PERSONAL CONSTRUCT PSYCHOLOGY AND AUTISM

There has been no significant writing within personal construct psychology about autistic spectrum disorders, despite the fact that this approach provides promising models in a number of other specific areas of human difficulty. This article outlines a PCP model of autism, based on a wide variety of recent research findings and writings, including those of autism sufferers themselves. Autism is considered in the light of Kelly's fundamental postulate and 11 corollaries as well as Procter's (1978) group and family corollaries. It is argued that Kelly's theory provides an integrative framework for considering this complex set of disorders with implications for further research in autism and the early development of social cognition as well as for therapeutic and educational intervention in helping people struggling with autistic spectrum disorders.     

Sleep disorders, epilepsy, and autism

The purpose of this review article is to describe the clinical data linking autism with sleep and epilepsy and to discuss the impact of treating sleep disorders in children with autism either with or without coexisting epileptic seizures. Studies are presented to support the view that sleep is abnormal in individuals with autistic spectrum disorders. Epilepsy and sleep have reciprocal relationships, with sleep facilitating seizures and seizures adversely affecting sleep architecture. The hypothesis put forth is that identifying and treating sleep disorders, which are potentially caused by or contributed to by autism, may impact favorably on seizure control and on daytime behavior. The article concludes with some practical suggestions for the evaluation and treatment of sleep disorders in this population of children with autism.     

Current knowledge on motor disorders in children with autism spectrum disorder (ASD)

Motor symptomatology in autism is currently poorly understood, and still not included in the autism spectrum disorder (ASD) diagnostic criteria, although some studies suggest the presence of motor disturbances in this syndrome. We provide here a literature review on early motor symptoms in autism, focusing on studies on psychomotor issues (tone, postural control, manual dexterity, handedness, praxis). The approach adopted in research to study altered motor behaviors is generally global and there is no detailed semiology of the motor or neuromotor disorders observed in people with ASD. This global approach does not enable understanding of the neuro-developmental mechanisms involved in ASD. Identification of clinical neuro-psychomotor profiles in reference to a standard would help to better understand the origin and the nature of the disorders encountered in ASD, and would thus give new directions for treatment.     

自闭症儿童依恋研究述评

摘要　　研究者曾一度认为自闭症儿童无法建立起依恋关系。本文系统回顾了自闭症儿童依恋研究的最新进展,将自闭症儿童是否存在依恋行为（尤其是安全型依恋行为）、依恋发展解释理论、研究方法、类型分布以及影响因素等问题进行了详细梳理,并结合研究分析,提出有关自闭症儿童依恋研究的几点启示,以供参考。     

Epileptic encephalopathies and their relationship to developmental disorders: do spikes cause autism?

Epileptic encephalopathies are progressive clinical and electroencephalographic syndromes where deterioration is thought to be caused by frequent seizures and abundant EEG epileptiform activity. Seizures occur in approximately 10-15% of children with pervasive developmental disorders (PDD) and 8-10% have epileptiform EEG abnormalities without seizures. Thirty percent of children with PDD have regression of social behavior and language at 2-3 years of age. Some authors speculate that the regression is caused by epileptiform activity even in the absence of overt clinical seizures ("autism with epileptic regression") and suggest that elimination of the epileptiform activity, either medically or surgically, should lead to improvement in behavior. This review examines the data showing that interictal epileptiform discharges are associated with transient clinical dysfunction and discusses the implications of these observations for autistic behavioral abnormalities. The results of resective surgery, vagal nerve stimulation, and multiple subpial transaction on children with autism and epileptiform EEG abnormalities are also discussed. I conclude that there is no evidence that interictal discharges per se cause (or contribute to) the complex behavioral phenotype of autism. There is no justification to support the use of anticonvulsant medication or surgery in children with PDD without seizures; that is, there is no evidence that treatment to eliminate EEG spikes will have a therapeutic effect on the behavioral abnormalities of PDD and autism.     

Bad Mothers and Monstrous Sons: Autistic Adults,Lifelong Dependency,and Sensationalized Narratives of Care

Sensationalized representations of autistic families in film and other media frequently feature violent encounters between mothers and sons. This essay analyzes two media stories and three films that suggest how limited—and therefore misleading—popular representations of the autism family are. Except for one of the films, these representations blame the problem of adult autistic dependency on either monstrous autism or bad mothering. Doing so elides collective social responsibility for autism care and denies the reality that autistic adults continue to have complex dependency needs that families cannot always meet. Narratives that sensationalize youth and adults with autism or scapegoat their maternal caregivers also diminish opportunities for social inclusion and for autistic people to live fully and dependently.     

Regression in Autistic Spectrum Disorders

A significant proportion of children diagnosed with Autistic Spectrum Disorder experience a developmental regression characterized by a loss of previously-acquired skills. This may involve a loss of speech or social responsitivity, but often entails both. This paper critically reviews the phenomena of regression in autistic spectrum disorders, highlighting the characteristics of regression, age of onset, temporal course, and long-term outcome. Important considerations for diagnosis are discussed and multiple etiological factors currently hypothesized to underlie the phenomenon are reviewed. It is argued that regressive autistic spectrum disorders can be conceptualized on a spectrum with other regressive disorders that may share common pathophysiological features. The implications of this viewpoint are discussed.     

Does DSM-IV Asperger's Disorder Exist?

DSM-IV criteria for autistic and Asperger's disorders were applied to 157 children with clinical diagnoses of autism or Asperger's disorder. All children met the DSM-IV criteria for autistic disorder and none met criteria for Asperger's disorder, including those with normal intelligence and absence of early speech delay. The reason for this was that all children had social impairment and restricted and repetitive behavior and interests (required DSM-IV symptoms for both autistic and Asperger's disorders) and all had a DSM-IV communication impairment (which then qualified them for a diagnosis of autistic disorder and not Asperger's disorder). Communication problems exhibited by all children were impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both), which are DSM-IV criteria for autism. These findings are consistent with those of 5 other studies and indicate that a DSM-IV diagnosis of Asperger's disorder is unlikely or impossible.     

Detail-oriented cognitive style and social communicative deficits,within and beyond the autism spectrum: Independent traits that grow into developmental interdependence

At the heart of debates over underlying causes of autism is the “Kanner hypothesis” that autistic deficits in social reciprocity, and a cognitive/perceptual ‘style’ favouring detail-oriented cognition, co-vary in autistic individuals. A separate line of work indicates these two domains are normally distributed throughout the population, with autism representing an extremity. This realisation brings the Kanner debate into the realm of normative co-variation, providing more ways to test the hypothesis, and insights into typical development; for instance, in the context of normative functioning, the Kanner hypothesis implies social costs to spatial/numerical prowess. In light of this growing body of research, we review relevant factor analytic and correlational, behavioural studies. Findings are then synthesised into three themes: an alternative triad of primary autistic trait categories – Social Interaction Deficits, Cognitive Inflexibility, and Sensory Abnormalities – that more accurately reflects the factor structure of autistic traits; continuity between clinical and non-clinical autism-spectrum trait presentation; and indications that although social and non-social autistic traits may be initially independent, Kanner-like co-variance emerges behaviourally from dynamic trait interactions over the course of development. A dynamic developmental model subsuming these patterns is offered, and its advantages demonstrated in a novel account of ritualistic behaviours: as developmentally emergent, compensatory mechanisms for interactions between cognitive inflexibility and sensory abnormalities. We conclude with the broader imperative that behavioural scientists appealing for directly and exclusively genetic links may instead benefit from a developmental framing within their own discipline.     

Early Negative Affect Predicts Anxiety, not Autism, in Preschool Boys with Fragile X Syndrome

Children with fragile X syndrome (FXS) face high risk for anxiety disorders, yet no studies have explored FXS as a high-risk sample for investigating early manifestations of anxiety outcomes. Negative affect is one of the most salient predictors of problem behaviors and has been associated with both anxiety and autistic outcomes in clinical and non-clinical pediatric samples. In light of the high comorbidity between autism and anxiety within FXS, the present study investigates the relationship between longitudinal trajectories of negative affect (between 8 and 71 months) and severity of anxiety and autistic outcomes in young males with FXS (n?=?25). Multilevel models indicated associations between elevated anxiety and higher fear and sadness, lower soothability, and steeper longitudinal increases in approach. Autistic outcomes were unrelated to negative affect. These findings suggest early negative affect differentially predicts anxiety, not autistic symptoms, within FXS. Future research is warranted to determine the specificity of the relationship between negative affect and anxiety, as well as to explore potential moderators. Characterizing the relationship between early negative affect and anxiety within FXS may inform etiology and treatment considerations specific to children with FXS, as well as lend insight into precursors of anxiety disorders in other clinical groups and community samples.     

Using the ADI-R to diagnose autism in preschool children

The use of an investigator-based interview (Autism Diagnostic Interview—Revised; ADI-R) in the diagnosis of 51 autistic and 43 nonautistic mentally handicapped preschool children of equivalent mental and chronological age is described. Significant differences occurred between the groups on every diagnostic subdomain from the DSM-IV/ICD-10 draft criteria, except specific aspects of stereotyped language, still relatively rare in these young children. All but one of the 51 children judged to be autistic by clinical observation and only two of the 30 nonautistic mentally handicapped children with mental ages of 18 months or higher met criteria for autism on an algorithm to DSM-IV/ICD-10 draft criteria. However, discrimination using domain totals between autistic and the 13 nonautistic, nonverbal mentally handicapped children with mental ages under 18 months was poor. Quality of social overtures to adults and peers, play, and unusual sensory behaviors and mannerisms continued to differentiate these two groups. The relevance of these findings to the diagnosis of autism in preschool children is discussed.     

Autism: beyond “theory of mind”

The theory of mind account of autism has been remarkably successful in making specific predictions about the impairments in socialization, imagination and communication shown by people with autism. It cannot, however, explain either the non-triad features of autism, or earlier experimental findings of abnormal assets and deficits on non-social tasks. These unexplained aspects of autism, and the existence of autistic individuals who consistently pass false belief tasks, suggest that it may be necessary to postulate an additional cognitive abnormality. One possible abnormality - weak central coherence - is discussed, and preliminary evidence for this theory is presented.     

Acquired epileptiform aphasia: a dimensional view of Landau-Kleffner syndrome and the relation to regressive autistic spectrum disorders.

Acquired epileptiform aphasia (AEA) is characterized by deterioration in language in childhood associated with seizures or epileptiform electroencephalographic abnormalities. Despite an extensive literature, discrepancies and contradictions surround its definition and nosological boundaries. This paper reviews current conceptions of AEA and highlights variations in the aphasic disturbance, age of onset, epileptiform EEG abnormalities, temporal course, and long-term outcome. We suggest that AEA, rather than being a discrete entity, is comprised of multiple variants that have in common the features of language regression and epileptiform changes on EEG. Viewed this way, we argue that AEA can be conceptualized on a spectrum with other epileptiform neurocognitive disorders that may share pathophysiological features. The implications of this viewpoint are discussed, with emphasis on parallels between the AEA variants and regressive autistic spectrum disorders.     

Cognitive imitation in typically-developing 3- and 4-year olds and individuals with autism

Individuals diagnosed with autism suffer from numerous social, affective and linguistic impairments. It has also been suggested that they have a global imitation deficit. That hypothesis, however, is compromised by the fact that individuals with autism suffer from various motor impairments. Here we describe an experiment on cognitive imitation, a type of imitation that doesn’t require motor learning. Nine male autistic subjects and 20 typically-developing 3- and 4-year olds were trained to respond, in a prescribed order, to different lists of photographs that were displayed simultaneously on a touch-sensitive monitor. Because the position of the photographs varied randomly from trial to trial, sequences could not be learned by motor imitation. In three different imitation treatments, including a ghost control, autistic subjects learned new sequences more rapidly after observing a model execute those sequences than when they had to learn new sequences entirely by trial and error. Moreover, the performance of autistic subjects did not significantly differ from the performance of typically-developing controls. The result of this and other studies suggests that individuals with autism suffer from a specific novel motor imitation deficit.     

Intonation and Emotion in Autistic Spectrum Disorders

The classic picture of an autistic individual includes an impoverished ability to interpret or express emotion. The prosody of spoken language in autistic children is thought to lack emotional content. In this study, the verbal intonation of children with autism was examined and compared to that of children with Asperger Syndrome (AS) and normal controls (ctrl). Utterances elicited by repetition and by spontaneous story completion were analyzed by quantifying phonetic features (pitch, amplitude, and length) and comparing them to subjective ratings of produced emotion (happy, sad or angry). Since the most consistent phonetic correlate of these emotional targets has been demonstrated to be pitch range, speakers with autistic spectrum disorders were expected to have decreased pitch range; however in the repetition task, autistic subjects actually had a larger pitch range than the other groups. Other measures of intonation including amplitude, duration, and location of pitch peak revealed defects that are more complex than predicted. In spontaneous speech, autistic subjects performed more poorly on both phonetic targets and subjective ratings than ctrls, and AS subjects fell between autistics and normals.     

Autism as a Form of Life: Wittgenstein and the Psychological Coherence of Autism

Autism is often taken to be a specific kind of mind. The dominant neuro‐cognitivist approach explains this via static processing traits framed in terms of hyper‐systemising and hypo‐empathising. By contrast, Wittgenstein‐inspired commentators argue that the coherence of autism arises relationally, from intersubjective disruption that hinders access to a shared world of linguistic meaning. This paper argues that both camps are unduly reductionistic and conflict with emerging evidence, due in part to unjustifiably assuming a deficit‐based framing of autism. It then develops a new Wittgensteinian account—autism as a different form of life—which avoids these issues. Rather than autistic systemising being the basis of autistic cognition, it is taken to be a reaction to pre‐epistemic and semantic anxieties that come with developing as a minority within a different form of life. This re‐framing can provide a coherent account of the autistic mind, and has significant conceptual, practical, and ethical implications.     

Minding the gap between neuroscientific and psychoanalytic understanding of autism

This paper offers an integrative approach to the increasingly complex puzzle of autistic spectrum disorders. The author demonstrates how the work of one group of neuroscientists in Parma, on a special class of brain cells called ‘mirror neurons', and the work of researchers at the University of California in San Diego, applying these findings to the problem of autism, intersect with Frances Tustin's discoveries about the nature, function and meaning of psychogenic autism in children and even autistic states in neurotic adults. Included in the author's considerations are the results of some by now well-known studies conducted by a group of biologists at the University of California at Berkeley in the 1960s on the effects of ‘enriched’ versus ‘deprived’ environments upon the development of the brain, and a study of autistic children diagnosed as brain damaged and treated psychoanalytically at the Paediatric Neuro-Psychiatric Institute of the University of Rome in the 1980s. The author concludes with a coherent picture of various dimensions of autistic phenomenon that may constitute more than just the sum of its parts, and points towards new areas for discussion and study.     

Processing of compound visual stimuli by children with autism and Asperger syndrome

A typical modes of visual processing are common in individuals with autism. In particular, and unlike typically developing children, children with autism tend to process the parts of a complex object as a priority, rather than attending to the object as a whole. This bias for local processing is likely to be due to difficulties in assembling subparts into a coherent whole, as proposed by Frith ( 10 1989) using the term “weak central coherence” or WCC. This study was aimed to better characterize the processing of complex visual stimuli by children with autism. Thirteen children with autistic spectrum disorders were individually paired with children of two control groups, one matched on verbal mental age (VMA) and one matched on chronological age (CA). Participants from the three groups were tested in two tasks. The first task involved hierarchical global/local stimuli, inspired by Navon ( 30 1977). The second task employed compound face‐like or geometrical stimuli. This task emphasized the processing of configural properties of the stimuli (i.e., spatial relationships). Children from the three groups showed a perceptual bias favouring the global dimension of the stimuli in the first task. By contrast, children with autism were deficient compared to normal children for the processing of the configural dimensions of the stimuli in the second task. These results suggest that visual cognition of children with autism is characterized by a dissociation between global and configural processing, with global processing being preserved and configural processing being altered in these children, therefore delineating the extents and limits of the WCC theory (Frith, 10 1989).     

自闭症谱系障碍个体的焦虑：发生机制、评估与治疗

自闭症谱系障碍是一种神经发育性障碍, 主要表现为社会交往互动障碍和重复刻板性行为。焦虑或焦虑障碍常被认为是自闭症个体最普遍的共病之一。焦虑与自闭症之间的关系尚不明确, 自闭症个体的焦虑与无法忍受不确定性、杏仁核功能和体积、情绪调节策略、消极思维存在一定关联; 目前已经开发出专门用于自闭症个体焦虑的评估工具; 修订版认知行为疗法对自闭症个体焦虑的治疗取得了良好效果。未来的研究应着重探索自闭症个体焦虑的认知与神经机制, 检验专用评估工具的有效性, 继续关注现代技术(如虚拟现实技术)对自闭症个体焦虑的治疗效果。     

Understanding Executive Control in Autism Spectrum Disorders in the Lab and in the Real World

In this paper, we review the most recent and often conflicting findings on conventional measures of executive control in autism spectrum disorders. We discuss the obstacles to accurate measurement of executive control, such as: its prolonged developmental trajectory; lack of consensus on its definition and whether it is a unitary construct; the inherent complexity of executive control; and the difficulty measuring executive-control functions in laboratory or clinical settings. We review the potential of an ecological-validity framework to address some of these problems, and describe new tests claiming verisimilitude, or close resemblance to “real life” demands. We also review the concept of veridicality, which allows for the measurement of the ecological validity of any task, and discuss the few studies addressing ecological validity in individuals with autism. Our review suggests that a multi-source approach emphasizing veridicality may provide the most comprehensive assessment of executive control in autism.