Transcript Slide 1
THE BIG PICTURE OF AUTISM: SCIENCE AND THEORY IN PLAIN ENGLISH Lars Perner, Ph.D. San Diego State University Presentation at the ANCA® Foundation Special Fall Conference and Fundraiser Vancouver, B.C. November 19-20, 2004 “If It [Were] Easy” Problems we face are often superficially similar to those faced by “neurotypicals” – – – – – Relationships Understanding others Conflict Budgeting Limited sensory abilities How we handle these problems Copyright © 2004 Lars Perner, Ph.D. 2 Purposes of This Talk Understand the many factors that influence autism in individuals Recognize individual variations and unique needs Build empathy with autistic individuals Get ideas on what to try and consider to help specific individuals Copyright © 2004 Lars Perner, Ph.D. 3 The Role of Theory (or Seeing “The Big Picture”) THEORY UNDERSTANDING EXPERIENCE WITH INDIVIDUAL INTERVENTIONS VALUES AND DECISIONS ANALYSIS Copyright © 2004 Lars Perner, Ph.D. 4 “It Takes Every Kinda’ Perspective to Go Around the Autistic Spectrum” with apologies to Robert Palmer Specialists and medical practitioners Teachers Parents Individuals on the Spectrum Biomedical researchers Psychologists and Counselors Theoreticians General population Other(?) Copyright © 2004 Lars Perner, Ph.D. 5 Why Do These Symptoms Go Together? Sensitivity to – Noise – Coarse materials – Food tastes Poor handwriting Difficulty maintaining eye contact Frustration with “spontaneous coordination” Difficulty imitating others Impaired spatial ability – Difficulty driving – Following maps Difficulty with sensory integration Difficulty doing arithmetic despite intelligence Depression Copyright © 2004 Lars Perner, Ph.D. 6 Diagnosis Diagnostic criteria are somewhat arbitrary May be needed for insurance and eligibility standards Frequently “fudged” to meet eligibility Future discoveries may help us better identify clusters of vulnerabilities Copyright © 2004 Lars Perner, Ph.D. 7 Arbitrary Medical Standards Schizophrenia takes precedence over autism/AS/PDD-NOS Autism/AS/PDD-NOS take precedence over ADD/ADHD Symptoms of depression may be “secondary” and may or may not be diagnosed separately Copyright © 2004 Lars Perner, Ph.D. 8 Diagnosis, Misdiagnosis, and “Undiagnosis” Diagnosed Has Autism Correctly Diagnosed Autism Misdiagnosed As Autism Undiagnosed Autism Copyright © 2004 Lars Perner, Ph.D. 9 Complicating Things… Autism Only Autism And Other Other Only Copyright © 2004 Lars Perner, Ph.D. 10 Comorbidity DEPRESSION/ BIPOLAR DISORDER ANXIETY ATTENTION DEFICIT/ HYPERACTIVITY AUTISTIC SPECTRUM CONDITIONS LEARNING DISABILITIES OBSESSIVECOMPULSIVE DISORDER OPPOSITIONAL DEFIANCE DISORDER SEIZURES/ TOURETTE’S Copyright © 2004 Lars Perner, Ph.D. 11 Autism and Other Conditions: Seeing the Whole Picture HAS AUTISM Auon HAS OTHER CONDITION AuOu adOu ADOu aMOu ADon ADOD AUTISM DIAGNOSED aMoD anOD ADoM aMon aMoM A Has autism a Does not have autism D Condition has been diagnosed n Condition has not been diagnosed M Misdiagnosis (False positive) u Undiagnosed condition (False negative) O Has other condition o Does not have other condition anoM OTHER CONDITION DIAGNOSED Copyright © 2004 Lars Perner, Ph.D. 12 Pervasive Developmental Disorders (PDDs) Categories – – – – Autism Asperger’s Syndrome Rett’s Pervasive Developmental Disorder—Not Otherwise Specified (PDD-NOS) Meaningfulness of diagnostic distinctions Rigidity of criteria Arbitrary nature of standards – Childhood Degenerative Disorder Differences – Within-group – Between-group Copyright © 2004 Lars Perner, Ph.D. 13 Causes of and Influences on Autism ENVIRONMENT GENETICS COMPENSATING ABILITIES SYMPTOMS GENETIC PROTECTION VULNERABILITY TO ENVIRONMENT EXHAUST SECONDARY SYMPTOMS Copyright © 2004 Lars Perner, Ph.D. 14 Non-Action If lacking INSTINCT MOVITATION Inefficient EXHAUST Efficient ACTION ABILITY/ INHIBITION REINFORCEMENT/ LEARNING SHUTDOWN “MELTDOWN” INAPPROPRIATE ACTION POSSIBLE ADAPTATION LIKELY ADAPTATION Low ability or inadequate inhibition Copyright © 2004 Lars Perner, Ph.D. 15 Genetics Varying estimates of the numbers of genes involved Models – Various genes individually cause specific problems leading to autism symptoms – Multi-gene Threshold: Must have a certain number of genes (e.g., 3-20) to exhibit symptoms Interaction of multiple genes – Fraternal vs. identical twins Genetic redundancy and protection Copyright © 2004 Lars Perner, Ph.D. 16 Question from Participants Likelihood of Children Inheriting Autism from Autistic Parents Question: “Speak to the issue of autistic people having children given genetic component.” Inheriting “autism” vs. specific traits Family history of both parents – Autism characteristics – Other characteristics (e.g., ADHD, depression, anxiety) Gender of child Dr. Ami Klin: [No definitive research but] “15% might be a reasonable estimate.] MAAP Newsletter, 2004, Volume II. Copyright © 2004 Lars Perner, Ph.D. 17 El Niñofication The tendency to move to one extreme or the other on performance or behavior – Examples Sensitivity Confrontation Math or verbal abilities Copyright © 2004 Lars Perner, Ph.D. 18 Brain Structure Specialization of brain areas (e.g., amygdala) Brain scan studies “White” vs. “gray” matter Neural connections – Learning – Survival and “pruning” – Structure of neurons and dendrites Copyright © 2004 Lars Perner, Ph.D. 19 Neurotransmitters Total of 52 known Especially important in autism: – – – – Dopamine Norepinephrine Serotonin Oxytocin Interaction of transmitters Copyright © 2004 Lars Perner, Ph.D. 20 Question from Participants “Fight or Flight” Response “Question: Can you add more fight-or-flight information in terms of brain chemistry and body reactions?” “Fight or Flight” response—evolutionary advantage Or: “Fight, Flight, Shutdown, or Meltdown” Causes – Activation of Sympathetic Nervous System – Release of adrenaline and cortisol Role of amygdala within autism – Some research suggests that the amygdala is, on the average, enlarged in people on the spectrum (large variation) – Amygdala may be overworked due to non-specialization in other brain areas Role of anxiety and depression Copyright © 2004 Lars Perner, Ph.D. 21 Flight or Fight Responses: A Simplified Model POST TRAUSENSORY INPUT THALAMUS LONG DETOUR PRE-FRONTAL CORTEX FRONTAL CORTEX LIMBIC SYSTEM MATIC STRESS DISORDER MAY RESULT FROM EXCESSIVE USE OF THIS CHANNEL AUTOMIC NERVOUS SYSTEM STRESS RESPONSE CANCEL UNNEEDED STRESS RESPONSE THIS CHANNEL IS STRENGTHENED THROUGH MATURATION Copyright © 2004 Lars Perner, Ph.D. 22 Two Competing Objectives for Computers and Brains SPEED (EFFICIENCY) RELIABILITY ASSUMPTIONS GENERALIZATION SPECIALIZATION FILTERING PRIORITIZATION INTUITION (HUMANS) QUESTIONING ASSUMPTIONS REDUNDANCY VERIFICATION FOCUS OF ATTENTION LOGICAL EXAMINATION Copyright © 2004 Lars Perner, Ph.D. 23 Hierarchy of Information and Thinking Decision making Thinking Awareness Pre-conscious awareness Non-conscious handling of stimuli Non-perceived stimuli Copyright © 2004 Lars Perner, Ph.D. 24 A FIVE FUNCTION MODEL OF THE PERFORMANCE OF INDIVIDUALS ON THE AUTISTIC SPECTRUM PERF0RMANCE INHIBITORY INSTINCTIVE FUNCTION INTUITIVE FUNCTION EXECUTIVE FUNCTION COMPENSATORY FUNCTION ACTIVE INTELLECTUAL FUNCTION Copyright © 2004 Lars Perner, Ph.D. 25 Abstraction and Generalization Individuals with autism often have difficulty in – – – – – Generalizing from one situation to another Understanding and/or accepting “exceptions” Understanding certain non-concrete ideas (BUT…) Understanding non-literal language Deciphering symbolic (graphical) representation Copyright © 2004 Lars Perner, Ph.D. 26 Question From the Audience What Teachers Can Do Question: “The early teen years are very difficult for all children. As a school, what would you like to see us teachers make happen? What would make life easier for the autistic child? How can they grow socially, emotionally without disaster?” Recognizing individual differences – Talking about options rather than giving “command” advice Working with special interests and motivations Time to “process” Help with reasoning on other people’s thoughts and feelings (“Theory of Mind”) Copyright © 2004 Lars Perner, Ph.D. 27