Mc master july 2012

528 views

Published on

DSM5 focusses more on nonverbal communication in autism spectrum disorder diagnosis, but does not specify what it is about nonverbal communication that is affected. In this presentation, I explain the reflexive nature of nonverbal communication, and why I call this the 'interbrain'. I also provide another explanation for dysempathy in ASD: the inability to recall empathic feelings

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
528
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Mc master july 2012

  1. 1. What are the "Persistent deficits in social communicationand social interaction" that constitutes the first requiredcriterion for a DSM-5 diagnosis of Autism SpectrumDisorder? Digby Tantam, Universities of Sheffield and Cambridge, UK; Septimus Ltd.
  2. 2. •  Assume a difference of reflective and reflexive nonverbal communication (NVC)•  Argue that reflexive NVC is not messaging, but interlinking—’the interbrain’•  The interbrain has low bandwidth in ASD•  Empathy impairment is a mix of reduced interbrain connection and narrative about intentions (‘theory of mind’)•  A different kind of dysempathy results from a lack of empathy recall•  The solitary brain has its advantages
  3. 3. ReflectiveNVC Reflexive NVC
  4. 4. The relationship of social communication disorder and ASDSocial communication Autism spectrum disorderdisorderA. Persistent difficulties in pragmatics or A. Persistent deficits in socialthe social uses of verbal and nonverbal communication and social interactioncommunication in naturalistic contexts, across contexts, not accounted for bywhich affects the development of social general developmental delays, andreciprocity and social relationships that manifest by all 3 of the following:cannot be explained by low abilities in 1.  Deficits in social-emotionalthe domains of word structure and reciprocitygrammar or general cognitive ability. 2.  Deficits in nonverbal communicative behaviors B. Persistent difficulties in the acquisition and used for social interaction use of spoken language, written language, and other modalities of language (e.g., sign language) 3.  Deficits in developing and for narrative, expository and conversational maintaining relationships, discourse. Symptoms may affect comprehension, production, and awareness at a discourse level appropriate to developmental individually or in any combination that are likely to level (beyond those with endure into adolescence and adulthood, although caregivers) the symptoms, domains, and modalities involved may shift with age.
  5. 5. 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)
  6. 6. Autism spectrum disorder, DSM5 criteriaA. Persistent deficits in socialcommunication and social interactionacross contexts, not accounted forby general developmental delays, andmanifest by all 3 of the following: 1.  Deficits in social-emotional Ranging from: reciprocity poorly integrated- verbal and 2.  Deficits in nonverbal nonverbal communication, communicative behaviors used through abnormalities in eye for social interaction contact and body-language, or deficits in understanding and use 3.  Deficits in developing and of nonverbal communication, maintaining relationships, to total lack of facial expression appropriate to developmental or gestures. level (beyond those with caregivers)
  7. 7. •  What would it mean to have: “Deficits in nonverbal communicative behaviors used for social interaction”
  8. 8. Tantam,Cordess,HolmesNo difference inbetween ASDandneurotypicals intotal otherdirected gaze,but difference intiming.
  9. 9. Tantam, D. Characterizing the fundamental social handicap inautism. Acta Paedopsychiatrica, 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 back to the face of the person looking)
  10. 10. Animals that gaininformation fromconspecifics gazedirection
  11. 11. 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.
  12. 12. Shannon Neeley, E., Bigler, E. D., Krasny, L., Ozonoff, S., McMahon, W.,& Lainhart, J. E. (2007). Quantitative temporal lobe differences: Autismdistinguished from controls using classification and regression treeanalysis. Brain and development, 29(7), 389-399.
  13. 13. Atttention direction
  14. 14. Fig. Castelli F et al. Brain 2002;125:1839-1849©2002 by Oxford University Press
  15. 15. Perlman, S. B., Hudac, C. M., Pegors, T., Minshew, N. J., & Pelphrey, K. A. (2011). Experimentalmanipulation of face-evoked activity in the fusiform gyrus of individuals with autism. SocNeurosci, 6(1), 22-30.
  16. 16. Tantam, D. Characterizing the fundamental social handicap inautism. Acta Paedopsychiatrica, 55, 83-91, 1991: what I didn’t say•  Gaze reflex 1 •  Focus on eyes (but means suppression of agonistic response) Happens in ASD, but does not•  Gaze reflex 2 linger, and does •  Follow other’s gaze to its destination not seem to develop e.g. to•  Gaze reflex 3 determine who is friendly to whom •  Follow direction of other’s gaze back to their eyes to detect their expression
  17. 17. Gaze following andthe interbrain
  18. 18. The language of the eyes Who is being shot? Terrorists or partisans?
  19. 19. Schurmann M, Hesse MD, Stephan KE, Saarela M, Zilles K, Hari R, et al. Yearning to yawn: the neural basis of contagious yawning. Neuroimage. [doi: DOI: 10.1016/j.neuroimage.2004.10.022]. 2005;24(4):1260-4.
  20. 20. The Wright brothers SynchronyArmies, churches, organizations, and communities often engage in activities forexample, marching, singing, and dancing that lead group members to act insynchrony with each other.….Across three experiments,people acting in synchrony with others cooperated more in subsequent groupeconomic exercises, even in situations requiring personal sacrifice. Our results alsoshowed that positive emotions need not be generated for synchrony to fostercooperation. In total, the results suggest that acting in synchrony with others canincrease cooperation by strengthening social attachment among group membersWiltermuth and Heath, 2009, Psychological Science
  21. 21. Fan, Y.-T., Decety, J,Yang, C-, Liu, J-L, 1 Cheng, Y. (2010). Unbroken mirrorneurons in autism spectrum disorders. Journal of Child Psychology and Psychiatry , doi:10.1111/j.1469-7610.2010.02269.x.
  22. 22. Rapid mirroring responses to black and whitephotos of emotional facial expressions (Beall et al,2008)Neurotypical EMG Children (7-12) with ASD
  23. 23. Cheng, Y., Chou, K. H., Fan, Y. T., & Lin, C. P. (2011). ANS: Aberrant Neurodevelopm ent of the Social Cognition Network in Adolescents with Autism Spectrum Disorders. PLoS ONE, 6(4).Decety suggestsinferior parietallobule confers‘Agency’
  24. 24. What would having no NVC be like?An analogic not digital problem
  25. 25. A lack of connectedness, orintersubjectivity•  Of shared attention (via the gaze reflexes)•  Of shared emotion (via contagion)
  26. 26. Schippers, M. B., Roebroeck, A.,Renken, R., Nanetti, L., & Keysers, C.(2010). Mapping the information flowfrom one brain to another duringgestural communication. Proceedingsof the National Academy of Sciences,-
  27. 27. How do we know who has high social status?pride
  28. 28. 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.
  29. 29. Alter Ego
  30. 30. The interbrain¡  Extended cognition¡  Automatic processing Jerry Ryan, 7 of 9 StarTrek¡  Reflexive vs. reflective processing¡  ‘The borg’ Neurotypical Aspie Brookdale care
  31. 31. •  Neurons are linked by electrical impulses and chemicals into a network•  Our brains can be linked to other brains the way that one computer can be linked to another via the internet•  These links are the nonverbal communications that pass between us, principally consisting of imitation and of gaze following•  Imitation and gaze following are automatically initiated by local brain networks apparently specialized for this
  32. 32. From Hegelian aesthetics to empathySeeing feeling What’s thein nature and difference?therefore The eyeshumanity,‘empathizing’ The movement
  33. 33. An ideawhosetime hascome?
  34. 34. Three kinds of empathy•  Affective (the brain’s empathy)•  Cognitive (the mind’s empathy)•  ??
  35. 35. The orbitofrontal cortex as cache? fNIRS evidenceBrink, T. T., Urton, K., Held, D., Kirilina, E., Hofmann, M. J., Klann-Delius, G., et al. (2011). The role oforbitofrontal cortex in processing empathy stories in 4- to 8-year-old children. Front Psychol, 2, 80. Negative affective empathy Positive affective empathy Logical cognitive empathy Non- logical cognitive empathy
  36. 36. Two kinds of empathy: fNIRS evidenceBrink, T. T., Urton, K., Held, D., Kirilina, E., Hofmann, M. J., Klann-Delius, G., et al. (2011). The role oforbitofrontal cortex in processing empathy stories in 4- to 8-year-old children. Front Psychol, 2, 80. Similar picture for auditory stimuli
  37. 37. All tool users thatunderstand wordsand signsand have atheory of mind
  38. 38. Narrative impairment•  Narrative• 
  39. 39. Chiu, P. H., Kayali, M. A., Kishida, K. T., Tomlin, D., Klinger, L. G., Klinger, M. R., etal. (2008). Self responses along cingulate cortex reveal quantitative neuralphenotype for high-functioning autism. Neuron, 57(3), 463-473.
  40. 40. NarrativeContagious emotion (STS/ DLPFC) Emotional dispositions/ cingulate Agency Fight/ care- (temporoparietal taking ? junction) amygdala
  41. 41. What if one is alone? Are people with ASD andneurotypicals the same then?
  42. 42. Palinkas, LA, Suedfeld, PPsychological effects of polarexpeditions. Lancet 2008; 371:153-63.
  43. 43. Atypical Asperger syndrome: a new clinical syndrome and linked to impaired social interaction?•  Primary abnormality is lack of empathy•  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’•  Strong overlap with ADHD and executive dysfunction•  And other associations of ADHD, including disorders of speech processing and of working memory
  44. 44. Three kinds of empathy•  Affective (the brain’s empathy)•  Cognitive (the mind’s empathy)•  Empathy recall
  45. 45. Empathy disorders•  Psychopathy in which there may be: •  An impairment of response to threat expressions •  A turning off of normal empathic responsiveness•  Typical autism spectrum disorder (ASD) •  An impairment in the response to all nonverbal expression, with a consequent reduction in emotional responsiveness and accuracy •  (secondarily) lack of fellow feeling for others•  Atypical ASD •  An inability to anticipate other’s emotional response •  Impaired response to other’s emotions
  46. 46. Location and overlap of brain lesions according to emotional versus cognitive empathy impairment-groups. Right Left Shamay-Tsoory S G et al. Brain 2009;132:617-627© The Author (2008). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
  47. 47. Narrative impairment affects Sally- Ann capacity and autobiography equally. Involves language and rhetoric i.e. emotion•  Narrative• 
  48. 48. Social communication disorder: where PDD-NOS is to be found?A.  Persistent difficulties in pragmatics or the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social reciprocity and social relationships that cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability.B. Persistent difficulties in the acquisition and use of spoken language, written language, and other modalities of language (e.g., sign language) for narrative, expository and conversational discourse. Symptoms may affect comprehension, production, and awareness at a discourse level individually or in any combination that are likely to endure into adolescence and adulthood, although the symptoms, domains, and modalities involved may shift with age.
  49. 49. •  Other people’s accounts (ToM) in DL PFC•  Other people’s looks in OFC=cache •  Experience of dead partner or spouse or God seeing what one does
  50. 50. Who is Jake? Look him up in thebrain index: the cache of all theinformation about experiences withJake
  51. 51. The role of the orbitofrontal cortex•  Accesses narrative•  Rhinencephalic ‘emotional flavour’ and intuitive judgements via insula?•  The memory of that Look in neurotypicals•  Absent in atypical AS?
  52. 52. The Look, or what determines how highly Iam regarded“…let us imagine that movedby jealousy, curiosity, or vice Ihave just glued my ear to thedoor and looked through thekeyhole….But all of a sudden Ihear footsteps in the hall.Someone is looking at me… Ishudder as a wave of shamesweeps over me”(Sartre, Being andNothingness pp260-277).
  53. 53. Nodes on networks considered:•  Superior temporal sulcus•  Inferior parietal lobule•  Dorsolateral PFC•  Orbitofrontal cortex•  Insula•  Cingulate: anterior (difficult to distinguish from orbitofrontal PFC) and possibly posterior•  Not cerebellum
  54. 54. Further information Due out 2011
  55. 55. Further information
  56. 56. "How the mighty have fallen! The weaponsof war have perished!"
  57. 57. Schadenfreude: envy and gloating not recognized bypeople with an ASD Shamay-Tsoory, S. G. (2007). Recognition of Fortune of Others Emotions in Asperger Syndrome and High Functioning Autism. J Autism Dev Disord.
  58. 58. A keen sense of justice
  59. 59. Owen Thor WalkerHome schooled from aged 13 becauseof bullying, provided code to cybercrime syndicate that took £10.3M fromprivate bank accounts (he got £15,500in payment for botnet code).New Zealand judge did not impose acustodial sentence because of theeffect on his career, but fined him£5000.Subsequently hired by TelstraClear, atelecomms company, to act as securityconsultant
  60. 60. Many people accept that ‘systemizing’ is of value, andthat people with an ASD are good at it. Perhaps theyare more than usually successful:•  Computer programmers•  Mathematicians (perhaps Newton was one)•  Physicists (perhaps Einstein)•  Engineers•  Philosophers (perhaps Wittgenstein is an example)
  61. 61. Is Asperger syndrome the future for communication, too? Bram Cohen, founder BitTorrent, and self diagnosed Professor Aspie Temple Grandin Derek Paravicini

×