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Wk4 - Autism Spectrum Disorder (Proposed Cognitive Deficits* (Extreme Male…
Wk4 - Autism Spectrum Disorder
Definition
Early onset in life
Typically life-long
Complex neurodevelopmental disorder
Abnormal social behaviour
Stereotyped behaviour + interests
Diagnosis
Diagnosed based on behaviour
DSM-5 Criteria*
Early
onset
of symptoms
Clinically significant
impairment
(in social, occupational, impt areas of functioning)
Repetitive / restricted pattern
of behaviour or interests
Highly restricted, fixated interests > abnormal in intensity
Hypersensitivity to stimuli (sensory input / interest)
Repetitive motor movements, speech or use of objects
Insistence on sameness (routine / behaviour)
Disturbances not better explained
by ID / global developmental delay (exclusionary - one of a kind)
Social
communication / interaction deficits
No biological markers
Prevalence
1:4 male to female ratio
Comorbidity with
Epilepsy (10%)
ADHD (20%)
Intellectual Disability (50%)
Anxiety + OCD
1% of children have it
Explanations
Early Onset
Earliest Signs
Lack of social reciprocity + communication
e.g. lack of eye contact, not responding to name, limited speech
Regression rarely occurs
Not formally diagnosed til age 5 (average), sometimes age 2 (e.g. birthday)
Motor coordination (clumsiness) - delays in walking, riding bicycle, catching a ball (50% of ASD are okay)
Biological Explanation of ASD
Bailey et al (1995)
Dizygotic: Autism concordance (0%) / Broad spectrum (10%)
Monozygotic: Autism Concordance (60%) / Broad-spectrum (92%)
Hallmayer et al (2011)
Monozygotic: Autism Concordance (58% male, 60% female) / Broad spectrum (77% males, 55% females)
Dizygotic: Autism (21% male, 27% female) / Broad Spectrum (31% male, 36% female)
Conclusion:
Shared environment accounts for variance > likelihood of ASD
Genetic related (e.g. twin concordance)
Abnormal Growth in Head Circumference (infancy)
2 - 10% larger brain size
Fewer connections in amygdala, hippocampus, anterior cingulate, cerebellum (emotional part of brain)
Abnormal levels of serotonin (1/3)
Proposed Cognitive Deficits*
Executive Dysfunction
Tasks to Test it
Planning Tasks
(Tower of Hanoi - move one at a time, small on top)
Set Shifting Tasks
(e.g. Wisconsin Card Sorting task)
Pellicano et al. (2006)
FOR 3 COGNITIVE DEFICITS
:!:
ASD vs. Typical developing children
% of ASD children show atypical performance
WCC tasks (35 - 92%)
Executive Function Tasks (28 - 55%)
TOM tasks (68%)
Cognitive deficits in ASD = exclusive (not universal)
Definition:
Disruption to high-level cognitive processes that regulate, control and manage lower-level cognitive processes >
achieve a goal
Limited Inner Speech
Typical Development
Verbal coding of non-verbal information (make to-do list in mind)
Inner Speech Development
1yrs: overt speech for social exchange
3yr: private speech = audible speech directed at self
6yr: inner speech = inaudible self-talk
Planning, hypothesis testing
Rule Acquisition Study
ASD vs. Typical Developing (Verbal vs. Non-verbal ability)
Set Shifting Task - Wisconsin Card Sorting Task
Silent condition / concurrent articulation affecting inner speech
1st condition:
typical developing better /
2nd condition:
ASD better
Conclusion:
ASD don't use inner speech but other forms of processing for hypothesis testing (e.g. visuospatial processing)
ASD
Preference for visuo-spatial representations
Doesn't think in words
- delay/impairment in overt speech
Weak Central Coherence
Explains Limitations
Can't use social context to interpret ambiguous message
Difficult to appreciate irony / humour
Explains Strengths
e.g. Superior performance in visual search tasks (local processing EFT)
Definition:
lack of capacity to use context and integrate as a whole
Extreme Male Theory
Empathising:
identify thoughts and emotions in others and responding appropriately (female superior)
Systemising:
understand system in terms of rules (male superior)
ASD
is extreme form: low empathising, high systemising
Role of Androgens
Androgens / testosterone = effect on brain development
Change in connectivity pattern / faster development of right hemi
Change in brain = development balance disrupted
More male-typical behaviour, less preference for female-typical
Cambridge Study: Testosterone in Amniotic Fluid
Perform analysis on pregnant mothers (prenatal)
High testosterone = male physical / behaviour characteristics
Consistent w theory but Inconsistent evidence
Ten et al. (2017): Face Masculinisation in ASD
Face and brain have connection - testosterone levels = male face
Autism affected by testosterone = so should faces
Results:
ASD faces more masculine
Deficit in Theory of Mind
Evidence
Failure in False-belief task (sally-anne task)
20% ASD (11 yrs) passed
86% Down Syndrome (10 yrs) passed
85% of typical children (4.5 yrs) passed
Conclusion from research
Higher functioning ASD = pass
simple false-belief tasks + even complex TOM tasks
Impaired TOM performance =
present in other populations
(e.g. deaf people / intellectual delay)
ASD is
slower at developing
TOM than others
Definition
Unable to conceive mental states
Unable to appreciate that other people have different perspectives, thoughts and beliefs from own.
Mind-blindness (unable to perceive other's POV)
Dimensional Approach to ASD
There's mild traits in normal pop (AQ)
Evidence in non-clinical AQ scorer:
Limited friendships, social anxiety
Similar patterns of cogn str / weaknesses (faster V, poor GPB)
Distinct Dimensions (subsets)
Not all or none > continuum
Mandy & Skuse Argue
2 independent autistic traits
Low correlation between social comm deficit and repetitive behaviours and interests.
Interventions
Goals
Maximise independence + QOL
Help child + family cope effectively
Minimise core problems
General Treatment Strategies
Teach appropriate social behaviour
Increase functional, spontaneous communication
Decrease disruptive behaviour
Promote Cognitive Skills
Engage child in treatment
Teach adaptive skills to increase responsibility + independence
Medications, diets, medical procedure, education, therapy, combined programs (EVERYTHING)
Early Intervention
Intensive, one-to-one usually, more intensive = better
Benefits / Improvements
Adaptive Behaviour
Social Skills
Intellectual + language abilities
Highly structured, Applied behaviour analysis
Based on learning theory
Goals based on current skill level, step-by-step approach = present stimulus + require specific response
Positive + negative reinforcement
Extend training to home environment
Limitations
Individual differences in progress
Predictors of response to intervention not well established
Best Practices for EI
Highly supportive teaching environment + promote generalisation
Assessment + individualised program + ongoing review
Begin before sch starts (autism specific curriculum)
Support transition to sch
Provide predictability + routine, functional approach to understanding behaviour
Visual Supports
Family involvement
Multi-disciplinary approach