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AUTISTIC DISORDER &
ASPERGER‟S SYNDROME
           Jackie MacKellar
           MSW Intern
           Ohio Elementary
Autism is a Pervasive Developmental Disorder, so-called because it
affects every aspect of a child‟s development.


It is characterized by marked impairment in social interaction and
communication, repetitive behavior and extremely narrow interests
and activities.




                                                               (DSM-IV, 2000)
(DSM-IV, 2000)
   Impairment in nonverbal communication (such as maintaining eye
    contact)
   Impairment in social interaction and peer relationships
   Language impairment, include either delay/lack of spoken language
    or inability to sustain a conversation
   Idiosyncratic, stereotyped, and repetitive use of language
   Sensory symptoms. Including over- and/or under-sensitivity to sight,
    hearing, touch, smell, or taste
   Difficulty with sensory integration and fine motor skills
   Unusual distress when routines are changed
   Stereotyped or repetitive movements
   Narrow interests and activities
   Lack of imaginative and social play



                                                 (DSM-IV, 2000; MedlinePlus, 2012)
What distinguishes Asperger‟s Syndrome from Autistic Disorder?

Not much.

The distinction between a diagnosis of high-functioning autism and one of
Asperger‟s has always been subjective. It has traditionally been distinguished
from Autistic Disorder by the lack of delay in language skills and a somewhat
more apparent desire to socially engage.

Proposed changes in DSM-V would remove AS as a separate diagnosis and
fold it into Autistic Disorder on the high-functioning end of the spectrum.
While Asperger‟s Syndrome is differentiated by generally less severe
impairment overall and there is no significant delay or regression of
language skills, language usage is atypical and social skills are lacking.
Symptoms include:

   Trouble understanding social cues and conversational language styles
   Conversation is one-sided and voice inflection is abnormal
   Inflexible adherence to a nonfunctional routine or ritual
   Repetition of movements or words and phrases
   Difficulties with fine-motor skills and sensory integration
   A persistent preoccupation with objects or narrowly focused topics of
    interest
   Median rate of autism is 5 per 10,000
   1 in every 110 8-year olds is
    diagnosed with autism
   Rates are more prevalent among
    Caucasians than among blacks and
    Hispanics
   Both Asperger‟s and Classic Autism
    are more common in men than women
    by four to five times
   Onset is before age 3, with diagnosis
    usually taking place between ages 4
    and 5
   Increased risk among siblings of
    autistic children (5%)




                                                                        (DSM-IV, 2000;
                                            National Institute of Mental Health [NIMH],
                                                                          06 Feb 2012)
Scientists are still not entirely sure what causes ASD and AS. Some
theories:

   Genetic
   Brain abnormalities
   Environmental factors
   Some combination of these




                                        (National Institute of Neurological Disorders and
                                        Stroke [NINDS], 2005; NINDS, 2009)
As with the cause of ASD, researchers are uncertain exactly how
autism occurs.

Recently, a couple of interesting (and controversial) theories
have been advanced by researcher Baron-Cohen.
No, not Borat:   His cousin, this guy:
   Theory that those with ASD/AS
    have no or limited theory of mind

   Supported by finding that autistic
    children have difficulty passing the
    Sally-Anne test even past the age
    of 4 (the age when most
    neurotypical children would be able
    to pass)




                                           (Baron-Cohen, 1985;
                                           Baron-Cohen, 1997)
   Defines the male brain as one that
    privileges systemizing (SQ) over
    empathizing (EQ)
   Postulates that autism is the expression
    of an extreme version of the male brain
   In measures of empathy and
    systemizing, 65% of people with
    ASD/AS have an “extreme” male brain
   Argues that autistic individuals lack
    cognitive but not affective empathy




                                               (Baron-Cohen, 2009)
   Poor problem-solving and organizational skills
   Concrete, literal thinking—difficulty understanding abstract concepts
   Difficulty differentiating between relevant and irrelevant information
   Interests that are obsessive and narrowly defined
   Low social standing among their peers
   Lack of executive functions results in difficulty shifting focus between
    activities, recognizing important information, or understanding the “big
    picture” (p. 11)
   Disinhibited reactions—often react out of emotion or rage rather than logic




                                                             (Myles, et al., 2005, p.10)
   Lack of awareness/understanding of social rules
   Strange speech patterns, inflections, and echolalia can isolate the student
    from his or her peers and encourage teasing
   Difficulty understanding abstract concepts, idioms, metaphors, sarcasm,
    irony, parables, rhetorical questions
   Lack of eye contact and inability to pick up on and send out appropriate
    nonverbals can affect relationships with peers
   Difficulty interpreting, inferring, or predicting the emotional states of others
    can make the child seem self-absorbed or uncaring to others, increasing the
    difficulty of forming friendships




                                                                    (Myles, et al., 2005)
   Eating disorders, such as anorexia nervosa
   Digestive/gastrointestinal problems
   Anxiety
   Attention Deficit Hyperactivity Disorder (ADHD)
   Borderline Personality Disorder
   Depression
   Obsessive-Compulsive Disorder (OCD)
   Tourette Syndrome (TS)

Depression is most common in adolescents, perhaps because of
increased awareness of social isolation.




                                                      (Myles, et al., 2005)
American Psychiatric Association [APA]. (2000). Diagnostic and statistical
        manual of mental disorders of the American Psychiatric Association
        (4th. ed. Rev.). Washington, DC: Author.
Badcock, C. C., & Crespi, B. B. (2006). Imbalanced genomic imprinting in brain
        development: an evolutionary basis for the aetiology of autism. Journal
        Of Evolutionary Biology, 19(4), 1007-1032. doi:10.1111/j.
        14209101.2006.01091.x
Baron-Cohen, S. (1985). Does the autistic child have a „theory of mind‟?.
        Cognition, 21 (1985), 37-46.
Baron-Cohen, S. (1997). Mindblind. (Cover story). Natural History, 106(7), 62.
Baron-Cohen, S. (2009). Autism: Empathizing-systematizing (E-S) theory.
        The Year in Cognitive Neuroscience, 1156(68-80).
Medline Plus (U.S. National Library of Medicine). (07 Feb 2012). Autism.
        http://www.nlm.nih.gov/medlineplus/ency/article/001526.htm
Myles, B.S., Hagen, K., Holverstott, J., Hubbard, A., Adreon, D., &
 Trautman,          M. (2005). Life journey through autism: An educator’s
 guide to           Asperger’s Syndrome. Arlington, V.A.: Organization for
 Autism Research, Inc.
National Institute of Mental Health (NIMH). (06 Feb 2012). Autism.
         http://www.nimh.nih.gov/statistics/1AUT_CHILD.shtml
National Institute of Neurologic Disorders and Stroke (NINDS). (2005).
         Asperger syndrome fact sheet. National Institute of Mental Health.
         Publication No. 05-5624.
National Institute of Neurologic Disorders and Stroke (NINDS). (2009).
         Austism fact sheet. National Institute of Mental Health. Publication
         No. 09-1877

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Topic Presentation: Autism & Asperger's

  • 1. AUTISTIC DISORDER & ASPERGER‟S SYNDROME Jackie MacKellar MSW Intern Ohio Elementary
  • 2. Autism is a Pervasive Developmental Disorder, so-called because it affects every aspect of a child‟s development. It is characterized by marked impairment in social interaction and communication, repetitive behavior and extremely narrow interests and activities. (DSM-IV, 2000)
  • 4. Impairment in nonverbal communication (such as maintaining eye contact)  Impairment in social interaction and peer relationships  Language impairment, include either delay/lack of spoken language or inability to sustain a conversation  Idiosyncratic, stereotyped, and repetitive use of language  Sensory symptoms. Including over- and/or under-sensitivity to sight, hearing, touch, smell, or taste  Difficulty with sensory integration and fine motor skills  Unusual distress when routines are changed  Stereotyped or repetitive movements  Narrow interests and activities  Lack of imaginative and social play (DSM-IV, 2000; MedlinePlus, 2012)
  • 5. What distinguishes Asperger‟s Syndrome from Autistic Disorder? Not much. The distinction between a diagnosis of high-functioning autism and one of Asperger‟s has always been subjective. It has traditionally been distinguished from Autistic Disorder by the lack of delay in language skills and a somewhat more apparent desire to socially engage. Proposed changes in DSM-V would remove AS as a separate diagnosis and fold it into Autistic Disorder on the high-functioning end of the spectrum.
  • 6. While Asperger‟s Syndrome is differentiated by generally less severe impairment overall and there is no significant delay or regression of language skills, language usage is atypical and social skills are lacking. Symptoms include:  Trouble understanding social cues and conversational language styles  Conversation is one-sided and voice inflection is abnormal  Inflexible adherence to a nonfunctional routine or ritual  Repetition of movements or words and phrases  Difficulties with fine-motor skills and sensory integration  A persistent preoccupation with objects or narrowly focused topics of interest
  • 7.
  • 8.
  • 9. Median rate of autism is 5 per 10,000  1 in every 110 8-year olds is diagnosed with autism  Rates are more prevalent among Caucasians than among blacks and Hispanics  Both Asperger‟s and Classic Autism are more common in men than women by four to five times  Onset is before age 3, with diagnosis usually taking place between ages 4 and 5  Increased risk among siblings of autistic children (5%) (DSM-IV, 2000; National Institute of Mental Health [NIMH], 06 Feb 2012)
  • 10.
  • 11. Scientists are still not entirely sure what causes ASD and AS. Some theories:  Genetic  Brain abnormalities  Environmental factors  Some combination of these (National Institute of Neurological Disorders and Stroke [NINDS], 2005; NINDS, 2009)
  • 12. As with the cause of ASD, researchers are uncertain exactly how autism occurs. Recently, a couple of interesting (and controversial) theories have been advanced by researcher Baron-Cohen.
  • 13. No, not Borat: His cousin, this guy:
  • 14. Theory that those with ASD/AS have no or limited theory of mind  Supported by finding that autistic children have difficulty passing the Sally-Anne test even past the age of 4 (the age when most neurotypical children would be able to pass) (Baron-Cohen, 1985; Baron-Cohen, 1997)
  • 15. Defines the male brain as one that privileges systemizing (SQ) over empathizing (EQ)  Postulates that autism is the expression of an extreme version of the male brain  In measures of empathy and systemizing, 65% of people with ASD/AS have an “extreme” male brain  Argues that autistic individuals lack cognitive but not affective empathy (Baron-Cohen, 2009)
  • 16.
  • 17.
  • 18. Poor problem-solving and organizational skills  Concrete, literal thinking—difficulty understanding abstract concepts  Difficulty differentiating between relevant and irrelevant information  Interests that are obsessive and narrowly defined  Low social standing among their peers  Lack of executive functions results in difficulty shifting focus between activities, recognizing important information, or understanding the “big picture” (p. 11)  Disinhibited reactions—often react out of emotion or rage rather than logic (Myles, et al., 2005, p.10)
  • 19. Lack of awareness/understanding of social rules  Strange speech patterns, inflections, and echolalia can isolate the student from his or her peers and encourage teasing  Difficulty understanding abstract concepts, idioms, metaphors, sarcasm, irony, parables, rhetorical questions  Lack of eye contact and inability to pick up on and send out appropriate nonverbals can affect relationships with peers  Difficulty interpreting, inferring, or predicting the emotional states of others can make the child seem self-absorbed or uncaring to others, increasing the difficulty of forming friendships (Myles, et al., 2005)
  • 20. Eating disorders, such as anorexia nervosa  Digestive/gastrointestinal problems  Anxiety  Attention Deficit Hyperactivity Disorder (ADHD)  Borderline Personality Disorder  Depression  Obsessive-Compulsive Disorder (OCD)  Tourette Syndrome (TS) Depression is most common in adolescents, perhaps because of increased awareness of social isolation. (Myles, et al., 2005)
  • 21.
  • 22. American Psychiatric Association [APA]. (2000). Diagnostic and statistical manual of mental disorders of the American Psychiatric Association (4th. ed. Rev.). Washington, DC: Author. Badcock, C. C., & Crespi, B. B. (2006). Imbalanced genomic imprinting in brain development: an evolutionary basis for the aetiology of autism. Journal Of Evolutionary Biology, 19(4), 1007-1032. doi:10.1111/j. 14209101.2006.01091.x Baron-Cohen, S. (1985). Does the autistic child have a „theory of mind‟?. Cognition, 21 (1985), 37-46. Baron-Cohen, S. (1997). Mindblind. (Cover story). Natural History, 106(7), 62. Baron-Cohen, S. (2009). Autism: Empathizing-systematizing (E-S) theory. The Year in Cognitive Neuroscience, 1156(68-80). Medline Plus (U.S. National Library of Medicine). (07 Feb 2012). Autism. http://www.nlm.nih.gov/medlineplus/ency/article/001526.htm
  • 23. Myles, B.S., Hagen, K., Holverstott, J., Hubbard, A., Adreon, D., & Trautman, M. (2005). Life journey through autism: An educator’s guide to Asperger’s Syndrome. Arlington, V.A.: Organization for Autism Research, Inc. National Institute of Mental Health (NIMH). (06 Feb 2012). Autism. http://www.nimh.nih.gov/statistics/1AUT_CHILD.shtml National Institute of Neurologic Disorders and Stroke (NINDS). (2005). Asperger syndrome fact sheet. National Institute of Mental Health. Publication No. 05-5624. National Institute of Neurologic Disorders and Stroke (NINDS). (2009). Austism fact sheet. National Institute of Mental Health. Publication No. 09-1877

Notas del editor

  1. Okay, first things first—let’s just quickly define autism. Autism is a Pervasive Developmental Disorder, so-called because it affects every aspect of a child’s development. It is characterized by marked impairment in social interaction and communication and extremely narrow interests or activities. There is no part of a child’s life that is not affected.
  2. Okay, first things first—let’s just quickly define autism. Autism is a Pervasive Developmental Disorder, so-called because it affects every aspect of a child’s development. It is characterized by marked impairment in social interaction and communication and extremely narrow interests or activities. There is no part of a child’s life that is not affected.
  3. Classic autism is what most people think of when they think of autistic children. In children with classic autism there is often mental retardation of some kind; many have low IQs, and some cannot interact with the world at all. However, even within classic autism there are wide-ranging variations of severity and functioning. Those children diagnosed with autism who have higher IQs and a somewhat easier time interacting with the world around them are often referred to as high-functioning—we’ll be returning to this idea in a moment. Autism is usually noticed by the parents within the first two years of life, but sometimes a child develops normally and then inexplicably loses those skills, or regresses.
  4. Asperger’s Syndrome is differentiated by generally less severe impairment overall, with no significant delay or regression of language skills. Language usage, however, is atypical.*Trouble understanding social cues and conversational language styles—conversation is one-sided and inflection is abnormal*An inflexible adherence to a nonfunctional routine or ritual*Repetition of movements or words and phrases*Difficulties with fine-motor skills and sensory integration*A persistent preoccupation with objects or narrowly focused topics of interest
  5. Asperger’s Syndrome is differentiated by generally less severe impairment overall, with no significant delay or regression of language skills. Language usage, however, is atypical.*Trouble understanding social cues and conversational language styles—conversation is one-sided and inflection is abnormal*An inflexible adherence to a nonfunctional routine or ritual*Repetition of movements or words and phrases*Difficulties with fine-motor skills and sensory integration*A persistent preoccupation with objects or narrowly focused topics of interest
  6. Using a spectrum conceptualization, Classic Autism, Asperger’s Syndrome, and Atypical Autism (Pervasive Developmental Disorder Not Otherwise Specified [PDD-NOS] are all included under the umbrella of the Autism Spectrum.
  7. Individuals on the spectrum may have different symptom combinations and serverities.No standard criteria for “high-functioning,” but it is generally considered to mean an ASD individual who has a higher IQ (no mental retardation) and who are better able to interact with the world around them. PDD-Not Otherwise Specified is sometimes referred to as Atypical Autism, which often has some different or subclinical features. With the DSM-V changes, Asperger’s Syndrome would fall at the highest-functioning end of the autism spectrum.
  8. Because ASD and AS tend to run in families, a genetic component is strongly suspected. No single gene has been identified, but it is thought that groups of genes play a role in the expression and severity of autistic traitsFunctional and structural brain abnormalities have been observed in AS & ASD patients, which might be due to the disruption of normal brain developmentUnidentified environmental factors may also play a role in influencing these genes, early in fetal development or possibly in the early years of life. Current research points to brain abnormalities as the cause of AS.  Using advanced brain imaging techniques, scientists have revealed structural and functional differences in specific regions of the brains of normal versus AS children.  These defects are most likely caused by the abnormal migration of embryonic cells during fetal development that affects brain structure and “wiring” and then goes on to affect the neural circuits that control thought and behavior. For example, one study found a reduction of brain activity in the frontal lobe of AS children when they were asked to respond to tasks that required them to use their judgment.  Another study found differences in activity when children were asked to respond to facial expressions.  A different study investigating brain function in adults with AS revealed abnormal levels of specific proteins that correlate with obsessive and repetitive behaviors.   Scientists have always known that there had to be a genetic component to AS and the other ASDs because of their tendency to run in families.  Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected.  There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD.  In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20.  This is greater than the risk for the general population Additional evidence for the link between inherited genetic mutations and AS/ASD was observed in the higher incidence of family members who have behavioral symptoms similar to AS/ASDbut in a more limited form.  For example, they had slight difficulties with social interaction, language, or reading.  (Broad Autism Phenotype)A specific gene for AS, however, has never been identified.  Instead, the most recent research indicates that there are most likely a common group of genes whose variations or deletions make an individual vulnerable to developing AS.  This combination of genetic variations or deletions will determine the severity and symptoms for each individual with AS
  9. In researching autism and asperger', I came across some really very outside-the-box theories regarding autism
  10. Yes, the research is really Sacha Cohen’s cousin, Simon Cohen.
  11. The mind blindness theory of autism argues that autistic people lack theory of mind, which is the ability to identify cognitive and affective mental states in oneself and others, and to understand that others are separate from you.“In the test process, after introducing the dolls, the child is asked the control question of recalling their names (the Naming Question). A short skit is then enacted; Sally takes a marble and hides it in her basket. She then 'leaves' the room and goes for a walk. Whilst she is away, and therefore unbeknownst to her, Anne takes the marble out of Sally's basket and puts it in her own box. Sally is then reintroduced and the child is asked the key question, the Belief Question: 'Where will Sally look for her marble?‘For the children to 'pass' this test they must answer the Belief Question correctly, by indicating that Sally believes that the marble is in her own basket, continuous with her perspective although not with the child's own. If the child cannot take an alternative perspective, they will indicate that Sally has cause to believe—as they do—that the marble has moved. To pass, the children have to show that Sally has her own beliefs that may not correlate with reality.”
  12. Baron-Cohen has also put forward a theory of autism that suggests that autism is just an extreme form of a brain with stereotypically male traits, which generally favor spatial abilities over verbal abilities. The terms Baron-Cohen uses to differentiate these cognitive types is ‘empathizing’ and ‘systemzing’. “The male brain is a defined psychometrically as those individuals in whom systemizing is significantly better than empathizing, and the female brain is defined as the opposite cognitive profile. Using these definitions, autism can be considered as an extreme of the normal male profile. “ Cognitive empathy is basically theory of mind, the drive and ability to identify the mental states of another, whereas affective empathy is the drive to respond to a person’s mental states with the appropriate emotion.
  13. I feel that the on the right diagram really illustrates how difficult living with ASD/AS can be, as every part of life is affected by and in turn affects the disorder. ASD/AS is often the most difficult for the highest-functioning individuals to deal with, because they have some amount of self-insight and are more aware of how they don’t fit in.
  14. “Academic challenges: Despite having at least normal intelligence, students with Asperger Syndrome often experience cognitive difficulties that impact their academic achievement. These difficulties can result from:• Poor problem-solving and organizational skills• Concrete, literal thinking—difficulty understanding abstract concepts• Difficulty differentiating between relevant and irrelevant information• Interests that are obsessive and narrowly defined• Low social standing among their peers”Emotions and stress: Asperger Syndrome affects how individuals think, feel, and react. When under stress, people with Asperger Syndrome experience increased difficulties and tend to react emotionally, rather than logically. To some, it is as if the “thinking center” of the brain becomes inactive, while the “feeling center” becomes highly active. All too often students with Asperger Syndrome react without thinking. This inability to inhibit their emotional urges may cause them to engage in rage behaviors. Even when they learn more acceptable behaviors, under stress they may not be able to retrieve and use the newly learned behavior. Instead, they will default to a more established behavior that is often inappropriate.”Executive Functioning: Executive functions are neurological processes that help us make decisions, initiate actions, and plan for future events. They also play a partin impulse control, strategic thinking, and a person’s ability to shift focus between two or more activities. These functions are impaired in people diagnosed with Asperger Syndrome, which can have a serious impact on classroom behavior and performance. These students have difficulty recognizing the most important topics within lectures and reading materials, and they may fail to understand the “big picture” of a given assignment or project.
  15. “Social rules: Students with Asperger Syndrome are poor incidental learners. They often learn social skills without fully understanding when and how they should be used.:“Social aspects of language: Students with Asperger Syndrome often find it difficult to maintain an interaction that does not involve a narrowly defined topic area. They may discuss at length a single topic that is of little or no interest to others and speak with exaggerated inflections or in a monotone fashion. This adult-like and pedantic speech can make them unappealing or “weird” to their peers, further exacerbating their social isolation. Echolalia, or the repetition of words and phrases with little or no social meaning, can also be problematic for students with Asperger Syndrome in conversational settings.”“Abstract concepts: The effects of Asperger Syndrome can make it difficult to understand the many abstract concepts that present themselves in conversation, including different meanings of the same word. Due to their concrete learning style, students with Asperger Syndrome often struggle with language that involves metaphors, idioms, parables, allegories, irony, sarcasm, and rhetorical questions.”“Nonverbal communication: Children with Asperger Syndrome often have difficulty using nonverbal communication behaviors effectively and appropriately. Examples of these deficits include limited or inappropriate facial expressions and gestures, awkward body language, difficulty with social proximity (standing too close or too far away during a conversation), and peculiar or stiff eye gaze.”“Theory of Mind”: This concept refers to the idea that people with Asperger Syndrome do not understand that other people have their own thoughts andfeelings. As a result, these individuals often have difficulty interpreting or predicting the emotions and behaviors of others. Because they cannot “put themselves in another’s shoes,” individuals with Asperger Syndrome may appear uncaring or self-centered, but there is no evidence to support that they feel superior to others.
  16. To add to the complexity of the disorder, individuals with Asperger Syndrome may have co-morbid conditions, including anorexia nervosa, anxiety, attention deficit hyperactivity disorder (ADHD), borderline personality disorder, depression, obsessive compulsive disorder (OCD), and Tourette Syndrome (TS). The most common co-morbid condition in adolescents with Asperger Syndrome is depression. depression in this age group