Autism

Question 1

ASD (DSM5)

Answer 1

• persistent deficits in social communication and social interaction (need all 3)
• restricted, repetitive patterns of behaviour, interests and activities (2 of 4 needed)
• umbrella term (autistic disorder, asperger’s syndrome, childhood defective disorder, pervasive developmental disorder)

Question 2

persistent deficits in social communication and social interaction

Answer 2

• need all 3
• deficits in social-emotional reciprocity
• deficits in non-verbal communication behaviours
• deficits in developing and maintaining relationships

Question 3

restricted, repetitive patterns of behaviour, interests and activities (2 of 4 needed)

Answer 3

• highly restricted, fixated interests
• stereotyped or repetitive speech, motor movements of use of objects
• hyper or hypo reactivity to new sensory input
• excessive adherence to routines

Question 4

strengths and weaknesses of DSM5 diagnosis

Answer 4

+ facilitates research and clinical service

• hazy diagnosis boundaries
• combination of genetic heterogeneity and diagnostic uncertainty complicates uncertainty in identifying genes
• diagnosis: a ‘ticket’ for services (pressure to diagnose as patients experiencing difficulties)
• within ASD variability
• some aspects can be diagnosed in children as young as 2, where as other aspects may take longer to resolve (diagnosis appears less stable)
• repetitive behaviours, interests and activities more evident in 3-5 yo compared to 2 yo
• as the disorder can be so variable, it is hard to give a stable diagnosis to everyone
• fragile clinical uncertainty that exists when one is dealing with a behaviourally diagnosed disorder

Question 5

pro’s of universal screening

Answer 5

• mean age of diagnosis would be reduced
• children wouldn’t be missed
• early intervention = better outcomes

Question 6

medical model

Answer 6

neurodevelopmental disability

Question 7

social model

Answer 7

neurodevelopmental difference - only disabling as they have to be in neurotypical world

Question 8

differences in the brain

Answer 8

• local over-connectivity; long distance under-connectivity
• disruptions severe in later developing regions
• difficulty with information integration

Muller (2008)
Wass (2010)

Question 9

Muller (2008)

Answer 9

fMRI to identify medium and long distance functional under-connectivity

Question 10

Wass (2010)

Answer 10

long distance under-connectivity - under functioning integrative circuitry resulting in deficits of integrating information (at neural level)
- e.g. social interaction, language and repetitive restrictive behaviours (demanding integration tasks)

local over-connectivity - hyperspecifism behaviours (very specific)

Question 11

earlier diagnosis

Answer 11

Jones and Klin (2013) - eye tracking studies - infants later diagnosed with ASD followed the hands of peoples compared to typically developing children who followed eyes (9-24 months)

Elsabbagh et al (2012) - EEG - neural sensitivity in infants due to dynamic eye gaze

• see a face, shift eyes away or towards it
• typical - big difference in neural sensitivity
• Autism - not a big difference

Question 12

cognitive profile

Answer 12

• theory of mind difficulties (understanding another persons thoughts and beliefs, communication, mentalising)
• executive function abilities (inhibition, planning and logic)
• weak central coherence (perception)
• enhanced perceptual function (see and percieve the world differently)

Kimhi et al (2014)

Question 13

Kimhi et al (2014)

Answer 13

• range of tasks assessing cognitive shifting (card sort), planning (tower of London), ToM (unexpected location & false belief) and verbal ability
• found that ASD individuals performed worse on EF and ToM tasks compared to control
• EF linked to verbal IQ in all children
• EF, planning and VIQ = ToM
• language ability explained variance in ToM

Question 14

information

Answer 14

3:1 (male:female)

50% have IQ deficit (<70) [Bertrand et al., 2001]

Question 15

weak central coherence (perception)

Answer 15

• seeing the parts of information [better as segmenting and spotting small details], having difficulty seeing the bigger picture/global percept)
• reduced global integration - don’t tend to have pop out affect for perceptual meaning
• autistic peoples perception is locally oriented
• better at low level perceptual ability (reduced neural complexity)
• drive for perceptual input
• high order processing optional in autism