2. Autism
Prevalence
1980s 4-7/10,000
Now 1/100-150
A common condition (about 12 Cardiff med students per year
group will go on to have a child on the autistic spectrum)
Why the increase in prevalence
Real vs. administrative increase? ( i.e. are we better at
recognising it)
Causes?
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3. Autism
What are we?
• What theories are there to explain the
“uniqueness” of human beings within the animal
kingdom?
•What defines us as human
•Have a think about this before going on to the
next slide and write your ideas down
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4. Autism
• Consciousness
• Imagination
• Language
• Complex social relationships
• Spirituality
• Awareness of impact of actions
4
Answers provided by a group of parents
and professionals at a recent conference
5. Autism
Autism and autism spectrum disorder
Problems with:
• Social communication and social
imagination
• Rigidity of thought and behaviour
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6. Autism
DSM 5 Classification (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 behaviours 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 behaviour to suit different social contexts through difficulties in sharing imaginative play and in making friends to an
apparent absence of interest in people
• B. Restricted, repetitive patterns of behaviour, interests, or activities as manifested by at least two
of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypes, echolalia, repetitive use of
objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behaviour, 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.
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7. Autism
Social communication
• Absent
• Disordered ( both verbal and non-verbal)
• Lacking communicative intent
– echolalia; hyper-lexia
• Problems with social use of language
– lack of reciprocity/ poor turn-taking)
• Literal. Inability to understand or use metaphor
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8. Autism
Social imagination
• No theory of mind (Sally Anne Test; squirrel)
• No empathy
– Lack of socio-emotional reciprocity
– Abnormal comfort seeking
• Abnormal or absent peer friendships
• Failure to use eye-contact, gesture, and posture to regulate
social interaction
• Lack of shared attention
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9. Autism
Restricted, repetitive and stereotyped play, behaviour,
interests and activities
• restricted/unusual interests
• attachments to unusual objects.
• specific, non-functional routines or
rituals.
• stereotyped and repetitive motor
mannerisms.
• distress over change
• preoccupations with part-objects – a
failure to ascribe meaning to the whole
• rigid thinking
• absent or restricted/repetitive
imagination
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10. Autism
Preoccupations with part-objects – a failure to ascribe
meaning to the whole
What does this say?
“There was a tear in her dress”
Of autistic readers about half will read tear as
in rip, and the other half tear as in crying – not
paying attention to the meaning of what they
are reading, rather reading word by word.
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11. Autism
Restricted interests: examples
• Cars & trains (can be
dangerous)
• Lamp-post numbers
• Dinosaurs
• Stamp collecting
• Bird-watching
• Bombs
• Music
• Knives and guns
• Dr Who
• World of WarCraft
• Celebrities (Lennon’s killer)
• Dates (of anything)
• Scores in sport
• Clothes labels
• Religion (fundamentalist
approach)
11
12. Autism
Not defining but fundamental to our successful functioning as
autonomous and socially integrated individuals
• Consciousness
• Imagination
• Language
• Complex social relationships
• Spirituality
• Awareness of impact of
actions
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Look at this list again – what strikes you about it now?
13. Autism
A dimensional disorder thus in part socially constructed
autism normal
Where does personality end and disorder begin?
13
14. Autism
High IQ
Low IQ
Severe autism Mild autism
Bill Gates
Enoch Powell
“Rain man”
Classic Kanner
autism
“Asperger syndrome”
Dog in
the
night
boy
A dimension that
interacts with
other dimensions
– e.g. IQ
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15. Autism
Three social “types”
• Aloof
– – avoids and dislikes social contact
• Passive
– – accepts social contact but not interested
• Active but odd
– – wants to engage socially but gets it wrong and
fails
15
16. Autism
Changing attitudes and explanations for autism
• Changelings :
– in which fairies stole a baby
and leave a fairy child in its
place, ? early references to
autism
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"So the goblins came. They
pushed their way in and
pulled baby out, leaving
another all made of ice."
(Maurice Sendak, Outside over there. Puffin
Books, Middlesex, UK, 1981)
17. Autism
Manifestation of extraordinary faith, innocence, and
innate goodness
Brother Juniper
(and the beggar)
Disciple of St Frances of
Assisi
Many classical features of
autism in his behaviours –
interpreted as saintly
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18. Autism
Profoundly neglected
• Feral children
– Victor, Wild boy of Aveyron: Wild
Peter of Hamelin
– Kamala and Amala, the “Wolf Girls”
of Midnapore
• Imprisoned
– Casper Hauser
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Victor (contemporary print)
19. Autism
20th
C
• Cold unemotional parenting (Kanner)
• Neuro-developmental impairment
To some extent these two models coexist in the West, with a
psychoanalytical explanations still current in France, but not
prevalent in UK, Sweden, USA, Australia.
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22. Autism
Male : female ratios in populations
Low functioning autism (IQ<70): 4:1
High functioning autism (IQ>70) 12-20:1
BUT
Are we missing high functioning girls?
All assessment tools largely developed and
validated on a mainly male population
A girl may score less than a boy, but be
functionally much more impaired, as the social
world of girls is far more sophisticated and socially
demanding
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23. Autism
Recommended further reading etc.
• Novel
– “The Curious incident of the Dog in the Night time” – Mark
Hadden
• Film
– Snowcake (Alan Rickman / Sigourney Weaver) – superb. Much
better than Rain Man which presents a stereotyped version of
the autistic savant, which is in life rather rare
• Look up the National Autistic Society website – a lot of
really useful information
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