Possible Applications of Triune Brain Theory in Developmental Disorders

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Possible Applications of Triune Brain Theory in
Developmental Disorders

• Dr Khalid Mansour
• Locum Consultant Forensic Psychiatrist in
  Learning Disabilities
• Eric Shepherd Unit

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How does the brain work?

• Main functional structure of the brain?
• Brain centres (Phrenology) (too simple)
• Brain circuits (e.g. Papez circuit FLS vs OPD
  M R diffusion tensor imaging Tractography)
  (vague, little clinical applications)
• Evolutional/developmental approach (Triune
  Theory)
• Strong scientific evidence
• More comprehensive theory of brain functioning
• High clinical potential

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Broadmans brain areas
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M R Diffusion Tensor Imaging Tractography
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Triune Brain Theory

• The most influential idea in neuroscience since
  World War II (Durant in Harrington 1992)
• MacLeans Triune Brain Concept has had limited
  acceptance or been largely ignored by
  professional neurobiologist (Science Journal 1990
  American Scientist journals 1992) (Cory in Cory
  Gardner 2002)

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(I) Triune Brain theory

• Senior Research Scientist
• National Institute of Mental health
• 1913 - 2007

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Triune Brain Theory

• Vertebrates can be divided from evolutionary
  point of view into three main categories
• Animal with brains made mainly of spinal cord,
  brain stem, basal ganglia and cerebellum
  (reptilian brain, the R-Complex or the Striatal
  Complex) e.g. Reptiles, birds fish
• Animals which brain is mainly made from the
  R-Complex the limbic Lobe (diencephalons,
  Amygdala, septum, Mammillary body, Fornix, limbic
  cortex Brocas area, cingulated cortex,
  hippocampus others) e.g. Rats, cats , dogs and
  monkeys
• Animals which brain is mainly made of R-Complex
  Limbic System the Neocortex e.g. Apes and
  humans

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Triune Brain Theory
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Triune Brain Theory

• (I)
• Animal with brains made mainly of Reptilian
  brain (R-Complex)
• Mainly Reptiles, birds fish
• Evolutionary functions
• Motor behaviour including motor routines, motor
  subroutine, motor memory and motor (non-verbal)
  communications
• Primitive emotions rage, fear submissiveness
• Copulation

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Triune Brain Theory

• (II)
• Animals which brain is mainly made from the
  reptilian brains the limbic Lobe
• Lower mammals e.g. Rats, cats , dogs and monkeys
• Evolutionary functions (beginning of family)
• Nursing of the offspring (parental care)
• Vocalisation (audio-vocal communication)
• Play

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Triune Brain Theory

• (III)
• Animals which brain is mainly made of R-Complex
  Limbic System the Neocortex
• Higher mammals e.g. Apes and humans
• Evolutionary functions (beginning of cultures)
• Problem solving skills (Mentation)
• Learning
• Detailed memory
• Verbal communication
• Preservation of ideas

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Triune Brain Theory
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Triune Brain Theory
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TRIUNE BRAIN
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TRIUNE BRAIN
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Clinical Applications of the Triune Brain Theory
in Developmental Disorders

• Triune Brain gt Triune Intelligence
• Better clinical assessment and diagnosis of
  autism
• Better diagnostic criteria of Autism
• Better understanding of aetiology of ASD
• Schizophrenia and Autism

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• (1) Triune Brain Triune Intelligence (?)

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(1) Triune Brain Triune Intelligence

• R-Complex processing object related data gt
  Object-Related Skills / Intelligence
• Limbic System processing emotional data gt
  Emotional Skills / Intelligence
• Neocortex processing social datagt Social Skills
  / Intelligence
• We could have
• Object related intelligence (general intelligence
  - IQ),
• Emotional Intelligence
• Social intelligence

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(1) Triune Brain Triune Intelligence

• Object Related Intelligence (general intelligence
  - IQ) managing physical environment (not
  emotionalised not socialised) e.g. budgeting
  and travelling
• Emotional Intelligence managing
  emotional/personalised environment e.g. emotional
  bonding, insight and empathy.
• Social Intelligence managing social environment
  e.g. functioning in social groups and social
  appropriateness.

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(1) Triune Brain Triune Intelligence

• Why Three-Dimensional Intelligence?
• Clinical Evidence Emotional Intelligence and
  Social Intelligence, are used in every day
  clinical work
• Emotional intelligence (Leuner,1966 Payne,
  1985 Greenspan, 1989 Salovey and Mayer,1990
  Goleman, 1995).
• Social Intelligence (Cohen, 2000 Goleman, 2006)
  
• ASD a good example of the separation of Object
  Related Intelligence from Emotional Intelligence
  and Social Intelligence

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(1) Triune Brain Triune Intelligence

• Potential applications of triune intelligence
• Explains variations in development of
  intelligence
• One step towards more use of IQ format
• Object related intelligence (General
  intelligence) IQ
• Emotional intelligence IQ
• Social Intelligence IQ
• End of categorical classification of ASD

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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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Variations of the Tri-dimensional Intelligence
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• (2) Better diagnostic criteria of Autism

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(2) Better diagnostic criteria of Autism

• Current Diagnostic Criteria DSM-IV
• (I) A total of six (or more) items from (a), (b),
  and (c), with at least two from (a), and one each
  from (b) and (c)
• (A) qualitative impairment in social interaction
• impairments in nonverbal behaviors such as
  eye-to-eye gaze
• failure to develop peer relationships
• lack of spontaneous seeking to share enjoyment,
  interests, or achievements
• lack of social or emotional reciprocity
• (B) qualitative impairments in communication
• delay in the development of spoken language
• marked impairment in sustain a conversation
• idiosyncratic language
• lack of social imitative play

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(2) Better diagnostic criteria of Autism

• Current Diagnostic Criteria DSM-IV (cont)
• (C) Restricted repetitive and stereotyped
  patterns of behavior, interests and activities
• stereotyped and restricted patterns of interest
• inflexible nonfunctional routines or rituals
• stereotyped and repetitive motor mannerisms
• preoccupation with parts of objects
• (II) Delays with onset prior to age 3 years
• (III) The disturbance is not better accounted for
  by Rett's Disorder or Childhood Disintegrative
  Disorder

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(2) Better diagnostic criteria of Autism
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(2) Better diagnostic criteria of Autism

• Proposed Diagnostic Criteria
• (1) Essential features
• Poor development of social intelligence/skills
• Lack of social reciprocity
• dysfunctional social aspects of play
• dysfunctional social aspects of communication
• Social awkwardness
• failure to develop peer relationships
• Poor development of emotional intelligence/skills
  
• Self-centredness with poor self awareness
• lacking empathy (dysfunctional theory of mind)
• Lack of emotional reciprocity
• Poor appreciation of emotional expressions
• Emotional awkwardness
• Poor emotional aspects of play
• Poor emotional aspects of communication

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(2) Better diagnostic criteria of Autism

• Proposed Diagnostic Criteria (Cont)
• (2) Compensatory Features
• (Try to feel less overwhelmed, more in control
  and more secure)
• Restricting environment
• Restricting interest
• Islets of exceptional interests
• tendency to keep rigid control over environment
• Rigid routines or rituals
• (3) Associated features
• Existential (not stress related) anxiety
• Pathological habits (dysfunctional routines)
• Poor development of speech
• Poor eye to eye contact
• OCD like symptoms and rituals
• Motor mannerisms
• Preoccupations with parts of objects

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• (3) Better clinical assessment of autism

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(3) Better clinical assessment of Autism

• Autism is primarily a disorder of emotional and
  social development which could be due to
  developmental abnormalities in both limbic system
  and neocortex. R-Complex could be intact or
  affected too.
• All affected brain functions could take different
  forms
• lost functions (like in ablation studies)
• exaggerated functions (irritation or excitation
  studies)
• partially lost or partially exaggerated
• Assessment of each neurological part separately
• Assessment of R-Complex
• Assessment of Limbic System
• Assessment of Neocortical System

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(3) Better clinical assessment of Autism

• General assessment of R-complex
• General functioning
• Deals mainly with objects related data
• Function survival in physical world
• Produce behavioural routines
• Specific functioning
• Routines (skills),
• Habits,
• Motor Communication,
• Repetitions (OCD like symptoms)
• Assessment of the subsystem
• Arousal or motivation assessment (e.g. rocking,
  ADHD)
• Involuntary muscular movements

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(3) Better clinical assessment of Autism
Development of motor routines
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(3) Better clinical assessment of Autism

• R-Complex Specific Functioning
• Object related Routines functional motor
  routines
• Primitive e.g., territorial behaviour
• Advanced e.g. tidying ones room
• Object-related Habits (Pathological) not
  functional motor routines e.g. pica, addiction,
  fire setting
• Object-related Checking (repetitive) behaviour
  e.g.
• Exaggerated routines (e.g. hoarding)
• Failed to execute routines (repetitive behaviour
  or OCD like symptoms)

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(3) Better clinical assessment of Autism

• General assessment of Limbic System
• General functioning
• deals mainly with emotional (individual-related)
  data
• Function survival in the physical world as an
  individual
• Not normally functional in autism
• Specific functioning (emotional routines and
  habits)
• Play
• audio-vocal communication
• Attachment with others
• Theory of mind
• Assessment of the subsystem
• Attachment disorders

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(3) Better clinical assessment of Autism

• Limbic System Specific functioning
• New emotional routines not well developed in ASD
  e.g.
• Self centeredness
• Hostile dependence on safe relations
• Increased anger or increased blaming behaviour,
• Dysfunctional empathy
• Pathological emotional habits e.g.
• deviated sexual interests (paedophilia)
• Dysfunctional emotional communication e.g.
• one way communication talking at you not to
  you
• Existential anxiety

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(3) Better clinical assessment of Autism

• General assessment of Neocortical system
• General functioning of Neocortex
• Deals mainly with social (group) data
• Function survival in the physical world as an
  individual who is in the same time a member of a
  bigger social group
• Specific functioning
• Social Routines (skills)
• Social Habits (pathological)
• Social Communication
• Assessment of the subsystem
• Imagination / Fantasy disorders (?)

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(3) Better clinical assessment of Autism

• Neocortical System Specific functioning
• Social routines how undeveloped
• Failure of functions social isolation, social
  awkwardness
• Exaggerated functions paranoid social attitudes
  (Nicky Reilly Syndrome)
• Pathological habits
• Drug-misuse-to-fit-in syndrome,
• hoax phone calls,
• Pyromania
• Social communication disorder
• Poor appreciation of danger (naivety syndrome)

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• (4) Better Understanding of Aetiology of ASD

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(4) Better understanding of aetiology of ASD

• No single aetiology for ASD
• Pathway of aetiologies
• Upward connections from R-Complex to LS and/or to
  neocortex
• Downward connection from Neocortex and/or LS to
  R-complex
• Each connection can be disturbed by different
  mechanisms

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(4) Better understanding of aetiology of ASD

• Autism is not a one thing multiple aetiologies.

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• (5) Schizophrenia and Autism

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(5) Schizophrenia and Autism

• Similarities
• Schizophrenia gt disturbance of processing of
  social (neocortical system) and emotional (limbic
  system) data
• Late stages Schizophrenia (deficit syndrome)gt
• autistic features
• Differences
• Schizophrenia acquired, adulthood illness,
  disintegrative (regressive)
• Autism developmental, childhood disorder,
  progressive

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(5) Schizophrenia and Autism

• Can autistics develop schizophrenia ?
• Autistics can mimic delusional patients on the
  ward. They can also be genuinely paranoid and
  make erroneous judgments but still not delusional
• Having hallucinations and delusions does not mean
  Schizophrenia (autism with psychotic symptoms is
  not a schizophrenia like Dementia with psychotic
  symptoms is not a schizophrenia)

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(5) Schizophrenia and Autism
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(5) Schizophrenia and Autism
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(5) Schizophrenia and Autism

• How to treat autistics with psychotic features?
• Autistics with psychotic features develop further
  while incorporating the psychotic features in
  their development (e.g. build self-esteem based
  on delusions of grandiosity)
• psychosis becomes part of the foundation of the
  personality gt functional psychosis
• If treated gt more disturbance
• Only treatment is replacement therapy (not only
  removal therapy)
• Antipsychotic medications are not usually very
  effective
• Behavioural and environmental therapies more
  effective

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