SW 644: Issues in Developmental Disabilities Autism and Aging Lecture Presenter: Mary Pearlman, M.D. 5/24/2015Mary Pearlman, M.D.1

SW 644: Issues in Developmental DisabilitiesAutism and Aging

Lecture Presenter:

Mary Pearlman, M.D.

04/18/23 Mary Pearlman, M.D. 1

Adolescent Development

Puberty: Definition Period of rapid physical growth and

sexual maturation that ends childhood and begins adolescence


Adolescence

Adolescence: Definition The period of biological, cognitive,

and psychosocial transition from childhood to adulthood usually lasting a decade or so.


Hormonal Changes

Are hormonal changes responsible for the emotional changes in puberty?

Hormonal changes can cause: More rapid arousal of emotions Quick shifts in extremes of emotions More thoughts about sex Girls: cyclical mood shifts and

physical function


Newness Examples

Breast Changes Height and Weight Physical Strength


Newness

Task; integrating with peers Girl needs poodle skirt “now” Or life is ruined Everyone will hate me I hate you, mother


Newness Hysteria Is Fixed By…

Learning new skills Experiencing how peers react Experiencing how time works

emotionally


Hormones

Hormones are responsible for emotional changes because they stimulate brain cell growth.


Synaptogenesis and Arborization Synaptogenesis and arborization: Under the influence of increased

hormones in adolescence there is rapid synaptogenesis and arborization.


Synaptogenesis

Synaptogenesis:Definition Synapse: the functional membrane to

membrane contact of the nerve cell with another cell

Genesis: beginning


Arborization

Arborization: Definition The terminal branching of nerve

fibers in a tree-like fashion


Pre- and Post- Pubertal Nerve and Fibers

Post pubertal nerve fibers have branching at end. Diagram of pre and post pubertal nerve and fibers.


Arborization and Synaptogenesis Arborization and synaptogenesis

occur randomly, without a pattern Learning and experience strengthens

some paths and lets some paths die


Synaptogenesis and Arborization (cont.)

Cognitive response is confusion Emotionally the adolescent has

increased excitability


Apoptosis

Apoptosis: definition Cell death. An important result of

learning. Cellular pathways that are not useful, die.


Apoptosis (cont.)

Selective Attention Expanded memory skills Growing knowledge base Metacognition Continued Language Mastery Formal Operational Thought


Formal Operational Thought

With formal operational thought a person can imagine and process possibility not just concrete things that are taken in exactly as sensed


New Attributes

All the New Attributes lead to typical beliefs and attitudes that most adolescents experience.

These ameliorate, with experience.


Adolescent Development: Autism Qualitative impairment in social

interaction Qualitative impairment in

communication Restricted repetitive and stereotyped

patterns of behavior, interests


Adolescent Development: Autism (cont.)

Sexuality


Sexuality

Teaching appropriate self care and social mores

Support family and staff to provide this teaching

Autism lack of social understanding


Sexual Aggression

Normal phase of development Need to teach specific behaviors to

those who can’t figure it out


Cognitive and Emotional Development

Cognitive and emotional development relates to conscience development

Conscience may never get beyond that of a young person


A Tale of Learning Control

Age 9 - Young man touching himself in public

Age 13 – Grabbed peer around neck and kissed her

Helpful intervention is to point out appropriate ways and times, and firm rule of always asking permission


A Tale of Learning Control (2)

Age 18 – Approaches young aide and asks her to marry him

Young man hasn’t internalized the rule; moral age is 7

People around him have to be taught how to set limits neutrally


A Tale of Learning Control (3)

Age 22 – Uses money to buy fancy women’s underwear

Age 24 – Refuses to go to work Age 25 – Caught kissing a willing peer Age 32 – No longer interested in

picture collection


Adolescent Development: Autism As time goes on, competition relates

more to friendship Sexuality has not worked out well Most are uninterested in children Some may have been victimized Important to look at cognitive, social

and conscience age of person with DD


Adolescent Development: Autism (cont.) Are 7 year-olds responsible for their

behavior? We don’t negotiate rules with people with

inadequate or immature conscience formation

There are situations where a person always has to have some kind of monitoring

Conscience formation, which goes along with social development, is not going to get any further than seven or thirteen

Role Modeling

Powerful tool for learning behaviorCreates possible self definitionsCreates motivation for behavior


Role Modeling (cont.)

What an adult is what an adult does Work Social relationships Play


The Personal Fable

One is destined for greatness Greatness? Defined by society or self Greatness? reality or fantasy


Adulthood: Normal Development Adulthood: Definition The time after adolescence and

before death A period of ongoing Senescence


Senescence

Senescence: Definition The state of physical decline, in which

the body gradually becomes less strong and efficient with age.


Senescence (cont.)

Because of senescence, any chronic vulnerability we have worsens with each decade.

Vulnerabilities in persons with DD show the same progression

Associated with some specific DD there appears to be more rapid progression


Homeostasis

Homeostasis: the adjustment of the body’s systems to keep physiological and emotional functions in a state of equilibrium


Tasks Specific to Various Phases Young is learning or setting up the

conditions for work, love, play The mid-adult is settled in and has to

figure out how to maintain these conditions in the face of change

The late adult has to figure out how to make things better for the future


Some Characteristics

Mature commitment Post formal thought Dialectical thought Cognitive flexibility synthesis


Some Characteristics (cont.)

Faith can be an important part of life Socialization Resource Managing behavior Sooth feelings Have a community


Adulthood: Autism

Abuse is increased by any characteristic that makes the child harder to care for

Abuse is increased by any characteristic that promotes a negative identification with the child

Abuse is increased as stress increasesAbuse increases as child cannot defend

themselves


Relationship with Police

Dangerous Encounters, Avoiding perilous Situations with Autism. Davis, Bill and Schunick, Wendy. Jessica Kingsley Publishers. 2002. Philadelphia.


Adulthood: Autism (cont.)

Health Habits Eating Exercise


Caretakers Concerns

Social skills related to illness and death

Who will care for my child after I die? How much should I protect my child

from the dangers of the world? Is my child too dependent on me?


Caretaker Concerns (cont.)

Language attached to experience Familial and cultural ritual Maintaining attachment after death Language of self feelings


Who Will Care for My Child After I Die?

Appoint a caretaker for attachment, finances, case coordination

Memory books-keeping soothing past attachments and behavioral models

People with DD survive change very well if attachment and individualizing needs tended to


How Much Should I Protect My Child from the Dangers of the World?

No risk and the person cannot grow or experience life

No safety and the person is hurt and gives up going out

Balance and safety nets


Autism and aging: Conclusion

Changing demographics and increased participation in community living are exposing us all to more issues of adolescence and aging

Remember development Remember individualization Remember the need for a variety of social

supports Listen


Adulthood: Autism, Caretaker Concerns

Is my child too dependent on me? Resource function model


Autism and aging

How do you figure out causes of behavior?

Usually behavior serves the function of meeting a primary need

Skills, tasks, concerns and challenges help determine primary need and how it is expressed

Patient and caretakers drop clues if you listen


Autism and aging: Bibliography

The Developing Person Through the Life Span. Berger, 5th edition Worth Publishers

Stedman’s Medical Dictionary: 26th Edition, Williams and Wilkins 1995

Seltzer, Marsha. Mother-Child Relationship Quality Among Adolescents and Adults with Autism. Am. Journal on Mental Retardation. Vol111, Number 2: 121-137/ March 2006.


Documents

SW 644: Issues in Developmental Disabilities Autism and Aging Lecture Presenter: Mary Pearlman, M.D. 5/24/2015Mary Pearlman, M.D.1