Autism, The Brain, Thinking And Behavior

Autism: the Brain, Thinking and Behavior

Mary Joann Lang, Ph.D., A.B.P.N. Beacon Day School Orange, California

Course Objective: To understand basic concepts related to the brain, thinking and behavior and how to make appropriate interventions for children with ASDs, which help each individual reach his or her maximum potentials. Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 2

Autism Defined According to the NIH

Autism is characterized by three distinctive behaviors:

1. difficulties with social interaction 2. problems with verbal and nonverbal communication 3. repetitive behaviors or narrow, obsessive interests. 

  These behaviors can range in impact from mild to disabling.  Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children or when more debilitating handicaps Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 3 mask it. 

Systems Theory

A system is greater than the sum of its parts. Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 4

Systems Theory Common Elements: input-signal going into a system output-the act of turning out throughput (or process)-raw material processed within a given time feedback-response to a particular process control-ability to manage or direct environment-the entire set of conditions under which one operates goal-the result toward which effort is directed Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 5

Systems Theory • Open System—capable of growth, development & adaptation. Interaction occurs within the environment. (i.e.: The Rules of a Classroom) • Closed System—relationships among system components are set and inflexible; no interaction with the environment (i.e.: The Laws of Physics)

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 6

Systemic Approach to Understanding the Brain

In order to understand an individual with Autism, it is necessary to understand him or her as an individual from a systems approach: • How do mind and body function? • How does the individual fit into the community and society? • What interventions can be provided to help an individual reach his or her potential?

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 7

Systemic Approach to

Understanding the Brain Functions of the Functions of the “Conductor” “Orchestra” Perception Attention Language Processes Visual-spatial Processes Memory Sensory Inputs Motor Outputs Knowledge and Skills

Inhibit Shift Flexibility Modulate Emotions Initiate Working Memory Planning Organizing Self-monitoring and Evaluating Ref.: Peter Isquith, “Executive Function: Concepts and Assessments”

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 8

Systems Theory

Medical Issues: SystemHuman Body Systems Location

Nervous System Brain and Nerves Skeletal System Bones and Skull Muscular System Skeletal, Cardiac and Smooth Muscles Endocrine System Glands and Hormones Cardiovascular System Heart and Blood Lymphatic and Immune Systems Lymphocytes and Macrophages Respiratory System Lungs and Airways Digestive System Mouth and Gastrointestinal Tract Urinary System Kidneys and Bladder Reproductive System Male and Female Organs Integumenary System Skin and Nails A person withHair, Autism will

experience System Interruptions with many of the Mary Jo Lang, above. Ph.D., A.B.P.N.-Beacon Day School-Orange, California

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Systems Theory Breaks in the System

• It is becoming clear that the normal trajectory of neurodevelopment is altered in autism. Abnormalities in brain growth, neuronal patterning and cortical connectivity are often seen. • Changes to the structure and function of synapses and dendrites have also been strongly suggested in the pathology of autism . • Finally, environmental factors are likely to interact with the underlying genetic profile, and foster the clinical heterogeneity seen in autism spectrum disorders. •

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 10 *reference: Pardo CA, CA, Eberhart CG, CG, “The neurobiology of autism,” Brain Pathol. 2007

System Theory The Beacon Model Cognition Educational Achievement Individual Physical Adaptive Behavior Emotional Functioning Participation/Social Roles Cognitive Health Behavioral Context

Supports:

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 11

Cognition/Thinking

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 12

Cognition/Thinking Exploring Brain Behavior with Respect to: • Attention • Memory • Language • Visual-Spatial Functioning • Executive Function, and • Emotional Functioning Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 13

School Neuropsychological Assessment Model Overall Cognitive Functioning and Academic Achievement

Speed and Efficiency of Cognitive Processing

Executive Functions

Memory and Learning Processes

Social, Emotional, Cultural, Environmental and Situational Factors

Visual-Spatial Processes

Language Processes

Sensory-Motor Function

Attentional Processes

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 14

Cognition/Thinking Attention

What happens when an individual interacts with environment?              

–        Always assimilating and accommodating info –        Take in, process and act –        In order to think—one must pay attention Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 15

Cognition/Thinking Attention

• Why do children with ASD have trouble with attention? They’re not able to determine what’s important—creating a system overload! • Sensory input is too much • Frequently don’t have organizational strategies…. • Don’t see relationships in environment •  Rate of info is provided in too much volume Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 16

Cognition/Thinking Memory

We are required to process information, store it and retrieve it as needed.

Some people are simply unable to keep pace with the demands of society. They suffer from one or more forms of memory dysfunction. Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 17

Cognition/Thinking Memory

• Memory requires systematic handling of information, including: – Receiving new information and holding it in short-term memory – Temporary storage of information as active working memory – Processing information and knowledge in long-term memory – Recalling information from long-term memory Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 18

Cognition/Thinking Visual/Spatial Processing

The ability to visualize Visualizing and process Directions/ Mobility information is needed for school success and for practical use. Visualizing Story Concepts while Reading or Listening

Visualizing Words (Spelling) Drawing Music Crafts Household Tasks

Visualizing Details Related to Past Experiences

Interpretation of Visualizing relationships Academic Concepts (Science, Math, involves spatial Social Studies) processing— knowing how Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 19

Cognition/Thinking Visual/Spatial Processing

Quality

Description

Saliency Recognition

•Problems discriminating important information from unimportant •Lacks ability to prioritize •Easily brought off task by sounds or images •Unusual recall of irrelevant facts •Sees “big picture” but fails to recognize details •Needs repeated instructions •Demonstrates memory inefficiencies

Surface Skimming Concentration Weaknesses

•Lacks focus •Lacks listening abilities •Focuses on details for too long or too short of time

Engagement Problems

•Takes excessive time to join activity •Daydreams •Relates “unrelated” materials to lessons •Creative Tendencies

Seeks Constant and Immediate Gratification

•Concentration Weaknesses •Restless, hyperactive •Needs exciting stimuli to hold attention •Never satisfied, demanding

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 20

Cognition/Thinking Language

• Aphasia—inability to produce or understand language caused by brain damage or dysfunction • Speech Production (Oral Expression) • Speech Comprehension (Receptive Language or Listening Comprehension) Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 21

Cognition/Thinking Language

• Problems Can be Associated with Weak Processing when Deficiencies involve: – – – – –

Phonological Abilities (sound) Morphology (root words and adaptations) Semantics (word meanings) Syntactic (word groupings/sentences) Discourse (larger word groupings/paragraphs) – Metalinguistics (how language works) – Pragmatics (understanding in context) Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 22

Cognition/Thinking Language—Impairments

Mixed aphasia —displays both receptive and expressive deficits Receptive aphasia — impaired comprehension Transcortical motor aphasia —impaired expressive aphasia Transcortical sensory aphasia —language comprehension is impaired, but repetition is preserved Wernicke’s aphasia — receptive language and repetitions are severely impaired. Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 23

Broca’s aphasia — non-fluent aphasia with effortful, often agrammatic speech production. Conduction aphasia — fluent aphasia with severely impaired repetition, but relatively preserved language comprehension Expressive aphasia —nonfluent output Global aphasia —complete loss of all linguistic function

Cognition/Thinking Language

Wernicke-Geshwind Model of Language Primary Motor Cortex Arcuate Faciculaus

Broca’s Area

Angular Gyrus

Primary Auditory Cortex

Wernicke’s Area

Primar y Visual Cortex

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 24

Cognition/Thinking Executive Function

Neuroanatomy: Frontal Lobe Involvement is associated with Executive Function. Identification of problem areas allows us to develop adaptive behavior skills for individuals with ASD. Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 25

Cognition/Thinking Executive Function

• Executive Functions include those behaviors that include: – – – –

Abstract and Critical Thinking Choosing to Take Action Voluntary Response to Stimulation Planning and Organizing

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 26

Cognition/Thinking Executive Functioning

• • • • • • • • • • • •

Terms Associated with Executive Functions* Abstract Reasoning Anticipation Attention Control Behavioral Initiation/ Productivity Behavioral Regulation Common Sense Concept Formation Creativity Estimation Fluency Goal Setting

• • • • • • • • •

Hypothesis Generating Inhibition of Impulsiveness Mental Flexibility Organization Planning Problem Solving Rule Learning Self-control Self-monitoring Set Formation and Maintenance • Set Shifting • Working Memory

*Source: Miller, Dan; Essentials of School Neuropsychological Assessment; Wiley, 2007, Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 27 p. 235.

Cognition/Thinking

Executive Functioning Development

Plan/Organize/Monitor

3-32 years

Emotional Modulation

3-?? years

Verbal Working Memory Nonverbal Working Memory Inhibit

2-13 years 3-24 months 0-?

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 28

Cognition/Thinking Emotional Function

Emotions are the feelings that color our lives and allow us to experience all of the joys and sorrows of life. Core emotions that are universally experienced and recognized:

– – – –

fear anger sadness enjoyment

Enjoyment can enhance learning; but fear, anger and sadness interfere with learning.

People with ASD experience all of the same emotions as other people—but they can’t always communicate their feelings. Reference: Center for Development and Learning

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 29

Cognition/Thinking Summary

Neuro Frontal Posterior Left Right Cortical Sub-cortical

Function Psych/M ed Cognitive ADHD-I Executive Language Visual/NV Learning Memory Motor Sensory Social/Emotiona l Behavior Academic

ADHD-C TS/OCD RAD ASD (NLD) MR Epilepsy TBI LD

Ed SLD OHI Ortho SLP Deaf Vis Imp PDD LI/ID TBI EBD

Ref: Peter Isquith, PhD, “Executive Function: Concepts and Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, Assessment”California 30

Breaks in the System Stored Energy Autistic children don’t know how to manage information overloads. Energy builds up—looking for a release. Eventually, the child discharges energy in any available manner. Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 31

Cognition/Thinking Visual/Spatial Processing

• Overload—the body responds by seeking a situation to reduce the overload….

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 32

Cognition/Thinking Visual/Spatial Processing

Reactions to System Overload Include Sensory-Seeking Behaviors, such as:

Screaming, Aggression, Rocking Etc… Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 33

System Theory The Beacon Model Cognition Educational Achievement Individual Physical Adaptive Behavior Emotional Functioning Participation/Social Roles Cognitive Health Behavioral Context

Supports:

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange, California 34