Ciccarelli, O., Catani, M., Johansen-Berg, H., Clark, C., & Thompson, A. (2008).Diffusion-based tractography in neurological disorders: concepts, applications, andfuture developments. [doi: DOI: 10.1016/S1474-4422(08)70163-7]. The LancetNeurology, 7(8), 715-727. Sahyoun, C. P., Belliveau, J. W., & Mody, M. (2010). White matter integrity and pictorial reasoning in high-functioning children with autism. Brain And Cognition, 73(3), 180-188.
Autism spectrum disorder, DSM5 criteriaA. Persistent deficits in social B. Restricted, repetitive patterns ofcommunication and social interaction behavior, interests, or activities asacross contexts, not accounted for manifested by at least two of theby general developmental delays, and following:manifest by all 3 of the following: 1. Deficits in social-emotional 1. Stereotypies reciprocity 2. Routines and rituals 2. Deficits in nonverbal communicative behaviors used 3. Special interests for social interaction 4. Hyper-or hypo-reactivity to 3. Deficits in developing and sensory input or unusual maintaining relationships, interest in sensory aspects appropriate to developmental level (beyond those with of environment caregivers)
Autistic syndrome Restricted repetitiveness (DSM-5) Impaired social communication and social interaction (DSM-5)Enter the other’s world, butdo not expect intersubjectivityBe aware of the importance of the past and look forcommemorative activitiesProvide predictability (may achieve this throughbehavioural means e.g. ABC approach)Be aware that anxiety—and frustration– may not beexpressedDo not assume that a lack of social interaction is a Language impairmentlack of interestValue peer support 22 RSM
Autistic syndrome Restricted repetitiveness (DSM-5) Impaired social communication and social interaction (DSM-5)Consider sameness to be a means of achieving comfort throughpredictabilityAn increase in repetition may indicate anxietyAn appropriate balance must be struck about how much comfort isappropriateRituals may be commemorative and acts of iImaginativereconstruction that are open to involvement and modification by kindlyothersSpecial interests provide quality of lifeOCD and hoarding involve an additional element of folie de doute, orwarding offRituals may come to be weapons Language impairment 22 RSM
Autistic syndrome Restricted repetitiveness (DSM-5) Impaired social communication and social interaction (DSM-5)Language, verbal IQ, and intellectual disability are correlatedAlternative means of communication may be usefulPeople with ID may develop simplifying concepts that can beeffective tools e.g. the open and closed faceWritten language may sometimes be more comprehensibleProcessing may take longer, but get there in the endApparent verbal fluency may be deceptive: it’s understanding notlanguage that mattersPsychotherapy may be a matter of connecting the dots… Language impairment 22 RSM
Associated conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5)Learning from the EE literature ADHDUnderstanding impersistenceCueing attention Tourette, dyspraxia, agnosiasDysexecutive Autistic syndromeHow does Dad handle it? Intellectual disability Language impairment 22 RSM
Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, Meltdowns are catastrophic reactions. ADHD Information overload, melt downs They can only be prevented when tension Is at an early stage but may then be unrecognizable unless individualAnxiety-related disorder prodrome is known Tourette, dyspraxia, Victimization A sensory assessment may be helpful, agnosias Include but should information demands Marginalization Intellectual disability Language impairment The search for the self22 RSM
Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5)Sensory issues, The risk of a person with an ASD being bullied is ADHDInformation overload, 7 times greater relative to the risk of a neurotypicalmelt downs child of the same ageAnxiety-related disorder Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self22 RSM
Consequences of bullying• Passive failure to be included • Reduced use of community resources (social exclusion) • Experience of being unwanted/marginalized• Active rejection , blaming, scapegoating Painted Bird by Edward • Stigma as a means of Gafford, inspired by the keeping threatening novel ‘Painted Bird’ by Jerzy Kosiński, itself Other at a distance based on what has been • Bullying claimed is a fictive war- time experience of the author in Poland
• 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 theThe limitless potential of socialcontrol by shaming individual in front of you, not just in life experience, or temperament, but in cognitive abilities • Be aware of shame and shamingSeeing the light – or
• Bullied pupils and thosePrevalence of bullying in secondary school by SEN type: Analysis of combined NPDand LSYPE data files. Naylor, P., Dawson, J., Emerson, E., and Tantam, D. (2011) with SEN report feelingN=15 770 13-14 year olds in mainstream school 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.
Does social exclusion lead to functionalmovement 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?
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?
Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5)Sensory issues, ADHDInformation overload,melt downs Making an impact:uproar, aggression, weaponizingAnxiety-related disorder Containing the risk so that non-reinforcement is Tourette, dyspraxia, possible agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self22 RSM
Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5)Sensory issues, ADHDInformation overload,melt downs Identity borrowings Anxiety-related disorder Providing a healthy identity Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self22 RSM
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 22
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
Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5)Sensory issues, ADHDInformation overload,melt downsAnxiety-related disorder Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self22 RSM
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 Tuesday, 16 Lunch-time meeting, October 12 Brandon Unit, Leicester
Disorder Hutton et My Balfe Hofvander Weighted al N=135 clinic et al et al mean % sample N=78 N=122 N=490 ADHD 43 43.0 Anxiety 16 42 47 50 39.4 Panic disorder 30 38.5 Depression 25 30 65 32.6 Obsessive-‐compulsive disorder 4 14 9.0Reportedprevalence of Substance misuse 4 16 4.7psychiatric Somatoform disorder 41 5 4.6disorder inolder Bipolar disorder 1 3.2 8 3.3adolescents Brief psychosis 3.4 2 2.3and adults Schizophrenia 3 3 2.2 EaJng disorder 5 0.7 Catatonia 1 0.6 Delusional disorder 1 0.2
Psychosis: illness features• Positive symptoms" • Hallucinations" • Disorganized thinking" • Delusions" • Movement disorder"• Negative symptoms in schizophrenia" • Decline in social and occupational functioning " • Reduction of nonverbal expression (‘ﬂattening of affect’)" • Partial mutism (poverty of speech)"
Ratio of improved trying this treatment (% ofType of medication to no effect or worse sample) Miscellaneous GI medication 4.00 10 (2%) Miscellaneous herbal medication 3.33 13 (2.7%) Atypical antipsychotics 2.08 80 (16.7%) Anxiolytics 2.00 12 (2.5%) Stimulants 1.80 172 (35.9%) Mood stabilizers 1.80 70 (14.6%) Chelation 1.60 32 (6.7%) GF and/or CF dietb 1.52 155 (32.4%) Antidepressants 1.31 136 (28.4%) Other dietc 1.19 54 (11.3%) Miscellaneous other medication 1.17 13 (2.7%)
What are the real drug effects?• Reducing severe depression: Antidepressants• Reducing positive symptoms: • Antipsychotics• Reducing anxiety • ?SSRIs• Reducing over-activity and increasing response control: • Stimulants• Reducing mood fluctuations• Lithium and anticonvulsants
Ratio of improved to Number of children trying thisType of intervention no effect or worse treatment (% of sample) Applied behavior analysis (ABA) 3.76 225 (47.0%) Social skills training 3.05 244 (50.9%) Picture exchange system (PECS) 2.88 231 (48.2%) TEACCH 2.86 88 (18.4%) Positive behavioral support 2.82 233 (48.6%) Sensory Integration 2.79 255 (53.2%) Occupational therapy 2.77 361 (75.4%) Physical therapy 2.68 146 (30.5%) Speech therapy 2.53 403 (84.1%) Early intervention services 2.39 331 (69.1%) Social stories 2.33 197 (41.1%)
Psychological treatments• Some specific anxiety reduction with cognitive methods• Some specific improvement of mood with behavioural activation• Otherwise there is no difference in modalities except• Flavour and values• Main outcome determinant is focus
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