Autism

PSYB2 Specification: What you need to know

Definition and Symptoms, including lack of joint attention
Autism as a syndrome: the triad of impairments
Biological explanations: including genetics and neurological correlates
Cognitive explanations: theory of mind, central coherence deficit, failure of
executive functioning
Studying autism: Sally-Anne test, Smartie tube test, comic strip stories
Therapeutic programmes for Autism: including drug treatment, the Lovaas
technique, parental involvement and behaviour modification
Evaluation of these programmes
"A complex lifelong disability which affects a
person's social and communication skills."

Prevalence of Autism
- 8 in 10,000 people (0.6% chance)
- 4x more likely in males. 3/4 autistics are male
- 90% of people with Asperger's are male
- 60 in 10,000 people with ASD

Kanner (1943)
Autism
Autistic Aloneness Desire for sameness Islets of Ability
Lack of empathy for others
Inability to display love or emotions
Difficulties in understanding people
Good at making sense of the world
Lower than average language ability
Low levels of imaginative thinking
Problems with communicating with others and building social
relationships
Low IQ
A preference for order and organisation and a resistance to change
Obsessional behaviour (Islets of ability, autistic savants)
Stereotypical movements (head banging, rocking)
Symptoms of Autism
DSM IV Criteria
Impairment (relevant to developmental level) Behaviour
Number of
impairments in
each category for
diagnosis
Qualitative impairment in reciprocal social
interaction
Poor use of eye contact and gestures;
lack of personal relationships; lack of
spontaneous sharing, for example joint
attention; lack of social/emotional
reciprocity
At least two
Qualitative impairment in verbal and non-
verbal communication
Delay in the acquisition of language, or
lack of speech; stereotyped and
repetitive use of language; failure to
sustain or initiate conversation; lack of
varied, spontaneous make-believe
play
At least one
Restricted repertoire of activities and interests
Repetitive or stereotyped movements,
such as hand flapping, interests that
are abnormally intense/narrow;
adherence to specific, non-functional
routines or rituals.
At least one
The Triad of Impairments: Frith (2003)
Frith argued that three features occur so regularly together in cases of autism
that they simply cannot be a chance combination of symptoms.
Triad of
Impairments
Repetitive Stereotyped Behaviour
Impairment in communication Impairment in social interaction
AO2: What symptom does this not explain?
Wing & Gould (1979)
Aim: To investigate the number of children suffering from autism in a
large population.

Method: 914 participants from 0-14 year olds were studied. All were known
to be suffering from some form of mental or physical handicap.
Most children had IQs below 70. Participants were separated into
groups on the basis of their intellectual ability. A follow up study
was conducted when child when aged between 16-30 years.

Results: 173 children showed at least one symptom from the triad of
impairments. If a child had the mental age of 20 months or more,
they would show all three symptoms associated with the triad.

Conclusion: The symptoms of autism should be seen as a triad of
connected impairments.
Joint attention is when both infant and another person are attentive to the same
object and another.
This is usually achieved by gazing and pointing and the infant is not interested in
only the object, but the caregiver's attitude and feelings towards that object.

Children with autism have a lack of joint attention - they do not seek to share
attention to an object with anybody.

Sigmen (1986)
Aim: To investigate joint attention activities such as pointing and showing
in children with autism.
Method: 3 groups of children were observed: autistic children, children
with an intellectual impairment other than autism, and healthy
children. Each play room was presented with various toys and
the child's parents. Instances of pointing and showing objects
were recorded.
Results: The autistic children showed significantly fewer instances of
pointing and showing than other groups of children.
Joint Attention
Autism
PSYB2 Specification: What you need to know

Definition and Symptoms, including lack of joint attention
Autism as a syndrome: the triad of impairments
Biological explanations: including genetics and neurological correlates
Cognitive explanations: theory of mind, central coherence deficit, failure of
executive functioning
Studying autism: Sally-Anne test, Smartie tube test, comic strip stories
Therapeutic programmes for Autism: including drug treatment, the Lovaas
technique, parental involvement and behaviour modification
Evaluation of these programmes
Explanations you need to know:

Biological
- Genetics
- Neurological Correlates

Cognitive
- Theory of Mind
- Central Coherence Deficit
- Failure of Executive Functioning

Cold Parenting
- Bettelheim (1967)


Explaining Autism
The way psychologists study the cause of autism in genetic terms is
through twin and family studies.

Family Studies - The University of Cambridge
- Found that autistic traits cluster in families
- 6% of siblings display traits of all three impairments
- 10-12% display only two
- 20% of siblings display only one

Twin Studies - Ritvo (1985)
23 pairs of MZ, 17 pairs of DZ

MZ = 96% conc rate
DZ = 23% conc rate
Biological Explanations: Genetics
Gerschwind et al found an "autistic gene" in males
that exists in chromosome 6 and 17. However it
can only be found in boys.

Links have been found between autism and
Tourette's Syndrome. TS is a genetic disorder.
Comings and Comings (1997) noted that
sufferers from both syndromes may share
similar symptoms, including obsessive and
ritualistic behaviours, need for routine and
stereotypical movements.

Fragile X - Bee (1989)

Links with Fragile X syndrome and autism. 5-10%
of people with autism also have Fragile X. More
predominant in males.


Biological Explanations: Genetics
Can Autism be explained by genetics?
Yes!
- Concordance rates in Ritvo (1985)
- Fragile X: Links with both syndromes
- University of Cambridge Family Studies

No!
- Conc rates should be 100% and 50%
- Twins and families also share environment
- No direct chromosomal link found by Gerschwind
This biological theory proposes that autistic individuals have one or
more abnormalities in the brain. The areas with these
abnormalities correlate with the areas responsible for normal
communication, social functioning and play. This ultimately
suggests that autism is due to these differences in brain
structure.

There are two ways of studying neurological correlates:
- Post-mortem studies
- Neuroimaging

List the strengths and limitations of each method.
Biological Explanations: Neurological
Correlates
Theory of Mind - The ability to understand that someone else can think
something different to your own thoughts.

First proposed by Frith (1989) who suggested that people with autism
lack the ability to guess what others are thinking or are going to do.
This is referred to as mind blindness.

A theory of mind is developed at around 4 years of age. When we are
3, we understand people have independent thoughts, but we can not
understand what these may be.

Supporting Evidence:
- Sally-Anne Test (1985)
- Smartie Tube Test (1989)
- Comic Strip Stories (1986)
Cognitive Explanations:
Lack of Theory of Mind
These tests all support the idea
that autistic individuals lack a
theory of mind
Sally-Anne Test
(Baron-Cohen et al, 1985)
Aim: To investigate if autistic children could have a different belief to their own.

Method:
3 groups were studied: 20 autistic children, 14 children with Down's, control
group of 27 healthy children, all with similar verbal ages.

The experimenter performs the following scenario with dolls:

"This is Sally, she has a basket. This is Anne, she has a box. Sally places the
marble into her basket and leaves the room. Anne plays a trick on Sally. She
takes the marble and puts it into her box. Sally comes back into the room."

The experimenter then asks the belief question:
- "Where will Sally look for the marble?"

And then three control questions:
- "Which one is Sally and which one is Anne?"
- "Where is the marble now?"
- "Where was the marble before?"
Sally-Anne Test: The Results
Correct response to the belief question as follows:

- Autistic: 20%
- Down's Syndrome: 86%
- Control Group: 85%

There were no failures in any of the control questions.


We can conclude that a lack of theory of mind is prominent in children
with autism. However, the results suggest not all autistic children lack
this theory of mind, therefore it is not generalisable. Also, it cannot be a
specific impairment to autism as DS sufferers and "normal" children
were also shown to lack a theory of mind.
Try to write the end of an AO2 burger for this study.
"This supports/conflicts the lack of theory of mind explanation because...."
A Smartie tube containing a pencil was shown to normal children and
autistic children. Individually, they were asked:
"What do you think is inside here?"
They answer Smarties as they have no reason to believe otherwise.
They are then shown that the tube contains a pencil. They are then asked:
"Your friend is about to come in. What will he say is in the box?"

Children above 3 respond "Smarties" as they understand that their friend
will not be aware there is a pencil is inside.
Autistic children of all ages respond "pencil" as they do not have this
understanding that others have different thoughts.
Smartie Tube Test
(Perner et al, 1989)
Try to write the end of an AO2 burger for this study.
"This supports/conflicts the theory of mind explanation because...."
Aim: To investigate whether autistic children would understand that someone else
could have a belief that was different from theirs.

Method: Autistic children were shown four pictures, which, when put into the correct
order, would form one of three types of story:
- A Mechanical Story, which did not involve any people.
- a Behavioural Story, which did not require any understanding of what the
people in the story were thinking.
- A Mentalistic Story in order to put this story in the correct order, the child
would need to know what the characters in the pictures were thinking or
believing (i.e. the child would need theory of mind)

The children had to put the four images into the correct order.

Results: The children had no trouble with the mechanical and behavioural stories, as
they didnt need to have theory of mind in order to understand the story.
However, they performed very poorly on the mentalistic stories.

Conclusion: This adds further evidence to the idea that autistic children lack theory of
mind.
Comic Strip Stories
(Baron-Cohen et al, 1986)
Try to write the end of an AO2 burger for this study.
"This supports/conflicts the theory of mind explanation because...."
Autism
PSYB2 Specification: What you need to know

Definition and Symptoms, including lack of joint attention
Autism as a syndrome: the triad of impairments
Biological explanations: including genetics and neurological correlates
Cognitive explanations: theory of mind, central coherence deficit, failure of
executive functioning
Studying autism: Sally-Anne test, Smartie tube test, comic strip stories
Therapeutic programmes for Autism: including drug treatment, the Lovaas
technique, parental involvement and behaviour modification
Evaluation of these programmes
Central Coherence: A tendency to process information for its general
meaning rather than the specific meaning of each
element.

Lack of Central Coherence developed by Frith as Theory of Mind does not account for the
repetitive behaviours or exceptional skills shown by some people with autism.

For example, when we look at a picture we tend to attempt to make sense of the whole by
imposing meaning on it; similarly we remember the gist of a message rather than each
individual word.

According to Frith, it is this capacity for coherence that is diminshed in the child with
autism.

The Ebbinghaus Illusion

Which of the middle circles is biggest?
Cognitive Explanations:
Central Coherence Deficit
Shah & Frith (1993) - Children's Embedded Figures Test
To investigate how well autistic children could locate a hidden figure.
Standardised test used the CEFT. A group of autistic and non-autistic
children of the same mental age had to locate a shape that was
hidden in a larger drawing.
Autistic children can identify the figures faster and more accurately than
non-autistic children.
Autistic children disregard context and do not succumb to the central
coherence force. Children with autism seem to have weak central
coherence.

Cognitive Explanations:
Central Coherence Deficit
Aim:
Method:
Results
:
Conc:
Hermelin and O'Connor (1967)
Showed that autistic children could recall a lot of unrelated words just as well as
they could recall related words and sentences. Control groups of non-autistic
children fared much better in the related compared to the unrelated.
Strengths
- CCD can explain communication impairment
- CCD can explain social impairment
- CCD can explain islets of ability

Limitations
- Does not explain repetitive and stereotyped behaviours
- Results from studies could also be explained by superior low
level processing
Evaluation of CCD
Executive Functioning:
"A higher order mental functioning. Allows us to start activities as
well as stop them - pay attention to some things and not
others."

A failure of executive funcitoning could explain many of the
symptoms of autism, as well as the Triad of Impairments:

Islets of ability: Extreme focus and practice over one thing.
Repeated/stereotyped behaviours: No control over start/stop

People with a failure of executive functioning would find it difficult
to switch from task to task, plan ahead or break from routine.
Cognitive Explanations:
Failure of Executive Functioning
Wisconsin Card Sorting Task
Set of cards given to children that can be sorted by colour,
shape or number. The researcher sets a sorting rule, but
during the task the rule is changed without telling the
sorter. The sorter must change the sorting pattern based
on the response of the researcher as they place each
card down.

This studies failure of executive functioning as it requires
the ability to start and stop activities quickly. Autistic
children fare much worse on this task than a control
group.
Cognitive Explanations:
Failure of Executive Functioning
Evaluation
Explains some features of autism not
explained by theory of mind and other
cognitive explanations.
Frith (1996) has concluded that it is
unlikely that one cognitive explanation can
explain all areas of autism, and executive
functioning can be used in conjunction
with these explanations to provide a better
overall picture.
Page 234, AQA AS Psychology B
Cold Parenting (Bettleheim, 1967)
Treatments
- Drug Treatments
- Aversion Therapy
- Parental Involvement
- The Lovaas Technique (ABA)
Therapeutic Programmes for Autism
v
Medication can be used to treat certain aspects of autism such as:
- Repetitive Behaviours
- Aggressive Behaviours
- Tantrums
- Self-harming

One type of medication used in the UK are SSRIs - Selective
Serotonin
Reuptake
Inhibitors
Examples of these include Fluoxetine and Paroxetine.

However, a limitation of these is Serotonin Syndrome.

Drug Treatments
Drug Treatments
Other drugs available for autism include:

Risperidone:
An anti-psychotic drug. It can reduce social withdrawal, stereotyped
behaviour and agression. However, many children do not respond to
this drug and it has no effects on any symptoms besides these.

Fenfluramine:
Lowers serotonin levels. Some evidence of improvement in behaviour
and thought processes. However, no consistent effect has been found
on language and cognitive levels. Effects are often subtle.
Geller et al (1984)
Fenfluramine used on 14 children with autism and found that they
showed increased social responsiveness, improved behaviour and
increased IQ.
McCraken et al (2002)
Double blind test with placebos. Children given risperidone results reduced
by 56.9% compared to placebo improvement of 14.1%.
STRENGTHS

- Provides relief from specific
symptoms
- More ethical than aversion
therapy/electrical shocks
- Geller et al (1984)
- McCraken et al (2002)
LIMITATIONS

- No drug yet developed to
combat all symptoms
- Medication would need to be
combined with other therapies
to work
- Side effects of drugs often
outweighs gain
- Many drugs have not even been
tested!
Evaluating Drug Treatments
Aversion Therapy
UCS
UCS
CS
CS CR
UCR
UCR
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Lovaas (1997) found that self-harming behaviour could be extinguished almost
immediately by using electrical shocks as an aversive stimulus.