Autism and Ageing - Issues in Developmental Disabilities

4/11/2020

SW 644: Issues in Developmental Disabilities

Autism and Aging

Lecture Presenter:

Mary Pearlman, M.D.

Mary Pearlman, M.D.

1

Adolescent Development

 Puberty: Definition

 Period of rapid physical growth and sexual maturation that ends childhood and begins adolescence

4/11/2020 Mary Pearlman, M.D.

2

Adolescence

 Adolescence: Definition

 The period of biological, cognitive, and psychosocial transition from childhood to adulthood usually lasting a decade or so.


3

Hormonal Changes

 Are hormonal changes responsible for the emotional changes in puberty?

 Hormonal changes can cause:

 More rapid arousal of emotions

 Quick shifts in extremes of emotions

 More thoughts about sex

 Girls: cyclical mood shifts and physical function


4

Newness Examples

 Breast Changes

 Height and Weight

 Physical Strength


5

Newness

 Task; integrating with peers

 Girl needs poodle skirt “now”

 Or life is ruined

 Everyone will hate me

 I hate you, mother


6

Newness Hysteria Is Fixed By…

 Learning new skills

 Experiencing how peers react

 Experiencing how time works emotionally


7

Hormones

 Hormones are responsible for emotional changes because they stimulate brain cell growth.


8

Synaptogenesis and

Arborization

 Synaptogenesis and arborization:

 Under the influence of increased hormones in adolescence there is rapid synaptogenesis and arborization.


9

Synaptogenesis

 Synaptogenesis:Definition

 Synapse: the functional membrane to membrane contact of the nerve cell with another cell

 Genesis: beginning


10

Arborization

 Arborization: Definition

 The terminal branching of nerve fibers in a tree-like fashion


11

Pre- and Post- Pubertal Nerve and Fibers

 Post pubertal nerve fibers have branching at end.

Diagram of pre and post pubertal nerve and fibers.


12

Arborization and

Synaptogenesis

 Arborization and synaptogenesis occur randomly, without a pattern

 Learning and experience strengthens some paths and lets some paths die


13

Synaptogenesis and Arborization

(cont.)

 Cognitive response is confusion

 Emotionally the adolescent has increased excitability


14

Apoptosis

 Apoptosis: definition

 Cell death. An important result of learning. Cellular pathways that are not useful, die.


15

Apoptosis (cont.)

 Selective Attention

 Expanded memory skills

 Growing knowledge base

 Metacognition

 Continued Language Mastery

 Formal Operational Thought


16

Formal Operational Thought

 With formal operational thought a person can imagine and process

possibility not just concrete things that are taken in exactly as sensed


17

New Attributes

 All the New Attributes lead to typical beliefs and attitudes that most adolescents experience.

 These ameliorate, with experience.


18

Adolescent Development:

Autism

 Qualitative impairment in social interaction

 Qualitative impairment in communication

 Restricted repetitive and stereotyped patterns of behavior, interests


19

Adolescent Development: Autism

(cont.)

 Sexuality


20

Sexuality

 Teaching appropriate self care and social mores

 Support family and staff to provide this teaching

 Autism lack of social understanding


21

Sexual Aggression

 Normal phase of development

 Need to teach specific behaviors to those who can’t figure it out


22

Cognitive and Emotional

Development

 Cognitive and emotional development relates to conscience development

 Conscience may never get beyond that of a young person

23 4/11/2020 Mary Pearlman, M.D.

A Tale of Learning Control

 Age 9 - Young man touching himself in public

 Age 13 – Grabbed peer around neck and kissed her

 Helpful intervention is to point out appropriate ways and times, and firm rule of always asking permission


24

A Tale of Learning Control (2)

 Age 18 – Approaches young aide and asks her to marry him

 Young man hasn’t internalized the rule; moral age is 7

 People around him have to be taught how to set limits neutrally


25

A Tale of Learning Control (3)

 Age 22 – Uses money to buy fancy women’s underwear

 Age 24 – Refuses to go to work

 Age 25 – Caught kissing a willing peer

 Age 32 – No longer interested in picture collection


26

Adolescent Development:

Autism

 As time goes on, competition relates more to friendship

 Sexuality has not worked out well

 Most are uninterested in children

 Some may have been victimized

 Important to look at cognitive, social and conscience age of person with DD


27

Adolescent Development: Autism

(cont.)

 Are 7 year-olds responsible for their behavior?

 We don’t negotiate rules with people with inadequate or immature conscience formation

 There are situations where a person always has to have some kind of monitoring

 Conscience formation, which goes along with social development, is not going to get any further than seven or thirteen

Role Modeling

Powerful tool for learning behavior

Creates possible self definitions

Creates motivation for behavior


29

Role Modeling (cont.)

 What an adult is what an adult does

 Work

 Social relationships

 Play


30

The Personal Fable

 One is destined for greatness

 Greatness? Defined by society or self

 Greatness? reality or fantasy


31

Adulthood: Normal

Development

 Adulthood: Definition

 The time after adolescence and before death

 A period of ongoing Senescence


32

Senescence

 Senescence: Definition

 The state of physical decline, in which the body gradually becomes less strong and efficient with age.

33 4/11/2020 Mary Pearlman, M.D.

Senescence (cont.)

 Because of senescence, any chronic vulnerability we have worsens with each decade.

 Vulnerabilities in persons with DD show the same progression

 Associated with some specific DD there appears to be more rapid progression


34

Homeostasis

 Homeostasis: the adjustment of the body’s systems to keep physiological and emotional functions in a state of equilibrium


35

Tasks Specific to Various Phases

 Young is learning or setting up the conditions for work, love, play

 The mid-adult is settled in and has to figure out how to maintain these conditions in the face of change

 The late adult has to figure out how to make things better for the future


36

Some Characteristics

 Mature commitment

 Post formal thought

 Dialectical thought

 Cognitive flexibility

 synthesis


37

Some Characteristics (cont.)

 Faith can be an important part of life

 Socialization

 Resource

 Managing behavior

 Sooth feelings

 Have a community


38

Adulthood: Autism

Abuse is increased by any characteristic that makes the child harder to care for

Abuse is increased by any characteristic that promotes a negative identification with the child

Abuse is increased as stress increases

Abuse increases as child cannot defend themselves


39

Relationship with Police

 Dangerous Encounters, Avoiding perilous Situations with Autism.

Davis, Bill and Schunick, Wendy.

Jessica Kingsley Publishers. 2002.

Philadelphia.


40

Adulthood: Autism (cont.)

 Health Habits

 Eating

 Exercise


41

Caretakers Concerns

 Social skills related to illness and death

 Who will care for my child after I die?

 How much should I protect my child from the dangers of the world?

 Is my child too dependent on me?


42

Caretaker Concerns (cont.)

 Language attached to experience

 Familial and cultural ritual

 Maintaining attachment after death

 Language of self feelings


43

Who Will Care for My Child After I

Die?

 Appoint a caretaker for attachment, finances, case coordination

 Memory books-keeping soothing past attachments and behavioral models

 People with DD survive change very well if attachment and individualizing needs tended to


44

How Much Should I Protect My Child from the Dangers of the World?

 No risk and the person cannot grow or experience life

 No safety and the person is hurt and gives up going out

 Balance and safety nets


45

Autism and aging: Conclusion

 Changing demographics and increased participation in community living are exposing us all to more issues of adolescence and aging

 Remember development

 Remember individualization

 Remember the need for a variety of social supports

 Listen


46

Adulthood: Autism, Caretaker

Concerns

 Is my child too dependent on me?

 Resource function model


47

Autism and aging

 How do you figure out causes of behavior?

 Usually behavior serves the function of meeting a primary need

 Skills, tasks, concerns and challenges help determine primary need and how it is expressed

 Patient and caretakers drop clues if you listen


48

Autism and aging: Bibliography

 The Developing Person Through the Life

Span. Berger, 5 th edition Worth Publishers

 Stedman’s Medical Dictionary: 26 th Edition,

Williams and Wilkins 1995

 Seltzer, Marsha. Mother-Child Relationship

Quality Among Adolescents and Adults with

Autism. Am. Journal on Mental Retardation.

Vol111, Number 2: 121-137/ March 2006.


49

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