SW 644: Issues in Developmental Disabilities Autism and Aging

1. SW 644: Issues in Developmental DisabilitiesAutism and Aging Lecture Presenter: Mary Pearlman, M.D. Mary Pearlman, M.D.

2. Adolescent Development Puberty: Definition Period of rapid physical growth and sexual maturation that ends childhood and begins adolescence Mary Pearlman, M.D.

3. Adolescence Adolescence: Definition The period of biological, cognitive, and psychosocial transition from childhood to adulthood usually lasting a decade or so. Mary Pearlman, M.D.

4. 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 Mary Pearlman, M.D.

5. Newness Examples Breast Changes Height and Weight Physical Strength Mary Pearlman, M.D.

6. Newness Task; integrating with peers Girl needs poodle skirt “now” Or life is ruined Everyone will hate me I hate you, mother Mary Pearlman, M.D.

7. Newness Hysteria Is Fixed By… Learning new skills Experiencing how peers react Experiencing how time works emotionally Mary Pearlman, M.D.

8. Hormones Hormones are responsible for emotional changes because they stimulate brain cell growth. Mary Pearlman, M.D.

9. Synaptogenesis and Arborization Synaptogenesis and arborization: Under the influence of increased hormones in adolescence there is rapid synaptogenesis and arborization. Mary Pearlman, M.D.

10. Synaptogenesis Synaptogenesis:Definition Synapse: the functional membrane to membrane contact of the nerve cell with another cell Genesis: beginning Mary Pearlman, M.D.

11. Arborization Arborization: Definition The terminal branching of nerve fibers in a tree-like fashion Mary Pearlman, M.D.

12. Pre- and Post- Pubertal Nerve and Fibers Post pubertal nerve fibers have branching at end. Diagram of pre and post pubertal nerve and fibers. Mary Pearlman, M.D.

13. Arborization and Synaptogenesis Arborization and synaptogenesis occur randomly, without a pattern Learning and experience strengthens some paths and lets some paths die Mary Pearlman, M.D.

14. Synaptogenesis and Arborization (cont.) Cognitive response is confusion Emotionally the adolescent has increased excitability Mary Pearlman, M.D.

15. Apoptosis Apoptosis: definition Cell death. An important result of learning. Cellular pathways that are not useful, die. Mary Pearlman, M.D.

16. Apoptosis (cont.) Selective Attention Expanded memory skills Growing knowledge base Metacognition Continued Language Mastery Formal Operational Thought Mary Pearlman, M.D.

17. 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 Mary Pearlman, M.D.

18. New Attributes All the New Attributes lead to typical beliefs and attitudes that most adolescents experience. These ameliorate, with experience. Mary Pearlman, M.D.

19. Adolescent Development: Autism Qualitative impairment in social interaction Qualitative impairment in communication Restricted repetitive and stereotyped patterns of behavior, interests Mary Pearlman, M.D.

20. Adolescent Development: Autism (cont.) Sexuality Mary Pearlman, M.D.

21. Sexuality Teaching appropriate self care and social mores Support family and staff to provide this teaching Autism lack of social understanding Mary Pearlman, M.D.

22. Sexual Aggression Normal phase of development Need to teach specific behaviors to those who can’t figure it out Mary Pearlman, M.D.

23. Cognitive and Emotional Development Cognitive and emotional development relates to conscience development Conscience may never get beyond that of a young person Mary Pearlman, M.D.

24. 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 Mary Pearlman, M.D.

25. 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 Mary Pearlman, M.D.

26. 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 Mary Pearlman, M.D.

27. 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 Mary Pearlman, M.D.

28. 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

29. Role Modeling Powerful tool for learning behavior Creates possible self definitions Creates motivation for behavior Mary Pearlman, M.D.

30. Role Modeling (cont.) • What an adult is what an adult does • Work • Social relationships • Play Mary Pearlman, M.D.

31. The Personal Fable One is destined for greatness Greatness? Defined by society or self Greatness? reality or fantasy Mary Pearlman, M.D.

32. Adulthood: Normal Development Adulthood: Definition The time after adolescence and before death A period of ongoing Senescence Mary Pearlman, M.D.

33. Senescence Senescence: Definition The state of physical decline, in which the body gradually becomes less strong and efficient with age. Mary Pearlman, M.D.

34. 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 Mary Pearlman, M.D.

35. Homeostasis Homeostasis: the adjustment of the body’s systems to keep physiological and emotional functions in a state of equilibrium Mary Pearlman, M.D.

36. 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 Mary Pearlman, M.D.

37. Some Characteristics Mature commitment Post formal thought Dialectical thought Cognitive flexibility synthesis Mary Pearlman, M.D.

38. Some Characteristics (cont.) Faith can be an important part of life Socialization Resource Managing behavior Sooth feelings Have a community Mary Pearlman, M.D.

39. 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 Mary Pearlman, M.D.

40. Relationship with Police Dangerous Encounters, Avoiding perilous Situations with Autism. Davis, Bill and Schunick, Wendy. Jessica Kingsley Publishers. 2002. Philadelphia. Mary Pearlman, M.D.

41. Adulthood: Autism (cont.) Health Habits Eating Exercise Mary Pearlman, M.D.

42. 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? Mary Pearlman, M.D.

43. Caretaker Concerns (cont.) Language attached to experience Familial and cultural ritual Maintaining attachment after death Language of self feelings Mary Pearlman, M.D.

44. 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 Mary Pearlman, M.D.

45. 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 Mary Pearlman, M.D.

46. 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 Mary Pearlman, M.D.

47. Adulthood: Autism, Caretaker Concerns Is my child too dependent on me? Resource function model Mary Pearlman, M.D.

48. 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 Mary Pearlman, M.D.

49. Autism and aging: Bibliography The Developing Person Through the Life Span. Berger, 5th edition Worth Publishers Stedman’s Medical Dictionary: 26th 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. Mary Pearlman, M.D.