Lecture 8 - Disorders of Development: ASD

Question 1

Developmental disorder definition

Answer 1

Disorder manifesting before adulthood that disrupts normal development.

Question 2

Conditions for a developmental disorder

Answer 2

• Motor, cognitive, socio-emotional
• One (specific) or more (pervasive) of these areas affected
• Can manifest in delay or deficit

Question 3

Developmental disorder examples

Answer 3

Autism Spectrum Disorder (ASD), intellectual disability, Attention Deficit Hyperactivity Disorder (ADHD), cerebral palsy, down syndrome and epilepsy

Question 4

Causes of developmental disorders

Answer 4

Chromosomal abnormalities, prenatal factors, unknown combination of multiple factors.

Question 5

Chromosomal abnormalities

Answer 5

Genetic mutation (down syndrome includes an extra copy of chromosome 21)

Question 6

Prenatal factors

Answer 6

Damage while in the womb (oxygen deprivation, maternal infection, malformations of the brain) – for example cerebral palsy

Question 7

Unknown combination of multiple factors

Answer 7

Genetic, environmental, psychological, neurological for example ASD.

Question 8

Kanner (1943) and Asperger (1944) - Early descriptions of autism

Answer 8

Low IQ, “autistic aloneness” (inability to relate to others), “desire for sameness” (upset by changes)

Question 9

Wing and Gould (1979) - Triad of Impairments

Answer 9

• A: Impairments in social interaction (lack of eye-to-eye contact, failure to develop peer relations)
• B: Impairments in communication (language delay, lack of varied make-believe play)
• C: Restricted, repetitive patterns of behaviour (narrow interests, ritualistic or compulsive behaviours)

Question 10

DSM4’s view of triad of impairments

Answer 10

DSM 4 says an autistic person should have six or more items from the above, with at least two from A and one each from B and C.

Question 11

4 autistic disorders in the DSM4

Answer 11

– Autistic disorder
– Asperger’s disorder (or syndrome)
– Childhood disintegrative disorder
– Pervasive developmental disorder, “not otherwise specified”

Question 12

Concerns with DSM4

Answer 12

Inconsistent diagnoses, low validity of diagnosis

Question 13

DSM5 changes

Answer 13

The DSM 5 removed Asperger’s syndrome as severity was categorised and labelled in terms of how much assistance the person needed.

3 impairments were combined into 2 – social communication and social interaction and restricted, repetitive patterns of behaviour, interests or activities. Sensory information was added too.

Question 14

Concerns with DSM5

Answer 14

Access to care, insurance, etc. affected and loss of identity (ex: Asperger’s Syndrome)

Question 15

DSM5 Benefits

Answer 15

• Aimed at allowing for more nuanced diagnosis - Better able to cater toward individual needs
• Helps reduce problems of inconsistency in diagnoses

Question 16

ICD-11 (May 2018)

Answer 16

Changed to reflect majority of these changes - Distinguishes between ASD with and without ID, criteria more flexible eg types of play that can be used cross-culturally

Question 17

Male female ratio in autism

Answer 17

~4x more common in males than females

Question 18

Causes of ASD

Answer 18

Hereditary and structural differences in the brain

Question 19

Hereditary components

Answer 19

Some evidence from twin and family studies

Question 20

Smith et al (2019)

Answer 20

Differences in autistic boys and girls are shown in their brain

Question 21

Mo et al (2021)

Answer 21

More data needed on structural differences in the brain

Question 22

Problems with diagnosis

Answer 22

Diagnosed and defined using behavioural criteria
Some signs appear early (12-18 months)
Typically around 3+ years, but can go undiagnosed
Increase recently in numbers, largely due to better diagnostic material and understanding of impairments
Developmental outcomes highly variable
Why so much variability in terms of what develops, when, and in whom?

Question 23

Attempts to explain ASD impairments

Answer 23

Executive functioning, weak central coherence, Theory of Mind deficits

Question 24

Executive functioning

Answer 24

Ex: planning, organising, inhibition, impulse control, sustaining attention
Explanation for repetitive behaviours?
Probably not causal role but early difficulties might play a role in developmental outcomes and there is a correlation between EF and Theory of Mind

Question 25

Weak central coherence

Answer 25

Typically developing people tend to process information globally. Weak central coherence means a bias for featural or local information, details Proposed to explain certain aspects of ASD (Frith & Happe, 1994) – Ex: Islets of ability, excellent rote memory, preoccupation with parts of objects – Superiority in detail, rather than deficit in global?

Question 26

Theory of Mind deficits

Answer 26

Theory of Mind effects social impairments, limiting effective social understanding and makes it difficult to interpret behaviour of others. It makes it difficult to communicate and might explain sameness and routine indirectly

Question 27

Baron-Cohen et al (1985) - Sally-Anne conditions

Answer 27

* ASD with mental age >4 * Typically developing children aged 4 * Down’s syndrome with mental age >4

Question 28

Baron-Cohen et al (1985) - Results

Answer 28

Typically developing and Down syndrome children solved the task 80% of the time. Only 20% of the ASD group could solve the task. Similar results with Smarties task.

Question 29

Sodian and Frith (1992) – Deception conditions

Answer 29

1. Sabotage: have a key and can lock the box when told the robber is coming • Manipulating robber’s behaviour 2. Deception: don’t have a key, but can tell the puppet the box is locked • Manipulating robber’s beliefs

Question 30

Sodian and Frith (1992) – Autistic children

Answer 30

Children with ASD successful in sabotage, but not deception condition – Motivated, and even showed sensitivity to the type of puppet – But could not manipulate robber’s beliefs

Question 31

Leslie & Thaiss (1992)

Answer 31

• 15 with ASD and 20 TD children, matched mental age – Compared performance on mental and non-mental representation task • Mental task: – Smarties false belief task (what will your friend think?) • Non-mental representation – Photograph task: information in a photograph was no longer accurate • No impairment in understanding of non-mental representations, only mental representations

Question 32

Hughes & Russell (1993)

Answer 32

Children fail false belief task because can’t ignore the knowledge about the object’s actual position

Question 33

Limitations of Theory of Mind

Answer 33

Not all children fail these tasks – High functioning ASD children sometimes perform at TD levels – Challenge universality of ToM deficits, and thus the hypothesis? Not necessarily (Happe, 1995) – High functioning ASD don’t solve until much older than TD children – Perhaps relying on different strategies on simpler tasks? – What about more challenging ToM tasks?

Question 34

Happe (1994)

Answer 34

This challenge is more natural yet more complex than the false belief tasks. Participants read a short story and are asked why a character say something they don’t mean. Even those who passed 2nd order ToM tasks were impaired – but this might be too vocabulary loaded.

Question 35

Baron-Cohen et al (1997)

Answer 35

Infer mental states from eyes alone – Designed to address ToM abilities beyond those of a 6-yr-old – Choose between correct emotion and “foil” (ex: concerned vs. unconcerned) ASD group significantly impaired compared to TD group and Tourette Syndrome group

Question 36

Does the Eyes Task really measure Theory of Mind?

Answer 36

– No significant differences on gender recognition task or “basic” emotion control conditions – BUT, test has been criticized, particularly by those with ASD

Question 37

Gernsbacher and Yergeau (2019)

Answer 37

Criticism of the Sally-Anne task - not all children don't have a Theory of Mind, hardly any replication, tasks fail to relate to Theory of Mind, the whole idea is societally harmful

Question 38

Failures of specificity and universality

Answer 38

Many individuals without ASD fail these tasks– Children with other developmental disorders as well – Typically developing children more likely to fail if they have fewer siblings, fewer adult relatives living nearby

Question 39

Why do some pass Theory of Mind tasks and other don't?

Answer 39

– ToM tasks rely heavily on spoken language – Longitudinal studies suggest vocabulary predicts performance on false belief tasks more than age – Meta-analyses comparing autistic vs non-autistic individuals found that vocabulary predicts false belief performance more than whether or not an individual has autism

Question 40

Failures of replicability and validity

Answer 40

Failure to replicate earlier findings, failures of convergent validity, failures of predictive validity

Question 41

Failure to replicate earlier findings

Answer 41

Ex. Baron-Cohen et al (1986) – no other study has found the same differences Strange stories and Sally-Anne tasks also mixed results Small sample sizes in original studies?

Question 42

Failures of convergent validity

Answer 42

Are different ToM tests measuring the same construct? Performance on many ToM tasks isn’t correlated (e.g. performance on strange stories and reading the mind in the eyes tasks)

Question 43

Failures of predictive validity

Answer 43

Does performance on ToM tasks predict socioemotional function? Evidence that does not significantly predict empathy/emotional understanding, social skills, peer relations/pro-social behaviour and more

Question 44

Acknowledging biases and impacts on autistic people?

Answer 44

– Traditional ToM deficit account has been accused of dehumanizing autistic individuals – Perspectives of autistic people rarely taken into consideration! (Jaswal & Akhtar, 2018)

Question 45

Acknowledging different expressions of social behaviour

Answer 45

– Neurotypical people fail to read minds of autistic people (Sheppard et al. 2016) – Different ways of viewing the world leading to breakdown in understanding

Question 46

Acknowledging the impact these perceptions can have on development

Answer 46

– Clinical practice! – Parent-child interactions! – Self-esteem and well-being!