SOCIAL COGNITIVE DISORDERS

These are mysterious brain abnormalities, which prevent infants and children from developing normal social and/or cognitive skills. It is not yet known where in the brain the complex interaction of genes and environment causes things to go astray, but many researchers are currently working to understand this aspect of brain (neurological development and more facts are becoming known every year.

Autism 

At the most severe level of abnormality is the disability known as Autism. Autism undermines many aspects of human behavior, including movement, attention, learning, memory, language, mood and social interaction. It can be detected in the movements of babies who roll over, sit up, crawl and walk in oddly uncoordinated ways. At 18 months, many autistic toddlers will not point, share attention with others or follow the expressions of other people. By age 2 or 3, autistic children display a profound lack of responsiveness to others. Many do not talk; instead they may engage in rituals, like arm flapping, that stimulate their bodies. They dislike change of any sort. About a quarter of autistic children appear normal until age 14 to 22 months and then experience the sudden onset of autistic symptoms.

The symptoms of Autism range from mild to severe, making the true incidence of the disorder difficult to assess. Classical autism in its most severe form, which results in mental retardation, occurs in about 1 in every 1,000 births. When milder forms (which are often referred to as High Functioning Autism or Asperger's Syndrome) are included, the incidence is 1 in 500.

Autism researchers agree that it will take years before the genetics and neurochemistry of the disease are understood completely.  But thanks to a combination of new tools for examining brain anatomy and keen observation, much of the mystery surrounding this disorder has recently begun to shrink.  Within the last year (2004), several laboratories have reported exciting new findings.  Clues focus on brain development and circuitry.  In addition, certain areas of the autistic brain show signs of chronic inflammation which appears to last a lifetime.  While these clues are exciting, they do not lead to immediate treatments.  In the meantime, intensive one-on-one therapies that teach children how to control their movements and interact socially succeed in only 30 to 50 per cent of treated children, ideally by age 2 or 3. But newer treatments based upon the new research, is emerging.  The goal is to intercept the miswiring of the autistic brain and, as the brain is developing, help it grow the connections it needs. *

Asperger's Syndrome

This disability is generally considered a (mild) form of Autism. While it remains little known, the number of diagnoses has soared since psychiatric authorities formally defined it in 1994.

Hans Asperger, the Viennese pediatrician who first described the condition in 1944, called his patients "little professors" who often use words as their lifeline to the world. Most Asperger's patients have average intelligence or above (unlike autistic people, by contrast, who often suffer some degree of cognitive disability).

The most striking characteristic of the syndrome is a consuming interest in arcane subjects. For example, they can be obsessed with clocks; the Titanic; deep-fat fryers; ex-presidents, spouses and aides; refrigerators; assassins; and train, plane and bus schedules. Although everyone knows someone with an all-encompassing interest in something, the key to the diagnosis is that their obsessive behavior significantly impairs their social functioning.

Youngsters with the condition are unable to pick up on the nonverbal cues that underlie most interactions with others, but they are smart enough to come to realize, and regret, a gap they can cross only with extreme difficulty. As teenagers they may experience what one expert called "extreme teasing." While many adults manage to master enough social skills to attend college, find good jobs and even marry, others sink into isolation. Researchers report high levels of depression and suicide, and antidepressants are the most common medications given to Asperger's patients.

Treatment is usually a mix of therapies to help with some patients' problems with motor skills and sound recognition combined with the most important kinds of help; behavioral training focused on social skills, and supportive psychotherapy to deal with the emotional impact of being different. The overall goal is to use the children's strengths - intelligence and verbal ability - to overcome their deficits.

WHAT TO LOOK FOR..

Asperger's syndrome can be difficult to diagnose in preschool children. Dr. Ami Klin of the Yale Child Study Center recommends that parents seek help if they notice several of the following behaviors:

A marked lack of interest in other children, or a consistently inappropriate style of engaging others, like long monologues.

Significant difficulty in understanding other children's feelings and expressions (inability to get jokes or teasing).

Few facial or bodily gestures; speech that is pedantic in tone or vocabulary.

Little make-believe and much repetition in play.

Overreaction to minor changes in routine or environment.

Precocious verbal skills and marked self-absorption in subjects unusual for the child's age.

These symptoms usually become more prominent in older children and therefore easier to spot. Clinicians also look for the combination of high intelligence and verbal skills, the absence of same-age friendships despite desire to form them and the growth of highly circumscribed interests. Even so, every child is different, and many experts recommend a full-scale evaluation by a multidisciplinary center/ clinician familiar with the syndrome*. (See section on Psychological Evaluation)

*Much of this information was reproduced from various articles in the NY Times Science Section, 2000, 2005

ADD/Social Learning Disability

This disability is the least severe in the continuum of psychoneurological disorders that effect social and/or cognitive functioning. Sometimes a social disability can occur in conjunction with disorders of attention (ADD/ADHD) and sometimes it can occur independently. Because it is less pervasive than the two previous disorders, it can be more easily overlooked until problems occur in school or socially. Parents eventually notice that the child does not get along well with others or seems socially isolated. As teens, these children are more likely to be teased and isolated; thus angry and/or depressed.

Treatment involves helping these children to recognize their strengths and abilities and to learn the cognitive and social skills they lack, preferably in a one-on-one setting. Often older children need supportive and insight psychotherapy to help them feel more acceptable, less alienated from their peers, less depressed and angry. Because children are so individual in their degree of disability and reaction to it, experts recommend a full-scale evaluation by a multidisciplinary center or trained clinician familiar with the disability (see section on Psychological Evaluation).

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Dr. Bohensky: admin@rockermail.com