DescriptionAutism is a term for a group of complexdisorders of brain development, and fallsunder the umbrella of pervasivedevelopmental disorders (PDD). It ischaracterized by difﬁculties in socialinteraction, verbal and nonverbalcommunication, repetitive behaviors,intellectual disabilities, and difﬁcultieswith motor coordination and attention. Autism: the Mu sical (2008)
BackgroundTerm coined by Swiss psychiatrist Eugene Bleuler in 1912, when hewrote about it in The American Journal of Insanity.Bleuler thought it was another form of schizophrenia.Austrian-American psychiatrist, Dr. Leo Kanner, was the ﬁrst torecognize autism as its own unique mental disorder.Scientist and pediatrician, Dr. Hans Asperger deﬁned AspergerSyndrome, a speciﬁc type of high functioning autism, in 1944.Austrian-American writer and child psychologist, Dr. BrunoBettelhiem, developed a theory of “refrigerator mothers” in 1967.
Demographics 1 in 110 American children have autism, a 600% increase over the past two decades. It is three to four times more common in boys than in girls. About 1 out of 70 boys is diagnosed with autism in the U.S. The disorder is often seen in identical twins. If one twin has autism, the other has a 63-98% chance to have autism as well. For dizygotic twins, the chance is between 0-10% For siblings, 3%
Signs and SymptomsImpairment in social interaction Nonverbal behaviors Failure to develop peer relationships Lack of spontaneous seeking to share enjoyment, interest, or achievements with othersImpairments in communication Lack of or delay in spoken language Inability to sustain conversation with others Stereotyped or repetitive use of language PECSRestricted, repetitive & stereotyped patterns of behavior, interests, and activities Hand or ﬁnger ﬂapping or twisting or complex whole-body movementsDelays or abnormal functioning in symbolic or imaginative play
Biological SignsEnlarged portions of autisticbrainSeveral abnormal genesidentiﬁed, including ones thatmay alter brain architectureGenes may interact with Research establishes potential biomarkers in Autistic brainenvironmental factors utilizing Structural MRIMajor brain areas implicated in Autism: cerebellum, cerebral cortex,temporal lobe, amygdala
NeurobiologyNow commonly believed to be caused by widespread abnormalities inbrain structure and function that occur prenatally and in early lifeNeurodevelopmental trajectory is altered: Cell migration Formation of neural networks Neurotransmitter systems fail to perform optimally Communication between neurons may be impairedNet result is an overall lack of coordination of sensory, motor, cognitive,language, and other functions resulting in major impairments in behaviorand development
Brain OvergrowthRelated to an acceleration of brain growth during ﬁrst 2years of life (which then slows and declines)Suggests pervasive, rather than regionally speciﬁcabnormalityLeads to ineffective processing and connectivitySymptoms of autism not recognized until 2nd or 3rd year ofbecause higher-level functions (such as language and morecomplex social interaction skills - that require integration) donot emerge until the 2nd or 3rd year of life
Poor Sensory Integration“Whole brain integrationdeﬁcit”Integration of sensory inforequires synchronization ofmultiple brain areasAs processing load increasesand working memory orshifting in attention is needed,breakdown becomesexacerbated Natasha Aldred Illustration “Autistic Brain”
Role of the Frontal Lobe Presence of stereotypical behaviors may be associated with difﬁculty with executive functions and inﬂexibility
Role of the Amygdala Structural Differences Functional Differences Larger amygdalae in autistic Larger amygdala means children than in neurotypical increased anxiety, poorer social children and communication skills Early dysfunction related to other In adolescents and adults, symptoms (processing emotions,amygdalae appear to be same size distinguishing faces, or smaller understanding social stimuli)
DiagnosisNo speciﬁc testUsually, parents are concerned with child’s developmentand physicians perform a psychiatric exam to rule outschizophrenia, mutism, or mental retardationDSM-IV criteria
Treatment/Prognosis No cure for Autism (although many claims have been made) Early intervention strategies (i.e., Sensory integration therapy) ABA (Applied Behavioral Analysis) Therapy to correct behaviors Referred to special support services (OT, PT, speech, etc.) Special education Health considerations (Leaky Gut, food allergies, GI issues, GFCF diet)ABA Therapy Hippotherapy Son-Rise Program GFCF diet
Case Study #1 Temple Grandin born Aug. 29, 1947 High-functioning Autism Diagnosed with mental retardation at age 2; Began talking at age 4 “Nerdy kid” who was teased throughout middle and high school Hypersensitivity to noise and other sensory stimuli Invented the “squeeze box” at age 18 Primarily a visual thinker; words are her second language Must wear clothes that counteract sensory integration dysfunction Structured lifestyle to avoid sensory overload
Case Study #2Billy, aged 27, with low-functioning AutismDx at age 4His family took care of him until he was 21, at which age he entered agroup home.Billy was very sensitive to the environment around him (i.e. If everyonewas calm, he was calm; if someone was anxious or aggressive, he toobecame anxious and aggressive)Rather than being agitated toward staff members or other residents, Billywould exhibit self-stimulatory behaviors.Calming him down often meant removing him from the environment.Severe reactions occurred at least once a day.REI recording was used to calm Billy down when he was most agitated,which was usually in the afternoon.
ReferencesNeuroscience For Kids - Autism. (n.d.). UW Faculty Web Server. Retrieved November 17, 2011, from http://faculty.washington.edu/chudler/ aut.htmlAutism Case Study for low functioning autism, anxiety, self-injurious behaviors. (n.d.). Welcome To The Strong Institute. Retrieved November 17, 2011, from http://www.stronginstitute.com/blog/autism-case-study-for-low-functioning-autism-anxiety-self-injurious-behaviors.htmlDSM-IV Criteria for Diagnosing Autism. (n.d.). Autism Watch. Retrieved November 17, 2011, from http://www.autism-watch.org/general/ dsm.shtmlHauser, M. (2010, April 29). Temple Grandin - The 2010 TIME 100 - TIME. Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com. Retrieved November 17, 2011, from http://www.time.com/time/specials/packages/article/ 0,28804,1984685_1984949_1985222,00.htmlHistory Of Autism Pioneers | History of Autism. (n.d.). History of Autism. Retrieved November 17, 2011, from http://www.historyofautism.com/ history-of-autism-pioneers.htmlRapin, I., & Tuchman, R. (2008). Autism: deﬁnition, neurobiology, screening, diagnosis. Pediatric Clinics Of North America, 55(5), 1129-1146.What is Autism? | Autism Speaks. (n.d.). Home | Autism Speaks. Retrieved November 17, 2011, from http://www.autismspeaks.org/what-autism