autism - social development

• origins of autism diagnosis

  • autism first described by american psychiatrist: kanner
  • four attributes described a group of his patients
  • autistic aloneness
  • desire for sameness
  • language problems
  • islets of ability - overall poorer functioning but preserved or enhanced skills in some areas
• origin of autism diagnosis

  • kanner changed his mind about the aetiology of autism
  • originally conceived autism as a biological disorder- innate inability to form effective relationships
  • moved to a psychodynamic understanding of autism caused by maladaptive parenting
• ICD-11: Autism spectrum disorder

  • persistent deficits in social communication and social interaction outside range of expected typical functioning for age and level of intellectual development
  • persistent restricted, repetitive and inflexible patterns of behaviour, interests, or activities that are not commensurate with the individuals age and sociocultural context
• ICD-11: autism spectrum disorder

  diagnosis is made in reference to:

  • presence or not of disorder of intellectual development
  • presence or not of impaired functional language
• DSM-5 criteria

  1. deficits in social-emotional reciprocity
  2. deficitis in nonverbal communicative behaviours
  3. deficits in developing, maintaining and understanding relationships
• DSM-5 criteria

  differential diagnosis: symptoms not better explained by intellectual disability

  comorbid diagnosis: can only be given when social communication below expected developmental level
• DSM-5 criteria

  1. stereotyped or repetitive motor movements, speech
  2. insistence on sameness, inflexible routines, ritualised behaviour or speech
  3. abnormal intensity of fixated interests
  4. hyper or hypo sensitivity to sensory input
• DSM 5 criteria

  • symptoms must be present in early childhood period ( but may not be fully manifested until social demands exceed limited capacities, or may be masked by learnt strategies)
  • symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning
• NICE guidelines autism assessment

  (1) Include in every autism diagnostic assessment:

  • Detailed questions about parents or carers concerns and, if appropriate, the child’s or young persons concerns

  •Details of the child's or young person's experiences of home life, education and social care

  • A developmental history, focusing on developmental and behavioural features consistent with ICD-10 or DSM-IV

  • Assessment (through interaction with and observation of the child or young person) of social and communication skills and behaviours, focusing on features consistent with assessment
• nice guidelines autism assessment

  • A medical history
  • A physical examination
  • Consideration of the differential diagnosis
  • Systematic assessment for conditions that may coexist with autism (see recommendation 1.5.15 in the NICE guideline)
  • Development of a profile of the child’s or young person’s strengths, skills, impairments and needs that can be used to create a needs-based management plan, taking into account family and educational context
  • Communication of assessment findings to the parent or carer and, if appropriate, the child or young person.
• biological causes of ASD

  brain structure

  • larger cerebral volume -excess of white matter
  • abnormalities in lateral occipital lobe ( motion processing)
  • pericentral region (sensorimotor processing)
• ASD: biological causes

  brain structure

  • basal gaglical a ( associated with poor motor performance and repetitive behaviour)
  • medial temporal lobe (face recognition)
  • right parietal operculum (sensory integration)
• ASD: biological causes

  brain function

  • decreased activation in amygdala and prefrontal cortex - brain areas involved in processing interactions of others
• ASD: biological causes

  perinatal factors

  • extremely preterm birth <26 weeks
• ASD biological causes

  heritability

  rutter et al

  60-91% concordance rate between MZ

  0.9% between DZ
• broader autism phenotype

  • first degree relatives of individuals with autism
  • siblings of children with ASd fold higher incidence of autism than general population
  • autism characteristics are more frequent in first degree relatives of individuals with ASD
• cognitive theories of autism spectrum disorder

  • Aetiology of ASD : Theory of mind deficit
  • individuals with ASD have theory of mind deficits
  • failure to understand the beliefs and intentions of others
  • sally anne task - baron cohen
  • need to infer sally is not aware than ann has moved marble
• seminal theory of mind study - baron - cohen

  • typically developing children pass false belief task by 5
  • children with ID with a mental age of 5 were also able to pass false belief task
  • children with ASD able to pass false belief task by age 10
  • compensatory mechanisms - children can be taught to pass false beleif tasks but social competence is not improved
  • RW advanced ToM tasks, involving jokes and sarcasm, fewer children with ASD passed these (happe)
• weak central coherence theory (firth)

  • ToM hypothesis does not fully explain all features of ASD, such as stereotyped and repetitive behaviours
  • Weak central coherence - bias for local info rather than global meaning
• weak central coherence theory (firth)

  • open ended tasks indicate that individuals with ASD have a processing bias for local versus global info
  • focus on facial features may explain deficits in recognition of facial emotions and failure to account for context in interpretation of social behaviour (happe and firth)
• executive functioning difficulties

  • ToM, hypothesis and weak central coherence theory may not fully explain all features of ASD, such as stereotyped and repetitive behaviours (happe and firth)
• executive functioning difficulties

  • Children with ASD have set shifting and planning difficulties but not inhibition difficulties
  • Assessed using Wisconsin Card Sorting Task and stroop test (e.g. Ozonoff & McEvoy, 1994)
• executive function and ToM difficulties are independent of each other

  • children with ADHD have poorer inhibition skills than children with ASD
  • executive dysfunction model does not explain what is unique about autism phenotype - no evidence for primary deficit
• Why do individuals with autism engage in repetitive andr estricted behaviours and interests?

  • Behavioural manifestation of anxiety- strong correlation between anxiety and frequency of repetitive behaviours

  • Provides some degree of control, unlike in social situations. – Social situations present a high amount of uncertainty for individuals with autism as they struggle to understand others’ mental states and predict their behaviour
• Why do individuals with autism engage in repetitive andrestricted behaviours and interests?•

  • Restricted interest facilitated by a particular strength of the autism phenotype (e.g. attention to detail supports an in depth interest in train timetables)
  • Alternatively this enhanced attention to detail is facilitated by intense study of particular topic
  • A high level of attention to detail might result in an insistence on sameness- as individuals can more easily detect small changes in the environment
• relationship between restricted interests and age

  • reduction of restricted patterns of interests and related behaviours after age 10 and for children with higher language ability
• relationship between restricted interests and age

  • being older and having better language skills might reflect better inhibition and set-shifting skills, which are associated with lower restricted interest scores
  • older children might have more typical interest - but still high intensity
  • a limitation of this study is parent report
  • parents may normalise behaviour and be less sensitive to changes
• self esteem = how we feel about ourselves
• self esteem

  • western culture claims that self-esteem is virtually indistinguishable from self-concept
  • however, asian cultures, distinguish between the two aspects of the self
  • such differences appear to be related to the collectivist-individualist orientation of the specific culture
• self-esteem

  • if individuals are independent and responsible for their successes and failures, then emphasising the positive aspects of the self serves as protection against low self-esteem
  • this is in contrast to cultures where individual attributes and accomplishments are less important in determining self-esteem
• • self-enhancement is another additional aspect of the self with cultural variation
  • self-enhancement is the process by which we maintain or boost our self-esteem
  • although expressed and valued differently across cultures, self-enhancement seems to be universally practices
• self-continuity

  • is another aspect of self: self-continuity is a persons perception of the interconnections among their past, present and future, and involves contextualised or decontextualised beliefs
  • contextualised beliefs are positively related to collectivism
  • decontextualised beliefs to individualism
• self-continuity:

  • In a study of 55 cultural groups in 33 nations, Becker et al.(2018) found that people from collectivistic cultures associated self-continuity with stability.
  • while members of individualistic cultures emphasised personal narratives perhaps to explain the changeability of core identity domains (residence, relationships and occupation
• multigroup ethnic identity measure

  • the MEIM-R is used to examine ethnic identity as a 'general phenomenon that is relevant across groups
• Multigroup ethnic identity measure

  • commitment to one's ethnic identity (e.g. i feel a strong attachment towards my own ethnic group)
• The MEIM-R includes only two subscales of exploration (e.g., I have often talked to other people in order to learn more about my ethnic group)
• cultural reaffirmation

  • with more intercultural marriages and multicultural identities are becoming more common
  • immigrants (migrants, newcomers, settlers, migrant workers) and refugees (displaced people, asylum seekers, exiles, forcibly displaced people) may be forced to develop a bicultural or multicultural identity
  • need to fit into different cultural contexts
  • cultural reaffirmation
• coping skills that multicultural individuals typically use

  1. non-acceptance - continuing to act according to traditional norms, ignoring cultural differences
  2. substitution - behaving in the most acceptable manner by substituting norms from the 'new' culture for traditional norms
  3. addition - evaluating the situation and depending on judgement using either non-acceptance or substitution
  4. synthesis - combining elements of different cultures
  5. resynthesis - integrating ideas from various cultures in an original way
• five factor model of personality

  • do people of different cultures have their own unique personality
  • the FFM suggests that five personality dimensions (extroversion, neuroticism, agreeableness, conscientiousness, and openness) are common to all humans regardless of culture
  • there is considerable evidence across many cultures to support the universality
• FFM 2

  • although the FFM model may not hold as strongly in less educated or preliterate groups
  • one explanation for the universality of the FFM is the evolutionary approach that suggests that these particular traits are naturally selected in order to serve an adaptive function necessary for survival
  • FFM does not in fact negate cultural variability
  • culture is believed to drive the behavioural manifestation of personality and facilitate personality expression in thoughts, feelings and behaviours