THE BIG PICTURE OF AUTISM: SCIENCE AND THEORY IN PLAIN ENGLISH Lars Perner, Ph.D. San Diego State University Presentation at the ANCA Foundation Special

THE BIG PICTURE THE BIG PICTURE OF AUTISM:OF AUTISM:

SCIENCE AND SCIENCE AND THEORY IN PLAIN THEORY IN PLAIN

ENGLISHENGLISH

Lars Perner, Ph.D.Lars Perner, Ph.D.San Diego State UniversitySan Diego State University

Presentation at thePresentation at theANCAANCA® Foundation Special Fall Foundation Special Fall

Conference and FundraiserConference and FundraiserVancouver, B.C.Vancouver, B.C.

November 19-20, 2004November 19-20, 2004

Copyright © 2004 Lars Perner, Ph.D.2

““If It [Were] Easy”If It [Were] Easy”

Problems we face are often Problems we face are often superficially similar to those faced by superficially similar to those faced by “neurotypicals”“neurotypicals”– RelationshipsRelationships– Understanding othersUnderstanding others– ConflictConflict– BudgetingBudgeting– Limited sensory abilitiesLimited sensory abilities

How How wewe handle these problems handle these problems


Purposes of This TalkPurposes of This Talk

Understand the many factors that Understand the many factors that influence autism in individualsinfluence autism in individuals

Recognize individual variations and Recognize individual variations and unique needsunique needs

Build empathy with autistic Build empathy with autistic individualsindividuals

Get ideas on what to try and consider Get ideas on what to try and consider to help specific individualsto help specific individuals


The Role of Theory (or SeeingThe Role of Theory (or Seeing“The Big Picture”)“The Big Picture”)

THEORY

UNDERSTANDING

ANALYSIS

INTERVENTIONS

EXPERIENCEWITH INDIVIDUAL

VALUES AND

DECISIONS


““It Takes Every Kinda’ Perspective to It Takes Every Kinda’ Perspective to Go Around the Autistic Spectrum”Go Around the Autistic Spectrum” with with

apologies to Robert Palmerapologies to Robert Palmer

Specialists and Specialists and medical medical practitionerspractitioners

TeachersTeachers ParentsParents Individuals on the Individuals on the

SpectrumSpectrum Biomedical Biomedical

researchersresearchers

Psychologists and Psychologists and CounselorsCounselors

TheoreticiansTheoreticians General populationGeneral population Other(?)Other(?)


Why Do These Symptoms Go Why Do These Symptoms Go Together?Together?

Sensitivity toSensitivity to– NoiseNoise– Coarse materialsCoarse materials– Food tastesFood tastes

Poor handwritingPoor handwriting Difficulty maintaining Difficulty maintaining

eye contacteye contact Frustration with Frustration with

“spontaneous “spontaneous coordination”coordination”

Difficulty imitating Difficulty imitating othersothers

Impaired spatial abilityImpaired spatial ability– Difficulty drivingDifficulty driving– Following mapsFollowing maps

Difficulty with sensory Difficulty with sensory integrationintegration

Difficulty doing Difficulty doing arithmetic despite arithmetic despite intelligenceintelligence

DepressionDepression


DiagnosisDiagnosis

Diagnostic criteria are somewhat Diagnostic criteria are somewhat arbitraryarbitrary

May be needed for insurance and May be needed for insurance and eligibility standardseligibility standards

Frequently “fudged” to meet Frequently “fudged” to meet eligibilityeligibility

Future discoveries may help us Future discoveries may help us better identify clusters of better identify clusters of vulnerabilitiesvulnerabilities


Arbitrary Medical StandardsArbitrary Medical Standards

Schizophrenia takes precedence over Schizophrenia takes precedence over autism/AS/PDD-NOSautism/AS/PDD-NOS

Autism/AS/PDD-NOS take precedence Autism/AS/PDD-NOS take precedence over ADD/ADHDover ADD/ADHD

Symptoms of depression may be Symptoms of depression may be “secondary” and may or may not be “secondary” and may or may not be diagnosed separatelydiagnosed separately


UndiagnosedAutism

CorrectlyDiagnosedAutism

Misd

iag

no

sed

As A

utism

Has AutismDiagnosed

Diagnosis, Misdiagnosis, and Diagnosis, Misdiagnosis, and “Undiagnosis”“Undiagnosis”


AutismOnly

AutismAnd Other

OtherOnly

Complicating Things…Complicating Things…


AUTISTICSPECTRUM

CONDITIONSATTENTION

DEFICIT/HYPER-

ACTIVITY

SEIZURES/TOURETTE’S

DEPRESSION/BIPOLAR

DISORDER

LEARNINGDISABILITIES

OBSESSIVE-COMPULSIVE

DISORDER

OPPOSITIONALDEFIANCEDISORDER

ANXIETY

ComorbidityComorbidity


HASOTHER

CONDITION

HASAUTISM

AUTISMDIAGNOSED

OTHERCONDITIONDIAGNOSED

ADOD anOD

AuOu

ADOu

Auon

aMon

anoM

aMoM

ADon

ADoM

adOu

A Has autisma Does not have autismD Condition has been diagnosedn Condition has not been diagnosedM Misdiagnosis (False positive)u Undiagnosed condition (False negative)O Has other conditiono Does not have other condition

aMOu

aMoD

Autism and Other Conditions: Autism and Other Conditions: Seeing the Whole PictureSeeing the Whole Picture


Pervasive Developmental Pervasive Developmental Disorders (PDDs)Disorders (PDDs)

CategoriesCategories– AutismAutism– Asperger’s SyndromeAsperger’s Syndrome– Rett’sRett’s– Pervasive Developmental Pervasive Developmental

Disorder—Not Otherwise Disorder—Not Otherwise Specified (PDD-NOSSpecified (PDD-NOS))

– Childhood Degenerative Childhood Degenerative DisorderDisorder

DifferencesDifferences– Within-groupWithin-group– Between-groupBetween-group

Meaningfulness of Meaningfulness of diagnostic distinctionsdiagnostic distinctions

Rigidity of criteriaRigidity of criteria Arbitrary nature of Arbitrary nature of

standardsstandards


Causes of and Influences on Causes of and Influences on AutismAutism

GENETICSVULNERABILITY

TO ENVIRONMENT

SYMPTOMS

GENETIC PROTECTION

COMPENSATINGABILITIES EXHAUST

SECONDARYSYMPTOMS

ENVIRONMENT


INSTINCT

ACTIONREINFORCEMENT/

LEARNINGEXHAUST

ABILITY/INHIBITION

MOVITATION

LIKELYADAPTATION

SHUTDOWN

“MELTDOWN”

INAPPROPRIATEACTION

Non-Action

If lacking

EfficientInefficient

POSSIBLEADAPTATION

Low ability or inadequate inhibition


GeneticsGenetics

Varying estimates of the numbers of genes Varying estimates of the numbers of genes involvedinvolved

ModelsModels– Various genes individually cause specific Various genes individually cause specific

problems leading to autism symptomsproblems leading to autism symptoms– Multi-gene Threshold: Must have a certain Multi-gene Threshold: Must have a certain

number of genes (e.g., 3-20) to exhibit symptomsnumber of genes (e.g., 3-20) to exhibit symptoms Interaction of multiple genesInteraction of multiple genes

– Fraternal vs. identical twinsFraternal vs. identical twins Genetic redundancy and protectionGenetic redundancy and protection


Question from ParticipantsQuestion from Participants

Likelihood of Children Likelihood of Children Inheriting Autism from Autistic Inheriting Autism from Autistic

ParentsParentsQuestion: “Speak to the issue of autistic people having children given geneticQuestion: “Speak to the issue of autistic people having children given geneticcomponent.”component.”

Inheriting “autism” vs. specific traitsInheriting “autism” vs. specific traits Family history of Family history of bothboth parents parents

– Autism characteristicsAutism characteristics– Other characteristics (e.g., ADHD, depression, anxiety)Other characteristics (e.g., ADHD, depression, anxiety)

Gender of childGender of child Dr. Ami Klin: [No definitive research Dr. Ami Klin: [No definitive research

but] “15% might be a reasonable but] “15% might be a reasonable estimate.] MAAP Newsletter, 2004, estimate.] MAAP Newsletter, 2004, Volume II.Volume II.


El NiñoficationEl Niñofication The tendency to The tendency to

move to one move to one extremeextreme or the or the other on other on performance or performance or behaviorbehavior– ExamplesExamples

SensitivitySensitivity ConfrontationConfrontation Math or verbal Math or verbal

abilitiesabilities


Brain StructureBrain Structure

Specialization of brain areas (e.g., Specialization of brain areas (e.g., amygdala)amygdala)

Brain scan studiesBrain scan studies ““White” vs. “gray” matterWhite” vs. “gray” matter Neural connections Neural connections

– LearningLearning– Survival and “pruning”Survival and “pruning”– Structure of neurons and dendritesStructure of neurons and dendrites


NeurotransmittersNeurotransmitters

Total of 52 knownTotal of 52 known Especially important in autism:Especially important in autism:

– DopamineDopamine– NorepinephrineNorepinephrine– SerotoninSerotonin– OxytocinOxytocin

Interaction of transmittersInteraction of transmitters


Question from ParticipantsQuestion from Participants

“Fight or Flight” Response“Fight or Flight” Response““Question: Can you add more fight-or-flight information in terms of brain Question: Can you add more fight-or-flight information in terms of brain

chemistry and body reactions?”chemistry and body reactions?”

““Fight or Flight” response—evolutionary advantageFight or Flight” response—evolutionary advantage Or: “Fight, Flight, Shutdown, or Meltdown”Or: “Fight, Flight, Shutdown, or Meltdown” CausesCauses

– Activation of Sympathetic Nervous SystemActivation of Sympathetic Nervous System– Release of adrenaline and cortisolRelease of adrenaline and cortisol

Role of amygdala within autismRole of amygdala within autism– Some research suggests that the amygdala is, on the Some research suggests that the amygdala is, on the

average, enlarged in people on the spectrum (large average, enlarged in people on the spectrum (large variation)variation)

– Amygdala may be overworked due to non-specialization in Amygdala may be overworked due to non-specialization in other brain areasother brain areas

Role of anxiety and depressionRole of anxiety and depression


Flight or Fight Responses:Flight or Fight Responses:A Simplified ModelA Simplified Model

SENSORYINPUT

STRESSRESPONSE

LONGDETOUR

AUTOMICNERVOUSSYSTEM

LIMBICSYSTEM

THALAMUS

FRONTALCORTEX

PRE-FRONTALCORTEX

CANCELUNNEEDEDSTRESSRESPONSE

THIS CHANNELIS STRENGTHENEDTHROUGH MATURATION

POST TRAU-MATIC STRESSDISORDER MAYRESULT FROMEXCESSIVE USEOF THIS CHANNEL


Two Competing Objectives for Two Competing Objectives for Computers and BrainsComputers and Brains

SPEED(EFFICIENCY)

RELIABILITY

ASSUMPTIONSGENERALIZATIONSPECIALIZATION

FILTERINGPRIORITIZATION

INTUITION (HUMANS)

QUESTIONING ASSUMPTIONSREDUNDANCYVERIFICATION

FOCUS OF ATTENTIONLOGICAL EXAMINATION


Hierarchy of Information and Hierarchy of Information and ThinkingThinking

Non-perceived stimuli

Non-conscious handling of stimuli

Pre-consciousawareness

Awareness

Thinking

Decision making


A FIVE FUNCTION MODEL OF THE A FIVE FUNCTION MODEL OF THE PERFORMANCE OF INDIVIDUALS ON THE PERFORMANCE OF INDIVIDUALS ON THE

AUTISTIC SPECTRUMAUTISTIC SPECTRUM

INSTINCTIVEFUNCTION

INTELLECTUALFUNCTION

COMPENSATORYFUNCTION

EXECUTIVEFUNCTION

INTUITIVEFUNCTION

ACTIVE

INHIBITORY

PERF0RMANCE


Abstraction and Abstraction and GeneralizationGeneralization

Individuals with autism often have Individuals with autism often have difficulty indifficulty in– Generalizing from one situation to anotherGeneralizing from one situation to another– Understanding and/or accepting “exceptions”Understanding and/or accepting “exceptions”– Understanding certain non-concrete ideas Understanding certain non-concrete ideas

(BUT…)(BUT…)– Understanding non-literal languageUnderstanding non-literal language– Deciphering symbolic (graphical) Deciphering symbolic (graphical)

representationrepresentation


Question From the AudienceQuestion From the Audience

What Teachers Can DoWhat Teachers Can DoQuestion: “The early teen years are very difficult for all children. As aQuestion: “The early teen years are very difficult for all children. As a

school, what would you like to see us teachers make happen? What wouldschool, what would you like to see us teachers make happen? What wouldmake life easier for the autistic child? How can they grow socially,make life easier for the autistic child? How can they grow socially,emotionally without disaster?”emotionally without disaster?”

Recognizing individual differencesRecognizing individual differences– Talking about options rather than giving Talking about options rather than giving

“command” advice“command” advice Working with special interests and Working with special interests and

motivations motivations Time to “process”Time to “process” Help with reasoning on other people’s Help with reasoning on other people’s

thoughts and feelings (“Theory of Mind”)thoughts and feelings (“Theory of Mind”)

Documents

THE BIG PICTURE OF AUTISM: SCIENCE AND THEORY IN PLAIN ENGLISH Lars Perner, Ph.D. San Diego State University Presentation at the ANCA Foundation Special