Autism Historical Perspectives Lecture 2008

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  • One reason for reduced activation might be weak connectivity between the relevant areas. While visual-spatial processing of stimuli is normal, as reflected in normal activation of extra-striate regions, the further processing of this information by the fronto-temporal structures of the mentalising system is blocked.

Transcript

  • 1. Autism Historical perspectives on autism Uta Frith UCL Institute of Cognitive Neuroscience 12th June 2008 Priory Court: 1st Dame Stephanie Shirley Lecture
  • 2. Setting a historical context for our knowledge How far can we go back in time? What early sources are there? What accelerated our current knowledge? The time line and three centenaries 2020 - 1920 - 1820.......even earlier
  • 3. Landmark date 2020 1943/44 1920 - 1820....... Leo Kanner (1943) Hans Asperger (1944) Each independently identified and named the syndrome How did knowledge of autism begin? How it has changed over time?
  • 4. Kanner’s evocative descriptions of the core features of autism • Autistic alonenes • Insistence on sameness • Islets of abilities
  • 5. 2020 - 1920 - 1820..1805..1790 Further back in time Some suggestive examples Short description of a boy at Bethlem Hospital (1805) Wild boy of Aveyron (ca 1790)
  • 6. 2020 - 1920 - 1820... ... ... ... ... ... 500 Even further back The holy fools of the Eastern Church From 4th Century Isidora, Simeon, Prokopius, Basil
  • 7. What can be gained from historical analysis? Has autism always been with us? How did people in the past cope? What are the universal features? - independent of cultural context But, we cannot proceed unless we have detailed case descriptions
  • 8. 2020 - 1920 - 1820 - 1720 The case of Hugh Blair of Borgue (ca. 1708 - 1765) A family feud Brother began civil suit to have Hugh’s arranged marriage annulled on grounds of mental incapacity Court annulled marriage Hugh Blair’s mental incapacity confirmed Statements from 29 witnesses Direct examination
  • 9. Contemporary portraits by Henry Raeburn
  • 10. Kirkudbright 1792
  • 11. The Edinburgh court in session
  • 12. William Hogarth: His servants painted ca. 1750
  • 13. Descriptions of odd behaviour • was teased and bullied • took no notice of strangers • never took part in conversation • visited neighbours at all hours • gave unwanted gifts • insisted on same place in church • went to all burials whether invited or not • collected useless sticks • carried stones from heap to heap • watched water dripping • could read and write • had prodigious memory Autistic aloneness Insistence on sameness Islets of ability
  • 14. Autism is not new Distilling the essence of autism across time need to look beneath the surface of behavioural descriptions Autism is universal despite different cultural manifestations
  • 15. Explanations of odd behaviour Inability to attribute mental states to self and others - mindblindness resulting in lack of reciprocal social interaction and communication Good perceptual processing Attention to detail Adequate basic information processing capacity Autistic aloness Insistence on sameness Islets of ability
  • 16. Going Fast forward in Time... 1745 ... ... 1985 The mindblindness hypothesis Mentalising aka Theory of Mind aka mind-reading The ability to attribute mental states (beliefs, desires) To self and others and predict behaviour on the basis of mental states rather than real states of affairs If dysfunctional, then lack of reciprocal social interaction, poor communication - can explain autistic aloneness
  • 17. Mind-blindness or lack of “Theory of Mind” or “impaired mentalizing” • Not putting yourself into someone else’s shoes • Not recognising that what another person knows, thinks or feels is different from what you know, think or feel • Not being able to predict what another person will do on the basis of what they know, think or feel • Not recognising that inner intentions govern others’ actions • Not being aware of your own knowledge, feelings
  • 18. Sally has a basket. Ann has a box. Sally puts a marble in her basket Sally goes out.
  • 19. Naughty Ann transfers marble into her own box.
  • 20. Sally comes back. Where will she look for her marble? Where she thinks it is!
  • 21. Hugh Blair failed test of Theory of Mind on 16 July 1747 Judges asked questions in writing and asked him to write his answers down He copied the questions! He did not realise that he knew something that judges did not know and that they wished to know about.
  • 22. 16 July 1747 Clerk’s writing answer the following question What brought you to Edinburgh? Hugh Blair’s writing Answer the followin question What brougt you to Edinbrugh Clerk’s writing You are not to copy what is set before you but write an answer to this question…. Hugh Blair’s writing You are not to coppy what his set before you but write an answer to this question...
  • 23. Fast Forward Again Fifty years after Hugh Blair Back to the time line 2020 - 1920 - 1820 1820
  • 24. 1820 - 1920 - 2020 The historical context around 1820 What happened? Napoleon banished Regency period (George IV) What achievements were new? Ampere studies electromagnetism Faraday invents electric motor First fossil recognised as dinosaur Babbage invents difference engine Portrait and landscape by Constable
  • 25. 1820 - 1920 - 2020 1820 What knowledge relevant to autism? Franz Josef Gall (1758 - 1828) Mind has a physical seat in the brain Brain controls emotions and actions Johann Friedrich Herbart (1776 - 1841) Mental phenomena can be studied objectively Principles of education
  • 26. 1820 - 1920 - 2020 The historical context around 1920 What happened? WWI is over Bolshevik Revolution in Russia The Mechanic by F. Leger What achievements were new? Einstein completes his theory of relativity Rutherford split an atom of nitrogen Insulin extracted to develop diabetes treatment Vitamin D discovered to treat rickets Tuberculosis vaccine A modern skyscraper
  • 27. 1820 - 1920 - 2020 1920 What knowledge relevant to autism? Neurological syndromes and psychoses Emil Kraepelin (1856 - 1926) “dementia praecox” Eugen Bleuler (1857 - 1939) “schizophrenia” and “autism”
  • 28. The 20th Century Sources First recognition of psychiatric disorders in children In Vienna Theodor Heller 1908 – dementia infantilis – disintegrative psychosis
  • 29. The 20th Century Sources In Moscow G.E. Suchareva 1926 schizoid psychopathy relationship to “Dementia praecox” congenital brain disorder cerebellum, basal ganglia, frontal lobes
  • 30. “Schizoid Psychopathies of Childhood” Grunya Efimovna Suchareva (1891-1981) Die schizoiden Psychopathien im Kindesalter 1926 Monatsschrift für Psychiatrie und Neurologie, Bd. 60 Translated by Sula Wolff
  • 31. Suchareva - anticipating Asperger Description of 6 boys aged 10 to 13 years seen over 3 years in Moscow clinic • Characteristic mode of abstract thought, absurdities, eccentricities Autistische Einstellung • Poor social adaptation; avoidance of peers; loners • Superficial emotions; hyper- and hyposensitivity • Poverty of expressions (face, voice) • Perseveration; echolalia; obsessive tendencies • Motor clumsiness, mannerisms, poor voice modulation • Differences to schizophrenia • Obvious brain basis of symptoms This work was largely forgotten
  • 32. After 1920 Pediatricians, psychiatrists, neurologists in many places started to be interested in children with ‘psychotic’ symptoms Was it only a matter of time for an inspired clinician researcher to identify autistic children among the large group of mentally handicapped children?
  • 33. Leo Kanner (1894- 1961) 1943 Autistic Disturbances of Affective Contact Enduring characterisation Autistic aloneness Insistence on sameness Islets of abilities Assumed biological basis but seduced by refrigerator mother theory Kanner’s concept of autism was unchallenged for ca. 50 years Now it refers to a narrowly defined subgroup on the autism spectrum
  • 34. Hans Asperger 1906 - 1980 1944 Die autistischen Psychopathen im Kindesalter Asperger assumed that disorder •has genetic basis •is life-long •coexists with high intelligence Proposed that educational treatment has to be specially adapted for children Almost forgotten, but rediscovered in 1990s
  • 35. Scheerer, Rothmann & Goldstein 1945 a neglected landmark paper A case of ‘idiot savant’: An experimental study of personality organization • • • • • Single case description of a boy Detailed neuropsychological study Contrast to Kanner’s autism Cognitive, not emotional disturbances are seen as primary Original ideas on impairment of abstract abilities, anticipating ideas on executive dysfunction • Attempt to explain special abilities as abnormal perceptual processes Kurt Goldstein 1878–1965 Neurologist
  • 36. Stephen Wiltshire drawing from memory Stephen spent 30 minutes taking in 360 degrees of Tokyo skyline from the roof top of Roppongi Hills (270 meters up). Over the next seven days he drew, from memory, a remarkably accurate panorama of the Tokyo skyline
  • 37. A scientific revolution 1960s • Autism a form of mental retardation • Due to brain pathology rather than poor parenting • If so, social-emotional problems may be explained as consequence of abnormalities in perception and thinking • If so, new information processing models can be applied
  • 38. The 1960s Beginnings of psychological experimentation • • • • • Removing stigma of poor parenting More attention to intellectual problems Less attention to affective problems Main target language problems Intervention by operant conditioning
  • 39. Beate Hermelin and Neil O’Connor “Experiments with autistic children” (1970) Information processing models Uneven profile of abilities Specific deficits good memory for meaningless vs poor memory for meaningful material Conclusions not peripheral input/output problems but central coding difficulties
  • 40. How far did the early experimental work “explain” autism? Main features of cases studied in the 60s – Delayed language, no speech, poor speech • Ideas on disturbance of semantics and pragmatics – Learning disability • Study of memory, attention, perception, motor skills and learning • Attempts to differentiate autism from other syndromes with intellectual impairments were only partially successful • Social difficulties remained the big unknown
  • 41. The historical context for the mindblindness hypothesis How did the hypothesis come about? Researchers were turning against Behaviourism Up to then Psychology was the Study of Behaviour Now the Study of Mental Life Study of mental states as they influence behaviour e.g. pretence, deception, belief, knowledge John takes his umbrella - because he thinks it’s raining,regardless of whether it is actually raining 1978 David Premack and Guy Woodruff: Does the Chimpanzee have a ‘Theory of Mind?’ 1983 Heinz Wimmer and Josef Perner: Beliefs about beliefs
  • 42. The natural life of the mindblindness hypothesis Step 1 Novel prediction Children with autism fail to understand False Beliefs while they understand False Photographs Confirmation (Baron-Cohen, Leslie & Frith, 1985) Since 1985 many more confirmations Step 2 Negative findings Meta-analysis of studies (Happé 1994) Children with succeed on False Beliefs with 5-year delay Step 3 Modifications Individuals with autism can learn about mental states, but still lack intuitive mindreading (e.g. Frith 2003) Step 4 Extensions Investigations of mind reading in other animals
  • 43. A major step forward In the 1990s Brain imaging methods become available Brain imaging was used to visualise brain system that is active during mentalising Surprising finding No matter what the task a specific neural system is activated during mentalising In autism Physiological test Are their functional differences in relevant brain regions? Anatomical test Are there structural differences in relevant brain regions?
  • 44. Castelli et al., 2000 Paracingulate sulcus STS-temporalparietal junction Basal temporal Mentalising system Basal temporal, periamygdaloid
  • 45. Evidence for brain abnormality in ASD linked to mentalising failure Asperger and HFA group show reduced brain activation in mentalizing system but equal activation in visual system Components show strong connectivity in the normal brain But weak connectivity in the autistic brain Castelli et al. 2002
  • 46. Medial prefrontal region functionally different in autism - less activated in autism during mentalising structurally different in autism - smaller volume
  • 47. Recent developments from mid-1990s • • • • Search for genetic and other biological causes Systematic search for intervention Continued development of diagnostic instruments Availability of brain imaging techniques allow building bridges from cognition to brain • Brain abnormalities may distinguish subgroups, but have not done so yet
  • 48. The mirror neuron deficit hypothesis • Can a deficit in this system explain autism? – Can perhaps explain lack of emotional resonance, and lack of learning by imitation, – but not uneven cognitive abilities, savant talents, executive dysfunction • Open questions – How is empathy related to mentalizing? – How is introspection into own mind related to reflection about other minds
  • 49. Has there been progress in explaining the nature and causes of autism? 100 years ago autism not recognised at all 50 years ago psychosocial origin presumed - not brain abnormality Now slow but steady progress towards identifying brain abnormality, genetic risk factors and other putative causes
  • 50. Leo Kanner - the legacy The name A clinical entity Nuclear cases as anchors
  • 51. Hans Asperger - the legacy • The interest in highly intelligent individuals – Focus of neuropsychological studies, possibly to the detriment of studying other individuals with ASD • The case of extreme male intelligence – Simon Baron-Cohen’s theory of the Extreme Male Brain and Systemizing (vs. Empathizing)
  • 52. Kurt Goldstein - the legacy • Work on frontal lobe dysfunction • Modularity of mind • Mystery of the savant
  • 53. Hermelin & O’Connor - the legacy • Apply neuropsychological methods • Explain savant intelligence
  • 54. Mindblindness hypothesis - the legacy Other hypotheses are needed as well Could be used to identify phenotype Need for standardised test of Theory of Mind
  • 55. 1820 - 1920 - 2020 2020 What knowledge relevant to autism? – Genetic blueprint – Visualising structure and function of the living brain – Increasing knowledge about the social brain and its evolutionary origins
  • 56. 1820 - 1920 - 2020 2020 (as seen in 2008) What progress has been made? Autism recognised as one of the most prevalent neuro-developmental disorders, with a basis in the genes Close to finding biological causes Close to identifying phenotypes and genotypes Early diagnosis and intervention Better educational treatments