1. Models of Development and Mental Health Lecture 3: Behavioural Model: Autistic Spectrum Disorders

2. Rosaleen McElvaney, Phd Autistic Spectrum Disorders Subcategory of Pervasive Developmental Disorders Spectrum –Asperger’s, Autistic, Childhood Disintegrative Disorder Described by Kanner (1943) –communication deficits, atypical cognitive potential, repetitious actions & unimaginative play absorption in the self or subjective mental activities’

3. Rosaleen McElvaney, Phd Diagnosis DSM IV TR Qualitative Impairment in Social Interaction –nonverbal behaviours –age-appropriate peer relationships –Spontaneous sharing, interests –Social or emotional reciprocity Qualitative Impairment in Communication –Language –Initiating or sustaining conversation –Stereotyped, repetitive, idiosyncratic language –Age appropriate make believe or initiative play Restrictive, Repetitive Behaviours and Interests –Preoccupation with stereotyped restrictive interests –Inflexible adherence to non-functional routines or rituals –Stereotyped repetitive motor mannerisms –Persistent preoccupation with parts of objects

4. Rosaleen McElvaney, Phd Referencing DSM-IV-TR American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, (4 th Edition), Text Revision. Washington, DC: APA

5. Rosaleen McElvaney, Phd Characteristics PrevalenceDiscrepant claims: 4.5 – 4.8 per 10,000 or much higher? ERHA study 5 per 10,000 – closer to 20 (Fitzgerald et al, 2000) AgeTypically early onset GenderBoys > Girls 3-5:1 (APA, 1994) Socio-economic status No differences Race/ethnicityLittle information

6. Rosaleen McElvaney, Phd Related problems (not diagnostic criteria) Intelligence: at least 75% of children with autism have learning disabilities; minority have special cognitive abilities e.g. excellent memory Behaviour problems: aggression, outbursts, temper tantrums and hyperactivity. Moods shifts, excessive fears. Self-injurious behaviour Motor skills: may be poor, normal or very good

7. Rosaleen McElvaney, Phd Course of Autism Variations in onset, typically before age 3 Diagnosis possible at age 3, but often occurs later Developmental course is variable (improvement & deterioration) In about 30% of cases adolescence brings serious deterioration May be less favourable outcomes for girls Poorer prognosis if language absent and IQ low Some cases improve in adulthood but typically outcomes not good

8. Rosaleen McElvaney, Phd Asperger’s Syndrome (Atwood, 1998, cited in Molloy & Vasil, 2002) Lack of empathy Naieve, inappropriate, one-sided interaction Little ability to form and sustain friendships Pedantic repetitive speech Poor non-verbal communication Intense interest in certain objects Clumsy ill co-ordinated movements & odd posture

9. Rosaleen McElvaney, Phd Aetiological Theories (Carr, 1999) Psychogenic theories –Inadequate parenting: psychodynamic therapy –Neurobiological: cognitive Vs emotional: behaviour therapy Biogenic theories –Neuroanatomy, neurochemistry & psychophysiology Cognitive theories –Emphasis on cognitive deficits Theory of mind; information processing deficits. Memory deficits; executive function deficits

10. Rosaleen McElvaney, Phd Behavioural Model How helpful? Emergence, Maintenance, Treatment? Continuum between normal & abnormal behaviour? Emphasis on behavioural manifestation of difficulties Socially constructed? (Molloy & Vasil, 2002)

11. Rosaleen McElvaney, Phd Behavioural Model Key principles –Operant & classical conditioning (Pavlov & Skinner) –Concerned with behaviour alone –Behaviour is learned –Behaviour is reinforced –It can be ‘unlearned’

12. Rosaleen McElvaney, Phd Components of Programmes (Carr, 1999, 2003) Psychoeducation Educational placement Family based approach Structured teaching method Behaviour modification Self care and skills training Communication skills training Management of challenging behaviour

13. Rosaleen McElvaney, Phd Critique of Behavioural Model Underlying assumptions may not be correct May be effective intervention not explanation for aetiology Focus on behaviour – too narrow? Evidence for short term gain – sustained over longer term?

14. Rosaleen McElvaney, Phd Therapeutic Interventions Applied Behavioural Analysis - ABA (Lovaas, 1987) –uses operant conditioning, preferably beginning before age 4 TEACCH (The Treatment and Education of Autistic and Communication Handicapped Children) (Schopler, 1987) –Structured learning activities –

15. Rosaleen McElvaney, Phd Additional References Eikeseth, S., Smith, T., Jahr, E and Eldevik, S. (2002). Intensive behaviouraltreatments at school for 4-to-7 year-old children with autism. Behaviour Modification, 26, 49-68

16. Rosaleen McElvaney, Phd Report of Task force on Autism (2001) http://www.education.ie/servlet/blobservlet/sped _autism.pdf Curriculum to include: –Programme access guidelines –Individualised ASD programme guidelines –Use of NCCA guidelines –General ASD strategies –Personal and social programme for all pupils highlighting the differing needs of sub groups on the ASD spectrum

17. Rosaleen McElvaney, Phd Task Force – curriculum contd Support strategies, circle of friends, buddying (with parental permission) Behavioural strategies/guidance (if behavioural difficulties have been identified) Resource implications Vocational and training guidelines

18. Rosaleen McElvaney, Phd Info Guest lecture – working with adolescents, Feb 2 nd Essay deadline – Thursday 2 nd April Next week – Anxiety & cognitive therapy model