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Endophenotypes of autism spectrum disorder

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autism spectrum disorder can be differentiated into separable sub-types or endophenotypes. Here's how

autism spectrum disorder can be differentiated into separable sub-types or endophenotypes. Here's how

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  • 1) Endophenotypes must be reliable and stable traits (reliability and stability).2) Endophenotypes must show evidence of genetic influences (heritability).3) Endophenotypes must be associated with the behavioural trait or disease of interest (phenotypic correlation).4) The association between endophenotype and trait of interest must derive partly from the same genetic source (genetic correlation).5) The association between the endophenotype and the trait of interest must be theoretically meaningful (causality). Gottesman & Gould, 2003 (see attached) developed more specific criteria for endophenotypes for psychopathology: 1. The endophenotype is associated with illness in the population.2. The endophenotype is heritable.3. The endophenotype is primarily state-independent (manifests in an individual whether or not illness is active).4. Within families, endophenotype and illness co-segregate.5. The endophenotype found in affected family members is found in nonaffected family members at a higher rate than in the general population. In terms of genetic influences, all of the above means that:-         Endophenotypes must show evidence of genetic influences (heritability). This doesn’t imply they should be 100% heritable, but there should be evidence that they are at least partly influenced by genes (e.g. based on findings from twin/adoption or family studies).-         The genetic influences on the endophenotype should (partly) overlap with the genetic influences on the condition of interest. In the current study, it is thought that the genetic influences on the (reduced) brain response to happy faces may tell us something about the genetic vulnerability for autism as a clinical condition. Once again, these genetic influences don’t have to have 100% penetrance.-         It is hoped that the endophenotype is a more reliable/stable trait that may be easier to measure than the complex behavioural phenotype of autism (see criteria 1 de Geus). If the endophenotype can be measured more reliably (i.e. less measurement error), and it is a less complex trait, the idea is that the endophenotype may be influenced by less genes, and you would thus increase the power to detect the genes involved. Of course the latter is a hypothesis: It may be that very many genes are involved in the brain response to happy faces. It may also be that this response is not so reliable after all (do we know anything about test-retest reliability of this measure?).-         Mikes important study gives a first clue that ‘response to happy faces’ could be a promising endophenotype for autism. Further studies (including reliability studies, and ideally some twin studies to explore the heritability of the endophenotype) should evaluate whether the measure truly passes the test for a good endophenotype. Of course the true litmus test would be a molecular genetic study using the measure. 
  • Anatomy lesson of Dr. Tulp
  • Jennie Pyers and a colleague
  • Bright-Paul, A., C. Jarrold, et al. (2008). "Theory-of-Mind Development Influences Suggestibility and Source Monitoring. [Article]." Developmental Psychology44(4): 1055-1068. According to the mental-state reasoning model of suggestibility, 2 components of theory of mind mediate reductions in suggestibility across the preschool years. The authors examined whether theory-of-mind performance may be legitimately separated into 2 components and explored the memory processes underlying the associations between theory of mind and suggestibility, independent of verbal ability. Children 3 to 6 years old completed 6 theory-of-mind tasks and a postevent misinformation procedure. Contrary to the model's prediction, a single latent theory-of-mind factor emerged, suggesting a single-component rather than a dual-component conceptualization of theory-of-mind performance. This factor provided statistical justification for computing a single composite theory-of-mind score. Improvements in theory of mind predicted reductions in suggestibility, independent of verbal ability (Study 1, n = 72). Furthermore, once attribution biases were controlled (Study 2, n = 45), there was also a positive relationship between theory of mind and source memory, but not recognition performance. The findings suggest a substantial, and possibly causal, association between theory-of-mind development and resistance to suggestion, driven specifically by improvements in source monitoring., (C) 2008 by the American Psychological Association Bruck, M., K. London, et al. (2007). "Autobiographical memory and suggestibility in children with autism spectrum disorder." Dev.Psychopathol.19(1): 73-95. Two paradigms were developed to examine autobiographical memory (ABM) and suggestibility in children with autism spectrum disorder (ASD). Children with ASD (N = 30) and typically developing chronological age-matched children (N = 38) ranging in age from 5 to 10 years were administered an ABM questionnaire. Children were asked about details of current and past personally experienced events. Children also participated in a staged event, and later were provided with true and false reminders about that event. Later, children again were interviewed about the staged event. The results from both paradigms revealed that children with ASD showed poorer ABM compared to controls. Generally, their ABM was marked by errors of omission rather than by errors of commission, and memory was particularly poor for early-life events. In addition, they were as suggestible as the typically developing children. The results are discussed in terms of applied and theoretical implications
  • Thomas Hobbes the social contract
  • Lev Vygotsky with daughter: inner speech guides action. Inner speech is one way of understanding theory of mind: what a person would say if they were there. May be particularly absent in ADHD
  • Transcript

    • 1. So you can diagnose an autism spectrum disorder. But is that enough? Possible endophenotypes of autism spectrum
      Digby Tantam
    • 2. Proposed DSM-V criteria for ASD
      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 behaviors 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 behavior to suit different social contexts through difficulties in sharing imaginative play and  in making friends  to an apparent absence of interest in people
    • 3. Proposed DSM-V criteria for ASD
      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.     Social-emotional reciprocity (mechanics of social interaction)
      2.     Nonverbal communication
      3.     Developing and maintaining relationships
    • 4. Proposed DSM-V criteria for ASD
      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.     Social-emotional reciprocity (mechanics of social interaction)
      2.     Nonverbal communication
      3.     Developing and maintaining relationships
      Nonverbal impairment
      Deficits in social-emotional reciprocity (‘rules’ of social interaction) 
      Possible impairment in social relationship formation
    • 5. What changes from DSM-IV
      Merging of AS with ASD and disintegrative disorder
      Lamented by Aspies
      Disintegrative disorder is progressive
      Disappearance of Rett syndrome
      Probably heralds separation of syndrome and aetiology, which is welcome
      Possible increase in age criterion
      May raise later confusion with schizophrenia (again)
      Disappearance of the triad
      Lamented by Wing, Gould, and Gillberg(Research Autism paper) because of Falck-Ytter
      who argue that social interaction and
      But still mixing primary impaired in social interaction with its effects in social relationship
      Verbal communication disappears
      Some Aspies think it reduces possible of Autism Spectrum Condition
    • 6. Falck-Ytter at al
    • 7. Scanpaths complex: mouths not always chosen over eyes, other factors e.g. eye aversion, need to disambiguate language
    • 8. Proposed DSM-V criteria for ASD
      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.     Social-emotional reciprocity (mechanics of social interaction)
      2.     Nonverbal communication
      3.     Developing and maintaining relationships
      Nonverbal impairment modulated by anxiety?
      Deficits in social-emotional reciprocity (‘rules’ of social interaction)  modulated by context?
      Possible impairment in social relationship formation
    • 9. Proposed DSM-V criteria for ASD (cont)
      Must meet criteria A, B, C, and D:
       
      B.    1.     Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 
      2.     Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, 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.
    • 10. Proposed DSM-V criteria for ASD (cont)
      Must meet criteria A, B, C, and D:
       
      B.    
      Stereotypies No more common than in ID.
      Link with social isolation. Dopamine mediated. Non-specific?
      Routines, rituals
      OCD, Most common absence in PDD-NOS. Anxiety-related
       Special interests
      Attention, but also with satisfaction, and cognitive phenotype Linked with clumsiness
      Hyper-or hypo-reactivity to sensory input
      Identity ? But may be absent
      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.
    • 11. Major remaining problem
      Heterogeneous syndrome
      Geared to categorical diagnosis (good for services) but not to dimensional approach
      Dimensions, cognitive phenotypes, are more useful for advice and remediation
      Dimensions, endophenotypes, are likely to be more important in genetic studies
    • 12.
    • 13. “Here, we report that quantitative trait analyses of ASD symptoms combined with case-control association analyses using distinct ASD subphenotypes identified on the basis of symptomatic profiles result in the identification of highly significant associations with 18 novel single nucleotide polymorphisms (SNPs). The symptom categories included deficits in language usage, non-verbal communication, social development, and play skills, as well as insistence on sameness or ritualistic behaviors”
      Hu, V. W., Addington, A., & Hyman, A. (2011). Novel autism subtype-dependent genetic variants are revealed by quantitative trait and subphenotype association analyses of published GWAS data. PLoS ONE, 6(4), e19067.
       
    • 14. “We present evidence from our own twin studies, and review relevant literature on autism and autistic-like traits in other groups. We suggest that largely independent genes may operate on social skills/impairments, communication abilities, and RRBIs, requiring a change in molecular-genetic research approaches”.
      Happe, F., & Ronald, A. (2008). The 'Fractionable Autism Triad': A Review of Evidence from Behavioural, Genetic, Cognitive and Neural Research. [Article]. Neuropsychology Review, 18(4), 287-304.
       
    • 15. Gaze following and the interbrain
    • 16. Project Development
    • 17. Tantam, Cordess, HolmesTotal amount of gazing, controls=people with ASBut gaze plus some other happening on the face of another person was different
    • 18. Tantam, D. Characterizing the fundamental social handicap in autism. ActaPaedopsychiatrica, 55, 83-91, 1991
      Gaze reflex 1
      Focus on eyes (but means suppression of agonistic response)
      Gaze reflex 2
      Follow other’s gaze to its destination
    • 19. All tool users that understand words and signs
    • 20.
    • 21. Tantam, D. Characterizing the fundamental social handicap in autism. ActaPaedopsychiatrica, 55, 83-91, 1991
      Gaze reflex 1
      Focus on eyes (but means suppression of agonistic response)
      Gaze reflex 2
      Follow other’s gaze to its destination
      Gaze reflex 3
      Follow direction of other’s gaze back to their eyes to detect their expression
    • 22. Brain regions showing positive change in coupling with the right pSTS (red to yellow) and FG (blue to turquoise) while viewing gaze shifts versus opening/closing the eyes.
      Nummenmaa L et al. Cereb. Cortex 2010;20:1780-1787
      © The Authors 2009. Published by Oxford University Press.
    • 23. CONCLUSIONS: This study provides preliminary evidence of impaired neural connectivity in the corpus callosum/cingulum and temporal lobes involving the inferior longitudinal fasciculus/inferior fronto-occipital fasciculus and superior longitudinal fasciculus in ASDs. These findings provide preliminary support for aberrant neural connectivity between the amygdala, fusiform face area, and superior temporal sulcus-temporal lobe structures critical for normal social perception and cognition.
      Jou, R. J., Jackowski, A. P., Papademetris, X., Rajeevan, N., Staib, L. H., & Volkmar, F. R. (2010). Diffusion tensor imaging in autism spectrum disorders: preliminary evidence of abnormal neural connectivity. Australian And New Zealand Journal Of Psychiatry, 45(2), 153-162
    • 24. Chiu, P. H., Kayali, M. A., Kishida, K. T., Tomlin, D., Klinger, L. G., Klinger, M. R., et al. (2008). Self responses
      along cingulate cortex reveal quantitative neural phenotype for high-functioning autism. Neuron, 57(3), 463-473.
    • 25.
    • 26. “Attributing behavioral outcomes correctly to oneself or to other agents is essential for all productive social exchange. We approach this issue in high-functioning males with autism spectrum disorder (ASD) using two separate fMRI paradigms. First, using a visual imagery task, we extract a basis set for responses along the cingulate cortex of control subjects that reveals an agent-specific eigenvector (self eigenmode) associated with imagining oneself executing a specific motor act. Second, we show that the same self eigenmode arises during one's own decision (the self phase) in an interpersonal exchange game (iterated trust game).
      Third, using this exchange game, we show that ASD males exhibit a severely diminished cingulate self response when playing the game with a human partner. This diminishment covaries parametrically with their behaviorally assessed symptom severity, suggesting its value as an objective endophenotype.
      These findings may provide a quantitative assessment tool for high-functioning ASD.”
      Chiu et al, 2008
    • 27. Gaze reflex 1 and 2 provide training in where to look and facilitate focussed social development
    • 28. People with AS lack gaze reflex 1 or at least look at geometric shapes preferentially (Pierce) do not attribute animation to shapes, do not treat machines as people
    • 29. Schippers, M. B., Roebroeck, A., Renken, R., Nanetti, L., & Keysers, C. (2010). Mapping the information flow from one brain to another during gestural communication. Proceedings of the National Academy of Sciences, -.
    • 30. Learning to look directly at right things (2)
    • 31. Learning to look at the right things
      But this may represent requirement to disambiguate language: mouth looking is more common in some children and some cultures
      Mouth looking may be more common in people with SLI, and not in people with ASD
    • 32.
    • 33. The Wright brothers
      Synchrony
      Armies, churches, organizations, and communities often engage in activities for example, marching, singing, and dancing that lead group members to act in synchrony with each other.….Across three experiments,
      people acting in synchrony with others cooperated more in subsequent group economic exercises, even in situations requiring personal sacrifice. Our results also showed that positive emotions need not be generated for synchrony to foster cooperation. In total, the results suggest that acting in synchrony with others can increase cooperation by strengthening social attachment among group members
      Wiltermuth and Heath, 2009, Psychological Science
    • 34.
    • 35. Mirror neuron studies
    • 36. I am looking at what you are looking at, and we both know that
      Each of us is paying attention to it.
      So we have the same things on our mind:
      Our mental contents are shared
    • 37. How do we know who has high social status?
      Pride
      They attract looks
    • 38. Not something I have to think about, or send a particular
      Message. So unlike speaking: more like just being connected
      ‘The interbrain’
    • 39. An idea whose time has come?
    • 40. Palinkas, LA, Suedfeld, P Psychological effects of polar expeditions. Lancet 2008; 371: 153-63.
    • 41. Who is Jake? Look him up in the brain index: the cache of all the information about experiences with Jake
    • 42. Superior temporal cortex and PFC network in gaze shifting: Nummanmaa et al
       
      Figure 2.
      Brain regions showing positive change in coupling with the right pSTS (red to yellow) and FG (blue to turquoise) while viewing gaze shifts versus opening/closing the eyes. Areas that showed a change in coupling with both FG and pSTS are shown in green. Mean coordinates of the pSTS and FG source regions used in the connectivity analyses are shown as red and blue spheres, respectively. Maps are thresholdedatP < 0.005, unc. for visual inspection, and the color bars denote the Tstatistic range. FEF, frontal eye field; FG, fusiform gyrus; IPS, intraparietal sulcus; MFG, middle frontal gyrus; SMG, supramarginal gyrus; STG, superior temporal gyrus; pSTS, superior temporal sulcus.
    • 43. Looking at the right things
      Inferring things from other’s gaze direction
    • 44. Falling prevalence of ASD in boys and men based on community survey of Sheffield city (pop. 400 000) N=124
    • 45. Falling prevalence of ASD in boys and men based on community survey of Sheffield city (pop. 400 000) N=124
      Secondary peak of fathers?

    • 46. Exposure to social situation? Mimicry? Evidence of drama?
      ABA? Esp gaze direction
      Teach people to look
      Teach people to control odd behaviour
    • 47. Dealing with anxiety
      Dealing with transitions
      Social value of special interests
    • 48. Stereotypies are an indication of intellectual disability, as is the poverty or complexity of interests
    • 49. Endophenotypes within non-verbal impairment
      With dyspraxia (is this the nonverbal element?)
      VIQ>PIQ
      ‘Typical’ Asperger syndrome
      More ‘temporal’
      With impaired narrative ability and possibly other SLI (is this the social interaction element)
      PIQ>VIQ
      ‘Atypical AS’ or PDD-NOS
      More ‘frontal’
      Association with ADHD
    • 50. Typical Asperger syndrome: NV expressive impairment
      Unusual manner, gives immediate impression of idiosyncrasy due to impaired nonverbal expressiveness
      Makes contact on own terms
      May discuss unusual or particular interests
      Problems with unexpected or unclear situations
      19/08/2011
    • 51.
    • 52. Atttention direction
    • 53. Associations with ‘typical’ ASD
      Clumsiness
      Topographical disorientation
      Unusual deployment of attention on environment: seeing the trees, not the word
      Sociolinguistic impairment: concrete language, failure to understand some humour (puns OK)
      Catastrophic reaction to social demand, e.g. conflict, loud noise, change
      Problems in making friends
    • 54. Treatment methods for typical ASD
      ABA and other methods of capturing engagement may work in children
      Remedial gymnastics has effect on social difficulties?
      Mimicry (but not imitation) e.g drama therapy
    • 55. Atypical Asperger syndrome: a new clinical syndrome and linked to impaired social interaction?
      Primary abnormality is impaired social interpretation
      May be conspicuous lack of a theory of mind
      Lack of internal narrative
      Ability to make relationships but not to keep them
      May be behavioural problems (‘pathological demand avoidance’)
      Lack of persuasiveness and ‘social influencing power’
    • 56. The language of the eyes
      Who is being shot?
      Terrorists or partisans?
    • 57. Empathy disorders
      Psychopathy in which there may be:
      An impairment of response to threat expressions
      A turning off of normal empathic responsiveness
      Autistic spectrum disorders
      An impairment in the response to all nonverbal expression, with a consequent reduction in emotional responsiveness
    • 58.
    • 59. Cognitive and affective empathy
      Fifty-two boys (25 aggressive and 27 non-aggressive) were compared for levels of aggression and for cognitive and affective empathy as expressed during a group interview involving bibliotherapy.
      Aggressive boys showed half the level of affective empathy as non-aggressive boys, although the groups did not differ in cognitive empathy
      Study of cognitive and affective empathy in aggressive boys(Schechtman, Z. (2002) Cognitive and affective empathy in aggressive boys: implications for counselling. International Journal for the Advancement of Counselling, 24, 211-.
      Although both groups can appear uncaring, our findings suggest that the affective/information processing correlates of psychopathic tendencies and ASD are quite different. Psychopathic tendencies are associated with difficulties in resonating with other people’s distress, whereas ASD is characterised by difficulties in knowing what other people think
      JONES, A. P., HAPPÉ, F. G. E., GILBERT, F., BURNETT, S. & VIDING, E. 2010. Feeling, caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder. Journal of Child Psychology and Psychiatry, 51, 1188-1197
      4 July 07
      10th. European Congress of Psychology
    • 60. Aggression and empathy
      Increased perspective taking reduces aggression
      (Richardson et al, 1994,Empathy as a cognitive inhibitor of interpersonal aggression. Aggressive Behaviour, 20, 276-289)
      Secondary inhibition (Feshbach and Feshbach, 1969) results from seeing the fear (Blair) or disgust (Nichol) in the other and acts to mitigate aggression
      (de Paul et al, 2006, Aggression inhibition in high- and low-risk subjects for child physical abuse: effects of a child’s hostile intent and the presence of mitigating information, Aggressive Behaviour, 32, 216-230
      Actress Janet Leigh from the shower scene in Hitchcock's Psycho
    • 61. Narrative coherence
      Inability to hold up against persuasion:
      A lack of an internal narrative “I could have done that”
      Acceptance of strongest narrative, or authority’s narrative, of most recently repeated narrative
      Link with theory of mind
      Bright-Paul, A., C. Jarrold, et al. (2008).
      Autobiographical memory
      Bruck, M., K. London, et al. (2007)
      www.existentialacademy.com
      61
    • 62. Coping with a lack of identity
      Fads
      ‘Obsessive’ relationships
      Lack of identity in many people with ASD
      Adopting identity wholesale
      Joining charismatic groups
      Moving places and work
      Searching for identity
      ‘Transexualism’
      ‘Aspie’
      Identities off the peg
      Gangster
      Professor
      Teddy bear
      2 Nov 2010
      Seeing the light – or ticking the box?
    • 63. Other endophenotypes that may be more common in atypical ASD
      Dyslexia
      Speech and language impairment, with reduced understanding of speech
      Dysexecutive syndrome
      The consequence of ADHD?
    • 64. Dysexecutive syndrome
      bb
    • 65. Dysexecutive syndrome
    • 66. Treating dysexecutive syndrome
      Self-care
      Mentoring
      Methylphenidate
      Diaries/ organizers
    • 67. A particularly wide ranging tool kit
      Readiness to consider the most intense emotional issues and in the next moment, the most practical and cognitive ones
      Having a clear grasp of the individual in front of you, not just in life experience, or temperament, but in cognitive abilities
      Be aware of shame and shaming
      The limitless potential of social control by shaming
      Seeing the light – or ticking the box?
    • 68. Contributors
      Sheffield survey
      Myles Balfe
      Ting Chen
      Mike Campbell
      submitted to Autism
      Bullying project
      Paul Naylor
      Jenny Wainscot
      Jenna Williams
      15 medical students
      International Journal of Psychology
      Parents, teachers, and people with Asperger syndrome
      Sheffield Asperger Parents Action Group
      Seeing the light – or ticking the box?
    • 69. Consequences of bullying
      Passive failure to be included
      Reduced use of community resources (social exclusion)
      Experience of being unwanted/marginalized
      Active rejection , blaming, scapegoating
      Stigma as a means of keeping threatening Other at a distance
      Bullying
      Painted Bird by Edward Gafford, inspired by the novel ‘Painted Bird’ by JerzyKosiński, itself based on what has been claimed is a fictive war-time experience of the author in Poland
    • 70. Does social exclusion lead to functional movement impairment
      Is there a difference in the amount of physical activity of pupils with AS compared to others?
      Mean number of steps per hour: AS group = 902, control group = 1312 (t= -2.645, p = .027)
      Seeing the light – or ticking the box?
    • 71. Where were people with AS in Sheffield?
      Most living at home, even above 30.
      Most had difficulties coping with changes in everyday environments
      Difficulties moving between places (for example using public transport)
      Most common places frequented were libraries and cinemas
      Seeing the light – or ticking the box?
    • 72. Bullied pupils and those with SEN report feeling unhappier and have less commitment to school than pupils who are not bullied and have no SEN.
      For pupils with SEN or no identified SEN, the risk of being bullied declines by approximately 9 per cent each chronological year.
      Pupils bullied in Year 9 (13-14-year-olds) are much more likely to drop out of school at Year 11 (15-16-year-olds) than those who were not bullied. This trend is even more pronounced for pupils with SEN.
      Prevalence of bullying in secondary school by SEN type: Analysis of combined NPD and LSYPE data files. Naylor, P., Dawson, J., Emerson, E., and Tantam, D. (2011) N=15 770 13-14 year olds in mainstream school
    • 73. Factors that might influence empathy suppression by people with AS
      Lack of emotional empathy
      Neurotypicals are united, and do not deserve empathy
      Uproar
      Lack of a shared social contract: ‘dissociation’
      Lack of social influencing power
      Seeing the light – or ticking the box?
    • 74. Abuse
      How many people with ASD have been abused?
      Difficult to establish but possibly a significant no.
      Suspicion should be raised by deterioration in behaviour, sexual disinhibition, regression
      Interviewing may be unreliable as people with ASD may not have a clear cut conception of abuse or even of sexually inappropriate behaviour
      People with ASD may feel that sexual favours are a fair exchange for social contact
      Need institutional policies for monitoring
      Friday, 19 August 2011
      Lunch-time meeting, Brandon Unit, Leicester
    • 75. Relationships
      Not being attractive (more often in heterosexual men)
      Being empathic
      Being too compliant (more often in women or some homosexual men)
      Not being able to sustain relationship
      Knowing what someone wants without them saying
      Anxiety about failing in relationships
      May find images or masturbation more attractive than actual people
      Unreciprocated attraction
      Stalking
      Sexual threatening behaviour
      Inappropriate sexual touching
      May flip into aggression towards sexually attractive others
      Abusive/ inappropriate/intimidating relationships
      Coercive sexuality
      Friday, 19 August 2011
      Lunch-time meeting, Brandon Unit, Leicester
    • 76. Medication for psychiatric disorder
      Changing circumstances esp power and influence
      Post aggression feedback
      Identification of mounting tension
      Prevention of reinforcement
    • 77. Dealing with lack of empathy
      Prevention of exploitation
      Modelling
      Empathy training?
    • 78. Telling the truth vs. knowing the truth
      Narrative
    • 79. Medicolegal problems
      Out of sight out of mind
      Modifications to counselling
      ‘Alexithymia’
    • 80. Emotional problems in adolescents and adults with Asperger syndrome(findings from Sheffield survey)
      Self-harm: thoughts 50%, actual 11%
      Violence: threats 83%, actual 34%
      Bullied 90%, 30% currently (includes adults)
      Majority have anxiety-related disorder
    • 81. Empathy disorders
      Psychopathy in which there may be:
      An impairment of response to threat expressions
      A turning off of normal empathic responsiveness
      Autistic spectrum disorders
      An impairment in the response to all nonverbal expression, with a consequent reduction in emotional responsiveness
      4 July 07
      10th. European Congress of Psychology
    • 82. FromAutism spectrum disorders: a life-span perspectiveJessica Kingsley2011
    • 83. Aggression and empathy
      Increased perspective taking reduces aggression
      (Richardson et al, 1994,Empathy as a cognitive inhibitor of interpersonal aggression. Aggressive Behaviour, 20, 276-289)
      Secondary inhibition (Feshbach and Feshbach, 1969) results from seeing the fear (Blair) or disgust (Nichol) in the other and acts to mitigate aggression
      (de Paul et al, 2006, Aggression inhibition in high- and low-risk subjects for child physical abuse: effects of a child’s hostile intent and the presence of mitigating information, Aggressive Behaviour, 32, 216-230
      Actress Janet Leigh from the shower scene in Hitchcock's Psycho
    • 84. Cognitive and affective empathy
      Fifty-two boys (25 aggressive and 27 non-aggressive) were compared for levels of aggression and for cognitive and affective empathy as expressed during a group interview involving bibliotherapy.
      Aggressive boys showed half the level of affective empathy as non-aggressive boys, although the groups did not differ in cognitive empathy
      Study of cognitive and affective empathy in aggressive boys(Schechtman, Z. (2002) Cognitive and affective empathy in aggressive boys: implications for counselling. International Journal for the Advancement of Counselling, 24, 211-.
      Although both groups can appear uncaring, our findings suggest that the affective/information processing correlates of psychopathic tendencies and ASD are quite different. Psychopathic tendencies are associated with difficulties in resonating with other people’s distress, whereas ASD is characterised by difficulties in knowing what other people think
      JONES, A. P., HAPPÉ, F. G. E., GILBERT, F., BURNETT, S. & VIDING, E. 2010. Feeling, caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder. Journal of Child Psychology and Psychiatry, 51, 1188-1197
    • 85. Does empathy lead to violence, either through an increase in aggression or a reduction in violence inhibition?
      Correlational studies link low empathy and increased aggression
      Empathy ‘mitigates aggression’ (Bjorkqvist, Osterman, & Kaukiainen, 2000)
      But aggressive two year-olds may actually show more empathy than non-aggressive two years olds (Gill & Calkins, 2003)
      Distinction between affective and cognitive empathy?
      4 July 07
      10th. European Congress of Psychology
    • 86. Reported prevalence of psychiatric disorder in older adolescents and adults
    • 87. Indicators of violent reoffending: the new OASys Violence PredictorPhilip Howard, Senior Research OfficerJackie Seaton, Senior Probation OfficeOffender Assessment and Management UnitNOMS, Ministry of Justice for England and Wales
      Sections 1-12
      1: offending information [criminal history]
      2: [current] offence analysis
      3: accommodation
      4: education, training and employability
      5: financial management and income
      6: relationships
      7: lifestyle and associates
      8: drug misuse
      9: alcohol misuse
    • 88. Friday, 19 August 2011
      Lunch-time meeting, Brandon Unit, Leicester
      What motivates aggression in AS?
      Doing the right thing
      Being accepted, perhaps in a deviant group
      Utilization behaviour
      Effort at communication
      Catastrophic reaction
      Asserting dominance
      Modelling
      Tension relief
      Hypomania, depression
      "This is my son” 4 year old artist from Art Gallery on OASIS home page
    • 89. Reported prevalence of psychiatric disorder in older adolescents and adults
    • 90. Psychological disorders associated with AS(many of these disorders probably greater in more able group)
      2 ‘Attachment disorder’ (disorganized in ADHD)
      7 Polymorphous anxiety: encopresis, checking, sleep disturbance, ‘shyness’
      11-13 Surge of anxiety-related problems including OCD, dysmorphophobia, panic disorder
      16-18 Secondary depression, social phobia
      >16
      Progressive social withdrawal often attributed to schizophrenia
      Late adolescence bipolar disorder
      Brief ‘cycloid’ psychoses
      Non-psychotic hallucinoses
      >18 ‘Catatonia’
      >25 Paranoid states
      >35 Social withdrawal, isolation, relationship disrepair
    • 91. Treating anxiety disorder
      Recognition
      SSRIs
      Counselling (no particular advantage to CBT)
      Prevention
    • 92. Friday, 19 August 2011
      Lunch-time meeting, Brandon Unit, Leicester
      Grief
      May be absent or delayed
      May be more for places or times than people
      Grieving over lost childhood is common
      Reflected in interests
      In wanting to be with younger people
      Ruminations
      Ruminations also serve to put past right
      Lack of emotional as opposed to cognitive coping
    • 93. Owen Thor Walker
      Home schooled from aged 13 because of bullying, provided code to cyber crime syndicate that took £10.3M from private bank accounts (he got £15,500 in payment for botnet code).
      New Zealand judge did not impose a custodial sentence because of the effect on his career, but fined him £5000.
      Subsequently hired by TelstraClear, a telecomms company, to act as security consultant
    • 94. Further information
      Due out 2011
    • 95.
    • 96. That’s as far as we go, folks
      So, thanks for listening

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