lecture 4 *DPP*

Joint attention or shared attention is the shared focus of two individuals on an object. It is achieved when one individual alerts another to an object by means of eye gazing, pointing or other verbal or non verbal indications

cognitive skills that guide global directed behaviour such as

person first langiuange : having autism / person with autism

indentity first being autistic / autistic people

prefernece autistic adults in english speaking coutries : identity firt language

1% roughly similar across the globe, rgional differences in autism awarenss and services

**skewed sex ratio :** male 75% 80%

**30% 50% intelecual disability**

aditional diagnoses ( ADHD , anxiety, epilepsy, sleeping and eating problems )

Leo Kannenr ( 1943) : first to diagnose autism in children

neurobiological developmental disorder with strong gentic component

behavioural observations

developmental history ( parents)

cognitive tests ( cognitive characterisitc are not diagnostic criteria )

DSM IV : autistic disorder , Asperger's syndome or PDD NOS

DSM 5 : autism spectrum disorde with degrees of severity / need for support

DSM IV : symptoms present < 3 years

DSM 5 : symptoms presented early but sometimes only later visible

DSM IV : language delay

DSM 5 : hypo/hyper sensory sensitivity and social communication dosorder

yes , the old one does not

**A. deficits in cosial communication and social interaction :**

1. deficits in social emotional reciprocity
2. defcits in non verbal communicative behaviours used for social interaction
3. deficits in developing, maintaining and understanding relationships

(little social'chit chat', joint attention, back and forrt conversation, lack of reciprocity)

**B. restricted, repetitive patterns of behaviour, interets r activities (at least 2)**

1. stereotyped or repetitive motor movements , use of objects or speech
2. instances in sameness, inflexible adherence to routine, or ritualized patterns or verbal nonverbal behaviour
3. highly restricted, fixated interests that are abnormal in intensity or focus
4. hyper or hyporeactive to sensory input or unusual interests in snsory aspects of the envionment

initially focus on children and social communicative behaviour and social insight

look for spontaneous gestures ( less = autism)

can you show and tell specific tasks ( brushing teeth )

does person understand how frindsip works

look for elay in reaching developmental milestone ( walking, talking, toilet use)

how does the child play ? (use of iagination, playing with others are low in autism )

intelligence tests ( WAISC)

insight on strenths and weaknesses ( morst often disharmonious IQ profile )

metching intervention and IQ strong predictor of late development

1) Theory of mind

2) test of execytive functioning ( verbal fluency test )

3) test central coherence ( child's embeded figures test )

1. not a single **gene**
2. not a single **area**
3. not a single **psychological** **explanation** can explain ALL causes of autism and ALL symptoms

1) executive dysfunction hypothesis

2) weak central coherence hypothesis

3) social attention (motivation) hypothesis

4) theory of mind hypothesis

global EF problems, especially flexibility porblems

focus on details instred of the whole picture

early lack of attention to social stimuli

impairement in ability ro reason baout own and otehr minds

mental flexibility (switching )

planning

working memory

inhibition ( stopping actions)

initiation ( starting actions )

1. EF problems are not specific for children with ASD (ADHD )
2. EF prblems have large individual differences
3. performance on task is not alweys accurate for real life performance

very good at spotting Waldo weak central coherence same as autism patients

natural tendency to see coherence between multiple stimuli

focus on details ( seeing the trees instead of the forest )

focus on whole (seeing the forest instead of the trees)

1. direct link central coherence and autism not studied much
2. conflicting empirical findings

early lack of attention to social stimuli ( faces , eyes) pssibly due to low reward of social stimuli with a cascading effect on later social development

1. Prospective research :first two months no difference in social attention
2. deviant brain responses to both social and non social rewards

Theory of Mind (ToM) = the ability to form ideas ( theories) about the mental world of self and others and to explain behaviour in mental terms

"Where will Slly look for the ball"

people's behaviour is based on their beliefs

someone's belif about reality may not concur with reality

schizophrenia , aorexia

older children pass the false belif task but stil expirince problems in everyday life

all (a)typical development results from genes , environment and interaction or co occurrence contributes to autism > 50% genes

twin studies

higher concurrence in MZ than in DZ twins

MZ 100% same genes, same parental environemt)

DZ twins (50% same genes, same parental environemt)

higher chance of autism in sibligs of child wit autism

mild autism traits in family members ( broader autsm phenotype (BAP)

not one single autism gene found

probably multiple risk increasing genes involved

ASD is a heterogenerous group complicates finding one genetic profile

older fathers or mothers, higher chance

use of valporate ( anti convulsant ) by mother, higher chance

vaccines ? not any associatin found

larger head circumfrance / brain volume

stronger growth in firt two years, after normalisation

both over and under conectivity ( white matter ) corpus collostrum conectivity

idfferent brain activity patterns while looking at faces ( fMRI, EEG)

1. **no pill or cure for autism**
2. **social skillsnterventions (SOVA)**
3. **early intensive interventions**

medical treatment only for co

modestly succhfull

difficult to genralize taught skills

empirical evidence

difficult because diagnosis is often later

can be time consuming

What should be the focus of intervention?

What is considered a 'good outcome'?

Change the abilitiesehaviours of the person vs chanigng the environemt ?