PSY 183 ASD 2024 PDF

Introduction to Psychopathology Alan J. Fridlund, Ph.D. NOTICE: These Lecture Notes © Copyright 2014, 2020, 2023, by Alan J. Fridlund, Ph.D. All Rights Reserved. They May Be Downloaded for Private Use Only by Students Currently Registered in UCSB Psych 18...

Introduction to Psychopathology Alan J. Fridlund, Ph.D. NOTICE: These Lecture Notes © Copyright 2014, 2020, 2023, by Alan J. Fridlund, Ph.D. All Rights Reserved. They May Be Downloaded for Private Use Only by Students Currently Registered in UCSB Psych 183. For-Profit Reproduction in Whole or In Part Without Written Permission of the Instructor Is a Violation of U.C. Regulations and the DMCA and Is Expressly Prohibited.  Notice All Course materials (class lectures and discussions, handouts, examinations, Web materials) and the intellectual content of the Course itself are protected by United States Federal Copyright Law, and the California Civil Code. UC Policy 102.23 expressly prohibits students (and all other persons) from recording lectures or discussions and from distributing or selling lectures notes and all other course materials without the prior written permission of the Instructor (See http://policy.ucop.edu/doc/2710530/PACAOS-100). Students are permitted to make notes solely for their own private educational use. Exceptions to accommodate students with disabilities may be granted with appropriate documentation. To be clear, in this class students are forbidden from completing study guides and selling them to any person or organization. The text has been approved by UC General Counsel. You are granted permission in Psych 183 to download and retain personal copies of these slides solely for your own use. Swiftamnesia  DSM-5-TR Autistic Spectrum Disorder Alan J. Fridlund, Ph.D.  Autistic Spectrum Disorder (ASD) Formerly, “Autism” ⚫ Classified in previous DSM-5 and newest DSM-5-TR as a Neurodevelopmental Disorder, a category which includes various intellectual, perceptual and communication disorders. ⚫ ASD includes a range syndromes distinguished by early-onset: – impairments in social interaction and communication. – restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. ⚫ About 1 in 150 children has some form of ASD; overall, ASD occurs 5-10 X more often in males than in females. ⚫ ASD in DSM-5-TR incorporates a wide range of functioning; – Level 1 – Relatively high-functioning, capable of independent living. – Level 2 – Moderate functional, with some repetitive behaviors, capable of semi-independent living. – Level 3 – Serious communication difficulties and repetitive behaviors, requires medication and 24/7 care.  Signs of Lower-Functioning ASD People with lower-functioning ASD, as children, tend to show: ⚫ Problems in verbal and nonverbal communication – No babbling, gesturing or pointing by ~12 months, and non-response to gestures. – No speech or echolalic (repeat) speech. – Social withdrawal: little interest in peers, making friends, or in joint play – Poor eye contact or “seeing through” people. – Lack of social smiling and “joint attention.” – Failure to initiate or respond to social interactions. ⚫ Sensory problems – Hyper-sensitivity or indifference to touch, smells, sounds, pain. – Absence of startle to loud noises. ⚫ Repetition and preference for sameness – Repetitive body movements (hand-flapping, finger-flicking). – Perseveration (gets stuck on a specific topic or task). – Very narrow set of interests and over-focus on preferred activities Problems with inattention in people with ASD lead to frequent co- diagnosis of ASD with ADHD. – Sometimes, self-injurious behavior (head-banging, skin-chewing). Medical Conditions Sometimes Comorbid with Lower-Functioning ASD ⚫ In 70% of ASD cases, no known medical disorder is apparent. ⚫ But in up to 30 % of ASD cases, ASD is diagnosed in DSM-5-TR as “ASD with a known genetic or medical condition,” such as: – Fragile X syndrome: most common known genetic cause of ASD and intellectual disability (formerly “mental retardation”); mutation in FMR1 gene on X chromosome. – Rett Syndrome - known genetic mutations of MCEP2 gene on X-chromosome: broad infantile deterioration with seizures, diagnosed around 6-18 months, affects mostly females. – Trisomy 21 (Down Syndrome) – and many others … Older Classifications within “Autism Spectrum Disorder” No Longer Diagnosed Separately in DSM-5 and DSM-5-TR Higher-functioning ASD: ⚫ Asperger’s Syndrome Lower-functioning ASD: ⚫ Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS); referred to early-appearing ASD with global developmental problems, including intellectual disabilities ⚫ Childhood Disintegrative Disorder - normal early development until middle childhood, then profound deterioration to custodial care.  “Early Infantile Autism” Precursor Diagnosis to ASD Leo Kanner ⚫ The diagnosis of “Early Infantile Autism” was first used by psychiatrist Leo Kanner at Johns Hopkins University in 1943. ⚫ Kanner, like many psychiatrists, believed “autism” to be an escape from reality, and so through the 1960’s, parents of autistic children were often blamed for their children’s disorder. The parents were accused of being contradictory communicators (“double-binding”) and the mothers were said to be emotionally withholding (“refrigerator mothers”). ⚫ The disorder was often confused with “childhood schizophrenia.” ⚫ “Autism” is now included the DSM-5-TR ASD category, and people with ASD are considered to have neurodevelopmental disorders which have nothing to do with child-rearing. ASD as a Set of Congenital Disorders Adult ASD in Rain Man (1988)  “Asperger’s Syndrome” (Higher-functioning ASD, incorporated into ASD by DSM-5 and DSM-5-TR) ⚫ First identified by Austrian pediatrician Hans Asperger in 1944, but not well-known until 1980’s. ⚫ Behavior resembles that of others with ASD (social impairment and repetitive interests and behavior), but intelligence is normal and speech is formally correct. However: – Empathic responding is deficient. – Social contacts are awkward and lacking in routine “manners.” – Routines are maintained insensibly and inflexibly. – Speech patterns are stilted and lecture-like, monotonous, or fixated on certain interests (air travel timetables, weather patterns, automobile engine details). – Sometimes: odd posturing, nervous tics, hand-flapping, violent outbursts, sensory hypersensitivity. ⚫ No clear demarcation from “high-functioning autism,” hence the combination of Asperger’s Syndrome with autism into ASD in DSM-5-TR. High-Functioning People Speculated to Have / Have Had ASD or Disclosed that They Had an ASD Diagnosis ⚫ Isaac Newton ⚫ John Nash ⚫ Hans Christian Andersen ⚫ Andy Warhol ⚫ Abraham Lincoln ⚫ Charles Schulz ⚫ Alan Turing ⚫ Glenn Gould ⚫ Albert Einstein ⚫ Hans Asperger ⚫ Alexander Graham Bell ⚫ Howard Hughes ⚫ Anton Bruckner ⚫ Isaac Asimov ⚫ Bela Bartok ⚫ Jim Henson ⚫ Paul Dirac ⚫ John Denver ⚫ Benjamin Franklin ⚫ Bill Gates ⚫ Bertrand Russell ⚫ Bob Dylan ⚫ Bobby Fischer ⚫ Kevin Mitnick ⚫ Carl Jung ⚫ Keith Olbermann ⚫ Emily Dickinson ⚫ Oliver Sacks ⚫ George Orwell ⚫ James Taylor ⚫ Erik Satie ⚫ Steve Jobs ⚫ Franz Kafka ⚫ David Byrne ⚫ Henry Ford ⚫ Dan Ackroyd ⚫ Nikola Tesla ⚫ Jerry Seinfeld ⚫ Alfred Hitchcock ⚫ Anthony Hopkins ⚫ Andy Kaufman ⚫ Mark Zuckerberg ⚫ Alfred Kinsey ⚫ Elon Musk ⚫ Carl Sagan  High-Functioning ASD People on TV Shaun Murphy M.D. (Freddy Highmore) Sheldon Cooper (Jim Parsons) & Amy Farrah Fowler (Mayim Bialik)  Is High-Functioning ASD Even a Disorder, or Simply an Instance of Neurodiversity? Temple Grandin, Ph.D. Professor of Animal Science Colorado State University Claire Danes in Temple Grandin [HBO Films, 2010] Temple Grandin as Neurodiversity Advocate [ TEDxDU, Denver, May 2011 ] Go to www.templegrandin.com  What Is the Etiology of ASD? ⚫ Probably a number of different types of ASD with various etiologies – unification of various disorders within DSM-5-TR “ASD” may prove counterproductive. ⚫ Between 600-1200 genes may contribute to the odds of developing ASD, as well as gene copy number variants (CNV’s) and chromosomal abnormalities. ⚫ Concordance of 70-95% for MZ twins, and 0-24% for DZ twins, suggesting genetic, epigenetic, and/or prenatal environmental links. ⚫ Older fathers raise the odds of children with ASD, probably due to gene mutations. ⚫ Brain findings show an over-abundance of neurons in the ASD brain beginning in utero; in the prefrontal cortex, ASD brains have 67% more neurons than average, and there is over-wiring of local connections among the neurons. ⚫ Considerable evidence suggests that childhood vaccines do not increase the incidence of ASD.  How Is ASD Treated? ⚫ Early Behavioral Intervention: – Self-care – Social skills ⚫ Lower-functioning ASD: ABA therapy focusing on floor-time play and group behavior, training to make eye-contact, facial expressions, and sustain attention ⚫ Higher functioning ASD: Social-script training, management of relationships, vocational and sexuality counseling – Educational: structured, 1:1 teaching environment with high reinforcement density. The initial focus is on language, then more general academics for higher-functioning people with ASD. ⚫ Medication: – Ritalin for “ADHD”-like behavior – Anticonvulsants, antipsychotics, and/or cannabinoids for violent outbursts, seizures, and other medical problems (seizures are present in up to 30% of ASD individuals) – Response to medications is highly individual, and violence and aggression must consider psychosocial environment. ⚫ Family Therapy and Applied Behavior Analysis (ABA Therapy) to foster healthy boundary-setting and preserve harmony in families severely stressed by a member with ASD. ⚫ Outcomes of treatment are unpredictable and vary on case-by-case basis ⚫ Long-term custodial care for lower-functioning cases. Lifespan across ASD people averages ~40 yrs due to co-morbid medical problems and life stress. ⚫ Financial and emotional costs of interventions and continuing care are often overwhelming or impossible for families; educational system is usually ill- equipped and ill-disposed to provide suitable education. Fridlund’s Last Lecture for ASB (2012) 8k views End