PSYC443: Autism Session 1

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PSYC443 Autism Session 1

• Dr Jason Low
• School of Psychology
• Victoria University of Wellington

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Case 1

• JN at 18 months, did not take delight in engaging
  in pretend play and had communication
  difficulties. He had a large collection of
  calculators (he was interested in numbers). With
  his collection of toy cars, he was interested
  only in placing them in long straight lines in a
  particular pattern and was mesmerised with the
  spinning of wheels. He often echoed what people
  said and most of the time it seemed as if he was
  looking through people, not at them.

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Case 2

• Stephen Wiltshire born in London. As a child, was
  mute and did not relate to other human beings.
  Even by age 3, he had no language, uncontrolled
  tantrums and lived entirely in his own world. At
  the age of five, noticed that the only pastime he
  enjoyed was drawing (esp. buildings). Once, he
  was taken on a helicopter ride over the city of
  London. After a brief ride, he returns to the
  ground where, in three hours, he completes a
  stunningly detailed and remarkably accurate
  drawing of London from the air which spans four
  square miles with 12 major landmarks and 200
  other buildings drawn to perfect perspective and
  scale
• http//www.youtube.com/watch?vAxAR9dnSuQM
• http//www.autismspeaks.org/sponsoredevents/autism
  _every_day.php

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Reasons to study atypical development?

• for PSYC443 as a window through which to view
  normal development
• elucidating cognitive processes key to normal
  development

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Historical perspective

• Autism was first described in 1943 by
  psychiatrist Leo Kanner. Applied the term to
  children who were socially withdrawn and
  preoccupied with routine, who struggled to
  acquire spoken language.
• Autistic loneliness
• Desire for sameness
• Islets of abilities

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Kanners main conclusion

• These children have come into the world with an
  innate inability to form the usual biologically
  provided affective contact with people.

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Historical Perspective Hans Asperger

• Autism was again described in 1944 by Austrian
  paediatrician Hans Asperger. Applied term to
  children who were socially maladroit, developed
  bizarre obsessions and yet were highly verbal and
  seemingly quite bright.

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Hans Asperger Case of Fritz

• When somebody was talking to him he did not enter
  into eye contact fundamental to conversation
• Normal speech melody was missing
• Stereotypic body movements (e.g., beating
  rhythmically on thighs)
• From very early on he had shown an interest in
  numbers and calculations
• Disturbance of contact existed at some deep level
  of affect and / or instinct

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Asperger Syndrome

• Diagnosis in late childhood or even adulthood
• No language delay as children
• Social interaction difficulties usually focused
  preoccupations (little professor)
• Variants of the same underlying disorder

Neurotypical
Aspergers
Autism
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Lessons from history

• Case of the Wild Boy of Aveyron (named Victor)
  (found in 1797 near Toulouse)
• His affections are limited cares for no one, and
  is attached to no one.
• He reflects on nothing. His imbecility is evident
  in his gaze.
• The most harmonious sounds make no impression on
  his ear (but is sensitive to opening of the
  cupboard containing walnuts).
• Indifferent to all childish amusements.

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Educating Victor

• Jean-Marc Itard in 1801 took on the task of
  Victors education
• Showed some acquisition of sign language and a
  few words (milk, oh god)
• Never learned the meaning of social values (a
  true idiot)

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Victor and autistic loneliness

• Mme Recamier seated Victor at her side, thinking
  perhaps that the same beauty that had captivated
  civilised men would receive similar homage from
  the child of nature, who seemed not yet 15 years
  old. Too occupied with the abundant things to
  eat, which he devoured with startling greed as
  soon as his plate was filled. When dessert was
  served, and he had filled his pockets with all
  the delicacies that he could fetch, he calmly
  left the table. Suddenly a noise came from the
  garden. We soon glimpsed Victor running across
  the lawn with the speed of a rabbit. To give
  himself more freedom of movement, he had stripped
  to his undershirt. Reaching the main avenue of
  the park, climbing the nearest tree with the ease
  of a squirrel, he perched in the middle of the
  branches.

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The Mothers dilemma
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Autism Triad
Social deficits
Imaginative Deficits
Communication deficits
Yes
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Epidemiology

• Rates in studies between 1966 and 1991 4.4 cases
  per 10,000 (Wing Potter, 2002)
• Rates between 1992 and 2001 12.7 per 10,000
  (Fombonne, 2003)
• Epidemic of autism?
• Changes in diagnostic practice?
• Increased awareness?
• Earlier diagnosis
• Issues of study design case ascertainment

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Epidemiology

• Boys disproportionately affected (ratio 3.4 or
  4.0 to 1 Frombonne, 2003 Volkmar et al., 1993)
• Possible that males have lower threshold
• More severe neurodevelopmental abnormalities
  needed in girls

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Organic Context

• Concordance rates for MZ twins (36-91) higher
  than compared to DZ twins (0) (Bailey et al.,
  1996)
• Elevated level of serotonin (chemical messengers)
  in 25 of individuals with autism (Klinger
  Dawson, 1996)
• Structural abnormalities in limbic system
  (emotion), amygdala (social cognition), and areas
  of cerebellum (sensori-motor integration)
  (Bauman, 1996)
• Dawson (2001) 3- and 4-year-olds reactions to
  neutral and fear depicting photos. Brain activity
  of autistic children didnt change in response to
  the different images.
• Need to ask whether it is specific brain damage
  or a disorder of development

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The Great Vaccination Scare

• Sudden increase, blame novel environmental agent
  (e.g., vaccination)
• First signs of autism noticed at 2nd year
• Proportion of cases show regression
• Proportion of cases have severe gastric
  conditions
• So MMR vaccination autism?
• Evidence?
• Meaning of increasing number of cases
• Number of cases diagnosed in relation to
  introduction of MMR in various countries?
• Difficulties in diagnosing in first year of life

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Difficulties in Diagnosis

• DSM-IV (1994) Autism
• A total of six (or more) items from impaired
  social interaction, and one each from impaired
  communication and impaired imagination, and onset
  prior to 3 years of age
• Often, earliest signs go unnoticed
• Problems arise with borderline cases
• Additional problems that may overshadow autistic
  features

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Difficulties in diagnosis

• Knobloch Pasamanick (1975) 50 children
  identified with failure to regard people as
  persons compared to 50 controls
• Followed up 3 to 10 years later
• Those seen before 12 months failure to regard
  people as persons disappeared
• Those seen in the second or third year were
  definitely diagnosed as autistic later on
• What facts can be learned from the above example?

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What happens in adulthood?

• The disability does not go away
• But through treatments (e.g., behavioural
  learning, language training, physical props to
  mental states), improvements in adaptation and
  behaviour can be observed
• Can be guided into a niche where skills are put
  to good use
• But future of any child with autism remains
  uncertain, as with any child

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a disorder of unknown cause
Hazard
(e.g., faulty genes, chromosome abnormality,
viral agents, anoxia)
Havoc (to neural development)
Harm (to development of brain systems)
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From here on

• Theoretical (and associated methodological)
  approaches to studying the autism triad
• Theory of Mind (Mindblindness)
• Executive (Dys)Functioning
• (Weak) Central Coherence
• Do these approaches highlight domain specificity
  issues, or are they interacting?
• Where and how does language fit in?