AUTISM By Pauline Narciso Philip Lai Henry Kang

AUTISM By: Pauline Narciso Philip Lai Henry Kang

Overview l Pauline – General Survey of Autism – Neural/Chemical Correlates l Philip – Comparison of Consciousness l Henry – Treatments

General Notes l Autism as a Syndrome: multiple disease entities l Autism is a developmental syndrome: l Common deficit: theory of mind

Bit of History l 1943 - Kanner l “extreme aloneness from the beginning of life and anxiously obsessive desire for the preservation of sameness. ” l Initial cause: Bad parents

Diagnostic Criteria l Severe abnormality of reciprocal social relatedness l Severe abnormality of communication development l Restricted, repetitive behavior, patterns of behavior, interests, imagination l Early onset (before 3 -5 years)

Other observed behaviors l Lack of awareness of feelings of others l Bizarre speech patterns l Lack of spontaneous and make-believe play l Preoccupation with parts of objects l Repetitive motor movements l Marked distress over changes

Begins when… l 80% of cases began as “Infantile Autism”

Screening Model for Infantile Autism l Is child’s eye-to-eye contact normal? l Is he/she comforted by proximity/body contact? l Does he/she often smile or laugh unexpectedly? l Does he/she prefer to be left alone?

Systematic Feature Examination l Hand stereotypies (strange looking or posturing) l Stiff gaze, avoidance of l Little reaction to strong, unexpected noise l Passive, obvious lack of interest

Disease Entities within Autism l IABD l Zapella Dysmaturational subgroup l Purine Autism l Asperger’s and Autistic Savants l All share common Autistic behaviors

Infantile Autistic Bipolar Disorder l Regression after initial normal development l Meets classical criteria for Autism l Autistic symptoms have a cyclical pattern l Positive family history of BD or Depression l Different of BD from Autistic who later has onset

Zapella Dysmaturational subgroup l l l l Loss of language after initial normal dev Meets classical criteria Complex tics present Normal neurological exam, normal lab exams Rapid improvement following therapy Reach quasi-normal abilities by age 5 -6 After age 6, usually fall into other psychopathological category, ADHD

Purine Autism l Classical criteria met l Too high/too low levels of uric acid l Constipation l Gout in family members l Seizures and self-injury in majority l “Purine”: abnormal levels of end product (uric acid) of all purine pathways

Quote on Purine Autistic l “the boy was an irritable baby who resisted any change in routine and never looked at people around him. By 2 years of age, the few words he had were rapidly disappearing. He lined up his toys in long straight lines instead of playing with them. He developed pica, teeth-grinding, compulsive biting to the point of bleeding. ”

On the functioning end. . l Asperger’s: meet criteria, but have normal IQ functioning l Autistic Savants: special skills in memory, music, math, calendar calc, drawing, and hyperalexia reading.

Theories on contributing factors Unfavorable pre, peri, post-natal factors l Cellular and structural changes in Limbic System (amygdala, cerebellum, and hippocampus) l L-hemi neural substrates fail to develop (loss lang. , consciousness, motor planning l Locus Coerulus: Mediates input from sensesunderdeveloped l Low mercury levels l

Who’s affected? l 1% of general public under the Autism Spectrum l Most often tend to be males

Altered States Compared to Normal l Resistance to change, Insist on sameness l Strong attachments to objects; Spins objects l Difficulty in mixing with others l Throw Temper Tantrums l Tend not to want to cuddle or be cuddled l Over-sensitivity or under-sensitivity to pain l No fears of danger

Sensory Processing l Painfully sensitive to certain sounds, textures, tastes, and smells. l Either too sensitive or less sensitive than normal. Some autistic have difficulty interpreting sensory information. l Like normal these experiences are not hallucinations but based on real experiences. l Some avoid being touched, a gentle touch for most, will hurt or shock autistics. l Some are insensitive to pain, and fail to notice injuries.

Emotions l Take major emergencies in stride but become upset over minor disruption. l Unemotional, but can be very emotional when things are important to them. l More candid and expressive with their emotions than normal people. l Small amount will have difficulty regulating their emotions. Individual will have verbal outburst, usually in strange or overwhelming environment.

Communications l Problem with semantic-pragmatic component, take a statement or question in a literal way. Ex. ) "I'd like coffee with my cereal“ l Repeating l Inability things that have been heard (echolalia) to understand body language, tone of voice l Some autistics are mute

Communication Cont. l Difficult in sustaining a conversation. No normal "give and take" in a conversation l Autistics tend to go on with their favorite subjects and do not give the other person a chance to talk. l People with autism might stand too close to the other person. l Body language, facial expressions, and gestures do not match what they are saying.

Attention l Trouble handling multiple stimuli of attention. l Very narrow focused attention, can not keep up with more than one thing at a time. l Shifting attention is a slow process, usually involves pauses or moments of delay.

Productivity l Great deal of variety among autistics. l Some autistic may never learn to talk and be dependent throughout their lives. l Others may do well in special supportive settings, working in a sheltered environment. l There autistics that are fully independent and function fairly well.

Theory of Mind l TOM is absent in autistics, can not attribute mental states. l Autistic can not reflect on their own mental states. l Cause abnormalities in social interactions, communications, and imagination. l Understanding mental states of others can allows individuals to make sense of past behavior, allows influence on present behavior and permits prediction of future behavior. l Normal 3 year olds no TOM, but 4 year olds tend to have a TOM.

Mirror Neurons Tested controls and autistics on 4 different tasks. l Researchers compared mu rhythms. At baseline, mu rhythms will fire in synchrony, large amplitude mu oscillations. l Normal when seeing an action perform will cause mu rhythms to fire asynchronously, therefore resulting in mu suppression. l

Mirror Neurons Cont. So mu wave suppression will reflect activity of the mirror neuron system. l In autistics, there was mu suppression in their own hand movements, but no mu suppression to the observed hand movements. l

Autism Treatment l Behavioral modification and communication approaches l Dietary and biomedical approaches l Complementary approaches

Behavioral & Communication l Applied Behavior Analysis – Rewarded behavior l TEACCH – Understand the world l PECS – Picture exchange l Social Stories – Theory of Mind l Sensory Integration

Biomedical Treatments l Medications – Serotonin Re-uptake Inhibitors – Anti-Psychotic Medications l Risperidone l Vitamins l Dietary and Minerals Interventions

Risperidone l Two double-blind, placebo-controlled responses of risperidone – Adults and Children Serotonin-Dopamine antagonist l Effective as a short-term treatment l – Tantrums, Aggression, Self-Injurious Behavior – Interfering repetitive behavior, self-injurious behavior, sensory motor behaviors, affectual reactions, overall behavioral symptoms

Risperidone Cont. l Figure 1: Mean Scores for Irritability

Risperidone Cont. l Figure 2: Change in Severity of Overall Symptoms

Vitamins & Minerals l Vitamin B – Most common vitamin supplement l Vitamins A and D – Eye contact and behavior l Vitamin C – Improve symptom severity

Dietary Interventions l Gluten – Disruption in biochemical and neuroregulatory processes l Yeast – Behavioral and medical problems

Complementary Approaches l Improving Communication Skills – Music Therapy l Speech Development – Art Therapy l Non-verbal, Symbolic Expression – Animal Therapy l Physical and Emotional Benefits

Conclusion l Autism is a spectrum l Autistics lack an essential element of consciousness-Theory of Mind

References l l l l l Autism Society of America. <http: // www. autism-society. org>. Bauman, Margaret L. and Kemper, Thomas L. , eds. The Neurobiology of Autism. Baltimore: John Hopkins UP, 1994. Centers for Disease Control. <http: //www. cdc. gov>. Coates, Sheila and Richer, John, eds. Autism The Search for Coherence. Philadelphia: Jessica Kingsley Publishers, 2001. Gabriels, Robin L. and Hill, Dina E. , eds. Autism-From Research to Individualized Practice. Philadelphia: Jessica Kingsley Publishers, 2002. Gilberg, Christopher. Diagnosis and Treatment of Autism. New York: Plenum Press, 1989. Gilberg, Christopher and Coleman, Mary. The Biology of the Autistic Syndromes. London: Mac. Keith Press, 2000. Happe, F. “Theory of Mind and Self. ” Ann. N. Y. Acad. Sci 1001 (2003): 134144. Harris, J. C. “Social neuroscience, empathy, brain integration, and neurodevelopmental disorders. ” Physiology & Behavior 79 (2003): 525 -532. Mc. Craken, James T. et al. “Risperidone in Children With Autism and Serious Behavioral Problems. ” The New England Journal of Medicine 347 (2002): 314 -321.

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