Autism: the Brain, Thinking and Behavior Mary Joann Lang, Ph.D., A.B.P.N. Beacon Day School Orange, California.

Autism: the Brain, Autism: the Brain, Thinking and Thinking and

Behavior Behavior

Mary Joann Lang, Ph.D., Mary Joann Lang, Ph.D., A.B.P.N.A.B.P.N.

Beacon Day SchoolOrange, California

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

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Course Objective:Course Objective:To understand basic concepts To understand basic concepts

related to the brain, thinking related to the brain, thinking and behavior and how to and behavior and how to make appropriate make appropriate interventions for children interventions for children with ASDs, which help each with ASDs, which help each individual reach his or her individual reach his or her maximum potentials.maximum potentials.


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Autism DefinedAutism DefinedAccording to the NIHAccording to the NIH

Autism is characterized by three distinctive Autism is characterized by three distinctive behaviors:behaviors: 1.1. difficulties with social interactiondifficulties with social interaction2.2. problems with verbal and nonverbal problems with verbal and nonverbal

communicationcommunication3.3. repetitive behaviors or narrow, obsessive repetitive behaviors or narrow, obsessive

interests. interests.

These behaviors can range in impact from These behaviors can range in impact from mild to disabling. Autism varies widely mild to disabling. Autism varies widely in its severity and symptoms and may go in its severity and symptoms and may go unrecognized, especially in mildly unrecognized, especially in mildly affected children or when more affected children or when more debilitating handicaps mask it. debilitating handicaps mask it.


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Systems TheorySystems Theory

A system is greater than the sum of A system is greater than the sum of its parts.its parts.


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Systems TheorySystems TheoryCommon Elements:Common Elements:

inputinput-signal going into a system-signal going into a system

outputoutput-the act of turning out-the act of turning out

throughput throughput (or process)(or process)-raw material processed -raw material processed within a given time within a given time

feedbackfeedback-response to a particular process -response to a particular process

controlcontrol-ability to manage or direct -ability to manage or direct

environmentenvironment-the entire set of conditions under which -the entire set of conditions under which one operates one operates

goalgoal-the result toward which effort is -the result toward which effort is

directed directed


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Systems Theory Systems Theory

• Open SystemOpen System—capable of growth, —capable of growth, development & adaptation. Interaction development & adaptation. Interaction occurs within the environment. (i.e.: occurs within the environment. (i.e.: The Rules of a Classroom)The Rules of a Classroom)

• Closed SystemClosed System—relationships among —relationships among system components are set and system components are set and inflexible; no interaction with the inflexible; no interaction with the environment (i.e.: The Laws of Physics)environment (i.e.: The Laws of Physics)


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Systemic Approach to Systemic Approach to Understanding the BrainUnderstanding the Brain

In order to understand an individual with In order to understand an individual with Autism,Autism,

it is necessary to understand him or her as it is necessary to understand him or her as anan

individual from a individual from a systems approachsystems approach::

• How do mind and body function?How do mind and body function?

• How does the individual fit into the How does the individual fit into the community and society?community and society?

• What interventions can be provided What interventions can be provided to help an individual reach to help an individual reach his or her potential?his or her potential?


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Systemic Approach to Systemic Approach to Understanding Understanding

the Brainthe BrainFunctions of theFunctions of the

““Orchestra”Orchestra”

PerceptionPerception

AttentionAttention

Language ProcessesLanguage Processes

Visual-spatial ProcessesVisual-spatial Processes

MemoryMemory

Sensory InputsSensory Inputs

Motor OutputsMotor Outputs

Knowledge and SkillsKnowledge and Skills

Functions of theFunctions of the

““Conductor”Conductor”

InhibitInhibit

Shift FlexibilityShift Flexibility

Modulate EmotionsModulate Emotions

InitiateInitiate

Working MemoryWorking Memory

PlanningPlanning

OrganizingOrganizing

Self-monitoring and Self-monitoring and EvaluatingEvaluating

Ref.: Peter Isquith, “Executive Function: Concepts Ref.: Peter Isquith, “Executive Function: Concepts and Assessments”and Assessments”


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Systems TheorySystems Theory Medical Issues:

Human Body Systems System LocationNervous System Brain and NervesSkeletal System Bones and SkullMuscular System Skeletal, Cardiac and Smooth MusclesEndocrine System Glands and HormonesCardiovascular System Heart and BloodLymphatic and Immune Systems Lymphocytes and MacrophagesRespiratory System Lungs and AirwaysDigestive System Mouth and Gastrointestinal TractUrinary System Kidneys and BladderReproductive System Male and Female OrgansIntegumenary System Hair, Skin and NailsA person with Autism will

experience System Interruptions with many of

the above.


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Systems TheorySystems TheoryBreaks in the SystemBreaks in the System

• It is becoming clear that the normal trajectory of It is becoming clear that the normal trajectory of neurodevelopment is altered in autism.neurodevelopment is altered in autism. Abnormalities in brain growth, neuronal patterning Abnormalities in brain growth, neuronal patterning and cortical connectivity are often seen. and cortical connectivity are often seen.

• Changes to the structure and function of synapses Changes to the structure and function of synapses and dendrites have also been strongly suggested in and dendrites have also been strongly suggested in the pathology of autism .the pathology of autism .

• Finally, environmental factors are likely to interact Finally, environmental factors are likely to interact with the underlying genetic profile, and foster the with the underlying genetic profile, and foster the clinical heterogeneity seen in autism spectrum clinical heterogeneity seen in autism spectrum disorders. disorders.

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


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System TheorySystem Theory

The Beacon Model

Supports:Physical

EmotionalCognitive

Behavioral

IndividualFunctioning

CognitionEducational Achievement

Adaptive BehaviorParticipation/Social Roles

HealthContext


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Cognition/ThinkingCognition/Thinking


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Exploring Brain Behavior with Exploring Brain Behavior with Respect to:Respect to:

• Attention Attention • MemoryMemory• LanguageLanguage• Visual-Spatial Functioning Visual-Spatial Functioning • Executive Function, and Executive Function, and • Emotional FunctioningEmotional Functioning

Cognition/ThinkingCognition/Thinking


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Executive Functions

Memory and Learning Processes

Visual-Spatial Processes

Language Processes

Attentional Processes

Sensory-Motor Function

Social, Emotional, Cultural,

Environmental and Situational Factors

Overall Cognitive Functioning and

Academic Achievement

Speed and Efficiency of

Cognitive Processing

School Neuropsychological Assessment Model


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Cognition/Thinking 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


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Cognition/Thinking Cognition/Thinking AttentionAttention

• Why do children with ASD Why do children with ASD have trouble with attention?have trouble with attention?

They’re not able to determine what’s They’re not able to determine what’s important—creating a system overload!important—creating a system overload!• Sensory input is too muchSensory input is too much• Frequently don’t have organizational Frequently don’t have organizational

strategies….strategies….• Don’t see relationships in environmentDon’t see relationships in environment• Rate of info is provided in too much volumeRate of info is provided in too much volume• Information is too complexInformation is too complex


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Cognition/Thinking Cognition/Thinking MemoryMemory

We are required to We are required to process informationprocess information, , store itstore it and and retrieve itretrieve it as needed. as needed.

Some people are simply unable to keep Some people are simply unable to keep pace with the demands of society. pace with the demands of society. They suffer from one or more forms ofThey suffer from one or more forms of memory dysfunction.memory dysfunction.


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Cognition/Thinking Cognition/Thinking MemoryMemory

• Memory requires systematic handling Memory requires systematic handling of information, including:of information, including:

– Receiving new information and holding it Receiving new information and holding it in in short-term memoryshort-term memory

– Temporary storage of information as Temporary storage of information as active active working memoryworking memory

– Processing information and knowledge in Processing information and knowledge in long-term memorylong-term memory

– RecallingRecalling information from long-term information from long-term memory memory


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Cognition/ThinkingCognition/ThinkingVisual/Spatial ProcessingVisual/Spatial Processing

Visualizing Directions/

Mobility

Visualizing Story Concepts while Reading or Listening

Visualizing Academic Concepts

(Science, Math, Social Studies)

Visualizing Details Related

to Past Experiences

DrawingMusicCrafts

Household Tasks

Visualizing Words

(Spelling)

The ability to visualize The ability to visualize and process and process information is information is needed for school needed for school success success and for practical use.and for practical use.

Interpretation of Interpretation of relationships relationships involves spatial involves spatial processing—processing—knowing how knowing how objects relate to objects relate to each other (size, each other (size, order, etc.)order, etc.)


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Cognition/Thinking Cognition/Thinking Visual/Spatial ProcessingVisual/Spatial Processing

Quality DescriptionSaliency Recognition

•Problems discriminating important information from unimportant•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 Weaknesses

•Lacks focus•Lacks listening abilities•Focuses on details for too long or too short of time

Engagement Problems

•Takes excessive time to join activity•Daydreams•Relates “unrelated” materials to lessons•Creative Tendencies

Seeks Constant and ImmediateGratification

•Concentration Weaknesses•Restless, hyperactive•Needs exciting stimuli to hold attention•Never satisfied, demanding


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Cognition/Thinking Cognition/Thinking LanguageLanguage

• AphasiaAphasia—inability to produce or —inability to produce or understand language caused by understand language caused by brain damage or dysfunctionbrain damage or dysfunction

• Speech Production (Oral Expression)Speech Production (Oral Expression)• Speech Comprehension (Receptive Speech Comprehension (Receptive

Language or Listening Language or Listening Comprehension)Comprehension)


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• Problems Can be Associated with Weak Problems Can be Associated with Weak Processing when Deficiencies involve:Processing when Deficiencies involve:

– Phonological Abilities (sound)Phonological Abilities (sound)– Morphology (root words and adaptations)Morphology (root words and adaptations)– Semantics (word meanings)Semantics (word meanings)– Syntactic (word groupings/sentences) Syntactic (word groupings/sentences) – Discourse (larger word Discourse (larger word

groupings/paragraphs)groupings/paragraphs)– Metalinguistics (how language works)Metalinguistics (how language works)– Pragmatics (understanding in context)Pragmatics (understanding in context)


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Cognition/Thinking Cognition/Thinking Language—ImpairmentsLanguage—Impairments

Broca’s aphasiaBroca’s aphasia — —non-fluent aphasia with non-fluent aphasia with effortful, often effortful, often agrammatic speech agrammatic speech production.production.

Conduction aphasiaConduction aphasia —fluent —fluent aphasia with severely aphasia with severely impaired repetition, but impaired repetition, but relatively preserved relatively preserved language comprehensionlanguage comprehension

Expressive aphasiaExpressive aphasia —non- —non-fluent output fluent output

Global aphasiaGlobal aphasia —complete —complete loss of all linguistic functionloss of all linguistic function

Mixed aphasiaMixed aphasia —displays —displays both receptive and both receptive and expressive deficitsexpressive deficits

Receptive aphasiaReceptive aphasia —impaired —impaired comprehensioncomprehension

Transcortical motor aphasiaTranscortical motor aphasia —impaired expressive —impaired expressive aphasiaaphasia

Transcortical sensory Transcortical sensory aphasiaaphasia —language —language comprehension is impaired, comprehension is impaired, but repetition is preservedbut repetition is preserved

Wernicke’s aphasiaWernicke’s aphasia — —receptive language and receptive language and repetitions are severely repetitions are severely impaired.impaired.


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Wernicke-Geshwind Model of Wernicke-Geshwind Model of LanguageLanguageBroca’s Area

Primary Auditory

Cortex

Primary Motor CortexArcuate Faciculaus

Angular Gyrus

Primary

Visual Cortex

Wernicke’s Area


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Cognition/Thinking Cognition/Thinking Executive FunctionExecutive Function

Neuroanatomy:Neuroanatomy:

Frontal Lobe InvolvementFrontal Lobe Involvement

is associated with is associated with

Executive Function.Executive Function.

Identification of problem areas allows Identification of problem areas allows us to develop adaptive behavior us to develop adaptive behavior skills for individuals with ASD.skills for individuals with ASD.


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Cognition/Thinking Cognition/Thinking Executive FunctionExecutive Function

• Executive FunctionsExecutive Functions include those include those behaviors that include:behaviors that include:

– Abstract and Critical ThinkingAbstract and Critical Thinking– Choosing to Take Action Choosing to Take Action – Voluntary Response to StimulationVoluntary Response to Stimulation– Planning and OrganizingPlanning and Organizing


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Cognition/Thinking Cognition/Thinking Executive FunctioningExecutive Functioning

Terms Associated with Executive Functions*Terms Associated with Executive Functions* • Abstract ReasoningAbstract Reasoning• AnticipationAnticipation• Attention ControlAttention Control• Behavioral Initiation/Behavioral Initiation/• ProductivityProductivity• Behavioral RegulationBehavioral Regulation• Common SenseCommon Sense• Concept FormationConcept Formation• CreativityCreativity• EstimationEstimation• FluencyFluency• Goal SettingGoal Setting

• Hypothesis GeneratingHypothesis Generating• Inhibition of ImpulsivenessInhibition of Impulsiveness• Mental FlexibilityMental Flexibility• OrganizationOrganization• Planning Problem SolvingPlanning Problem Solving• Rule LearningRule Learning• Self-controlSelf-control• Self-monitoringSelf-monitoring• Set Formation and Set Formation and

MaintenanceMaintenance• Set ShiftingSet Shifting• Working MemoryWorking Memory

*Source: Miller, Dan; *Source: Miller, Dan; Essentials Essentials of School Neuropsychological of School Neuropsychological Assessment;Assessment; Wiley, 2007, p. Wiley, 2007, p. 235.235.


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Cognition/Thinking Cognition/Thinking Executive Functioning DevelopmentExecutive Functioning Development

Plan/Organize/MonitorPlan/Organize/Monitor 3-32 3-32 yearsyears

Emotional ModulationEmotional Modulation 3-?? years3-?? years

Verbal Working MemoryVerbal Working Memory 2-13 2-13 yearsyears

Nonverbal Working MemoryNonverbal Working Memory 3-24 3-24 monthsmonths

InhibitInhibit 0-?0-?


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Cognition/Thinking Cognition/Thinking Emotional FunctionEmotional Function

Emotions are the feelings that color our lives and allow us to Emotions are the feelings that color our lives and allow us to experience all of the joys and sorrows of life. Core emotions experience all of the joys and sorrows of life. Core emotions that are universally experienced and recognized: that are universally experienced and recognized:

– fear– anger– sadness – enjoyment

Enjoyment can enhance learning; but fear,Enjoyment can enhance learning; but fear,anger and sadness interfere with learning.anger and sadness interfere with learning.

People with ASD experience all of the same emotions as People with ASD experience all of the same emotions as other people—but they can’t always communicate their other people—but they can’t always communicate their feelingsfeelings..

Reference: Center for Development and LearningReference: Center for Development and Learning


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Cognition/Thinking Cognition/Thinking SummarySummary

NeuroNeuro FunctionFunction Psych/Psych/MedMed

EdEd

FrontalFrontal

PosteriorPosterior

LeftLeft

RightRight

CorticalCortical

Sub-corticalSub-cortical

CognitiveCognitive

ExecutiveExecutive

LanguageLanguage

Visual/NVVisual/NV

LearningLearning

MemoryMemory

MotorMotor

SensorySensory

Social/Social/EmotionalEmotional

BehaviorBehavior

AcademicAcademic

ADHD-IADHD-I

ADHD-CADHD-C

TS/OCDTS/OCD

RADRAD

ASD ASD

(NLD)(NLD)

MRMR

EpilepsyEpilepsy

TBITBI

LDLD

SLDSLD

OHIOHI

OrthoOrtho

SLPSLP

DeafDeaf

Vis ImpVis Imp

PDDPDD

LI/IDLI/ID

TBITBI

EBDEBD

Ref: Peter Isquith, Ref: Peter Isquith, PhD, “Executive PhD, “Executive Function: Concepts and Function: Concepts and Assessment”Assessment”


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Breaks in the SystemBreaks in the System

Stored EnergyStored EnergyAutistic children don’t know Autistic children don’t know

how to manage how to manage information overloads.information overloads.

Energy builds up—looking Energy builds up—looking for a release.for a release.

Eventually, the child Eventually, the child discharges energy in any discharges energy in any available manner. available manner.


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• OverloadOverload—the body responds by —the body responds by seeking a situation to reduce the seeking a situation to reduce the overload….overload….


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Reactions to System Reactions to System Overload Include Overload Include Sensory-Seeking Sensory-Seeking Behaviors, such as:Behaviors, such as:

Screaming, Screaming, Aggression, Aggression, RockingRockingEtc…Etc…


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System TheorySystem Theory

The Beacon Model

Supports:Physical

EmotionalCognitive

Behavioral

IndividualFunctioning

CognitionEducational Achievement

Adaptive BehaviorParticipation/Social Roles

HealthContext

Autism: the Brain, Thinking and Behavior Mary Joann Lang, Ph.D., A.B.P.N. Beacon Day School Orange, California.

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