Microsoft word - whats new for 2008 - aqa-b autism
What’s new for 2008? On the AQA-B specification: Autism
If you are planning to start the new AQA-B specification from September 2008, one of thenew topics you will need to prepare is Autism. This is one of the optional topics in Unit 2. Here are some resources to help your preparation for this area of the course. What is autism? Autism is a described by the Diagnostic and Statistical Manual IV (DSM-IV) as a pervasive mental disorder, meaning that those people who are affected have severe and extensive problems. These affect many aspects of their development including social and communication skills, thinking and language. Autism affects approximately 45 people in every 100,000, ie just less than 0.05% of the UK population although many more are affected by mild symptoms of the disorder. Symptoms of autism Autism is described as a syndrome as individuals typically have a cluster of symptoms. The three key characteristics are sometimes called the ‘triad of impairments’. These are:
impaired social interaction: little reaction to others, poor use and understanding of
facial expressions and a tendency to avoid eye-contact. Little understanding of theemotions experienced by other people.
impaired communication: little or entirely absent speech. When language is sued it
repetitive/stereotyped behaviours: dependence on routine and resistance to
change, strong attachments to or interest in objects may develop and repetitivebehaviours (that may be self-harming) eg hair-pulling can be exhibited.
Some other characteristics that have been identified include:
a preference for objects over people
occasional narrow fields of high intelligence or ability (‘islands’ or ‘pockets’ of ability)
abnormal perception (eg insensitivity or hypersensitivity)
distorted mobility patterns (eg walking on tip-toe or avoiding cracks in the
lack of theory of mind (failing to understand how others feel or see the world)
self-absorption (eg failure to respond to conversation or music)
weak central coherence ie tending to focus on a narrow aspect of a scene rather
limited imagination, such as a lack of pretend play
Explaining autism from different perspectives Each of the major approaches to psychology offers one or more different explanations for autism. Some focus on explaining how the disorder develops, others focus on accounting for specific symptoms. The major ones are discussed below. Psychological explanation: cold parentingSometimes called the ‘refrigerator mother’ hypothesis, this explanation suggests that rigid,uncommunicative parenting leads the child to withdraw socially. Bettleheim (1967)proposed that this was a consequence of the parents’ wish that the child did not exist. However, subsequent research has shown that, whilst child abuse can lead to social
withdrawal and lack of communication (both key aspects in autism), this explanationcannot account for these symptoms in autism. Whilst good care can improve symptoms inabused children this is not the case in autism and, conversely, many children with autismhas loving, caring parents. Clearly, blaming parents does not offer an explanation forautism. Biological explanation: geneticsThe higher incidence of autism in boys than in girls is one indicator that the disorder maybe genetic. Evidence has shown there is a slight but significant trend for autism to appearin siblings – 3% shared the disorder - (Bolton et al, 1994). When a control group ofchildren with Down’s syndrome were compared, no such trend was found. The pattern ofconcordance in twins also suggests a genetic influence. Ritvo et al (1985) found that 96%of identical twins shared the disorder but only 23% of non-identical twins. Interestingly, theconcordance rate here was much higher than for siblings even though non-identical twinsare no more genetically similar. This is powerful evidence that the environment is alsoimportant in the development of autism.
Furthermore, although the range of symptoms is too varied for a single gene to beresponsible, two chromosomes have been implicated in susceptibility to autism. Forexample, Bailey et al (1998) provided evidence that chromosome 7 was involved in thedevelopment of autism and other research has also suggested that chromosomes 2, 15and 16 are important. Cognitive explanationsUnlike the cold parenting and genetic explanations, which attempt to account for howautism arises, cognitive explanations attempt to explain how differences in thinking resultin the symptoms we associate with autism. Thus, these explanations are not mutuallyexclusive. For example, a genetic predisposition might underlie a particular cognitiveproblem. Lack of ‘theory of mind’‘Theory of mind’ refers to the beliefs that a person has about someone else’s thinking. It isa concept that enables us to understand and predict other people’s responses andbehaviour. Without a theory of mind, social interaction becomes almost impossiblebecause it leaves the individual unable to comprehend the thinking and feelings of others. This ability, sometimes called ‘mind-reading’ normally begins to appear early indevelopment, alongside pretend play – the ability to recognise that someone or somethingis being used to ‘represent’ something else. For example, the statement from a motherholding a banana to her ear and says ‘mummy’s on the telephone’ is obviously false butwill entertain a child of 18 months because they recognise the pretence. This‘metarepresentation’, the use of one thing or idea to stand for another, is not onlyimportant in play but in understanding other people. In order to comprehend the mentalstate of another person, a child needs to be able to attribute mental states such as ‘hope’,‘believe’ or ‘intend’ – this is a form of metarepresentation and this, as well as pretend play,is absent in autism.
Impairments of ‘mind-reading’ in autism have been illustrated in many different ways, forexample in the now classic ‘Sally-Ann’ study (Baron-Cohen & Frith, 1985). However, thereare many other ways to demonstrate this problem. Baron-Cohen (1989) found that at lessthen five years old, children with autism were just as good as normal children at pointing at
things they wanted. However, they were much less likely to engage in pointing to indicatea shared interest. These behaviours occur in real life, so a child with autism would be justas likely to point at their preferred food but would not, for example, use pointing to attractanother person’s attention to a helicopter. Weak central coherenceFrith & Happé (1994) suggested that people with autism tend to focus on information at a‘local’ level, that is, to concentrate on a narrow aspect rather than taking account of thewhole scene at a ‘global’ level. So, a child with autism may only notice the wheels of atractor, apparently ignoring the cab, trailer and farmer. This difference in attention leads to‘fragmented’ perception – their view of a scene may be ‘missing’ some information. However, although this may be detrimental in some respects, it leads to some interestingeffects. For example, children with autism are less likely to be fooled by some types ofvisual illusions. In the Tichener’s circles illusion, most viewers will see the inner circle onthe left as smaller than the one on the right – this is because they process the wholeimage globally. A person with autism, attending to each part of the image independently,will not be affected by the relative differences in size between the inner and outer circles. Executive functioning deficitsWhen we engage in a complex behaviour we mentally plan the activity so that we payattention to the relevant parts of the task at the right time. This cognitive organisation iscalled our ‘executive function’; it allows us to avoid distractions and use rules to conducttasks. In autism, executive functioning is impaired and one consequence is difficulty withswitching between the demands of a task. For example, Ozonoff et al (1991) used theWisconsin Card Sorting Test and the Tower of Hanoi test to identify impairments ofexecutive function in children with autism. They found that the children with autism hadproblems with the card sorting task because it required them to swap from one rule toanother (eg from sorting cards by colour to sorting them by shapes). The Tower of Hanoitask requires forward planning and this, too, was difficult for children with autism. Thesefindings can help to account for the distress people with autism experience when theirroutine is changed – they have difficulty shifting from one set of mental expectation toanother so cannot predict what will happen under a new set of circumstances. This leadsto anxiety because the situation has become unfamiliar – imagine yourself suddenlytransported into a different culture or onto another planet in which you have nounderstanding of the social rules that dictate how other people will behave – you would bevery frightened. One child with Asperger’s Syndrome (a milder impairment on the autisticspectrum) describe himself as coming from ‘Planet Asperg’ – an indication that he felt therest of the world was entirely ‘foreign’ to him.
One recent approach to investigating resistance to change in autism has used brainscanning. Functional magnetic resonance imaging (fMRI) allows researchers to identify theparts of the brain that are active during different types of cognitive processing. Gomot et al(2006) used a sample of 12 children with autism aged 10-15 and an IQ, age and sex-matched sample of 12 children without autism. Their brains were scanned while theycompleted a task that involved ‘novelty’ and ‘deviance’ detection – they had to detect newsounds (novelty) and ones which didn’t fit an expected pattern (deviance). The childrenwith autism showed different patterns of brain activation during these tasks, especially inareas of the brain known to be involved in novelty detection and attention switching. Problems with controlling the relative importance given to new information duringprocessing may cause people with autism to ignore new stimuli which they are notattending to and so provide an explanation for their resistance to change. Different approaches to treatment for autism As with explanation for autism, there are a range of difference therapeutic approaches offered by the different psychological perspectives. A selection of these is described below.
Several different types of drugs have been used therapeutically in autism. Anti-psychotics,including haloperidol and risperidone are useful in reducing stereotypical movementsincluding repetitive self-harming behaviours, such as head-banging. They are also used tocombat social withdrawal. Antidepressants, including fluoxetine (or ‘Prozac’ – a SelectiveSerotonin Reuptake Inhibitor) are also used to reduce repetitive behaviours. Such drugsact at the synapse, preventing the reabsorption of the neurotransmitter serotonin into thepresynaptic membrane. As a consequence they effectively increase the level of serotonin. When used with high-functioning people with autism they can not only help to controlrepetitive behaviours but also reduce symptoms of anxiety. Conversely, there is someevidence that drugs such as fenfluramine, which reduce levels of serotonin in the blood,are helpful in controlling the symptoms of autism although evidence is not conclusive(Ross et al, 1987; Leventhal et al, 1993).
A different pharmacological approach is to use stimulant drugs, such as those used in thetreatment of attention deficit hyperactivity disorder (ADHD). Methylphenidate (Ritalin),used to help people with ADHD, can also be useful in controlling hyperactivity in peoplewith autism and improves their ability to focus. In a study of children with autism, Quintanaet al (1995) compared methylphenidate to a placebo. They found that methylphenidatesignificantly reduced hyperactive behaviours and did not increase stereotyped, repetitivebehaviours. Behavioural techniquesToken economy programmesA token economy is a behaviour modification system employing operant conditioningtechniques to positively reinforce appropriate behaviours. Primary reinforcers such assweets, or secondary reinforcers (tokens) can be used to shape desirable responses andto increase the frequency of these behaviours. For children with autism these can includesocial behaviours such as listening to others rather than interrupting.
Classical conditioning underlies behaviour therapies such as aversion therapy. This pairsan unpleasant stimulus with a ‘to be reduced’ behaviour so can be used to reduce self-injurious responses such as head banging. The intention is that when an unpleasantstimulus, such as an electric shock, is paired with the maladaptive behaviour the behaviourwill stop. How successful are therapies for autism?Therapies for autism aim to control symptoms rather than cure the disorder. When thereare so many different symptoms of autism and no single explanation, it is unlikely that anysingle therapeutic approach will be successful. This is borne out in the range of techniquesused and in the variability in their success. In assessing the effectiveness of anytherapeutic programme it is important to consider many aspects including the scientificvalidity of investigations (such as the use of placebo comparison groups) and the ethicalimplications of the regime imposed. Placebo groups are often used in the assessment ofdrug treatments but can also be employed in behavioural programmes. When consideringethical implications, both behavioural and drug therapies raise issues. Drugs may haveunpleasant side effects and behavioural therapies may be very unpleasant for theindividual or may threaten their individual rights. Some useful websites Finally, here are some websites providing a range of resources that may be useful to help you and your students.
- the home page of the National Autistic Society
Research Centre at Cambridge – the site contains much useful information
- the home page of the judge Rotenberg Center, a
residential facility which uses aversion therapy to treat autism
References Bailey A, Luthert P, Dean A, Harding B, Janota I, Montgomery M, Rutter M & Lantos P
(1998) A clinopathological study of autism. Brain, 12195): 889-905.
Baron-Cohen S (1989) perceptual rôle-taking and protodeclarative pointing in autism. British Journal of Developmental Psychology, 7: 113-27.
Baron-Cohen S, Leslie AM & Frith U (1985) Does the autistic child have a theory of mind?
Bettleheim B (1967) The Empty Fortress. New York: Free Press. Bolton P, Macdonald H, Pickles A, Rios P, Goode S, Crowson M, Bailey A & Rutter M
(1994) A case-control family history study of autism. Journal of Child Psychology &Psychiatry, 35(5): 877-900.
Frith U & Happé F (1994) Autism: beyond theory of mind. In D Messer & J Dockrell (1999)
Developmental Psychology: A Reader. London: Arnold.
Gomot M, Bernard FA, Davis MH, Belmonte M, Ashwin KC, Bullmore ET and Baron-
Cohen S (2006) Change detection in children with autism : an auditory event-related fMRI study. NeuroImage, 29:475-95.
Leventhal BL, Cook EH Jr, Morford M, Ravitz AJ, Heller W & Freedman DX (1993) linical
and neurochemical effects of fenfluramine in children with autism. Journal ofNeuropsychiatry and Clinical Neuroscience, 5(3):307-15.
Ozonoff S, Pennington BF & Rogers SJ (1991) Executive function deficits in high-
functioning autistic individuals: relationship to theory of mind. Journal of ChildPsychology & Psychiatry, 32: 1081-106.
Quintana H, Birmaher B, Stedge D, Lennon S, Freed J, Bridge J, Greenhill L (1995) Use of
methylphenidate in the treatment of children with autistic disorder. Journal of Autism& Developmental Disorders, (3):283-94.
Ritvo ER, Freeman BJ, Mason-Brothers A, Mo A & Ritvo AM (1985) Concordance of the
syndrome of autism in 40 pairs of afflicted twins. American Journal of Psychiatry,142: 74-7.
Ross DL, Klykylo WM & Hitzemann R (1987) Reduction of elevated CSF beta-endorphin
by fenfluramine in infantile autism. Pediatric Neurology,3(2):83-6.
PRODUKTRESUMÉ 1. LÄKEMEDLETS Ceplene 0,5 mg/0,5 ml injektionsvätska, lösning. 2. KVALITATIV OCH KVANTITATIV SAMMANSÄTTNING En injektionsflaska med 0,5 ml lösning innehåller 0,5 mg histamindihydroklorid. För fullständig förteckning över hjälpämnen, se avsnitt 6.1. 3. LÄKEMEDELSFORM Injektionsvätska, lösning. Klar, färglös vattenlösning. 4. KLI