lecture 7

• Terminology


  Language and approach used to describe autism
• Medical model of autism


  • Dichotomizes people as ''typical'' and ''atypical'' or ''non-disabled'' and ''disabled"
  • Differences associated with autism to be evidence of deficits
  • Assumption that disability is inherently inferior to non-disability
  • Advocates for curing these deficits via intervention
• Social model of autism


  • Socially valued differences in functioning or appearance, and disabilities
  • Environmentally mediated - emphasises the loss of opportunities to participate in society
  • Autism is disabling in societies that do not make efforts to remove barriers to participation that autistic people face
  • Acknowledge that social barriers do not explain all aspects of disability and recognise individual contributions in the context of a disabling society
  • Autism itself can be celebrated while still recognising impairments and support needs
• Leo Kanner (1943)


  • Infantile autism
  • Autistic aloneness
  • Insistence on sameness
  • Islets of ability
• Hans Asperger (1944)


  • Autistic psychopathy
  • Difficulties in social integration
  • Originality of thought & exceptional achievements
• Triad of Impairments


  • Social interaction
  • Imagination
  • Communication
• DSM-V: 2013


  • Social-communication skills: Building friendships, Reciprocity, Initiating and maintaining, Emotions, Poorly integrated verbal and nonverbal communication, Eye contact, Gestures, Facial expressions
  • Repetitive behaviour & restricted interests: Repetitive motor movements, Insistence on sameness, Restrictive interests, Repetitive speech, Compulsive behaviours, Pervasive, Present from childhood, Impacts on quality of life, Cannot be better explained by the presence of intellectual disability

  
• Screening instruments


  SCQ (Berument et al., 1999)
• In-person assessments


  ADOS-2 (Lord et al., 2012)
• ASD classification includes a "Calibrated severity score"
• There has been an ~25-fold increase in prevalence of autism from 0.04% to ~1.1%
• Reasons for increased prevalence


  • Behavioural diagnosis: definition of autism changes /widening of diagnostic criteria/ heterogeneity
  • Better identification/assessments/services
  • Awareness of the condition has increased
  • Research
  • Awareness of compensation/camouflaging has increased
• Autistic women and girls


  • Delayed diagnosis – on average 5 years later than males
  • Presentation of autistic characteristics may differ in autistic females
  • A large proportion of research in autism has focused on autistic males
  • Measures are predominantly developed based on male samples - Sensitivity and specificity issues
• Biological basis of Autism


  • Strong genetic component
  • Twin studies provide the best evidence of genetic influences
  • Rare genetic variations (account for 10-20% of cases)
  • High sibling likelihood (19%)
  • Broader Autism Phenotype
  • We do not yet have any clear biological markers
  • Heterogeneity in genes, biology, cognition, and behaviour
• Cognitive theories of autism


  • Theory of Mind account
  • Weak central coherence theory
  • Social motivation theory
  • Mirror neuron theory
  • Executive dysfunction
• Theory of Mind


  • Allows us to predict behaviour on the basis of mental states (wishes, beliefs, feelings)
  • Makes us better at understanding what other people are doing
  • Enables us to monitor the intentions of others/why they're doing something
  • Differences in representing/interpreting another's mental state: Putting yourself into someone else' shoes, Understanding what another person thinks or feels, Difficulty communicating, not recognising sarcasm, jokes
• Theory of Mind tasks

  • False belief / Sally-Ann task
• Autistic children are delayed in the development of Theory of Mind skills, with 50% passing by 9 years instead of 4 years
• Implicit vs. Explicit Theory of Mind


  • Autistic adults show a lack of spontaneous ToM through anticipatory eye movements on the most basic of tasks despite passing them explicitly
  • Intact task performance does not equate to intact spontaneous mentalizing - compensation
• Criticisms of Theory of Mind Account


  • Universal?
  • Unique?
  • Unitary?
  • Developmental progression?
  • Double Empathy Problem (Milton, 2012)
• Double Empathy Problem


  • Recognises that autistic people have difficulty connecting with others
  • Autistic social differences are better conceptualised as operating bi-directionally for autistic and non-autistic people
  • A breakdown in reciprocity and mutual understanding that can happen between people with very differing ways of experiencing the world
• Senju, Southgate, White & Frith, 2009: 'Criticisms of Theory of Mind Account'
• Criticisms of Theory of Mind Account


  • Universal?
  • Unique?
  • Unitary?
  • Developmental progression?
  • Double Empathy Problem (Milton, 2012)
• Double Empathy Problem (Milton, 2012)


  • Recognises that autistic people have difficulty connecting with others
  • Autistic social differences are better conceptualised as operating bi-directionally for autistic and non-autistic people
  • A breakdown in reciprocity and mutual understanding that can happen between people with very differing ways of experiencing the world
• Double empathy problem (Crompton et al., 2020)


  • Figure 1. Illustration of the diffusion chain technique
  • Figure 2. Mean and range of story details (out of 30) transferred in the diffusion chain, by group and position
  • Figure 3. Self-rated interactional rapport by chain type and interaction condition
• Double empathy problem (Crompton et al., 2020)


  • In-group out-group effect
  • High rates of success in communication and understanding others when the other person is more 'similar to them' or shares a particular interaction style
  • Problem arises when mix different interaction styles
• Local Processing Bias/Weak Central Coherence


  • An information processing style, not a deficit/inability
  • Tendency to process 'local' details well at the expense of 'global' meaning/context
  • Creates advantages when analytical skills are required
  • In many contexts this is perceived as an area of strength rather than the presence of a deficit
• Verbal tests – homographs


  • The little girl had a big tear in her dress
  • A big tear rolled down the little girl's cheek
  • Autistic individuals more likely to read word by word instead of for sentence meaning
• Verbal tests – text comprehension


  • poor at integrating information across sentences
  • Tendency for lower scores on tests of verbal comprehension (uneven IQ profiles)
• Visuo-spatial tests


  • Embedded Figures
  • Visual illusions
• Cognitive strengths


  • Islets of ability
  • about 1 in 10 have an identified 'skill'
  • savant skills
  • music
  • maths
  • art
  • perfect pitch
• Nadia


  • age 3
  • age 5
• Criticisms of Local Processing Bias Theory


  • Universal?
  • Unique?
  • Unitary?
• Social Motivation


  • Attention to social information
  • Joint attention
• Joint Attention


  • Emerge in first 6 months of life
  • Critical for development of social-communication and language skills
• Joint Attention impairments


  • A fundamental characteristic of the early social communication impairments
  • Early developing skill therefore impairment evidenced by 6-8 months of infancy
  • Central to the early diagnosis of autism
• Criticisms of social motivation theory


  • Universal?
  • Unique?
  • Unitary?
  • Innate? Average diagnosis of autism is after 3yrs
• Core deficit model


  A single impairment explains multiple cognitive, behavioural and neurobiological phenomena and all profiles within a diagnostic category
• Criticisms of the Core deficit model:
• Criticisms of the core deficit model


  • Medical model/deficit model
  • Cognition as a central cause
  • Failure to address other areas of need
  • Translation to functional differences