Child Psychology - Autism

- a developmental disorder which lasts for a lifetime

- affects how people interact with others and how they see the world

- 1 in 100

- more boys than girls (5x)

- difficulty interpreting facial expressions, misunderstand sarcasm and be rigid in their interests

- speech can be limited, therefore friendships can be difficult to make

- symptoms are detected at around age 4

- preference for routine, sensory sensitivity, specific interests, a learning difficulty may be present

- asperger's syndrome - average or above average intelligence & speech is less problematic

The exact cause is still unknown; considered that a combination of factors contribute to it

Genetics:

Twin study - Bailey et al (1995) reported a 60% concordance for autism in MZ twins vs 0% in DZ twins. The higher MZ concordance suggests genetic inheritance. When considering a broader spectrum, the concordance increased from 60% to 92% in MZ pairs and from 0% to 10% in DZ pairs, suggesting that interactions between multiple genes may contribute to expression of autism related traits.

Hallmayer et al (2011) found a similar concordance between MZ and DZ twins when looking at male and female twins. For strict autism, concordance for male twins was 58% for 40 MZ pairs and 21% for 31 DZ pairs. For female twins, concordance was 60% for 7 MZ pairs and 27% for 10 DZ pairs. The lower number of female pairs reflects the smaller number of females diagnosed with autism. For autism symptoms, the concordance for male twins was 77% for 45 MZ pairs and 31% for 45 DZ pairs. With the female twins, concordance was 50% for 9 MZ pairs and 36% for 13 DZ pairs.

- a cognitive skill which is a person's ability to understand other people's mental states and to see the world from the perspective of the other person 

- when a child has theory of mind, they understand that every person has their own set of beliefs, emotions etc

- it begins early in life - at about 5 months of age, typical children can recognise different facial expressions, but understanding the meaning comes a few months later. They can then use this non-verbal information to guide their behaviour

- Osterling and Dawson (1994) studied videotapes of first birthday parties of typical children and children who later received a diagnosis of autism. They found that the best predictor of future diagnosis was lack of attention to the face of others; children with autism do not tend to use the gaze of others to guide their behaviour. Most children without autism develop a full understanding of ToM by age 4, explaining why diagnosis comes following this age

- The Sally-Anne Test for ToM (Baron-Cohen et al,1985) A group of autistic kids, kids with Down's syndrome and 'normal' kids took part. There were 2 dolls, Sally and Anne. Sally had a basket and Anne had a box; Sally has a marble, puts it in her basket and goes outside to play. While she is gone, Anne takes the marble out of the basket and puts it in her own box. 

Sally returns and the child is asked - 'Where will Sally look for the marble?' The correct response is to point to or name Sally's basket, which indicates that the child knows that Sally believes the marble to be somewhere it is not. The incorrect response is to point to Anne's box.

Two control questions are also asked - 'Where is the marble really?' and 'Where was the marble in the beginning?' Every child was tested twice - the second time a new location for the marble was introduced.

For the child to succeed in this task they have to attribute a belief to Sally.

At least 85% of the 'normal' children and children with Downs gave the correct response to the belief question, while only 20% of the autistic children did so. This suggests that children with autism have an underdeveloped theory of mind.

Weak Central Coherence - an imbalance of integrating information at different levels. Typically, when processing information, a child can draw info together to construct a higher level meaning (central coherence). Children with autism do not have this ability.

Environmental Factors - this theory is that a child is born with a vulnerability to autism, but it only develops if they are exposed to a specific environmental triggers e.g. being born prematurely or being exposed to the medication sodium valproate during pregnancy.

Neurological Factors - it has been suggested that the connections between the cerebral cortex, the limbic system and the amygdala within the brain are connected in such a way that allows for overstimulation, which can contribute to the experience of extreme emotions and hypersensitivity often observed in autistic children.

- it is not possible to 'treat' autism as it is a persuasive disorder. Therapies are focused on supporting their needs and minimising their difficulties.

Applied Behaviour Analysis (ABA):

- a systematic way of observing someone's social communication, identifying desirable changes in that behaviour and using appropriate methods to make those changes. It can be used to improve communication skills in children and adults with autism.

- it works by demonstrating effective ways to interact with others and rewarding the improved behaviour when it is displayed (postivite reinforcement). Behaviours that are not indicative of positive behaviour are ignored and not reinforced. Therapists develop a tailored programme for each child; they customise the intervention to their skills or needs.

evaluation:

- many different interventions, so evaluation of effectiveness is complex; existing studies only show short-term effects; operant conditioning is only effective if the behaviour is consistently rewarded - if this is not adhered to, effectiveness can be compromised

Cognitive Behavioural Therapy (CBT):

- can be useful for children who experience anxiety as a symptom of their autism. It works on the basis of exploring their thoughts and feelings about the source of their anxiety and provides them with skills to manage it.

- when used with children with autism, CBT needs to be adapted from its typical structure - it places greater emphasis on repetition and visual cues.

- Sobronoff et al (2005) found that, following a brief CBT intervention, children experienced less anxiety and an increase in the child's ability to identify positive strategies to deal with stressful situations that would have previously been problematic for them. If parents were involved in the process of the treatment, it was more successful.

evaluation:

- it is less accsessible to non-verbal children, as it it requires them to talk to the therapist about their thoughts; biomedical interventions (restricted diets, drugs) are an alternative therapy that can be used alongside, or instead of psychological treatments