Cu autism2013


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Cu autism2013

  1. 1. Autism Elspeth Webb Childhood Autism
  2. 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? 2
  3. 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 3
  4. 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. 5. Autism Autism and autism spectrum disorder Problems with: • Social communication and social imagination • Rigidity of thought and behaviour 5
  6. 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. 6
  7. 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 7
  8. 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 8
  9. 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 9
  10. 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. 10
  11. 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. 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 12 Look at this list again – what strikes you about it now?
  13. 13. Autism A dimensional disorder thus in part socially constructed autism normal Where does personality end and disorder begin? 13
  14. 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 14
  15. 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. 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 16 "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. 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 17
  18. 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 18 Victor (contemporary print)
  19. 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. 19
  20. 20. Autism Gender autistic Normal males females “Autism is an extreme form of maleness” Simon Baron Cohen 20
  21. 21. Autism Systemising Empathising Other way around Autistic males Autistic females Normal females Normal males 21
  22. 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 22
  23. 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 23