The Spectrum of Social and Communication Disorders

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The Spectrum of Social and Communication Disorders

• Lorna Wing

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1.Kanner and Eisenberg criteria

• Profound lack of affective contact
• Mute, or language not used to communicate ideas
  or feelings
• Fascination with objects, manipulated with
  dexterity but not for appropriate use
• Resistance to change in elaborate repetitive
  routines
• Islets of ability, visuo- spatial and/or memory
• Attractive, intelligent appearance
•  
• ( Features K E considered to be essential)

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2.Triad of impairments of-

• Social Interaction
• Social Communication (verbal and non-verbal)
• Social Imagination
• Associated with
• Rigid, repetitive pattern of behaviour

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3.Social Interaction Impairment

• Different manifestations
• Aloof, indifferent
• Passive
• Active but odd, bizarre
• Over-formal, stilted

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4.Social Communication Impairment (verbal and
non-verbal)

• Different manifestations
• No communication
• Communicates own needs
• Repetitive, one-sided
• Formal, long-winded, literal

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5.Social Imagination Impairment

• Different manifestations
• Handles objects for simple sensations
• Handles objects for practical uses
• Copies pretend play of others
• Limited pretend play repetitive, isolated
• Invents own imaginary world but rigid,
  stereotyped

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6.Social Imagination Impairment cont..

• Poor or no ability to imagine how others are
  thinking and feeling
• Poor or no ability to imagine the consequences of
  actions especially their effects on others

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7.Repetitive Activities

• Bodily movements
• Fascination with sensory stimuli
• Simple, object directed
• Routines involving objects
• Routines in space or time
• Verbal routines
• Routines related to special skills or interests

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8.Physical Conditions

• Tuberous sclerosis
• Fragile X
• Phenylketonuria (untreated)
• Rett's syndrome
• Williams' syndrome
• Sotos' syndrome
• Cornelia de Lange syndrome
• Turner's syndrome
• Kleinfelters syndrome
• Neurofibromatosis
• Down's syndrome
• etc

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9.Developmental Conditions

• ADHD
• Developmental language disorder
• Dyspraxia
• Dyslexia
• DAMP syndrome
• Generalised learning disability

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10.Aspergers Description

• Socially odd, detached, egocentric
• Speech long-winded, repetitive, literal
• Poor/odd intonation
• Poor non-verbal communication
• Circumscribed interests,
• Repetitive routines
• Specific learning disorders
• Poor motor co-ordination
• Odd gait and posture
• Marked lack of common sense

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11.Neuropsychiatric Conditions (may occur with
ASD or be wrongly diagnosed if ASD not
recognised).

• Anxiety
• Affective disorders
• Tourettes syndrome
• Anorexia nervosa
• Obsessive-compulsive disorder
• Undifferentiated psychotic episode
• Paranoid ideas
• Schizophrenia
• Schizoid personality disorder
• Catatonia

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12.Examples of Catatonic Features

• Movements (slowness, tip-toe walking, freezing,
  stereotypies)
• Postures (odd hand and body movements)
• Speech (echolalia, mutism, odd intonation)
• Behaviour (poor eye contact, bizarre actions,
  negativism)
• Classic stupor is rare in ASD

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13.Suggested Syndromes

• De Sanctis (19061908) Dementia precosissima
  catatonica
• Earl (1934) Primitive catatonic psychosis of
  idiocy
• Kanner (1943) Early infantile autism
• Asperger (1944) Autistic psychopathy
• Bender (1947) Pseudo-defective schizophrenia
• Mahler (1952) Symbiotic psychosis
• Weygandt Hulse (1954) Dementia infantilis
• Wolff (1964) Schizoid personality disorder of
  childhood (Loners)
• Newson (1983) Pathological demand avoidance (PDA)
• Rapin Allen (1983) Semantic-pragmatic disorder
• Cohen Donnellan (1987)Multiplex developmental
  disorder

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14.DSM IV PDD SUBGROUPS

• Autistic Disorder
• Retts Disorder
• Childhood Disintegrative Disorder
• Aspergers Disorder
• PDD NOS (this includes the ICD-10 Atypical
  Autism)

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15.Published studies comparing Aspergers and
High functioning autism

• Authors who thought there were differences
  (statistical not absolute) 14
• Authors who thought there were no differences
  22
• No differences but hoped to find in future
• 6
• Total 42

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16.The Dimensional Approach

• Type of social impairment ?
• Type of communication ?
• Type of imaginative activities, if any?
• Type of repetitive behaviour ?
• Other features ? (sensory, motor, attention, mood
  etc..)
• Level of ability ? (language, visuo-spatial,
  motor, self-help)
• Other disabilities? (developmental, physical,
  psychiatric)
• Maladaptive behaviour affecting others?
• Is there an identifiable cause ?
• Family situation and environment

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17.Prevalence in 10,000

• IQ UNDER 70 (Wing Gould, 1979 children born
  1956-1970)
• Kanner's 5
• Other spectrum 15
• (including a few Asperger's and some SLD and PLD)
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• IQ 70 (Ehlers and Gillberg, 1992 children born
  1975-1983)
• Asperger's (Gillberg's criteria) 36
• Other spectrum 35
• (including a few Kanner's, some high functioning
  autism and some fitting Wolff's 'loners')
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• Total 91
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• It takes all sorts to
• make a world