Autism and the autistic spectrum

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Autism and the autistic spectrum

• By Dr Mary Wheatcroft
• Child and adolescent psychiatrist
• Derby city south team
• The Town House

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Aims

• to be able to describe the core impairments in
  autism and common associated features
• to be able to give an account of psychological
  theories which may underlie the above

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Outline

• What is the autistic spectrum
• How common is it
• How is it diagnosed
• what underlies the condition
• biology
• psychological theories
• Treatment

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Core impairments
Social interaction
Restricted interests
communication
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Impairment in reciprocal communication
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Impairment in language

• 50 no speech
• pronominal reversal
• ecolalia

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Markedly restricted repertoire of interests and
impairment of imagination
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• onset before 3 years

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Other features

• abnormal response to sensory stimuli
• auditory
• visual
• touch /pain
• smell

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other common problems

• hyperactivity
• sleep problems
• food fads
• self injurious behavior

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Associated handicaps

• epilepsy 30-40
• leaning difficulties 70 (20 if include
  Aspergers)

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Epidemiology

• rare
• prevalence 4 to 11 per 10,000 autism
• 1 per 1000 for all autistic spectrum
• sex ratio 31 boys to girls

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Underlying biology

• 1 in 10 probably a pure genetic form ie not
  associate with other conditions causing brain
  damage
• genetic increased risk to siblings 1-2 ie 100
  fold increase in risk

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associated conditions

• fragile X
• other chromosomal abnormalities
• tuberous sclerosis
• neurofibromatosis
• PKU
• Lactic acidosis
• purine disorders
• rubella emryopathy
• herpes encephalitis
• ect

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CHAT
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Brain damage
Psychological / cognition
Changes in behavior
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B1
B2
B3
Cognitive deficit
Behavior
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What is the cognitive defect

• Theory of mind
• weak central coherence

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Theory of mind

• children have 2 systems of representation
• primary representation of things and
  meta-representations which capture peoples
  propositional attitudes (mental states) to those
  events and objects

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First order theory of mind

• He knows that she knows

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Second order

• She knows that he knows she knows

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Assets Deficits

• ordering behvioural pictures
• understanding see
• proimpreative pointing
• sabotage

• ordering mentalistic pictures
• Baron Cohen et al 1986
• understanding know
• Perner et al 1989
• protodeclarative pointing
• Baron Cohen 1989
• deception
• Sodian and Frith 1992

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Assets Deficits

• False Photographs
• recognising happiness/ sadness
• object occlusion

• false beliefs
• Leekam and Perner 1991, Lesile and Thaiss 1992
• recognizing surprise
• Baron Cohen
• information occlusion
• Baron Cohen

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• literal expression
• instrumental gestures
• desire and emotion words

• metaphorical expression
• Happe 1993
• expressive gestures
• Attwood et al 1988
• belief and idea words
• Tager- Fusberg 1993

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Strange stories

• Double bluff
• White lie
• Metaphor

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Central Coherence
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Suggested reading

• Autism an introduction to psychological theories
• Happe F.G.E. 1994 UCL press
• Children with Autism
• Trevarthen, Aitkien, Papoudi, Robarts second
  edition 1998 Jessica Kingsley

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• Can Autism be detected at 18 months?
• The needle the haystack and the CHAT
• Baron Cohen, Allen, Gillberg British journal of
  psychiatry 1992, 161, 839-843

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• www.autism-society.org
• www.oneworld.org/autism_uk
• www.autism.org