asperger’s syndrome, anxiety, and neurophysiology
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Asperger’s Syndrome, Anxiety, and Neurophysiology. Prepared by Robert S. Lagos For the Kiwanis Club October 21, 2011 Dexter, ME. Introduction: What is Asperger’s Syndrome?. - PowerPoint PPT PresentationTRANSCRIPT
Asperger’s Asperger’s Syndrome, Anxiety, Syndrome, Anxiety,
and Neurophysiology and Neurophysiology
Prepared by Robert S. LagosPrepared by Robert S. Lagos
For the Kiwanis ClubFor the Kiwanis Club
October 21, 2011October 21, 2011
Dexter, MEDexter, ME
Introduction: What is Introduction: What is Asperger’s Syndrome?Asperger’s Syndrome?
• Defined as an autism spectrum disorder (ASD), characterized by difficulties in social interaction and restricted, stereotyped patterns of behavior and interests.
• Named after the Austrian pediatrician Hans Asperger, who, in 1944 described children in his practice with similar traits.
Introduction: What is Introduction: What is Asperger’s Syndrome?Asperger’s Syndrome?
• In 1994, AS is standardized as a diagnosis in the DSM IV
• Will likely be subsumed into Autism disorder in DSM V (2012 or 2013).
Introduction: What is Introduction: What is Asperger’s Syndrome?Asperger’s Syndrome?
• Lots of information nowadays!
– Books written by people with autism/AS and also specialists in the field
– Internet
– Other Media
Introduction: What is Asperger’s?Introduction: What is Asperger’s?
• About 1 in 100 diagnosed– Why the increase? Could be:
•Increase in attention and education of autism
•Effects of a changing society and culture over last 50 years: greater anonymity, erosion of community and family, spread of solitary pursuits like TV, internet.
Frequency of Asperger’s?Frequency of Asperger’s?
• More males than females (about 3:1 or 4:1) – “true” ratio probably less. • Tony Attwood speculates 2:1• Lack of diagnosis of women: probably due to
societal roles expected of women vs. men• May also be due to the gender differences
Frequency of Asperger’s?Frequency of Asperger’s?
Hans AspergerHans Asperger
Modern Day:Modern Day:Tony AttwoodTony Attwood
World famous researcher and World famous researcher and authorauthor
(and others)(and others)
(Well known for pioneer (Well known for pioneer research work with early research work with early
infantile autism)infantile autism)
Pioneers of Asperger’s Syndrome Research
Common Themes, Symptoms, Common Themes, Symptoms, and Issues of Asperger’s/HFAand Issues of Asperger’s/HFA
• Inability to connect socially with others in outside world. Shyness, as well as a different interest focus. Inability to read and pick up non-verbal cues.
Common Themes, Symptoms, Common Themes, Symptoms, and Issues of Asperger’s/HFAand Issues of Asperger’s/HFA
• Cultural divide, difference to that of outside world. General feeling of lack of understanding and compatibility with it. Difference in perception.
• Isolation. ?? ?
Common Themes, Symptoms, Common Themes, Symptoms, and Issues of Asperger’s/HFAand Issues of Asperger’s/HFA
• Specialized range of interests– Often over-focused on a single topic– Can be vocationally beneficial, and at least
of entertaining value.– Many technological contributions are
attributed to intense focus in a particular area.
– Some degree of repetitive aspects/behaviors within interests.
Other frequent themes/issues Other frequent themes/issues
• Obsessive thinking• Sensory overload• Anxiety and hyper-reactivity• Language and mental
processing delay• Motor and directional skills:
some difficulties• Delays in learning physical
activities
• Lack of social interest: internalization
• Inability to respond emotionally• No small talk• May not understand sarcasm –
things taken literally
Other frequent themes/issues Other frequent themes/issues
• Awkward body language• Problems with eye contact• Repetitive movements• Not flexible about routines/rituals• May be singled out by peers as
“strange”
Other frequent themes/issues Other frequent themes/issues
Other frequent themes/issues Other frequent themes/issues
• Common Comorbidities:• OCD• Attention deficit• Depression/mood shifts
• High Functioning Autism:• More language delay• May be more withdrawn
Some common positive Some common positive characteristicscharacteristics
• Gifted in select areas• Thinking “outside the box”• Uniqueness – personality and abilities• Reliability and truthfulness• Attention to detail• Intense dedication and focus on
different areas of interest.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Brains of autistic persons have been found to differ in several ways from a “neurotypical” brain.– Associated with “male-like” brain:
systematizing skills over empathizing– Tend to use different areas of the brain– But many facts not yet tied together.
• Brain cells are linked by axons, long cables insulated with myelin, which form the white matter.
• In autistic people, there seem to be too many cables within local areas, but not enough links from one region to another.
• This problem may be developmental – the development of the white matter has been found to be delayed in autistic persons.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Imbalances have been found in neurotransmitters (i.e. chemicals helping nerve cells communicate with one another):
– Serotonin (affecting emotion and behavior)
– Glutamate (plays a role in neuron activity)
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
1. Frontal Lobes2. Corpus Callosum3. Amygdala4. Hippocampus5. Cerebellum
Back of Head Front of Head
(Time Magazine, May 15, 2006, p.44-45)
Regions of the Brain Important in Autism
• Frontral lobes
– Important in reasoning, emotion, personality.
– Found to be enlarged in autistic persons, due mainly to excess white matter, the brain’s connector cables.
– Often found to grow at an unusual rate by age 2.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Cerebellum
– Important in motor activity, coordination, and motor/sensory planning.
– Like frontal lobes, overloaded with white matter.
– The above skills can all be weak for people with autism.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Corpus Callosum
– Facilitates communication between the left and right hemispheres of the brain.
– Found to be undersized.– Activity across regions of the brain are
poorly coordinated.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Hippocampus
– Vital to memory.– Found to be about 10% larger than
normal for autistic persons.• May, however, be because autistic persons
rely on memory to interpret situations that most people process elsewhere.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Amygdala
– Important in emotion and social behavior.
– Also found to be enlarged for autistic persons.• Size may be related to the high level of
anxiety in autistic people.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Genetics
– No single gene has been isolated. But different gene combinations have been associated.
– Lately it has been found that autistic persons tend to have fewer copies of certain genes (due to depletion in chromosome #16).
– Asperger’s and autism tend to run in families, i.e., higher chance if relative such as sibling or parent has it.
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
• Still uncertain as to whether many structural differences are the cause or the result.
• Some physiological differences not as pronounced in person’s with Asperger’s
• Although differences evident, it is all very much a puzzle yet to be pieced together!
Neurophysiological attributes of Neurophysiological attributes of persons with autism / A.S.persons with autism / A.S.
Anxiety and A.S.Anxiety and A.S.
• Anxiety is normal – but likely to be significantly more disabling in AS than in general population.
• Important AS symptom: excessively overwhelmed by stimuli: May be highly correlation with anxiety.
• Could other A.S. symptoms be a form of this hyper-reactivity toward stimuli?
• Could this hyper-response toward stimuli, in fact, even define A.S./autism?• But harder to observe than more obvious
symptoms.
Anxiety and A.S.Anxiety and A.S.
• For many, the biggest obstacle in life – can interfere with quality of life.
• Can severely affect human relationships, business dealings, and ability in general to deal with people.
• Often painful as well as disabling.
• May be impossible to reason out even if reasoning seems obvious.
How anxiety may affect persons How anxiety may affect persons with A.S. with A.S.
• Gets in the way of getting things done. – Paralyzing.– Many situations uncomfortable and terrifying.
• Feeling of being overwhelmed; sometimes leads to depression and meltdowns (breakdowns).
• Affects confidence in being able to connect and interact with others.
Experiences of persons with A.S. Experiences of persons with A.S. surveyed regarding anxietysurveyed regarding anxiety
• Awkward/erratic eye contact another manifestation – social discomfort.
• Hard to say “no” or assert needs.
• Tension of socializing expends much energy; need to lie down to relax after social event to recoup energy.
Experiences of persons with A.S. Experiences of persons with A.S. surveyed regarding anxietysurveyed regarding anxiety
Situations which particularly trigger Situations which particularly trigger anxiety (A.S. group survey)anxiety (A.S. group survey)::
• Meeting somebody for the first time
• Not knowing how to interpret signals from other people– feeling clueless as to how to go about
approaching people– fear of alienating the other person
• Confrontation or even anticipation of anxiety
• New place, routine, situation
• Job interviews (***)
• Social climate in school
• Anticipation of school work and homework
Situations which particularly trigger Situations which particularly trigger anxiety (A.S. group survey)anxiety (A.S. group survey)::
• Tasks needing to be done which may seem huge or forbidding, creating feeling of being overwhelmed
• Attempting to apply the same principles and advice given to clients or others to oneself
• Performances, competitions.
Situations which particularly trigger Situations which particularly trigger anxiety (A.S. group survey)anxiety (A.S. group survey)::
Coping RemediesCoping Remedies
• Possible to find areas in which to excel or enjoy which are less anxiety dependent. – Can tap into certain special interests and talents.
• Drug therapy sometimes helpful, but may not justify side-effects, effort, and cost. Effectiveness can vary according to the person.
• Cognitive therapy (see later) is a helpful tool. But can require repeated applications.
• Peer support and empathy particularly helpful.
• Parental empathy and support very important in development.
Coping RemediesCoping Remedies
Comorbidities tying in with anxietyComorbidities tying in with anxiety
• OCD (Obsessive Compulsive Disorder)
• Depression• Acute sensory sensitivity
What are the common What are the common connections?connections?
Research and DiagnosisResearch and Diagnosis
• Diagnostic criteria for AS do not include mood disorders such as anxiety, depression, OCD.
• But many with AS are overwhelmed by:– Life experiences– Social rejection/bullying/not being understood– Isolation– Vulnerability– Sensory overloads
• It has been found that anxiety symptoms cannot be explained by increased stress alone– Environment and biology may be interrelated.
• The amygdala (part of the brain)– Involved with regulation of emotions– Some evidence of it being different for those with
A.S.– Important in anxiety problem
Research and DiagnosisResearch and Diagnosis(continued)(continued)
Comments on Research and Comments on Research and DiagnosisDiagnosis
Thomas EdisonThomas Edison
Comments on Research and Comments on Research and DiagnosisDiagnosis
• ASD Not an exact diagnosis. However, the symptoms are very real: marked differences, both from standpoint of person’s life history as well as behavior, as well as physical development.
Comments on Research and Comments on Research and DiagnosisDiagnosis
• Still many medical professionals uninformed about Asperger’s.– But information is on the rise.
Comments on Research and Comments on Research and DiagnosisDiagnosis
• Maybe in the future, people within the AS umbrella may be grouped differently? Will diagnosis acquire a different name? ex: “basal ganglia” problem?
TherapiesTherapies
• Medications which may be used:– Anti-anxiety, anti-depressants:
Tricyclics, SSRI Inhibitors; Prozac, Imipramine, Celexa, Zoloft, many others.
– Effectiveness varies widely according to the individual. Some see a significant improvement due to medication, others do not.
• Cognitive Therapy
– This addresses thought distortions and obsessive thinking.
– A time-limited approach which allows one to view more objectively distortions in thought patterns and emotions.
– “Thought stoppers”
Therapies (continued)Therapies (continued)
• Peer and other support
– Peer group support– Asperger Chat lines– Internet, other media– Parents, spouses, friends who know
about and empathize with Asperger’s
Therapies (continued)Therapies (continued)
Family: Raising / Dealing with a Family: Raising / Dealing with a Child with ASCChild with ASC
Family: Raising / Dealing with a Family: Raising / Dealing with a Child with ASCChild with ASC
• Probably won’t be easy.
Family: Raising / Dealing with a Family: Raising / Dealing with a Child with ASCChild with ASC
• Best suggestion: LISTEN TO CHILD. Don’t assume to know everything about human psychology. Don’t force-mold the child.
Family: Raising / Dealing with a Family: Raising / Dealing with a Child with ASCChild with ASC
• Child still needs guidance, direction, and discipline. But different psychology may be needed.
Family: Raising / Dealing with a Family: Raising / Dealing with a Child with ASCChild with ASC
• “I don’t know” may be best answer, hand-in-hand with intuition and “trial and error” supportive approach.
Family: Raising / Dealing with a Family: Raising / Dealing with a Child with ASCChild with ASC
• Professional or therapeutic help encouraged, and in some cases, may be necessary.
Intimate RelationshipsIntimate Relationships
• Can be difficult to get• Most frequent relationship with
someone on opposite end of spectrum• Other can be a “social mentor”
• Partner with A.S. next most frequent• Internet a good source (Tony Attwood)
The Emerging “Aspie” CultureThe Emerging “Aspie” Culture
• Chat lines and internet a great source of social contact for “aspies”.
• Asperger support groups: meeting others, in person, with similar issues.
• Culture can be “cliquish”, like many other cultures. Countering culture domination an issue.
Services for persons with ASC in Services for persons with ASC in New EnglandNew England
• Autism Society of America: incl. Maine, New Hampshire, Vermont, Massachusetts, other states: events, conferences, legislation work. Email (Maine): asmonline.org
• AANE (Asperger’s Association of New England): adult groups, parent groups, conferences, referrals. Email: aane.org
Services for persons with ASC in Services for persons with ASC in New EnglandNew England
• Some Special schools in New England:– Aucocisco School in Cape Elizabeth– New England Center for Children in Boston
• Autism chat lines / group sites:– Wrong planet.net– Startlink-IRC– Maine Asperger Group (newly formed):
http://maineaspergers.ning.com/
• SENG: Supporting Emotional Needs of the Gifted: sengifted.org
• A lot more information on the web
Other Services OnlineOther Services Online
• Temple Grandin: Doctor of animal science who developed humane slaughter technique (High Functioning Autism)
• John Robeson: Author of “Look me in the eye” (Asperger’s)
• Others
Celebrities having HFA or Celebrities having HFA or Asperger’s Asperger’s (featured in media recently)(featured in media recently)
Historical/famous people Historical/famous people ““associatedassociated”” with Asperger’s with Asperger’s
• Thomas Edison• Albert Einstein• Thomas Jefferson• Richard Nixon• Sir Isaac Newton• Ludwig Van Beethoven• Bill Gates• Glenn Gould (pianist)• Andy Warhol• Hans Christian Anderson• others
Some ReferencesSome References(Work done on topic of AS and Anxiety)(Work done on topic of AS and Anxiety)
• Judith Reaven and Susan Hepburn: Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder in a Child with Asperger Syndrome… (2003)
• Meena Desari: Asperger Syndrome and Anxiety (2009)
• Nick Dubin: Asperger Syndrome and Anxiety: A Guide to Successful Stress Management (2009)
• Tony Attwood: The Complete Guide to Asperger Syndrome (2007)
• Valerie Gauss: Cognitive Behavioral Therapy for Adult Asperger Syndrome (2007)
Contact: [email protected]