One in 68 Children has Autism

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(II) SHIFTING THE PARADIGM ON AUTISM SPECTRUM DISORDER: The Theory of Mind Mechanism Hypothesis

October 21, 2007 6:57 pm Published by

Over the past several months, I have been critically thinking about how we can deliver optimal active treatment and behavioral services. In my interactions with clinicians, managers, assistant managers and direct care staff over the years, I have observed that there are various ways in which we attempt to improve our clinical services. For example, I have found that in the course of their work, staff members and clinicians try to incorporate their own set of beliefs and expectations about the autistic populations – that are not necessarily evidenced based – with the purpose of bettering their quality of service. The set of principles that we have derived from our experiences with working with this population, undoubtedly guide the nature of the services we provide. For this reason, I think that amongst these principles we should focus on the underlying learning processes of individuals with autism.

According to the theory of mind mechanism hypothesis (ToMM), autistic individuals develop thoughts, feelings and communication as part of the core architecture of the human brain. There is an empirical association between their impaired developments of this mechanism and their intellectual and cognitive deficits, behavioral problems, and difficulties in communication and social interaction. The notion behind this association is that the impairment in intellectual functioning affects the ability of the autistic individual in aspects of acquired knowledge, information processing, and communication. With regards to their ability to acquire knowledge, for instance, they are generally deficient in their understanding of the thoughts, emotions, attitudes, and intention of others. Researchers have recognized these characteristics as “mind blindness”. This relationship between the deficits in brain function and development may be thought to explain for concomitant problems regarding their ability to plan, flexibility of thought and action, set shifting, inhibition, attention, working memory, and verbally mediated skills.

The theory of mind mechanism hypothesis (ToMM) has been important in our interpretation of the language, communicative and social interaction impairments in autism. Through ToMM, we can come to understand that one of the central difficulties encountered by autistic individuals is in their cognitive ability to use language appropriately in social contexts with intention and practical purpose. Deficits in particular aspects of pragmatic functioning are evident at all developmental stages, even in highly verbal adults with autism.

In adapting the ToMM hypothesis to the QSAC adult programs, we are incorporating what is referred to as the Neuro-Behavioral Model, whose focus lies in stimulating consumers’ areas of the brain that are more developed, and utilizing these strengths to work to improve their weaknesses.

(I) SHIFTING THE PARADIGM ON AUTISM SPECTRUM DISORDER: Pychotropic Medication

October 13, 2007 10:56 pm Published by

In my experience, a high incident of autistic individuals are taking a mood stabilizer medication to reduce instability, repetitive behavior, impulsivity, aggression, self-injurious behaviors, and seizure disorder. Some autistic individuals are prescribed as a Selective Serotonin Reuptake Inhibitors (SSRI) or anti-depressant, where Prozac or Zoloft have been the most prescribed. Other autistics consumers are on an alpha or beta-blocker for irritability and hyperactivity. When we compare the psychotropic agents prescribed for autistic individuals, the data shows that a high incidence of consumers are taking atypical neuroleptic medication in comparison with the mood stabilizer agents. I have found that the most prescribed atypical neuroleptic medications for autistics are Risperdal, Abilify and Seroquel; the most prescribed anti-seizure or mood stabilizer agent is Depakote. Possibly, one of the reasons is that they have very good mood stabilization effects. It seems that the mood dysregulation component involving the neurotransmitters in the brain is a common denominator in our autistic population.

Anecdotal observations suggest that the Selective Serotonin Reuptake Inhibitors (SSRI) are safe medications for autistic individuals, but they have paradoxical effects probably due to the nature of the autistic condition (neurological involvement), which instead of reducing the stereotypical or obsessive-compulsive components of the autistic individuals may increase the hypomanic stage or movement disorders.

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QSAC is a New York City and Long Island based nonprofit that supports children and adults with autism, together with their families, in achieving greater independence, realizing their future potential, and contributing to their communities in a meaningful way by offering person-centered services.

QSAC pursues this mission through direct services that provide a supportive and individualized setting for children and adults with autism to improve their communication, socialization, academic, and functional skills.