In the practice of traditional psychology, a therapist has to consider the following:
Readiness – the clients’ receptiveness and manage the expectations of the client and their family.A therapist determines developmental, age appropriate treatment, and constantly modifies techniques, shifting focus, and reframing in pursuit of a better understanding of behavior. Therapists carefully consider any diagnosis (Dx) held by the client to achieve an understanding of the brain function, and maintain a rational approach. The Article in Scientific American; “The Teen Brain” illustrates just how the brain changes as it ‘grows’ from child-hood through adolescence and on to adulthood, and as individuals, helpers and therapists we can understand how varied stages of development influence our decision making. The ‘growth’, more accurately depicted as concentration in areas of activity, result in what Jay N. Giedd, a psychiatrist and investigator in the Child Psychology Branch of the National Institute of Mental Health, describes as ‘synaptic pruning’. Pruning is the process where the developing brain eliminates unnecessary connections between neurons, and in return producing a more efficient conduction of nerve impulses. The less effective connections are terminated and more controlling impulses are strengthened, creating the visual appearance of multiple firings of neurons in more concentrated areas. These areas shift as the child brain progresses though adolescence, and becomes adult.
Celia Oliver, PhD, PsyD, shared with the class that she specializes in anxiety, and described what she calls “Celia’s biases”
· “It’s all in the brain.
· What’s working – find the catalyst function in the brain.
· The de-pathology of the disorder.
· All disorders are Neurological.
· Counseling is cool!”
Celia described abnormalities of the limbic system, the Amygdala and the Hippocampus and their role in the individual with ASD connected with socioemotional perception and memory impairments.
Other abnormalities such as Cereballar-frontal system effect impairments in automatic and voluntary special attention abilities, and frontal-striatal pathways cause defective sensory gating resulting in difficulties inhibiting repetitive thoughts, speech and actions.
Picture showing three-dimensional representations of Amygdala and Hippocampus.
The Mirror Neuron System.
Although it is vital to understand all these differences in the function of the brain before building a successful treatment plan or intervention, the advances in medical research and technology in the past few years has given us more knowledge of how our brain works that has been known for centuries. This is an exciting time in the world of neuroscience, and the discovery of the mirror neurons system (MNS) in the Motor cortex in 1996 may hold the key to unlocking Autism. A research group of neuroscientists Giacomo Rizzolatti, Leonard Fogassi and Vittorio Gallese that also included Luciano Fadiga worked together at the University of Parma, Italy. They were probing the brain of a macaque monkey when they discovered a curious cluster of cells in the premotor cortex, an area of the brain responsible for planning movements. The cluster of cells fired when not only the monkey performed an action, but also when the monkey saw the same action performed by someone else. The cells responded the same way whether the monkey reached out to grasp an object, or merely watched as another monkey or a human did. Because the cells reflected the actions that the monkey observed in others, the neuroscientists named them “mirror neurons.” Later experiments confirmed the existence of mirror neurons in humans and revealed that in addition to mirroring actions, the cells reflected sensations and emotions.
The ASD mirror neuron system.
Numerous brain imagining and neuro recording studies indicate a variety of neurological and anatomical (Hadjik-hani, Joseph et al 2006) differences between the brains of those diagnosed with Autism Spectrum Disorder (ASD) or with Asperger’s Syndrome (AS) and Neurotypical (NT) brains. Functional evidence for the presence of MNS in humans comes from several studies using transcranial magnetic stimulation (TMS), electroencephalography (EEG), megnetoencephalography (MEG), and functional magnetic resonance imaging (fMRI) methodologies.
Studies of individuals with ASD have shown malfunctioning MNS in the Inferior Frontal Gyrus (part of the pre-motor cortex) that explains inaccuracy in assessing the intension of others, and may help cognitive scientists understand how theory of mind (ToM) often missing in those with ASD, is developed. Both the imitation and the attribution of mental states involve translating from another person’s perspective into one’s own. In addition, imitation requires a shared representation of perceived and executed action, and there is evidence suggesting that the MNS together with the superior parietal lobule serve this function (Iacoboni and others 1999; Williams and others 2001; Decety and others 2002; Heiser and others 2003; Koski and others 2003; Leslie and others 2004; Buxbaum and others 2005). Several studies have found imitative deficits in autism (Williams and others 2004), including deficits in imitating simple body movements and actions with symbolic meaning (Rogers and Pennington 1991) and in imitating facial expressions of emotion (Hertzig and others 1989; Loveland and others 1994). These deficits are present early in development (Rogers and others 2003). Together, these findings suggest that the basis for imitative and empathic deficits in autism could arise from a dysfunction in the MNS. (Hadjikhani, Joseph et al 2006)
The Mu wave component.
The Scientific American article “ Broken mirrors” describing findings of a studies of the MNS in people with Au-tism, researchers relied upon observation that the firing of neurons in the pre-motor cortex suppresses the Mu wave – a component of the EEG measurement. Mu waves, also known the comb or wicket rhythm, are electromagnetic oscillations in the frequency range of 8-13 Hz and appear in bursts of at 9 - 11 Hz. Mu wave patterns arise from synchronous and coherent electrical activity of large groups of neurons in the human brain. This wave activity appears to be associated with the motor cortex (central scalp), and is diminished with movement or an intent to move, or when others are observed performing actions.
In the Ramachandran Oberman study, ASD brain the Mu waves were not suppressed when the MNS in the pre-motor cortex fired when the subject observed an action. These findings support others that suggest the MNS of children with Autism are deficient.
Discussion -: Mu waves and the perception of reality.
If the Mu wave if not suppressed, could they communicate ‘actual’ rather than ‘observed’ pre motor and motor movements? The individual with ASD may confuse what they see happening to others with what is happening to themselves. If this dysfunction also occurs in other areas of the brain, then it is possibly a reason why children with Autism will avoid using their imagination, and struggle to engage in pretend play. As sleep pattern disruption is common in individuals with ASD, dysfunctional MNS could be associated with fear of dreaming or reluctance to disengage, or relax, or “switch off” in readiness for sleep. When behavioral evidence of the lack of ToM is identified we can also observe the individual with ASD assumes that others around them automatically know what they are thinking, and struggle to grasp that someone else may have a different perspective from that of their own.
Considering all these differences between individual brain functions, it is important when working with children on the spectrum, that we manage our speech (tone, intensity/ volume and pace) facial expression and whole body language communication. The therapist has to find ways to uncover the challenges without further reinforcement of the triggers of behaviors. These individuals when given a structure of understanding can learn to identify for example; what is real, and what is not. What is a threat, and what may be a gesture of friendship. If the MSN fa-cilitate empathy allowing NT individuals to feel the emotions of others, to identify and understand their feelings and motives and see things from their perspective, then the intervention methods we chose differ greatly when working with those who have deficits in these areas. Research shows that in individuals on the spectrum co mor-bidity is common and many studies have found elevated rates of mood disorders and anxiety in children with ASD and AS such as general anxiety, separation anxiety, worrying, hypochodriasis, non-situational anxiety or panic. Some individuals with ASD describe these co existing symptoms and others surmise that the lack of understand-ing of their own thoughts leaves them depressed and confused. Temple Grandin describes ToM as a visualizing strength, but others such as Simon Baron-Cohen suggest the inability to put oneself in someone else’s position leads to misunderstandings causing depression and low self-esteem. Appreciating that Children with ASD need to be taught ToM skills naturally found in people with typically developing brains at a very early age is vital. Developing strategies to effectively teach and treat these individuals is a challenge indeed, and an integral piece of our studies at Antioch NE. When one considers the developmental stages of the brain, research supports that both, the earlier, the better, in that early intervention is most effective, but also the theory that the ‘window for change’ in brain function remains open throughout life is supported by numerous cases of brain injury victims being rehabilitate successful.
Cognitive Behavioral Therapy Adapted for ASD treatment.
While exactly how the brain generates empathy remains a subject of intense debate in cognitive science, Cognitive Behavioral Therapy (CBT) treatment programs when successfully modified to fit the needs of individuals on the spectrum have become a powerful tool for intervention. Tony Atwood supports the use of social stories in the final stages of a six week CBT program that he and his college Kate Sofronoff have devised to support individuals and their parents toward a better outcome. Research on the efficacy of CBT is ongoing and seems at first glance to be a concrete model of support for ongoing improvement, especially if parents are included and receive the train-ing to help their child to be come self-supporting.
Celia illustrated the connections between the elements of Cognitive-Behavioral Psychotherapy-:
· Environmental Context.
· Thoughts.
· Feelings.
· Behaviors/Actions.
· Individual Physiology.
The balloon analogy allows us to understand that just as our thoughts, feelings and actions are connected to our individual brain functions, as therapists counselors, helpers and parents our actions in support of an individual with ASD are also connected, and that our opinions, reactions and physiology are viewed within our own percep-tion. Maintaining a subjective and professional approach is a challenge when someone or something tugs at one of our strings. However, with continued adjustments, evaluations, and review, we may continue to rehabilitate the functions of the brain on the surface affecting the overt behaviors without ever fully knowing what the actual functions are. Clinically base analysis, functional assessment, and whole family counseling are just a few of the approaches that studies report as effective, and the continued advances in our use and understanding of technol-ogy, combined with a more accepting society bode well for the future of all with these differences.
Medical Intervention.
A vast area of investigation touched upon during the class is medication, its specific purpose and the overall outcome. I hope to understand more about the overall use of medication for individuals with ASD, and the affects of prescription drug use on brain development, and consider the possibility of specific medical intervention to sup-port development of mirror neurons and other specific brain functions.
Reference:
Nouchine Hadjikhani, Robert M. Joseph, Josh Snyder and Helen Tager-Flusberg Anatomical Differences in the Mirror Neuron System and Social Cognition Network in Autism Cerebral Cortex (2006) 16:1276—1282. doi:10.1093/cercor/bhj069 Advance Access publication November 23, 2005
Kate Sofronoff, Tony Attwood, and Sharon Hinton. (2005) A randomized Controlled trial of a CBT intervention for anxiety in children with Asperser Syndrome. Journal of Child Psychology and Psychiatry 46:11 page 1152-1160.
Kate Sofronoff, Tony Attwood, Sharon Hinton and Irina Levin. (2006) A Randomized Controlled Trial of a Cog-nitive Behavioral Intervention for Anger Management in Children Diagnosed with Asperser Syndrome. Original Paper Springer Science+ business Media LLC 2006
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