Autism the Brain Thinking and Behavior

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					 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 mask it.

                    Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day
                            School-Orange, California          3
  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
Functions of the                 the Brain                                  Functions of the
“Orchestra”                                                                    “Conductor”

Perception                                                                           Inhibit
Attention                                                                   Shift Flexibility
Language Processes                                                     Modulate Emotions
Visual-spatial Processes                                                             Initiate
Memory                                                                   Working Memory
Sensory Inputs                                                                     Planning
Motor Outputs                                                                   Organizing
Knowledge and Skills                                        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:
                     Human Body Systems
   System                         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                       Hair, Skin and Nails
     A person with Autism will experience
 System Interruptions with many of the above.

                      Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day
                              School-Orange, California                          9
                                 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.

•   *reference: Pardo CA, Eberhart CG, “The neurobiology of autism,” Brain Pathol. 2007 Oct;17 (4): 434-47. Department of
    Neurology, Johns Hopkins University School of Medicine


                                         Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day
                                                 School-Orange, California                                              10
             System Theory

         The Beacon Model

Supports:             Cognition
              Educational Achievement                     Individual
 Physical
                  Adaptive Behavior
Emotional                                                Functioning
              Participation/Social Roles
Cognitive
                        Health
Behavioral
                       Context



              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
                             Executive Functions
  Achievement

 Speed and            Memory and Learning Processes
 Efficiency of
  Cognitive
  Processing             Visual-Spatial                        Language
                           Processes                           Processes
Social, Emotional,
     Cultural,
Environmental and                       Sensory-Motor                  Attentional
Situational Factors
                                          Function                     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
  •   Information is too complex
                     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
                                                                      Visualizing
                                                                        Words
                                                                       (Spelling)
The ability to visualize and                                                              Drawing
                                           Visualizing                                     Music
process information is                     Directions/                                     Crafts
needed for school success                   Mobility                                     Household
                                                                                           Tasks
and for practical use.

   Interpretation of             Visualizing                                             Visualizing
   relationships involves      Story Concepts
                                while Reading
                                                                                        Details Related
                                                                                           to Past
   spatial processing—           or Listening                                            Experiences
                                                                       Visualizing
   knowing how objects relate                                      Academic Concepts
   to each other (size, order,                                       (Science, Math,
                                                                      Social Studies)
   etc.)
                        Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day
                                School-Orange, California                                        19
                       Cognition/Thinking
                               Visual/Spatial Processing
Quality              Description
Saliency             •Problems discriminating important information from unimportant
Recognition          •Lacks ability to prioritize
                     •Easily brought off task by sounds or images
                     •Unusual recall of irrelevant facts
Surface Skimming     •Sees ―big picture‖ but fails to recognize details
                     •Needs repeated instructions
                     •Demonstrates memory inefficiencies
Concentration        •Lacks focus
Weaknesses           •Lacks listening abilities
                     •Focuses on details for too long or too short of time
Engagement           •Takes excessive time to join activity
Problems             •Daydreams
                     •Relates ―unrelated‖ materials to lessons
                     •Creative Tendencies
Seeks Constant and   •Concentration Weaknesses
Immediate            •Restless, hyperactive
Gratification        •Needs exciting stimuli to hold attention
                                     Mary Jo Lang,
                     •Never satisfied, demanding 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

Broca’s aphasia —                                   Mixed aphasia —displays
   non-fluent aphasia with                                both receptive and
                                                          expressive deficits
   effortful, often
                                                 Receptive aphasia —impaired
   agrammatic speech production.
                                                    comprehension
Conduction aphasia —fluent aphasia
                                                 Transcortical motor aphasia —
   with severely impaired repetition,
                                                    impaired expressive aphasia
   but relatively preserved language
   comprehension                                 Transcortical sensory aphasia —
                                                    language comprehension is
Expressive aphasia —non-fluent
                                                    impaired, but repetition is
   output
                                                    preserved
Global aphasia —complete loss of all
                                                 Wernicke’s aphasia —receptive
   linguistic function
                                                    language and repetitions are
                                                    severely impaired.

                           Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day
                                   School-Orange, California                       23
                Cognition/Thinking
                                 Language

Wernicke-Geshwind Model of Language
                     Primary Motor Cortex
      Broca’s Area                                                 Arcuate Faciculaus


Primary                                                                 Angular Gyrus
Auditory
 Cortex                                                                     Primary
                                                                             Visual
                                                                            Cortex
                                   Wernicke’s Area



                        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                              •     Hypothesis Generating
•   Anticipation                                    •     Inhibition of Impulsiveness
•   Attention Control                               •     Mental Flexibility
•   Behavioral Initiation/                          •     Organization
•     Productivity                                  •     Planning Problem Solving
•   Behavioral Regulation                           •     Rule Learning
•   Common Sense                                    •     Self-control
•   Concept Formation                               •     Self-monitoring
•   Creativity                                      •     Set Formation and Maintenance
•   Estimation                                      •     Set Shifting
•   Fluency                                         •     Working Memory
•   Goal Setting
                                                    *Source: Miller, Dan; Essentials of
                                                       School Neuropsychological Assessment;
                                                       Wiley, 2007, p. 235.
                              Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day
                                      School-Orange, California                                27
           Cognition/Thinking
          Executive Functioning Development


Plan/Organize/Monitor                                        3-32 years

Emotional Modulation                                         3-?? years

Verbal Working Memory                                        2-13 years

Nonverbal Working Memory                                    3-24 months

Inhibit                                                         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           Function                    Psych/Med Ed
Frontal         Cognitive                   ADHD-I                SLD
Posterior       Executive                   ADHD-C                OHI
Left            Language                    TS/OCD                Ortho
Right           Visual/NV                   RAD                   SLP
Cortical        Learning                    ASD                   Deaf
Sub-cortical    Memory                      (NLD)                 Vis Imp
                Motor                       MR                    PDD
                Sensory                     Epilepsy              LI/ID
                Social/Emotional            TBI                   TBI
                Behavior                    LD                    EBD
                Academic
                                                                  Ref: Peter Isquith, PhD,
                                                                  ―Executive Function: Concepts
                       Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day   and Assessment‖
                               School-Orange, 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

Supports:             Cognition
              Educational Achievement                     Individual
 Physical
                  Adaptive Behavior
Emotional                                                Functioning
              Participation/Social Roles
Cognitive
                        Health
Behavioral
                       Context



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

				
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