Understanding Behavior

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Understanding Behavior Social Interactions in
Children with Autism Spectrum Disorders

• Kevin M. Antshel, Ph.D.
• Assistant Professor of Psychiatry / Licensed
  Psychologist
• Department of Psychiatry Behavioral Sciences
• SUNY Upstate Medical University

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Outline

• Autism basics
• Model for understanding social interactions in
  autism
• Psychiatric comorbidity
• Temperament
• Autism specific deficits
• Interventions
• Conclusions / Questions

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Autism Spectrum Disorders

• DSM-IV defines autism as
• (1) impairments in social interaction
• (2) impairments in communication
• (3) restricted, repetitive and stereotyped
  patterns of behavior and interests
• Grouped under Pervasive Developmental Disorders
  with
• Asperger disorder
• impairment in social interaction
• restricted interest/repetitive behaviors
• PDD NOS
• impairment in reciprocal social interaction
• impairment in communication skills OR restricted
  interest / repetitive behaviors

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Frith, 1993
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Prevalence / Etiologies

• 1 166 500
• Substantial genetic component ( 90)
• Genetic syndrome in 10 20 of cases
• 30 50 of ASD cases have mental retardation
• Males are substantially more likely to be
  diagnosed with ASD
• sex ratio is larger among children with higher IQ

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Annual Health Care Costs
Croen et al., 2006
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Model for understanding social interactions in ASD
Solomon et al., 2004
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Psychiatric Comorbidity
Croen et al., 2006
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Consider comorbidity

• 1. When signs of problems outside the autism
  spectrum are apparent
• Hyperactivity, distractible inattention
• Sad or irritable mood, decreased pleasure in
  activities, increased withdrawal
• Vegetative signs
• Increased anxiety
• Affective instability
• Cognitive disorganization
• 2. When there is an abrupt change in behavior
  from baseline
• First rule out a medical problem (seizures,
  migraine, medication side effect)
• 3. When there is a severe and incapacitating
  problem behavior
• Aggression
• Self-injury
• Agitation
• Sleep disturbance
• 4. When there is a worsening of symptoms already
  present
• Decreased communication
• Increased hand flapping or motor stereotypies
• Decreased adaptive behavior and daily living
  skills

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Temperament
Anckarsater et al., 2006
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Model for understanding social interactions in ASD
Solomon et al., 2004
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ASD Deficits Theory of Mind

• The ability to construct representations of
  others, oneself, and interactions between oneself
  and others
• Knowledge that others have minds
• Requires the use of social cues to make
  inferences about individuals, such as their
  status, motivation, mood state, trustworthiness,
  etc.
• Contributes to perspective taking

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ASD Deficits Executive Functions

• Set-Shifting Deficits
• inability to shift cognitive strategy to changing
  contingencies
• correlated with autism symptomatology within the
  ritualistic/repetitive behavior domain
• Preference for Detail Over Global
• processing on detail at the expense of global
  configurations poor central coherence
• missing the overarching meaning of a situation

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Pelicano, 2007
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Prefrontal Systems
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ASD Behavioral Rigidity

• Rigidity in behavior is interpersonally oriented
• Most intrusive feature by parents
• Insistence on Sameness in ASD
• multiple areas of functioning
• aversion to novelty

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South et al., 2005
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South et al., 2005
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ASD Deficits Emotion Awareness Recognition
Miles Johnston, 2006
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Emotion Awareness Recognition Neurological
Substrates

• Amygdala
• Superior Temporal Sulcus
• Fusiform Gyrus

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Amygdala

• integrative center of highly processed sensory
  information, emotional circuits, and outputs that
  influence somatomotor and autonomic activity
• key region for processing information of
  motivational salience
• involved in directing the visual system to seek
  out and attend to the eyes as a socially salient
  stimulus
• strong positive correlation in individuals with
  ASD between the level of amygdala activity and
  gaze fixation on the eye region

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Klin et al., 2003
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Superior Temporal Sulcus

• higher-order processing region for the
  integration of multisensory stimuli and motion
  perception
• sensitive to subtle changes in facial movement
  associated with facial affect
• active when auditory stimuli is associated with
  socially relevant features
• greater activation in response to angry prosody
  of human voices relative to neutral prosody
• integration of visual and auditory stimuli with
  their affective salience

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Fusiform Gyrus

• processing of static facial stimuli
• interconnectivity between the fusiform gyrus,
  superior temporal sulcus amygdala

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Integrating Affective Social Processing

• fusiform gyrus and superior temporal sulcus
  encode the visual properties of socially relevant
  stimuli
• ?
• neurons within the amygdala that associate the
  visual percept with its emotional meaning
• ?
• amygdala can simultaneously influence the
  perceptual representation of the stimulus in the
  fusiform gyrus and the superior temporal sulcus
  region
• ?
• regions are anatomically connected to prefrontal
  cortex, where social evaluative processes become
  associated with motivational goals and executive
  control of behavior

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ASD Socioemotional Heterogeneity

• Subtypes
• Aloof, low-functioning individuals notable for
  total disengagement from social interaction and
  failure to engage in interpersonal reciprocity
• Loner subtype characterized by individuals with
  high or superior functioning who may navigate the
  social realm by gravitating toward occupations
  that condone an isolated style and by mastering
  social nuances by rote.
• An active but odd cluster characterized by
  individuals with ASD who actively seek social
  interaction but do so in an inappropriate and
  one-sided fashion
• Passive subgroup comprises individuals who fail
  to initiate social interaction but who accept the
  advances of others and potentially enjoy such
  advances

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ASD Interventions
White et al., 2007
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ASD Interventions
Krasny et al. 2003
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Conclusions

• ASDs are a significant public health issue
• Psychiatric comorbidity is the rule, not the
  exception
• ASD specific deficits
• Theory of mind
• Executive function
• Emotion awareness recognition
• Interventions
• Treat psychiatric comorbidity
• Individual / group social skills therapy