Triune theory 3333

Possible Applications ofPossible Applications of
Triune Theory inTriune Theory in
Developmental DisordersDevelopmental Disorders
Dr Khalid MansourDr Khalid Mansour
Locum Consultant Forensic Psychiatrist inLocum Consultant Forensic Psychiatrist in
Learning DisabilitiesLearning Disabilities
Eric Shepherd UnitEric Shepherd Unit

How does the brain work?How does the brain work?
 Main functional structure of the brain?Main functional structure of the brain?
 Brain centres (too simple)Brain centres (too simple)
 Brain circuits (vague, not clinical)Brain circuits (vague, not clinical)
 Evolutional/developmental approachEvolutional/developmental approach
(triune):(triune):
 Strong scientific evidenceStrong scientific evidence
 More comprehensive theory of brainMore comprehensive theory of brain
functioningfunctioning
 High clinical potentialHigh clinical potential

Triune TheoryTriune Theory
 ““The most influential idea in neuroscienceThe most influential idea in neuroscience
since World War II” (Durant in Harringtonsince World War II” (Durant in Harrington
1992)1992)
 MacLean’s Triune Brain Concept has hadMacLean’s Triune Brain Concept has had
limited acceptance or been largely ignoredlimited acceptance or been largely ignored
by professional neurobiologist (Scienceby professional neurobiologist (Science
Journal 1990 & American ScientistJournal 1990 & American Scientist
journals 1992) (Cory in in Cory & Gardnerjournals 1992) (Cory in in Cory & Gardner
2002)2002)

 Not favourable attention from someNot favourable attention from some
international journalsinternational journals
 lacking practical applications to humanlacking practical applications to human
sciences (e.g. psychiatry)sciences (e.g. psychiatry)
 Full potential could be achieved whenFull potential could be achieved when
mixed with clinical sciencesmixed with clinical sciences

(I) Triune theory(I) Triune theory
Senior Research ScientistSenior Research Scientist
National Institute of Mental healthNational Institute of Mental health
1913 - 20071913 - 2007

Vertebrates can be divided from evolutionaryVertebrates can be divided from evolutionary
point of view into three main categories:point of view into three main categories:
1.1. Animal with brains made mainly ofAnimal with brains made mainly of spinal cord,spinal cord,
brain stem, basal ganglia and cerebellumbrain stem, basal ganglia and cerebellum
((reptilian brainreptilian brain, the, the R-ComplexR-Complex or theor the StriatalStriatal
ComplexComplex))
2.2. Animals which brain is mainly made from theAnimals which brain is mainly made from the R-R-
Complex plus the limbic LobeComplex plus the limbic Lobe (diencephalons,(diencephalons,
Amygdala, septum, Mammillary body, Fornix,Amygdala, septum, Mammillary body, Fornix,
limbic cortex: Broca’s area, cingulated cortex,limbic cortex: Broca’s area, cingulated cortex,
hippocampus & others)hippocampus & others)
3.3. Animals which brain is mainly made of:Animals which brain is mainly made of: R-R-
Complex, Limbic System and the NeocortexComplex, Limbic System and the Neocortex

(I)(I)
Animal with brains made mainly ofAnimal with brains made mainly of Reptilian brainReptilian brain ((R-R-
ComplexComplex))
1.1. MainlyMainly ReptilesReptiles, birds & fish, birds & fish
2.2. Evolutionary functions:Evolutionary functions:
a)a) Motor behaviour including motor routines,Motor behaviour including motor routines,
motor subroutine, motor memory and motormotor subroutine, motor memory and motor
(non-verbal) communications(non-verbal) communications
b)b) Primitive emotions: rage, fear &Primitive emotions: rage, fear &
submissivenesssubmissiveness
c)c) CopulationCopulation

(II)(II)
Animals which brain is mainly made from theAnimals which brain is mainly made from the
reptilian brains plus the limbic Lobe:reptilian brains plus the limbic Lobe:
 Lower mammals e.g. Rats, cats , dogsLower mammals e.g. Rats, cats , dogs
and monkeysand monkeys
 Evolutionary functions: (beginning ofEvolutionary functions: (beginning of
family)family)
 Nursing of the offspring (parental care)Nursing of the offspring (parental care)
 Vocalisation (audio-vocalVocalisation (audio-vocal
communication)communication)
 PlayPlay

(III)(III)
Animals which brain is mainly made of:Animals which brain is mainly made of: R-Complex,R-Complex,
Limbic System and the Neocortex:Limbic System and the Neocortex:
1.1. Higher mammals e.g. Apes and humansHigher mammals e.g. Apes and humans
2.2. Evolutionary functions:Evolutionary functions: (beginning of cultures)(beginning of cultures)
 Problem solving skills (Mentation)Problem solving skills (Mentation)
 LearningLearning
 Detailed memoryDetailed memory
 Verbal communicationVerbal communication
 Preservation of ideasPreservation of ideas

(II) Basic behavioural brain circuits(II) Basic behavioural brain circuits
(Affective Neurosciences: Panksepp 1998)(Affective Neurosciences: Panksepp 1998)
Jaak PankseppJaak Panksepp
Emeritus Professor of the Department of PsychologyEmeritus Professor of the Department of Psychology
Bowling Green State UniversityBowling Green State University

Basic behavioural brain circuits ofBasic behavioural brain circuits of
Panksepp:Panksepp:
 Arousal system:Arousal system:
 The self system:The self system:
 Seeking/DriveSeeking/Drive
system:system:
 Homeostasis system:Homeostasis system:
 Anger/rage systems:Anger/rage systems:
 Family Care system:Family Care system:
 Attachment system:Attachment system:
 Play system:Play system:
 Grief system:Grief system:
 Sexuality system:Sexuality system:
 Fear system:Fear system:

Basic behavioural brain circuitsBasic behavioural brain circuits
(Affective Neurosciences: Panksepp(Affective Neurosciences: Panksepp
1998)1998)
 Based mainly on animal studiesBased mainly on animal studies
 Brain circuits develop differentially through the threeBrain circuits develop differentially through the three
brain units:brain units: R-Complex, Limbic System andR-Complex, Limbic System and
NeocortexNeocortex
 Main organising behavioural centres :Main organising behavioural centres :
 Pre-frontal areaPre-frontal area (organise and energise the rest of the(organise and energise the rest of the
neocortical behavioural functions)neocortical behavioural functions)
 AmygdalaAmygdala (organise and energise the rest of Limbic(organise and energise the rest of Limbic
System functions)System functions)
 PAG (Peri-aquiductal Gray-matter / Midbrain)PAG (Peri-aquiductal Gray-matter / Midbrain) (organise(organise
and energise the rest of the R-Complex behaviouraland energise the rest of the R-Complex behavioural
functions)functions)
 Different chemical transmittersDifferent chemical transmitters

Basic behavioural brain circuitsBasic behavioural brain circuits
(Affective Neurosciences: Panksepp(Affective Neurosciences: Panksepp
1998)1998)
 Through behaviour we can identify which brainThrough behaviour we can identify which brain
component executing the behaviour.component executing the behaviour.
 We can associate this to more specific substructures andWe can associate this to more specific substructures and
chemical transmitterschemical transmitters
 Provide neuro-specific data of behaviourProvide neuro-specific data of behaviour
 Converted behaviour into neurological symptoms relatedConverted behaviour into neurological symptoms related
to problems with specific brain centre/s disorderto problems with specific brain centre/s disorder
 e.g. panic (biological/instinctual), fear (personalised),e.g. panic (biological/instinctual), fear (personalised),
concern (socialised) > other features e.g. ADHD >concern (socialised) > other features e.g. ADHD >
subsystem (Arousal) problemssubsystem (Arousal) problems

Clinical Applications of the TriuneClinical Applications of the Triune
Theory in DevelopmentalTheory in Developmental
Disorders:Disorders:
1.1. Triune Brain > TriuneTriune Brain > Triune
“Intelligence”“Intelligence”
2.2. Better clinical assessment andBetter clinical assessment and
diagnosis of autismdiagnosis of autism
3.3. Better diagnostic criteria of AutismBetter diagnostic criteria of Autism
4.4. Better understanding of aetiologyBetter understanding of aetiology
of ASDof ASD
5.5. Schizophrenia and AutismSchizophrenia and Autism

(1)(1) Triune Brain:Triune Brain:
Triune Intelligence (?)Triune Intelligence (?)

(1)(1) Triune Brain: Triune IntelligenceTriune Brain: Triune Intelligence
 R-Complex: processing object related data >R-Complex: processing object related data >
Object-Related Skills / IntelligenceObject-Related Skills / Intelligence
 Limbic System: processing emotional data >Limbic System: processing emotional data >
Emotional Skills / IntelligenceEmotional Skills / Intelligence
 Neocortex: processing social data> SocialNeocortex: processing social data> Social
Skills / IntelligenceSkills / Intelligence
 We could have :We could have :
 Object related intelligence (general intelligence - IQ),Object related intelligence (general intelligence - IQ),
 Emotional Intelligence &Emotional Intelligence &
 Social intelligenceSocial intelligence

 Object Related IntelligenceObject Related Intelligence (general(general
intelligence - IQ): managing physicalintelligence - IQ): managing physical
environment e.g. budgeting and travellingenvironment e.g. budgeting and travelling
 Emotional Intelligence:Emotional Intelligence: managingmanaging
emotional/personalised environment e.g.emotional/personalised environment e.g.
emotional bonding, insight and empathyemotional bonding, insight and empathy
 Social Intelligence:Social Intelligence: managing socialmanaging social
environment e.g. functioning in socialenvironment e.g. functioning in social
groups and social appropriatenessgroups and social appropriateness

Why Three-Dimensional Intelligence?Why Three-Dimensional Intelligence?
 Clinical evidence:Clinical evidence: concepts of Objectconcepts of Object
Related Intelligence (general intelligence -Related Intelligence (general intelligence -
IQ), Emotional Intelligence and SocialIQ), Emotional Intelligence and Social
Intelligence, are used in every day clinicalIntelligence, are used in every day clinical
workwork
 ASD:ASD: a good example of the separation ofa good example of the separation of
Object Related Intelligence fromObject Related Intelligence from
Emotional Intelligence and SocialEmotional Intelligence and Social
IntelligenceIntelligence

 Too many variationsToo many variations
 Better expressed in IQ formatBetter expressed in IQ format
 Object related intelligence (General intelligence) IQObject related intelligence (General intelligence) IQ
 Emotional intelligence IQEmotional intelligence IQ
 Social Intelligence IQSocial Intelligence IQ
 End of categorical classification of ASDEnd of categorical classification of ASD

Variations of the Tri-dimensional Intelligence:Variations of the Tri-dimensional Intelligence:

(2) Better diagnostic criteria(2) Better diagnostic criteria
of Autismof Autism

(2) Better diagnostic criteria of Autism(2) Better diagnostic criteria of Autism
Current Diagnostic Criteria DSM-IVCurrent Diagnostic Criteria DSM-IV
(I)(I) A total of six (or more) items from (a), (b), and (c), withA total of six (or more) items from (a), (b), and (c), with
at least two from (a), and one each from (b) and (c)at least two from (a), and one each from (b) and (c)
(A) qualitative impairment in social interaction:(A) qualitative impairment in social interaction:
 impairments in nonverbal behaviors such as eye-to-eye gazeimpairments in nonverbal behaviors such as eye-to-eye gaze
 failure to develop peer relationshipsfailure to develop peer relationships
 lack of spontaneous seeking to share enjoyment, interests, orlack of spontaneous seeking to share enjoyment, interests, or
achievementsachievements
 lack of social or emotional reciprocitylack of social or emotional reciprocity
(B)(B) qualitative impairments in communication:qualitative impairments in communication:
 delay in the development of spoken languagedelay in the development of spoken language
 marked impairment in sustain a conversationmarked impairment in sustain a conversation
 idiosyncratic languageidiosyncratic language
 lack of social imitative playlack of social imitative play

Current Diagnostic Criteria DSM-IV (cont)Current Diagnostic Criteria DSM-IV (cont)
(C) Restricted repetitive and stereotyped patterns(C) Restricted repetitive and stereotyped patterns
of behavior, interests and activities:of behavior, interests and activities:
 stereotyped and restricted patterns of intereststereotyped and restricted patterns of interest
 inflexible nonfunctional routines or ritualsinflexible nonfunctional routines or rituals
 stereotyped and repetitive motor mannerismsstereotyped and repetitive motor mannerisms
 preoccupation with parts of objectspreoccupation with parts of objects
(II) Delays with onset prior to age 3 years:(II) Delays with onset prior to age 3 years:
(III) The disturbance is not better accounted for by Rett's(III) The disturbance is not better accounted for by Rett's
Disorder or Childhood Disintegrative DisorderDisorder or Childhood Disintegrative Disorder

Proposed Diagnostic CriteriaProposed Diagnostic Criteria
(1) Essential features:(1) Essential features:
 Poor development of social intelligence/skillsPoor development of social intelligence/skills
 Lack of social reciprocityLack of social reciprocity
 dysfunctional social aspects of play, verbal communication & non-dysfunctional social aspects of play, verbal communication & non-
verbal communicationverbal communication
 Social awkwardnessSocial awkwardness
 failure to develop peer relationshipsfailure to develop peer relationships
 Poor development of emotional intelligence/skills :Poor development of emotional intelligence/skills :
 Self-centredness with poor self awarenessSelf-centredness with poor self awareness
 lacking empathy (dysfunctional theory of mind)lacking empathy (dysfunctional theory of mind)
 Lack of emotional reciprocityLack of emotional reciprocity
 Poor appreciation of emotional expressionsPoor appreciation of emotional expressions
 Emotional awkwardnessEmotional awkwardness
 Poor emotional aspects of play, verbal communication & non-verbalPoor emotional aspects of play, verbal communication & non-verbal
communicationcommunication

Proposed Diagnostic Criteria (Cont)Proposed Diagnostic Criteria (Cont)
(2) Compensatory Features:(2) Compensatory Features:
 Restricting environmentsRestricting environments
 Restricting general interestRestricting general interest
 Islets of exceptional interestsIslets of exceptional interests
 tendency to keep rigid control over environmenttendency to keep rigid control over environment
 Rigid routines or ritualsRigid routines or rituals
(3) Associated features:(3) Associated features:
 Existential (not stress related) anxietyExistential (not stress related) anxiety
 Pathological habits (dysfunctional routines)Pathological habits (dysfunctional routines)
 Poor development of speechPoor development of speech
 Poor eye to eye contactPoor eye to eye contact
 OCD like symptoms and ritualsOCD like symptoms and rituals
 motor mannerismsmotor mannerisms
 Preoccupations with parts of objectsPreoccupations with parts of objects

(3) Better clinical assessment(3) Better clinical assessment
of autismof autism

(3) Better clinical assessment of Autism(3) Better clinical assessment of Autism
 Autism is primarily a disorder of emotional andAutism is primarily a disorder of emotional and
social development which could be due tosocial development which could be due to
developmental abnormalities in both limbicdevelopmental abnormalities in both limbic
system and neocortex. R-Complex could besystem and neocortex. R-Complex could be
intact or affectedintact or affected
 All affected brain functions could take differentAll affected brain functions could take different
forms:forms:
 lost functions (like in ablation studies)lost functions (like in ablation studies)
 exaggerated functions (irritation or excitation studies)exaggerated functions (irritation or excitation studies)
 partial lost or exaggeratedpartial lost or exaggerated

General assessment of R-complexGeneral assessment of R-complex
1.1. General functioningGeneral functioning
 Deals mainly with objects related dataDeals mainly with objects related data
 Function: survival in physical worldFunction: survival in physical world
 Produce behavioural routinesProduce behavioural routines
2.2. Specific functioningSpecific functioning
 Routines (skills),Routines (skills),
 Habits,Habits,
 Communication,Communication,
 Repetitions (OCD like symptoms)Repetitions (OCD like symptoms)
3.3. Assessment of the subsystemAssessment of the subsystem
 Arousal or motivation assessment can lead to ADHDArousal or motivation assessment can lead to ADHD

Involuntary muscular movementsInvoluntary muscular movements

Development of motor routinesDevelopment of motor routines

R-Complex Specific FunctioningR-Complex Specific Functioning
 Object related Routines: functional motorObject related Routines: functional motor
routinesroutines
 Primitive e.g. rocking, territorial behaviourPrimitive e.g. rocking, territorial behaviour
 Advanced e.g. tidying one’s roomAdvanced e.g. tidying one’s room
 Object-related Habits (Pathological) : notObject-related Habits (Pathological) : not
functional motor routines e.g. picafunctional motor routines e.g. pica
 Object-related Checking (repetitive) behaviour:Object-related Checking (repetitive) behaviour:
e.g.e.g.
 Exaggerated routines (e.g. hoarding)Exaggerated routines (e.g. hoarding)
 Failed to execute routines (repetitive behaviour orFailed to execute routines (repetitive behaviour or
OCD like symptoms)OCD like symptoms)

General assessment of Limbic SystemGeneral assessment of Limbic System
1.1. General functioningGeneral functioning
 deals mainly with emotional (individual-related) datadeals mainly with emotional (individual-related) data
 Function: survival in the physical worldFunction: survival in the physical world as an individualas an individual

Not normally functional in autismNot normally functional in autism
2.2. Specific functioning (emotional routines and habits)Specific functioning (emotional routines and habits)
 PlayPlay
 audio-vocal communicationaudio-vocal communication
 Attachment with othersAttachment with others
 Theory of mindTheory of mind
 ADHD/EADHD/E
 Attachment disordersAttachment disorders

Limbic System Specific functioning:Limbic System Specific functioning:
 New emotional routines: not well developed inNew emotional routines: not well developed in
ASD e.g.ASD e.g.
 Self centerednessSelf centeredness
 Hostile dependence on safe relationsHostile dependence on safe relations
 Increased anger or increased blaming behaviour,Increased anger or increased blaming behaviour,
Dysfunctional empathyDysfunctional empathy
 Pathological emotional habits e.g.Pathological emotional habits e.g.
 deviated sexual interests (paedophilia)deviated sexual interests (paedophilia)
 Dysfunctional emotional communication e.g.Dysfunctional emotional communication e.g.
“one way communication” phenomenon“one way communication” phenomenon
 Existential anxietyExistential anxiety

General assessment of Neocortical systemGeneral assessment of Neocortical system
1.1. General functioning of NeocortexGeneral functioning of Neocortex
 Deals mainly with social (group) dataDeals mainly with social (group) data
 Function: survival in the physical world as anFunction: survival in the physical world as an
individual who is in the same time aindividual who is in the same time a membermember
of a social groupof a social group
2.2. Specific functioningSpecific functioning
 Social Routines (skills)Social Routines (skills)
 Social Habits (pathological)Social Habits (pathological)
 Social CommunicationSocial Communication
 Fantasy disorders (?)Fantasy disorders (?)

Neocortical System Specific functioning:Neocortical System Specific functioning:
 Social routines: how undevelopedSocial routines: how undeveloped
 Failure of functions: social isolation, socialFailure of functions: social isolation, social
awkwardnessawkwardness
 Exaggerated functions: paranoid social attitudesExaggerated functions: paranoid social attitudes
(Nicky Reilly Syndrome)(Nicky Reilly Syndrome)
 Pathological habits:Pathological habits:
 Drug-misuse-to-fit-in syndrome,Drug-misuse-to-fit-in syndrome,
 hoax phone calls,hoax phone calls,
 fire settingfire setting
 Social communication disorderSocial communication disorder
 Poor appreciation of danger (naivety syndrome)Poor appreciation of danger (naivety syndrome)

(4) Better Understanding of(4) Better Understanding of
Aetiology of ASDAetiology of ASD

(4) Better understanding of(4) Better understanding of
aetiology of ASDaetiology of ASD
 No single aetiologyNo single aetiology
 pathway of aetiologiespathway of aetiologies
 Upward connections from R-Complex to LSUpward connections from R-Complex to LS
and/or to neocortexand/or to neocortex
 Downward connection from Neocortex and/orDownward connection from Neocortex and/or
LS to R-complexLS to R-complex
 Each connection can be disturbed byEach connection can be disturbed by
different mechanismsdifferent mechanisms

(4) Better understanding of(4) Better understanding of
aetiology of ASDaetiology of ASD
 Autism is not a one thing: multiple aetiologies.Autism is not a one thing: multiple aetiologies.

(5) Schizophrenia and Autism(5) Schizophrenia and Autism

Similarities:Similarities:
 Schizophrenia > disturbance of processing ofSchizophrenia > disturbance of processing of
social (neocortical system) and emotional (limbicsocial (neocortical system) and emotional (limbic
system) datasystem) data
 Late stages Schizophrenia (deficit syndrome)>Late stages Schizophrenia (deficit syndrome)>
autistic featuresautistic features
Differences:Differences:
 Schizophrenia: acquired, adulthood illness,Schizophrenia: acquired, adulthood illness,
disintegrative (regressive)disintegrative (regressive)
 Autism: developmental, childhood disorder,Autism: developmental, childhood disorder,
progressiveprogressive

 Can autistics develop schizophrenia ?Can autistics develop schizophrenia ?
 Autism is primarily a disorder in NS and LSAutism is primarily a disorder in NS and LS
 Having hallucinations and delusions does notHaving hallucinations and delusions does not
mean Schizophrenia (autism with psychoticmean Schizophrenia (autism with psychotic
symptoms not schizophrenia like Dementiasymptoms not schizophrenia like Dementia
with psychotic symptoms)with psychotic symptoms)
 Autistics can mimic, be paranoid and makeAutistics can mimic, be paranoid and make
erroneous judgments but still not delusionserroneous judgments but still not delusions

 How to treat autistics with psychotic features?How to treat autistics with psychotic features?
 Autistics with psychotic features develop further whileAutistics with psychotic features develop further while
incorporating the psychotic features (delusions ofincorporating the psychotic features (delusions of
grandiosity)grandiosity)
 psychosis becomes part of the foundation of thepsychosis becomes part of the foundation of the
personality > functional psychosispersonality > functional psychosis
 If treated > more disturbanceIf treated > more disturbance
 Only treatment is replacement therapy (not only removalOnly treatment is replacement therapy (not only removal
therapy)therapy)
 Antipsychotic not very effectiveAntipsychotic not very effective
 Behavioural and environmental therapies moreBehavioural and environmental therapies more
effectiveeffective

Triune theory 3333

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Triune theory 3333