Autism

Elspeth Webb

Childhood Autism

Autism

Prevalence

1980s 4-7/10,000Now 1/100-150

A common condition (about 12 Cardiff med students per year group will go on to have a child on the autistic spectrum)

Why the increase in prevalence Real vs. administrative increase? ( i.e. are we better at

recognising it)Causes?

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Autism

What are we?

• What theories are there to explain the “uniqueness” of human beings within the animal kingdom?

•What defines us as human•Have a think about this before going on to the next slide and write your ideas down

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Autism

• Consciousness • Imagination• Language

• Complex social relationships• Spirituality• Awareness of impact of actions

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Answers provided by a group of parents and professionals at a recent conference

AutismAutism and autism spectrum disorder

Problems with:• Social communication and social

imagination• Rigidity of thought and behaviour

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Autism

DSM 5 Classification (Must meet criteria A, B, C, and D)

• A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,

2. Deficits in nonverbal communicative behaviours used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.

3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behaviour to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

• B. Restricted, repetitive patterns of behaviour, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypes, echolalia, repetitive use of objects, or idiosyncratic phrases).

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behaviour, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

• C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

• D. Symptoms together limit and impair everyday functioning.

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Autism

Social communication

• Absent

• Disordered ( both verbal and non-verbal)

• Lacking communicative intent – echolalia; hyper-lexia

• Problems with social use of language – lack of reciprocity/ poor turn-taking)

• Literal. Inability to understand or use metaphor

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Autism

Social imagination

• No theory of mind (Sally Anne Test; squirrel)

• No empathy– Lack of socio-emotional reciprocity– Abnormal comfort seeking

• Abnormal or absent peer friendships

• Failure to use eye-contact, gesture, and posture to regulate social interaction

• Lack of shared attention

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Autism

Restricted, repetitive and stereotyped play, behaviour, interests and activities

• restricted/unusual interests

• attachments to unusual objects.

• specific, non-functional routines or rituals.

• stereotyped and repetitive motor mannerisms.

• distress over change

• preoccupations with part-objects – a failure to ascribe meaning to the whole

• rigid thinking

• absent or restricted/repetitive imagination

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AutismPreoccupations with part-objects – a failure to ascribe

meaning to the whole

What does this say?

“There was a tear in her dress”Of autistic readers about half will read tear as in rip, and the other half tear as in crying – not paying attention to the meaning of what they are reading, rather reading word by word.

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Autism

Restricted interests: examples

• Cars & trains (can be dangerous)

• Lamp-post numbers• Dinosaurs• Stamp collecting• Bird-watching• Bombs• Music

• Knives and guns• Dr Who• World of WarCraft• Celebrities (Lennon’s killer)• Dates (of anything)• Scores in sport• Clothes labels• Religion (fundamentalist

approach)

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Autism

Not defining but fundamental to our successful functioning as autonomous and socially integrated individuals

• Consciousness• Imagination• Language

• Complex social relationships• Spirituality• Awareness of impact of

actions

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Look at this list again – what strikes you about it now?

Autism

A dimensional disorder thus in part socially constructed

autism normal

Where does personality end and disorder begin?

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Autism

High IQ

Low IQ

Severe autism Mild autism

Bill Gates

Enoch Powell“Rain man”

Classic Kanner autism

“Asperger syndrome”

Dog in the night boy

A dimension that interacts with other dimensions – e.g. IQ

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Autism

Three social “types”

• Aloof– – avoids and dislikes social contact

• Passive– – accepts social contact but not interested

• Active but odd – – wants to engage socially but gets it wrong and

fails

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Autism

Changing attitudes and explanations for autism

• Changelings :– in which fairies stole a baby

and leave a fairy child in its place, ? early references to autism

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"So the goblins came. They pushed their way in and pulled baby out, leaving

another all made of ice." (Maurice Sendak, Outside over there. Puffin

Books, Middlesex, UK, 1981)

Autism

Manifestation of extraordinary faith, innocence, and innate goodness

Brother Juniper (and the beggar)

Disciple of St Frances of AssisiMany classical features of autism in his behaviours – interpreted as saintly

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Autism

Profoundly neglected

• Feral children – Victor, Wild boy of Aveyron: Wild

Peter of Hamelin– Kamala and Amala, the “Wolf Girls”

of Midnapore

• Imprisoned– Casper Hauser

18Victor (contemporary print)

Autism

20th C

• Cold unemotional parenting (Kanner)

• Neuro-developmental impairment

To some extent these two models coexist in the West, with a psychoanalytical explanations still current in France, but not prevalent in UK, Sweden, USA, Australia.

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Autism

Gender

autistic Normal

males

females

“Autism is an extreme form of maleness” Simon Baron Cohen

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Autism

Systemising

Empathising

Other way around

Autistic males

Autistic females

Normal females

Normal males

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Autism

Male : female ratios in populations

Low functioning autism (IQ<70): 4:1

High functioning autism (IQ>70) 12-20:1

BUT

Are we missing high functioning girls?

All assessment tools largely developed and validated on a mainly male population

A girl may score less than a boy, but be functionally much more impaired, as the social world of girls is far more sophisticated and socially demanding

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Autism

Recommended further reading etc.

• Novel– “The Curious incident of the Dog in the Night time” – Mark

Hadden

• Film– Snowcake (Alan Rickman / Sigourney Weaver) – superb. Much

better than Rain Man which presents a stereotyped version of the autistic savant, which is in life rather rare

• Look up the National Autistic Society website – a lot of really useful information

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