Autism The Brain, Thinking and Behavior Executive Function

Autism: the Brain,
Thinking and
Behavior
Executive Function
Mary Jo Lang, Ph.D.,

A.B.P.N.
Beacon Day School
Orange, California
Autism Defined
Autism is a
brain development disorder that
impairs social interaction and
communication, and causes
restricted and repetitive behavior, all
starting before a child is three years
old. This set of signs distinguishes
autism from milder
Mary Jo Lang, Ph.D., A.B.P.N.-
autism spectrum disorders (ASD)
Beacon Day School-Orange,
California
Autism—According to the
NIH
• Autism is characterized by three
distinctive behaviors.
– difficulties with social interaction
– problems with verbal and nonverbal
communication
– repetitive behaviors or narrow, obsessive
interests.
 
• These behaviors can range in impact from
mild to disabling. Autism varies widely in
its severity and symptoms and may go
unrecognized, Mary
especially in mildly affected
Jo Lang, Ph.D., A.B.P.N.-
children or when more California debilitating
Systemic Approach to
Understanding the Brain
In order to understand an individual

with Autism,
it is necessary to understand him or
her as an
individual from a systems
approach:
• How do mind and body function?
California
Breaks in the System
• It is becoming clear that the normal trajectory of
neurodevelopment is altered in autism.
Abnormalities in brain growth, neuronal
patterning and cortical connectivity are often
seen.
• Changes to the structure and function of

synapses and dendrites have also been strongly
suggested in the pathology of autism .
• Finally, environmental factors are likely to

interact with the underlying genetic profile, and
foster the clinical heterogeneity seen in autism
spectrum disorders.
California
• *reference: Pardo CA,
CA, Eberhart CG,
CG, “The neurobiology of autism,” Brain Pathol. 2007
Course Objectives:
Part I
• Understanding the Body, the Brain and the Environment as
a System
• Understanding How the Brain Works
• Identify Factors which Influence the Brain, Thinking and
Behavior (intro to framework)
Part II
• Explore Brain Behavior with Regard to Attention, Memory,
Language, Visual-Spatial Functioning, Executive Function
and Emotional Functioning
Part III
• Examine a Framework within which Individuals with Autism
can Maintain Maximum Independence and Quality of Life
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PART I—Objectives
• Understanding the Body, the Brain
and the Environment as a System
• Understanding How the Brain Works
• Identifying Factors that Influence the

Brain, Thinking and Behavior (intro to
framework)
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Systems
Theory
A system is greater than the sum of

its parts.
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Systems Theory—
Common Elements:
input
output
throughput (or process)
feedback
control
environment
goal
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Systems Theory
• Open--capable of growth,
development & adaptation.
Interaction occurs within the
environment.
• Closed--relationships among system

components are set and inflexible;
no interaction with the environment
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Human Body Systems
System Location
Nervous System Brain and Nerves
Skeletal System Bones and Skull
Muscular System Skeletal, Cardiac and
Smooth Muscles
Endocrine System Glands and Hormones
Cardiovascular System Heart and Blood
Lymphatic and Immune Systems Lymphocytes and
Macrophages
Respiratory System Lungs and Airways
Digestive System Mouth and
Gastrointestinal Tract
Urinary System Kidneys and Bladder
Reproductive System Male and Female Organs
Integumenary System Hair, Skin and Nails

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The Nervous System
• The nervous
system is the
most complex of
all the body’s
systems.
• Together with
the endocrine
system it
controls Mary Jo Lang, Ph.D., A.B.P.N.-
everything the California

The Nervous System
• The nervous system reaches almost every part of
the body, from muscles and sense organs to the
insides of teeth and bones.
• The body has more than 80 major nerves, and

each one can obtain more than a million neurons.

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The Nervous System
Peripheral Nervous System Divisions:
• The Sensory Division gathers information

from sensors to update the CNS about events
occurring inside and outside the body.
(Autistic children may have sensory
integration issues, such as hearing, vision,
etc.)
• The Somatic Division carries instructions to
skeletal muscles, enabling the body to
respond under conscious control to outside
events. (Skeletal-motor issues,
muscule/skeletal, sensory-seeking, etc.)
• The Automatomic Division delivers
messages to the body’s internal organs to
control their activities. (Intestinal
Mary Jo Lang, Ph.D., A.B.P.N.- issue,
incapricous, bed wetting, etc.)
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The Nervous System
The Spinal Cord
• How does information

travel to and from the periphery
and respond to cues from the
brain?

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The Nervous System—
The Brain
• Evidence firmly links
autism with
abnormalities in the
brain stem, the
cerebellum, the
medial temporal
lobe, and the
frontal lobe.
(Reference: Penn, HE; Clinical-

Developmental Psychology
Program, York University, Toronto,
Ontario; “Neurobiological
correlates of autism: a review ofMary Jo Lang, Ph.D., A.B.P.N.-
recent research,” Child Beacon Day School-Orange,
Neuropsychol. 2006 Feb;12(1):57- California
Systems Theory—The
Senses
Sensory Systems—
all are affected
by Autism
 Taste
Smell
Hearing
Sight
Touch

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The Digestive System
• The job of the digestive system is to
turn food into fuel that the body can
use for energy, growth and repair.
• The body processes carbohydrates,
fats and proteins into fuels, and
expels any
undigested waste
materials.
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Functions:
Ingestion
Propulsion
Mechanical Digestion
Chemical Digestion
Absorption
Egestion

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• The gastrointestinal tract is a long
tube-like system called the
alimentary canal.
• It is divided into
– The esophagus and stomach
– The small and large intestines

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• Accessory organs are attached to the
digestive tract:
– Teeth, tongue and salivary glands
– Liver
– Gallbladder
– Pancreas
– Cells lining the canal last only three to

four days—due to excessive use, and
constantly rebuild.
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• Food on the Move
– Muscles power the Digestive System,
which pushes food through the system
at varying speeds.
– Food is made up of nutrients, most of

with are complex molecules that the
body does not absorb. These molecules
must be broken down into simpler
chemicals byMaryenzymes —which cut up
Jo Lang, Ph.D., A.B.P.N.-
molecules atBeacon
specificCalifornia points.
Day School-Orange,
• Surveys published in the gastroenterology
literature have stated that gastrointestinal
problems, such as chronic constipation or
diarrhea, occur in 46% to 85% of children
with ASD.
• In a recent cross-sectional study that used structured

interviews and matched control groups, a lifetime history of
gastrointestinal symptoms (including abnormal stool
pattern, frequent constipation, frequent vomiting, and
frequent abdominal pain) was elicited in 70% of the
children with ASDs, compared with 42% of the children with
other developmental disabilities (P = .03) and 28% of the
children without developmental disabilities (P < .001).
• Reference: Scott M. Myers, MD, Chris Plauché Johnson, MD, MEd the Council on Children
Mary
With Disabilities, “Management of Jo Lang, Ph.D.,
Children WithA.B.P.N.-
Autism Spectrum Disorders,”
PEDIATRICS Vol. 120 No. 5 November 2007,
Beacon Day pp. 1162-1182
School-Orange,
California
Gluten-Free, Casein-Free Diets are advocated
by some practitioners. Their Theories are
unproven, but are based on:
• The human digestive system did not evolve on a

diet containing large quantities of wheat and
dairy products. Guten (in wheat, rye, barley and
possible oats) and casein (dairy) can cause
problems:
– They are common food allergens.

– Certain peptides can bind to opioid-receptors in the
brain.
• Causing sleepiness, giddiness, inattention and aggression.
• Mary Jo Lang, Ph.D., A.B.P.N.-
Reference: Adams, James B., PhD, “summary of Biomedical Treatments for Autism,” ARI Publication 40;
April, 2007. Beacon Day School-Orange,
California
The Immune System
The human body
defends itself from
disease and
infection with its
Immune System.
People with autism

often suffer from
compromised
immune systems.
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The Immune System
Antibodies (immunoglobulins) are
found in blood, lymph and other
tissue fluids.
• These Y-shaped molecules have unique

“arms” that are programmed to a specific
antigen carried by specific pathogens.
• The molecules can target

harmful pathogens for
Mary Jo Lang, Ph.D.,destruction.
A.B.P.N.-
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Part II—Objectives
To Explore Brain Behavior with

Respect to:
• Memory
• Language
• Visual-Spatial Functioning
• Attention
• Executive Function, and
• Emotional Functioning
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Brain-Behavior
Relationships
1. Cognition
2. Educational
Achievement
3. Adaptive
Behavior
4. Participation,
Social Roles
5. Health
6. Context Mary Jo Lang, Ph.D., A.B.P.N.-
California
Executive Function

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Executive Skills
• Skills that select and achieve goals or
develop problem solutions.
– Planning
– Organization
– Time Management
– Working Memory
• The ability to hold information in mind while
performing complex tasks.
– Metacognition
• Observing how you problem solve (bird’s-eye
view)
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Executive Skills
• Skills that guide or modify behavior as
one moves along the path.
– Response Inhibition
• Think before you act
– Self-regulation of Affect
• Managing emotions
– Task Initiation
• Begin a task without undue procrastination
– Flexibility
• Revise plans when obstacles arise
– Goal-directed Persistence
• Capacity or drive to follow through to the
completion of a Jogoal
Mary Lang, Ph.D., A.B.P.N.-
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Executive Function
• Parallel between brain development
and the child’s ability to think, act,
and feel.
– Important in understanding how
executive skills develop.
• Frontal brain systems make up the
neurological base for executive skills.
– Prefrontal cortex contains the executive
skills.
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Prefrontal Brain Systems
• Play a preeminent role in the
relationship between brain structure
and executive function.
• Among the last to fully develop in
late adolescence
• Final, common pathway for
managing information and behavior
from other brain regions.
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Frontal Lobe Functions
• As summarized by Hart and Jacobs
(1993):
– The frontal lobes decide what is worth
attending to and what is worth doing.
– The frontal lobe provides continuity and
coherence to behavior across time.
– The frontal lobes modulate affective and
interpersonal behaviors so that drives are
satisfied within the constraints of the
internal and external environments.
– The frontal lobes monitor,
School-Orange, evaluate, and
Beacon Day
adjust. (pp. 2, 3) California

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Developmental Tasks
Requiring Executive
• Preschool Age
Skills
– Run simple errands (e.g., “Get your
shoes from the bedroom”).
– Tidy bedroom or playroom with
assistance.
– Perform simple chores and self-help
tasks with reminders (e.g., clear dishes
from table, brush teeth, get dressed).
– Inhibit behaviors: don’t touch a hot
stove; don’t run into the street; don’t
grab a toy from another
Mary Jo Lang, Ph.D., A.B.P.N.-child; don’t hit,
bite, push, etc.

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Developmental Tasks
Continued
• Kindergarten-Grade 2
– Run errands (two to three step directions).
– Tidy bedroom or playroom
– Perform simple chores, self-help tasks; may
need reminders (e.g., make bed).
– Bring papers to and from school.
– Complete homework assignments (20-
minute max. )
– Decide how to spend money (allowance).
– Inhibit behaviors: follow safety rules, don’t
swear, raise hand before speaking in class,
keep hands to self.
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Developmental Tasks
Continued
• Grades 3-5
– Run errands (may involve time delay or greater
distance, such as going to a nearby store).
– Tidy bedroom or playroom (may include
vacuuming, dusting, etc.).
– Perform chores that take 15-30 min. (e.g., clean
up after dinner, rake leaves).
– Bring books, papers, assignments to and from
school
– Keep track of belongings when away from home.
– Complete homework assignments (1 hour max. ).
– Plan simple school projects such as book reports.
– Keep track of changing daily schedule.
– Save money for desired objects, plan how to earn
money.
– Inhibit/self-regulate:
Beacon Daybehave when teacher is out
School-Orange,
of the classroom; refrain from rude comments,
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Developmental Tasks
Continued
• Grades 6-8
– Help out with chores around the home, including both
daily responsibilities and occasional tasks (e.g.,
emptying dishwasher, raking leaves, shoveling snow);
tasks may take 60-90 min. to complete.
– Baby-sit younger siblings or for pay.
– Use system for organizing schoolwork, including
assignment book, notebooks, etc.
– Follow complex social schedule involving changing
teachers and changing schedules.
– Plan and carry out long-term projects, including tasks to
be accomplished and reasonable timeline to follow; may
require planning multiple large projects simultaneously.
– Plan time, including after school activities, homework,
family responsibilities; estimate how long it takes to
complete individual tasks and adjust schedule to fit.
– Inhibit rule breaking
Mary Join the
Lang, absence
Ph.D., A.B.P.N.- of visual authority.
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Developmental Tasks
Continued
• High School
– Manage schoolwork effectively on a day-to-day
basis, including completing and handling
assignments on time, studying for tests, creating
and following timelines for long-term projects, and
making adjustments in response to feedback from
teachers and others (e.g., grades on tests, papers).
– Establish and refine a long-term goal and make
plans for meeting that goal.
– Make good use of leisure time, including obtaining
employment or pursuing recreational activities
during the summer.
– Inhibit reckless and dangerous behaviors (e.g., use
of illegal substances, sexual acting out, shoplifting,
or vandalism).
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Assessing Executive
Skills
• Assessing executive skills in the context
of a formal evaluation is difficult. Some
examples:
– Two critical executive skills are initiation
and sustained attention. In standardized
testing situations, the examiner cues the
student to start and presents tasks that are
necessarily brief in nature, thereby
reducing the demand for sustained
attention.
– Standardized testing situations require the
presence of an adult performing a
monitoring function. With the tester
performing this
Mary Jorole, the
Lang, Ph.D., student does not
A.B.P.N.-
have to monitor his or her own
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Assessing Executive
Skills
• Continued…
– In the context of a highly structured, if not
ritualized, set of tasks, the need for
planning and organization on the part of
the student is reduced, if not in many cases
eliminated.
– Executive skills are most in demand in the
face of complex, open-ended tasks
requiring problem solving and creative or
unique solutions. Standardized tests are
designed to be easily scored with a catalog
of right and wrong answers that are
straightforward and
Beacon invariant, again
Day School-Orange,
minimizing demands on executive skills.

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Assessing Executive
Skills Continued
• Absence of evidence is not evidence
of absence. A child’s strong
performance on a clinic measure of
executive function does not
necessarily mean that the same child
applies good planning ability in the
context of daily performance at
home or at school.
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Informal Assessment
Measures
• Case History/Interview
– How does the child manage homework and
other chores and responsibilities at home? How
organized is the child?
• Classroom Observations
– Sets the stage for a clear definition of the
executive skill as a specific behavior, points to
the direction for intervention, and provides the
gold standard for evaluating effectiveness.
• Work Samples
– Tests, writing assignments, and agenda pages
• Assess skills such as error monitoring, planning, and
organization and yields ideas for interventions such
as cue questions and templates.
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Behavior Checklists
• Behavior Rating Inventory of
Executive Functions
• Brown ADD Scales- Adolescent
Version
• Comprehensive Behavior Rating
Scale for Children
• Child Behavior Checklist- Teacher
Report Form
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Formal Assessment
Measures
• NEPSY
• Porteus Mazes
• Matching Familiar Figures Test
• Trailmaking Tests
• Wisconsin Card Sorting Test
• Connors Continuous Performance
Test-II
• Delis-Kaplan Executive Function
Scale Mary Jo Lang, Ph.D., A.B.P.N.-
• Cognitive Assessment System

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Behavioral Observations
With Formal Assessment
Measures
• Self-Regulation of • Response
Affect Inhibition
• Metacognition • Planning/
• Goal-Directed Prioritization
Persistence • Time
• Flexibility Management
• Sustained • Organization
Attention • Task Initiation
• Working MemoryMary Jo Lang, Ph.D., A.B.P.N.-
California
Steps in Executive Skill
Intervention Planning
• Step 1: Collect assessment
information from a variety of
sources.
• Step 2: Review data; list specific
problem behaviors and connect
them to the most appropriate
executive skill domain.
• Step 3: Select one executive skill
domain for initial intervention and
identify a specific behavioral goal.

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Steps Continued…
• Step 4: Design the intervention, incorporating one or
more of the following elements:
– Environmental supports or modifications that will be put
in place to help support the development of the skill.
– The specific skills the child will be taught and the
procedure used to teach them.
– What incentives will be used to help motivate the child
to use or practice the skills.
• Step 5: evaluate intervention effectiveness by looking
at each intervention component and answer the
following questions:
– Was the component put in place?
– Was it effective?
– Does it need to be continued?
– What is the plan for fading this component.
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Autism: the Brain,

Mary Jo Lang, Ph.D.,

In order to understand an individual

• Changes to the structure and function of

• Finally, environmental factors are likely to

• Understanding How the Brain Works

• Identifying Factors that Influence the

A system is greater than the sum of

• Closed--relationships among system

Mary Jo Lang, Ph.D., A.B.P.N.-

everything the California

• The body has more than 80 major nerves, and

Mary Jo Lang, Ph.D., A.B.P.N.-

• The Sensory Division gathers information

• How does information

Mary Jo Lang, Ph.D., A.B.P.N.-

(Reference: Penn, HE; Clinical-

Mary Jo Lang, Ph.D., A.B.P.N.-

Mary Jo Lang, Ph.D., A.B.P.N.-

– Cells lining the canal last only three to

– Food is made up of nutrients, most of

• In a recent cross-sectional study that used structured

• The human digestive system did not evolve on a

– They are common food allergens.

People with autism

• These Y-shaped molecules have unique

• The molecules can target

To Explore Brain Behavior with

Mary Jo Lang, Ph.D., A.B.P.N.-

adjust. (pp. 2, 3) California

bite, push, etc.

minimizing demands on executive skills.

• Cognitive Assessment System

identify a specific behavioral goal.

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