Lecture 2 - Autism Flashcards
How does the medical model define autism?
A neurodevelopmental disability that results in people experiencing difficulties in a range of areas.
How does the social model define autism?
A neurodevelopmental difference.
Autism is only disabling as autistic people are required to live in a neurotypical world that isn’t set up well to accommodate their profile and needs.
How has the logo for the National Autistic Society changed and why?
1963-2002 = it was a puzzle piece with a picture of a weeping child in. This was controversial because it describes the child as being isolated and not ‘fitting in’. It also suggests the people with autism are puzzles and uses dark colours which suggests unhappiness.
2002-2018 = They changed it to a brighter logo of a person helping another person. This was better as it represents unity, togetherness and friendship and includes brighter colours. However does still seem slightly patronising as it suggests people with autism need help from others.
2018 - present = Changed to a bright circle made up of rainbow colours. This suggests a brighter and cheerful mood and optimism. Using a circle highlights diversity by showing it’s not a linear spectrum and the circle also represents unity and togetherness.
How has the logo for Cure Autism Now Foundation changed and why?
1995-2007 = It was just the foundation name for the logo. This suggests we need to remove autism and the idea of a cure can be seen as insulting and hurtful.
2007-present = They changed the name to Autism Speaks and presents their goal to enhance lives. However it still uses the puzzle piece which can be seen as controversial.
What happened in 1943?
Leo Kanner first wrote about autism. He wrote about a small set of children who had the same features: Extreme aloneness, preservation of sameness, delayed/deviant language.
What happened in 1944?
Hans Asperger published about a set of more abled children but described them as having difficulties in the areas proposed by Kanner.
What happened in 1980?
Lorna Wing proposed the Wing Triad of Impairments - proposed autistic children had a triad of impairment including: Communication, socialisation and imagination.
In 1980 autism was also included in the DSM as ‘infantile autism’ - it was only recognised in young children (not adults or older children).
What happened in 1994?
Autism was included in ICD-10, DSM-VI and ADI-R.
It was also the first time Asperger’s Syndrome was used.
What happened in 2013?
Autism was included in DSM-5 and Asperger’s Syndrome was dropped from the classification criteria.
What happened in 2018?
ICD-11 came out and caught up with the new set of criteria.
What are the diagnostic classifications of ASD in the DSM-5?
Autistic disorder.
Asperger’s syndrome.
Childhood degenerative disorder.
Pervasive developmental disorder - not otherwise specified (PDD-NOS).
These were all amalgamated into one umbrella term.
What were the symptoms needed to receive a diagnosis of ASD according to DSM-5?
Persistent deficits in social communication and social interaction:
- Deficits in socioemotional reciprocity.
- Deficits in nonverbal communicative behaviours.
- Deficits in developing and maintaining relationships.
Restricted, repetitive patterns of behaviour, interests or activities:
- Highly restricted, fixated interests.
- Stereotyped or repetitive speech, motor movements or use of objects.
- Hyper- or hypo-reactivity to sensory input.
- Excessive adherence to routines.
What is the clinical assessment like for autism?
It is often a semi-structured behavioural assessment of communication, social interaction and restricted and repetitive behaviour/play.
There is a prescriptive set of activities that are led by the clinician and the clinician would then score them up on the different activities and see if they are scored above or below the threshold.
What is the male:female ratio for autism diagnosis?
Autism = 4:1
Asperger’s = 10:1
The true male-to-female ratio for autism is closer to 3:1 but there is a diagnostic gender bias and girls are at a disproportionate risk for not receiving a clinical diagnosis.
What is CAT-Q?
It was proposed by Hull et al. (2009).
It’s a questionnaire on camouflaging autistic traits and looks at different types of camouflaging:
- Compensation = finding ways around social and communication difficulties e.g. not attending events.
- Masking = hiding aspects of one’s autistic presentation.
- Assimilation = strategies used to fit in with others in uncomfortable social situations.
What are the uses of CAT-Q?
Used in research settings to quantify camouflaging behaviours and compare between groups (see how many people are camouflaging).
In clinical settings as a potential screening tool for individuals who may be missed under current autism diagnosis because they camouflage.
By autistic and non-autistic people to aid identification of beneficial or harmful behaviours they use in social situations.
Why is it important to know about the experiences of females diagnosed with autism in mid-late adulthood?
Models of autism understanding and diagnostic process are largely based on males.
Diagnosis typically occurs later for females compared to males (Begeer et al., 2013).
Diagnosis is an ‘important milestone’ but the process can be ‘challenging’ and ‘arduous’ (Crane et al., 2018).
There is currently little research that specifically focuses on older females.
What is the diagnostic process for females like?
Ratio of diagnosis (Rutherford et al., 2016):
- Childhood = 5 males : 1 female.
- Adulthood = 2 males : 1 female.
The ratio being more similar in adulthood suggests they are being misdiagnosed or not diagnosed at all.
Females are more likely to be misdiagnosed/missed completely (Eaton., 2018).
What did Leedham et al. (2020) do and what did they find?
Interviewed 11 females who had been diagnosed with autism age 40+.
Used one-to-one semi-structured interview analysed using IPA.
Were asked questions such as what was the exact diagnosis given, what was your experience of receiving the diagnosis, has anything changed etc.
Found 4 main themes:
- Autism is a hidden condition = people didn’t feel like they fitted in and hated who they were pretending to be, doctors wouldn’t listen to them when they said their diagnosis was wrong.
- The process of acceptance = some started to think they were just those symptoms and doubted their abilities, some felt relieved they now understood why they felt how they felt.
- Post-diagnostic impact of others = some family/friends researched a lot into it, whereas others refused to accept the individual had this diagnosis. Made it so people couldn’t talk to their loved one or sometimes improved relationships.
- A new identity on the autism spectrum = feeling like they fit in somewhere and are able to understand why they feel the way they do.
What are the clinical implications of the Leedham et al. (2020) study?
Accurate and timely diagnosis is important.
Undertrained professionals can cause distress.
Clinicians should not rely on reports of others.
Coming to terms with diagnosis is an extensive process.
Ways to support self-compassion should be considered.
What are the pros of potential universal screening for autism?
It can be freeing and give people a sense of relief.
Makes intervention easier and can put it in place at early age.
May diminish gender bias.
Mean age of diagnosis would be lower.
What are the cons of potential universal screening for autism?
There is a lot of stigma around autism.
They may miss other comorbid disorders.
It is costly and time consuming.
A diagnosis may have a negative impact if people are coping well with it.
What work has been done on genetic testing for autism?
A lot of work on this has started by taking the genotype first route. They are looking at individuals with genetic characteristics e.g. individuals with 16p11.2 and trying to assess the cognitive and behavioural profile of these genes e.g. Arnett et al. (2019), Jeste & Geschwind (2014).
What is grey matter?
Grey matter is a type of tissue that contains the cell bodies, dendrites and axon terminals of neurons so it is where all the synapses are.
