5. Autism

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5. Autism

• What is Autism
• Prevalence of Autism
• Autistic Spectrum Disorders
• Characteristics of Autism
• Diagnosing Autism
• Theories
• the theory-of-mind deficit theory
• the executive function deficit theory
• the central coherence theory
• Learning Outcomes

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What is Autism?

• complex developmental disability
• Autism first described by Kanner (1943)
• typically appears during the first three years of
  life
• most severe childhood neuropsychiatric condition
• triad of impairments
• socialisation
• communication
• imagination

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Prevalence of Autism

• 2-6 cases per 1,000
• growing at a rate of 10-17 percent per year
• boygirl 41
• Usually identified before 30 months
• No racial or socioeconomic differences

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Autistic Spectrum Disorders

• Autism is one of five disorders coming under the
  umbrella of Pervasive Developmental Disorders
  (PDD)
• Autistic Disorder
• Asperger's Disorder
• Childhood Disintegrative Disorder (CDD)
• Rett's Disorder
• PDD-Not Otherwise Specified (PDD-NOS)

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Characteristics of Autism

• Persons with autism may exhibit some of the
  following traits.
• Insistence on sameness resistance to change
• Difficulty in expressing needs uses gestures or
  pointing instead of words
• Repeating words or phrases in place of normal,
  responsive language
• Laughing, crying, showing distress for reasons
  not apparent to others
• Prefers to be alone aloof manner
• Tantrums
• Difficulty in mixing with others
• May not want to cuddle or be cuddled
• Little or no eye contact

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Characteristics of Autism

• Unresponsive to normal teaching methods
• Sustained odd play
• Spins objects
• Inappropriate attachments to objects
• Apparent over-sensitivity or under-sensitivity to
  pain
• No real fears of danger
• Noticeable physical over-activity or extreme
  under-activity
• Uneven gross/fine motor skills
• Not responsive to verbal cues acts as if deaf
  although hearing tests in normal range.

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Language development

• delayed and deviant
• peculiar use of sounds and words
• Echolalia
• Pronominal reversal - use 'i' where 'you' is
  meant and vice-versa
• e.g. 'do you want a drink' instead of 'i want a
  drink'
• denial of personal identity? (psychoanalysts)
• or just related to echoing
• Use of '-ing'
• 'daddy piping', 'boy bubbling' (boy blowing
  bubbles) - 9 yr old autistic girl (Wing 1976)

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Social development

• physical and emotional distance from others
• failure to develop social attachments
• lack of cooperative group play
• difficulties in reacting to or recognising other
  people's feelings

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Intellectual development

• poor on verbal ability
• may perform above average on memory or spatial
  tasks
• may be talented in music or drawing
• 1/4 - 1/3 have IQgt70

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Diagnosing Autism

• no medical tests for diagnosing autism
• Early Diagnosis
• Diagnostic Tools
• The NICHD lists these five behaviors that signal
  further evaluation is warranted
• Does not babble or coo by 12 months
• Does not gesture (point, wave, grasp) by 12
  months
• Does not say single words by 16 months
• Does not say two-word phrases on his or her own
  by 24 months
• Has any loss of any language or social skill at
  any age.

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Diagnosing Autism

• several tests have been developed that are now
  used in diagnosing autism
• CARS rating system (Childhood Autism Rating
  Scale)
• The Checklist for Autism in Toddlers (CHAT)
• The Autism Screening Questionnaire
• The Screening Test for Autism in Two-Year Olds

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Theories

• Some current psychological theories of autism
• the theory-of-mind deficit theory
• the executive function deficit theory
• the central coherence theory

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Theory of Mind

• autistic children cannot engage in
  meta-representations, therefore cannot develop
  ToM
• autistic children don't seem to show
  pretend/symbolic play (Baron-Cohen, 1987)
• Therefore predict poor performance on false
  belief tasks
• Baron-Cohen, Leslie Frith (1985) found this
  poor performance.
• Also
• chance performance on mental-physical distinction
  (Baron-Cohen, 1989)
• poor understanding of functions of the mind
  (Baron-Cohen, 1989)
• fail appearance-reality tests (Baron-Cohen, 1989)
• dont know that seeing leads to knowing
  (Baron-Cohen Goodheart, 1994 Leslie Frith,
  1988)

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Theory of Mind

• chance performance on recognising mental state
  words (Baron-Cohen et al., 1994)
• dont produce range of mental state words
  (Tager-Flusberg, 1992)
• difficulty understanding complex causes of
  emotion (Baron-Cohen, 1991)
• dont know that eye region indicates
  thoughts/wants (Baron-Cohen Cross, 1992)
• fail to make accidental-intentional distinction
  (Phillips, 1993)
• unable to deceive (Baron-Cohen, 1992)
• dont understand intentionally non-literal
  statements (Happé, 1994)
• poor use of pragmatics (Baron-Cohen, 1988)

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Problems with ToM

• Prior et al (1990) found autistic children could
  succeed on Baron-Cohen et al's (1985) task
• a child may fail a test for any number of
  uninteresting reasons such as lack of motivation,
  attention or task comprehension

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Executive Dysfunction

• Executive function
• suppress incorrect response
• retain relevant information in working memory
• executive function involved in flexible planning
• e.g. Tower of Hanoi
• deficit occurs with frontal brain damage leading
  to perseverative behaviour
• false photograph test (Leekam Perner, 1991
  Russell et al., 1999)

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Executive Dysfunction (2)

• Not specific to autism
• also occurs in
• schizophrenia
• obsessive-compulsive disorder
• Gilles de la Tourette syndrome
• ADHD
• Parkinsons disease and more.
• So - by itself, executive dysfunction cannot
  explain autism
• may co-occur with ToM deficit

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Problems with ToM Executive Dysfunction

• Deficit accounts of autism fail to explain why
  people with autism show not only preserved but
  also superior skills in certain areas.
• Savant skills
• ten times more common in people with autism than
  in others with mental handicap
• occurring in approximately one in ten individuals
  with autism

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Weak Central Coherence

• Central coherence (Frith, 1989)
• people need/desire high-level meaning
• everyday tendency to process incoming information
  in context for gist
• this feature of human information processing is
  disturbed in autism
• 'weak central coherence'
• autism biased toward local vs global info
  processing
• "inability to experience wholes without full
  attention to the constituent parts
• do not succumb to visual illusions (Happé, 1996)
• failure to use context in reading (Happé, 1995)

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The Ebbinghaus Illusion (from Frith, 2003)
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Weak Central Coherence

• predicts
• relatively good performance where attention to
  local information (i.e. relatively piece-meal
  processing) is advantageous
• e.g. can recognise object from a single part
• poor performance on tasks requiring the
  recognition of global meaning or integration of
  stimuli in context
• e.g. cannot integrate fragments to identify an
  object
• cognitive style rather than cognitive deficit.

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Embedded figures test (from Frith, 2003)
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Weak Central Coherence

• Evidence
• Perceptual coherence.
• Visuo-spatial constructional coherence
• Verbal-semantic coherence
• weak coherence and theory of mind independent
  (Happé, 1995)
• savant skills
• musical talent
• graphic talent

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Wechsler Block Design Task (from Frith, 2003)
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3 Complementary Theories?

• Theory of Mind deficit
• Social and communication impairments
• Executive Function impairment
• Stereotyped behaviour and narrow interests
• Weak Central Coherence
• Special talents and peaks in performance
• Do these theories address three primary deficits
  affecting different brain systems?

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Learning Outcomes

• Be able to describe autism and the
  characteristics of the disorder
• Be able to describe and evaluate research on
  autism
• Be able to describe and evaluate theories of
  autism
• Be able to compare and contrast theories of autism

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Reading

• Essential Reading (on Digital Resources)
• Frith, U. Happe, F. (1994) Autism Beyond
  Theory of Mind. Cognition, 50, pp.115-132
• Frith, U. Hill, E. (2004) Autism Mind and
  brain. Oxford Oxford University Press. Chapter
  1.
• Further Reading
• See pdf handout

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Questions to ask

• What are the different theories of autism (at the
  cognitive level)?
• What does the research into autism tell us?
• Does the research support the theories?