Saturday, January 16, 2010

Autism spectrum and education

Our professional development "kick-off" event this school year was a presentation from a local psychiatrist who specializes in working with children who are dysfunctional along the Austism spectrum. I've blogged in the past about the infrequent link between vaccination, mitochondrial disorders, and Autism-like symptoms (because this is such a controversial issue, please note: as stated previously, I am a strong proponent of vaccines and the large-scale research that demonstrates that vaccines do not cause Autism). I remain interested in the Autism spectrum because of the complexity of the problem from a research perspective, the potential benefits to education from discovering more information about causes of and treatments for the disorder, as well as my own growing experience in working with students who are dysfunctional to some degree along the spectrum.

The Autism spectrum is usually broken down into three regions: Autism, Asperger Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified. Individuals in each of these regions of the spectrum have dysfunction in communication and processing skills, but it is the severity of their atypical function that drives classification into a specific region of the spectrum. Language skills are the most important difference between those classified as having Autism versus Asperger Syndrome. Individuals with Autism generally have no or very low-level language skills, while those with Asperger Syndrome can have language skills that are similar to others of the same age. However, there are some important differences in language use and processing in those with Asperger Syndrome, such understanding some of the subtleties of interpersonal communication like metaphor.

One of the new facts that I learned from our presenter that there is a strong coincidence of ADHD, OCD, and TS with Asperger Syndrome (AS). This piqued my interest a bit, because I'm somewhat familiar with the overlap in medications used to treat these disorders - many of them are antipsychotics that target the brain's dopamine receptors. I also learned from our presenter that individuals with AS often become focused on one "need", and that behavioral melt-downs are often triggered when that need is not met as quickly as the individual wants. Our presenter described this symptom, quite poetically I thought, as an "unbearable agony of unmet desire". Yet again this made me think of dopamine, because of it's frequent association with brain-based explanations of desire.

I started to wonder about dopamine's role in Autism spectrum disorders, and began doing some research. I've discovered that there are two medications that have been approved to treat the irritability mentioned by our presenter that is often associated with these disorders. The newest medication is called "Abilify", approved in 2009. "Risperidal" was approved in 2006 for the treatment of certain autism-related behaviors. Both medications are considered atypical antipsychotics because they target both dopamine and serotonin receptors. I also found some relatively new computational biology research proposing that dopaminergic processing is not reward-based, but expectation-based. If AS is caused, in part, by dopamine malfunction in the brain, this new research from computational biology certainly supports the urge from our presenter to avoid reward/punishment strategies with AS individuals, and to be as consistent as possible when they become focused on a particular need being met. Though not specifically tied to dopamine function, Alfie Kohn's article in the New York Times on conditional parenting is, in essence, a psychological debunking of reward and punishment as an effective strategy for influencing behavior, regardless of dysfunction along the Autism spectrum.

Perhaps Asperger Syndrome involves dopaminergic pathway disorder, but given that it is a spectral disorder, it's not surprising that medications that target other neurotransmitter pathways are able to treat - with some success - individuals with dysfunction along the spectrum. Research is also beginning to link the prosocial deficits associated with Autism with genetic and epigenetic oxytocin receptor abnormalities. Research in synapse formation is also emerging as a resource to help us understand the link between Autism and savantism, which, though rare, is 10 times more prevalent in those with dysfunction along the Autism spectrum. Learning more about the brain function of savants, given their amazing skills in many fields, clearly has great potential in helping us to understand how the non-savant brain learns and processes information.

Though the Autism spectrum is of interest from a brain research perspective because of the complexity involved and the potential gains in neuroscience, cognitive psychology, and education, my feeling is that the most important lessons we can learn at this point in time are those that will help us to provide the best educational experience for our current students "on the spectrum". I'm particularly focused on those with AS, since they have language skills sufficient to be successful in a variety of classroom settings. It's clear to me that consistent expectations and interactions are important for these students, and others. Professionals also recommend that we should coordinate our work with others who have an impact on these students, such as parents, school nurses, psychologists / psychiatrists, and other teachers. Although I'm certainly biased by my interest in the brain and cognitive psychology, I recommend that other schools engage in professional development around the issue of working with students with Autism spectrum disorders. The lessons learned will improve your work with all students.