Psy. HC4 Autisme

• Autism


  Term 'autism' used by Bleuler (1911) to describe symptoms of schizophrenic patients
• Autism Spectrum Disorder DSM-5

  • Deficits in social communication and social interaction, including: Social emotional reciprocity, Nonverbal communication, Relationships
  • Restricted, repetitive behavior and interests (>2): Stereotypic or repetitive behavior, Insistence on sameness, High restricted, fixated interest, Hyper- or hypo responsiveness
• Autism Spectrum


  • Reciprocity
  • Nonverbal communication
  • Relations
  • Repetitive behavior
  • Need for routine
  • Focused interest
  • Sensory sensitivity
• Intelligence


  Co-occurring diagnoses
• Autism Spectrum


  • New in DSM-5: Sensory problems - Hyper- or hypo sensitivity
  • Severity levels: Level 1-requiring support, Level 2-requiring substantial support, Level 3-requiring very substantial support
  • PDDNOS/Asperger
  • Symptoms must be present in early development but may not fully manifest until later/masked
• Autism prevalence 1-2%
• Around 70% normal intelligence
• Around 30% regression (loss of skills)
• It's a man's disorder...
• Females with Autism


  • In general: 20% - 25% females
  • Explanations: Genes, Symptoms, Compensation, Clinician bias
• Savant skills


  • 10% of autistic individuals
  • Disharmonious IQ profile
• Medical characteristics


  • Epilepsia (± 25%)
  • Insomnia and sleep problems (± 60%)
  • Motor impairments (e.g. poor fine motor skills)
  • Gastrointestinal symptoms (± 45%)
  • No empirical evidence of connection between vaccinations and mercury (kwik)
  • Fraudulent Lancet paper (1998)
• Assessment


  • Current behavior and Development
  • Observation
  • Parent interview
  • No Biomarkers!
• Treatment


  • There is no 'cure' for autism
  • Focus on individual and environment
  • Customized care, Psychoeducation, Psycho/behavioral therapy, Fysio/speech therapy
  • Medication directed at co-occurring problems (anxiety, hyperactivity, rigidity)
  • Early intensive interventions (e.g. ABA)
  • Heated discussion, see recent NAR report
• Medical Model


  People experience and interact with the world around them in many different ways; there is no one "right" way of thinking, learning, and behaving, differences are not viewed as deficits
• Social Model


  People experience and interact with the world around them in many different ways; there is no one "right" way of thinking, learning, and behaving, differences are not viewed as deficits
• • What causes autism? Short answers: We don't know, there is no single cause
  • We do know, it's not the mothers fault and its not due to vaccination
  • Real answer: Genetics, neurobiology, G x E (sensitivity to exposure), rGE (liability to exposure)
• Heredity of autism


  • Concordance rate: Identical (Monozygotic) twins: 80% (100% shared genes, shared uteral environment)
  • Fraternal (Dizygotic) twins: 31% (50% shared genes, shared uteral environment)
  • Siblings: 20% (50% shared genes, no shared uteral environment)
• Neurobiological explanations?


  • Growth
  • Chemistry
  • Anatomy
  • Function
• Growth


  • Abnormal brain growth
  • Too much growth in early development
  • Larger head circumference
  • No autism
  • Autism
• Chemistry


  • Neurotransmitters (transmit signal)
  • Serotonine
  • Oxytocine
  • Reward system
  • Excitation/inhibition balance
• Anatomy


  • No 'characteristic' brain structure found yet
  • Less neurons in lymbic system (amygdala, hippocampus) and Cerebellum (movement, cognition)
  • Evidence: MRI, postmortem and animal studies
• Activity


  • EEG
  • Brain waves (oscillations)
  • Some evidence for atypical activity during in specific regions during: perception faces, emotions, perspective taking
  • Need for studies on real-time interactions
• Psychological explanations


  • Central Coherence
  • Executive Functions
  • Emotional competence
  • Theory of Mind
• Central Coherence


  • Natural tendency to see connection between stimuli
  • Weak central coherence: focus on detail
  • Strong central coherence: focus on whole
• Central Coherence


  • Hidden figures / Navon task
• Benefits of weak Central Coherence in autism?
• Communication


  • Pragmatics, social context
  • Taking thing literally
  • Atypical Imagination
• Executive Functioning


  • Cognitive functions that regulate goal directed behavior
  • Mental flexibility
  • Planning
  • Working memory
  • Inhibition
  • Initiative
  • Tower of Hanoi
  • Stroop test
• Theory of Mind


  • 'The ability to ascribe mental states to people and to explain and predict behavior in terms of underlying mental states'
  • Perspective taking, empathy
• Theory of Mind


  • False Belief task
• Social attention


  • Object
  • Other
  • Self
  • Joint attention
  • Social Referencing
  • Use emotional response of other to determine how to respond
• • In sum: Spectrum: High diversity
  • Diverse causes?
  • Evidence based assessment and support
  • Normality
  • Neurodiversity