social Interaction
Reading the Eyes
e.g. Individuals with autism tend to not monitor gaze
when watching social interactions (show preference for
mouth and other moving parts)
Theory of Mind and the Triad
Social Interaction
Theory of Mind and the Triad
Social Interaction
Moving Triangles Task

Normal adolescent:
What happened was that the larger triangle- which was like a bigger kid or a bully-
and he had isolated himself from everything else until two new kids came
along and the little one was a bit more shy, scared, and the smaller triangle
more like stood up for himself and protected the little one. The big triangle got
jealous of them, came out, and started to pick on the smaller triangle. The
little triangle got upset and said like Whats up? Why are you doing this?

Adolescent with autism:
The big triangle went into the rectangle. There were a small triangle and a circle.
The big triangle went out. The shapes bounce off each other. The small circle
went inside the rectangle. The big triangle was in the box with the circle. The
small triangle and the circle went around each other a few times. They were
kind of oscillating around each other, maybe because of a magnetic field.
After that, they go off the screen. The big triangle turned like a star- like a
Star of David- and broke the rectangle.

Theory of Mind and the Triad
Social Interaction
Lack Joint Attention/Gaze Following
Can result in mislabeling
Difficulty reasoning about intentions
Pragmatic aspects of language are difficult (e.g.,
sarcasm; tend to interpret literally)
Understanding of nonverbal communication is
impaired
Theory of Mind and the Triad
2. Communication
Theory: inability to reason about mental states of
others makes the social world incredibly difficult
to predict
Results in
preference for social isolation
preference for routines (b/c predictable) and interests in
non-social objects that can be understood (e.g.,
fascination with numbers, math, and physical
systems)
Poor attachments
No pretend play
Theory of Mind and the Triad
3. Unusual Behavior
Theory of Mind Theory of Autism
recall triad of impairments

communication
Social interaction
Behavior
theory of mind
If you are interested in learning more about autism
http://www.grandin.com/inc/visual.thinking.html

Chapter 1 available on-line:
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