Title: Autism Spectrum Disorders: Core Symptoms and their Development
1Autism Spectrum Disorders Core Symptoms and
their Development Rhea Paul, Ph.D.,
CCC-SLP Southern Connecticut State
University Yale Child Study Center Feb. 11-15,
2008 rhea.paul_at_yale.edu
2Triad of symptoms
- Severe, qualitative impairment in social
interaction - Qualitative impairment in communication
- Restrictive, repetitive or stereotyped behaviors
interests or activities
3Social Interaction
- Gaze
- Attentional patterns
- Eye contact
- Joint Attention
- Imitation
- Emotion and attachment
- Reciprocity
- Play
- Peer Relations
4Eye Contact/Using Gaze to Share
5Eye Contact
6 Gaze Patterns
2-year-olds with autism and typical development
viewing video of child playing
7Gaze development in ASD
- Newborns show preference for faces
- prefer eyes by 2 mo.
- Can detect direction of others gaze by 4 mo.
- Children with ASD fail to develop these patterns
- Problems in gaze persist throughout the life
span, even in HFA - Are resistant to intervention
8Joint Attention (Intersubjectivity)
- Dyadic infant looks at adult
- Triadic Begins w/ gaze following (6 mo.)
- Progresses to following point (8-10 mo.)
- Then to initiation w/ smiling and pointing at
objects of interest (12 mo.) - Lays basis for conversation
- Very low frequency in ASD, appears later than TD
- Can increase with age
9Joint Attention
- Video examples
- JA DD
- JA Autism
- Imitate JA
10Imitation
- Emerges in infancy
- Basis of learning
- Fades in typical development
- Role of mirror neurons
- Less spontaneous imitation and less in
elicitation settings for children with ASD
11Imitation
- In normal development
- http//www.youtube.com/watch?v-rWKSTtM6Ys
- In ASD
- Haddia example
12Emotion and attachment
- Social referencing
- Comfort seeking
- Sharing emotion with gaze
- Children with ASD
- Do show attachment
- Have difficulty recognizing emotions may be
related to difficulties in face perception - Less likely to coordinate expression of emotion
(smile) with gaze - Difficulties in empathy (hurt examiner
experiment) - Decreased social referencing (robot experiment)
13Sharing emotions
14Sharing emotions
15Reciprocity
- Turn-taking emerges before language
- Back-and-forth nature of social interaction
- Deficits in reciprocity can be seen in both
verbal and nonverbal individuals
16Reciprocity Preverbal
17Reciprocity Verbal
18Play
- Normal development
- 0-8 mo. All schemes to all objects
- 8-12 mo. Functional play
- 12-18 mo. Autosymbolic play
- 18-24 mo. Single scheme symbolic play
- 24-36 mo. Multischeme symbolic
- 3-5 Pretend, role play
- 5-12 games with rules
19Play in ASD
- Favor exploratory, means-ends, construction,
stereotypical play over pretend play - Even symbolic play can be repetitive and
stereotypic - May prefer solitary play
- May have difficulty w/ flexibility in games w/
rules
20Play
http//www.youtube.com/watch?vzAu6ehEGMQcfeature
related
21Peer Relations
- TD children move from family-centered to
peer-centered social relations - Children with ASD may
- Prefer to remain solitary
- Be ineffective in approaching and engaging peers
- Make fewer approaches to peers
- Respond less often to peer bids
- Those w/ HFA may
- prefer adults to peers
- Expand interest in peers during adolescence
- Become depressed over loneliness and lack of
friendships
22Communication Definitions
- Communication
- Message
- Sender
- Receiver
- Language
- Rule-governed
- Conventional
- Symbolic
- Culturally Determined
- Communication
- Speech
- Vocal expression
- Sounds of language
23Language Domains
Content
Content
Form
Content
Form
Use
Use
24Communication is a primary deficit in autism
- Of the triad of symptoms, communication is
directly involved in two - Communication deficits are a primary means of
identifying and diagnosing autism - Communication in autism involves both delay and
deviance. - Primary area of difficulty is in pragmatics
- BUT deficits in other areas can also be seen
sometimes are similar to those of children with
specific language impairments (SLI).
25Communication in Typical Development
26Communication Development Capacities at birth
- Vision best at face-to-face range
- Infants show preferences for
- Faces over other visual stimuli
- Speech over other sounds
- Female voices over other voices
- Own mothers voice over other female voices
- Motherese speech-style over adult directed style
- Can discriminate phonemes of native and
non-native languages
27Typical Communication Development Preverbal
Early Language
- Perlocutionary Stage 0-8 mo.
- 0-4 mo. Preference for faces, speech
- 4-8 mo. Development of vocal communication
- 6-10 mo.
- Emergence of preference for ambient language
patterns - Emergence of speech-like sounds
28Communication Development Preverbal Form
- Perception
- 0-6 mo. general speech processing abilities that
are biologically determined and generic can
apply to any linguistic input (Eimas et al.,
1971.) - 7-12 mo. Change in preferences from those that
would apply to any language toward ones those
closely tuned to the sound patterns of the
environment
- Production
- 0-2 mo. Vegetative sounds
- 2-4 Cooing laughing
- 4-8 mo. vocal play
- 6-10 mo. canonical babble
- 8-18 mo. jargon babble with prosodic contours of
ambient language
29Perlocutionary Communication
30Illocutionary Stage 8-12 mo.Use
- Development of intentional communication
expressed through - Gestures, e.g., pointing
- Vocalization
- Gaze
- Small range of functions expressed
- Proto-imperative
- Proto-declarative
- 2.5 communicative acts/minute
- Emergence of prosodic patterns of ambient
language.
31Illocutionary Stage Content and Form
- Expressive vocabulary starts slowly
- 12 mo 1-3 words
- 15 mo. 10 words
- 18 mo. 50-100 words first word combinations
- First 50 words include proper and common nouns,
adjectives, verbs, social terms - Receptive vocabulary is larger 50 words at 15
mo. - Most words have CV shape, one syllable
- Sounds used are same as those found in babble
- /b/, /p/ /m/, /n/, /d/, /h/, /w/.
32Illocutionary Stage Gestures used to express
intents Contact Point
33Illocutionary Stage Gestures used to express
intents Reach
34Illocutionary Stage Gestures used to express
intents Distal Point
35Illocutionary Stage Gestures used to express
intents Show
36Illocutionary Stage Other Conventional Gestures
37Illocutionary Communication
38Locutionary Communication 12-18 mo.
- Same intents expressed with gestures,
vocalization now expressed with words - New discourse-related intentions expressed
- request information
- answer
- acknowledge
- 5-7 communicative acts/minute on average
- First words spoken
- First words comprehended outside of routines
- Rapid increase in spoken vocabulary
- 15 mo 3 words
- 18 mo. 50-100 words (/-100)
- 24 mo. 300 words (/-150)
- Word combinations begin when vocabulary50
39Locutionary Development Content
- Early two-word utterances express a small range
of meanings - Agent, action, object combinations
- Possession
- Location
- Attributes
- Meanings related to object permanence
40Locutionary Communication
41Communication Development 18-24 mo.
- Repertoire of speech sounds increase
- CVC and multisyllabic words increase many still
single syllable - Average child is 50 intelligible
- Average expressive vocabulary size at 18 mo. Is
100 words (/- 100) - Multiword utterances increase in frequency
vocabulary grows - Understanding of sentences is not far ahead of
production - Pragmatic developments
- New discourse-related communicative functions
- Discourse management
- Turns increasing awareness of conversational
obligation - Topics 1-2 turns/topic
- Register variation
4218-24 mo. Communication
43Limitations in Communication is ASD
Prelinguistic Level
- Delayed onset of speech (Stone et al., 1994)
- Atypical preverbal vocalizations (Sheinkopf et
al., 2000) - Depressed rate of preverbal communication
(Wetherby, Prizant Hutchinson, 1998) - Restricted range of communicative behaviours,
limited primarily to regulatory functions (Mundy
Stella, 2000) - Low responsiveness to speech (Osterling Dawson,
1994) - Delayed and deviant use of gestures (Dawson et
al., 1998 Stone, et al., 1997) - Dearth of pretend and imaginative play (Stone et
al., 1994) - Laci of imitation orally, vocally, and verbally
(Volkmar et al., 1997)
44TD Comment
45ASD Comment
46Developing Language
47Communication Development 24-36 mo. Form and
Content
- Average expressive vocabulary size at 24 mo. Is
300 words (/-150) word classes include - Object action words
- Kinship terms
- Spatial terms
- Question words
- Color, shape words
- Grammatical morphemes, verb phrase marking
emerges some overgeneralization - Grammatical forms for sentences such as
questions, negatives are emerging - Sentence length is 3-5 words
- Intelligibility increases from 50 to 70
48Communication Development 48-60 mo. Form
Content
- Vocabulary at school entry6000 words
- Basic grammatical forms mastered expressively and
receptively - few grammatical errors are heard
- Overgeneralization may persist
- Average 4 year is 100 intelligible
- Speech errors may persist, but speech can be
understood - Residual errors in /s/, /l/, and /r are last to
resolve
49Background Pragmatics of Language
- Pragmatic domains
- Communicative functions
- Discourse management
- Register variation
- Presupposition
- Prosody
50Communication Development 48-60 mo. Use
- Communicative functions
- Increase in range of functions
- New genre narration
- Increase in decontextualized talk
- Discourse management
- Requires less support from adults still needs
some - Longer turns more turns/topic
51Communication Development 48-60 mo. Use
- Register variation
- New polite forms
- permission requests, permission directives, some
indirect requests - 4-7 hints
- Ability to use motherese
52Preschool Conversation
53Early Verbal Communication in ASD
- Pronoun reversals
- Idiosyncratic word use
- Use of immediate and delayed echolalia
(communication strategy) - Perseverative conversation
- Atypical voice and prosodic features
54Echolalia
- http//www.youtube.com/watch?vsniGZoVB0R4feature
related
55Conversation in ASD
56Communication Development in Later Childhood and
Adolescence
- Syntax/Semantics
- Increases in oral and written forms
- Increases in figurative, nonliteral language
- Pragmatics
- Discourse Genres
- Narration
- Persuasion/negotiation
- Exposition
- Ambiguity/sarcasm
- Register variation
- Slang
- Figurative language
57Communication in Youth
58Impairments in Higher Level Language Skills in ASD
- Reduced topic management skills
- appropriate topic termination
- Responding to cues to change topic
- Commenting contingently say something relevant
- Reduced presuppositional skills due to theory of
mind (ToM) deficits - Poor ability to share topics
- infer others informational state
- Obsessive, circumscribed interests
- Sparse conversation OR overly talkative about
special interests - Gaze and prosodic deficits persist
59Discourse Management Example
60Presupposition Example
61Prosody Example
62Circumscribed Interest Example
63Repetitive behaviors
- http//www.youtube.com/watch?v-6blmKiPe9cfeature
related - http//www.youtube.com/watch?vMB9UDDLJfKMfeature
related
64Controversial Treatments
- Promise to cure the core symptoms of ASD
- Definition of the core deficits often lacks solid
empirical evidence (e.g., metabolic problems,
exposures, visual processing) - Offer vague benefit (e.g., improve focus)
- Lack of empirical evidence
- Reliance on uncontrolled studies, single-case
testimonials - Claim that they cannot be studied
- Often claim persecution form the scientific
establishment - Staying open-minded
65Gluten- Free Cassien-Free Diet (GFCF)
- Leaky gut -gt peptides crossing blood-brain
barrier -gt disrupted neurotransmitter breakdown
-gt increase of opiotoids -gt activity-autism. - Leaky gut could be caused by yeast overgrowth,
gastrointestinal disease due to immunization,
etc. - No evidence for these causal relationships
- Systematic study of GFCF diet initiated at
University of Rochester
66Ethyl Mercury (Thimerosal) Exposure
- Danish Natural Experiment
- 1970 1992 petrussis vaccine contained
Thimerosal - 1992-1997 same vaccine w/o Thimerosal
- 1997 different petrussis vaccine w/o Thimerosal
- Danish Psychiatric Register Data contrary to
prediction, no difference in rates of autism was
found between groups who received Thimeraosal and
those who did not
67Chelation Therapy
- Hypothesized toxic effects of mercury exposure,
mercury accumulates in internal organs (hair
trace analysis) - Chelation introduction into the blood stream
agents that bond with specific metals in the body - Purely hypothetical connection between mercury
poisoning and autism - No empirical evidence supporting the claim, no
reports of curing autism or improving symptoms
following chelation - Possible side-effects of chelation washes out
valuable minerals, very costly diagnostic process - Two children have died following chelation.
68Supplements
- Assumption that developmental disabilities may be
caused by innate biochemical errors - E.g., B6magnesium supplements
- Lack of well-controlled, long-term follow up
studies - Possible side effects high dose of B6 possible
neuromotor side effects in adults, magnesium
potentially toxic metal in high doses
69Secretin
- Pancreatic hormone assisting digestion
- Cure of autism (Horvath et al., 1998) after
single injection of the hormone - Controlled studies secretin has the same effect
as placebo (Carey et al., 2002 Chez et al.,
2000 Owley et al., 1999) - Positive effect on children with autism and
diarrhea, but no reduction in aberrant behaviors
no effect on those w/o diarrhea (Kern et al.,
2002)