Understanding the challenges children with ASD face with their surroundings

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Understanding the challenges children with ASD face within their surroundings Overview Background facts What is different about the ASD view of the world? Social difficulties Non-social difficulties Non-social assets

Sensory difficulties Conclusions Prof. Francesca HappĂŠ Francesca.happe@kcl.ac.uk

Background facts  Diagnostic

criteria: Social impairment, Communicative impairment, Evident by 3yrs Rigid/repetitive behaviour and interests

 1%

of population may have an autism spectrum disorder (ASD): includes autism, atypical autism, Asperger’s syndrome

 Males

out-number females

 Increase

in numbers with ASD probably due to better recognition, widening criteria, etc

 Associated

difficulties: intellectual disability, epilepsy, sensory abnormalities

The ASD triad: No single explanation? Social impairments “Theory of mind”

“Executive functions”

Problems recognising thoughts and feelings?

Problems generating, planning, monitoring?

Communication impairments

Restricted/ Repetitive Behaviours & Interests

“weak coherence” Detail-focused cognitive style?

What is different about the ASD view of the world? Social difficulties ‘Theory of mind’ = recognising others’ thoughts, beliefs, desires …putting yourself in another person’s shoes Tested by ability to attribute a false belief (3 years+)

Manifest in everyday social skills (2 years+) e.g. making secrets pretending lying

Social Insight is a ‘gatekeeper’

Neurotypicals learn through social interaction

• orient to others’ eye gaze, pointing, etc • interested in what others find interesting • infer thoughts/feelings behind actions • imitate others’ actions Paying attention to others becomes second-nature

People with ASD are typically less oriented to others • may look less at faces • interested in what they find interesting • interaction may be puzzling/frightening Figuring out what others think/mean is hard work

Eye-tracking studies: What captures ASD attention?

Klin et al

Eye tracking studies – what do people with ASD pay attention to?

→ Environmental features may distract from social interaction

Social and Communication problems well explained by ‘Mind-blindness’ Most ASD children fail simple ‘false belief’ tests that 3- to 4-year-old ordinary children pass ‘Mind-blindness’ may explain: e.g. -social interest but difficulty, -lack of communication, -over-literal understanding, -apparently callous behaviour -lack of pretend play

Understanding emotions  ‘Reading

minds’ and ‘empathising’ may be distinct abilities  Difficulty knowing what others are feeling is not the same as not caring about others’ feelings  Our study of ‘callous/unemotional’ traits showed these are unrelated to ASD severity – although a ‘double hit’ can occur

Mind-blindness in the Classroom? Look at me when I‟m talking to you!

Even signs need some mindreading

„Everyone‟ ≠„John‟

Angry, embarrassed, or hot?

Painful honesty… & upsetting fascinations

Social insight has costs

‘Neurotypicals’ like what others like

Shutts, Banaji & Spelke, 2009, Dev Sci •3-yr-olds choose toys, foods, games, clothes endorsed by same sex, same age •Are apparently unaware of source of their preference

‘Herd effects’ (see Raafat, Chater & Frith, 2009, TICS)

Social insight, conformity and talent?

3 ways that mindblindness may enhance talent? 1. No ‘blinkers’ from shared thoughts? 2. Don’t spend time/neural space on social ‘savant’ skills?

3. Better able to achieve unself-conscious (implicit?) performance… ‘flow’?

Repetition isn’t necessarily the enemy of creativity

What is different about the ASD view of the world? Non-social difficulties

Executive Functions Planning & Monitoring

Control & Flexibility

Generating & manipulating ideas

Many people with ASD have difficulty - dealing with the unexpected - planning ahead - controlling impulsive behaviour - shifting between tasks

Wisconsin Card Sort Test: Flexibility

Difficulties with flexibility and practicalities of life often limit independent living, even with very high intelligence

Executive dysfunction in the classroom? Scaffolding planning & imaginative rehearsal?

What do we do when our frontal lobes are overloaded?

Reducing impulsivity?

Easing transitions?

What is different about the ASD view of the world? Non-social assets -



„Weak central coherence‟ exact memory jigsaw puzzle and other spatial skills... Perfect pitch, attention to details (miss the whole?) Distress at ‘tiny’ changes?

What is different about the ASD view of the world? An eye for detail

Changes in your environment... What counts as a ‘tiny’ change?

Can you spot the difference?

What matters to you is never ‘tiny’…

Embedded Figures Test

Object Recognition from fragments

Example of consecutive frames from the Fragmented Figures Test (Snodgrass et al, 1987): Booth, 2006.

Central Coherence as Cognitive Style

‘weak’------------------Central Coherence-----------------‘strong’ e.g. good proof reading

e.g. good gist recall

A continuum of cognitive style from ‘weak’ to ‘strong’ coherence? Both extremes have costs and benefits? Possible sex differences? Around 50% fathers & 30% mothers of ASD boys show weak coherence (Happé, Briskman & Frith 2001)

Does detail-focus spark talent? Eye for detail is related to talent in music, maths, art of memory (HappĂŠ & Vital, 2009) Passionate special interests can be used to motivate wider learning

Drawing by Gilles Trehin http://urvillecity.free.fr/

‘Weak coherence’ in the classroom? What‟s “cow”?

Reading a story…

What does the person with ASD see?

Teaching „zooming out‟?

…or reading a list?

What counts as the same?

Sensory Abnormalities in ASD  Sensory

sensitivity e.g., covering ears to loud, unexpected sounds; restricted food preferences

 Sensory

under-responsivity e.g., failure to orient to name or react to pain

 Sensory

seeking e.g., rocking, hand flapping, noise-making Ben-Sasson et al. 2009

Sensory Abnormalities Are very common in individuals with ASD  

95% of young children with ASD show some degree of sensory processing dysfunction Tomchek & Dunn (2007) Also found in intellectually disabled individuals without ASD

Can occur in any sensory modality e.g. impairments in auditory, visual, touch, & oral sensory processing are commonly reported in ASD Kern et al. (2007) 

over 90% of children with ASD have sensory symptoms in multiple domains Leekam et al. (2007)

Sensory Abnormalities Can show patterns of both over- & under-responsivity ď ľ ď ľ

Chen, Rogers, & McConachie (2008) some studies suggest under-responsivity may be more frequent in ASD Rogers & Ozonoff (2005) sensory seeking behaviours are often interpreted as counteracting underresponsivity to sensory stimuli Dunn (1999)

Sensory abnormalities and adaptation  Sensory

symptoms associated with restricted repetitive behaviours Rogers, Hepburn, & Wehner (2003)

 Under-responsiveness,

sensory seeking, and auditory filtering difficulties predict poorer school performance in HFA Ashburner, Ziviani,& Rodger (2008)

 Sensory difficulties correlate with maladaptive behaviors: – parent-reported child anxiety, social relating, communication disturbances, self-absorption and antisocial behaviors. Baker et al (2008)

Sensory abnormalities: sources of difficulty Sensory symptoms might reflect:  Eye for detail?  Failure

to use context? (predictionreduced perceived intensity)

 Abnormal

 Genuine


physiological differences?

Sensory abnormalities: what might help?  Sensory

likes and dislikes are idiosyncratic, vary between and even within individuals with ASD

 But

some are more predictable, and can be considered in planning the environment….

 Common

dislikes – florescent light flicker – loud/unexpected/shrill noise – light touch

Common fascinations - spinning objects, glitter - echo of own vocalisations - deep pressure

Concluding thoughts  Challenge  Social

of translation between ASD and ‘Neurotypical’ views

stimuli are the most salient aspect of environment for NTs

 Special

interests and sensory fascinations can be great motivators (or distractions)

 ASD  Best

eye for detail means we need to consider ‘trees not just forest’ environments will scaffold deficits, enhance assets

Thanks to All the participants in our research studies SRS Team: Steph Lietz, Emma Colvert, Emma Woodhouse, Nicola Gillan, Tori Hallett, Catherine Ames Angelica Ronald, Robert Plomin and the TEDS Team

MRC Wellcome Trust Autism Speaks francesca.happe@kcl.ac.uk

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