Autism
description
Transcript of Autism
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Visual impairment and autism: Does social engagement hold the key?
Peter Hobson and Tony Lee
Tavistock Clinic and Institute of Child Health, UCL.
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Autism
Autism involves:
• A profound impairment in interpersonal engagement
• Characteristic abnormalities in language
• A severe restriction in symbolic and flexible thinking
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Someone else
ThingChild
Hobson (1993): The Relatedness Triangle
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Are there autistic like features in congenitally blind children?Brown, R., Hobson, R.P., Lee, A., and Stevenson, J., (1997)
Journal of Child Psychology and Psychiatry, 38, 693-703
Participants:
24 congenitally blind children aged 3 and 9 years- Totally blind or minimal light perception from birth, no
identifiable neurological impairment- Selected from six schools in England- 15 with VIQ>70, 9 with VIQ<70
Upper ability were compared with 10 sighted children matched for age and IQ
Lower ability compared with 9 sighted children with autism, matched for age and IQ
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Group of 24 children with congenital blindness: Scores on Childhood Autism Rating Scale
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14 15 - 17 18 - 20 21 - 23 24 - 26 27 - 29 30 - 32 33 - 35 36 - 38 39 - 41
Total Score (excluding Item VII on visual responsiveness)
Num
ber
of p
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ipan
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Children with VI - IQ>70 Children with VI - IQ<70
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Hobson, R.P., Lee, A., and Brown, R., (1999)Are there autistic like features in congenitally blind children?
Journal of Autism and Developmental Disorders, 29, 45-56.
Participants:
On the basis of a seeded cluster analysis of clinical features from the DSM-III-R, 9 congenitally blind children from the study were placed in the cluster with the children with autism
- All 9 children satisfied DSM-III-R criteria for autism- 4 boys and 5 girls, with diagnoses of congenital optic
atrophy (4), ROP (3), bilateral retinal dysplasia(1) and Leber’s amaurosis (1)
These participants were compared with a newly constituted group of 9 sighted children with autism (all male), matched according to age and VMA (verbal subtests of WISC or WIPPSI)
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Hobson, R.P., Lee, A., and Brown, R., (1999)Are there autistic like features in congenitally blind children?
Journal of Autism and Developmental Disorders, 29, 45-56.
Chronological Age Verbal Mental Age
Meanyr;mo
SDmo
Rangeyr;mo
Meanyr;mo
SDmo
Rangeyr;mo
Non-sighted with autism
n = 9
6;06 16 5;00 - 8;10 4;02* 8 3;03 - 5;01
Sighted with autism
n = 9
7;08 17 5;02 - 9;06 4;08 11 2;11 - 5;07
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Study 1
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. par
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rmal
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DSM-III-R: Impairments in Communication
Non-sighted participants Sighted participants with autism
Study 1: DSM-III-R clinical features among non-sighted and sighted children with autism
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9N
o. p
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DSM-III-R: Impairments in Reciprocal Social Interaction // Restricted Activities, Interest and Imagination
Non-sighted participants Sighted participants with autism
Study 1: DSM-III-R clinical features among non-sighted and sighted children with autism
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Reversible autism among children with congenital blindness? A controlled follow-up study.
Hobson, R.P., & Lee, A. (2010). Journal of Child Psychology and Psychiatry, 51, 1235-1241.
* n = 8
Chronological Ageyears; months
Verbal mental ageyears; months
TIME 2 Mean SD Range Mean SD Range
Non-sighted with autismn = 9
15;00 1;01 13;06-16;04 10;00 2;01 6;06 - 13;07
Sighted with autismn = 7
15;07 1;09 13;03-17;09 10;07 2;03 8;00 - 13;07
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Continue to meet DSM criteria
Fail to meet DSM criteria
Non sighted(n = 9)
1 8
Sighted (n = 7)
7 0
Fisher’s exact p = 0.01 (2-tail)
Diagnosis of autism at T2, according to DSM criteria
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% p
arti
cip
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wit
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alit
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DSM-III-R: Impairments in Communication
Non-sighted participants Sighted participants with autism
Study 2: DSM-III-R clinical features among non-sighted and sighted children with autism
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% p
art
icip
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rmali
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DSM-III-R: Impairments in Reciprocal Social Interaction // Restricted Activities, Interest and Imagination
Non-sighted participants Sighted participants with autism
Study 2: DSM-III-R clinical features among non-sighted and sighted children with autism
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3 point + improvement
on CARS
< 3 point improvement on
CARS
Non-sighted 9 0
Sighted 1 6
Fisher’s exact p = 0.01 (2-tail)
CARS 1 vs CARS 2
Non-sighted Sighted
t 6.794 -0.078
df 8 6
p (2 tail) >0.001 0.940
Childhood Autism Rating Scale: T1 vs T2
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VIQ1 vs VIQ 2
Non-sighted(note: n = 8)
Sighted(n = 7)
t = -2.495 t = -1.146
df 7 df 6
p < .05 ns (p < .3)
What happens to verbal ability?
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Conclusions
• Autism is a syndrome• This syndrome is heterogeneous in
pathogenesis as well as aetiology• Congenitally blind children who fulfil the
diagnostic criteria for autism early in childhood may no longer satisfy those criteria 8 years later – and in this respect, there is a contrast with sighted children with autism
• What are the pros and cons to considering autism among VI children ‘autism-like’?
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So…Visual impairment and autism: Does social engagement hold the key?
We are left with the possibility that -both in sighted children with autism -and for different reasons, visually impaired children who develop clinical features considered typical of autism
- ‘autism’ arises through impediments to interpersonal engagement vis-à-vis a shared, visually specified world.