Abstract
The difficulty that a person with autism has in establishing relationships, maintaining them (communicating and responding appropriately) is a common experience of those close to them., That impaired perceptual and cognitive processing can underlie this difficulty and the interactions of people with autism with the material environment has been established in the laboratory. The consequences at a psychological level of analysis may converge in the inadequacy of second-order representations of the world. An attenuation of such endogenous monitoring processes could also indirectly account for features of withdrawal and the stereotypies often observed. At another level of analysis there are delays in neurotransmission, in the CNS and a lack of flexibility of physiological response shown by evoked potential recordings. Tomographic studies of blood flow and metabolism illustrate a lack of correlation between information processing centres in the brain that may sometimes arise from diffuse gray matter atrophy. A “stop-go” form of modulation of central processing is mediated by anomalous ascending serotonergic and dopaminergic function (transmitters with inhibitory and switching functions). On these bases it is no wonder that representations are not formed and inappropriate and repetitive behaviors follow, although the link remains somewhat speculative. Both levels of analysis are useful for an explanation. As behavioral and pharmacotherapy, though helpful, are severely limited in their efficacy, more effort is required to synthesize the different levels of analysis into a psycho-biological approach, to remedial programs and new forms of therapy.
Résumé
L’incapacité des sujets autistes d’établir des relations avec l’autre, ca veut dire, de communiquer d’une manière adéquate, est un problème majeur pour l’entourage. Le fait, que le comportement relationel anormal est partiellement causé par l’empèchement des fonctions perceptives et cognitives, a été approuvé par des recherches expérimentales. Sur le plan psychologique il y résulte par conséquence l[incapacité d’établir une répresentation adéquate du monde intérieur et extérieur dans le sense des “représentations d’ordre secondaire”. Une autre vue s’appuye sur des faits neurobiologiques: des troubles des fonctions neurotransmetteurs qui, sur le plan neurophysiologique, indiquent une assomilation d’excitation perturbée (cela ce montre par des potentiels évoqués sensoriels transformés). Les recherches tomographiques montrent une interaction troublée entre des différentes régions nerveuses-central, qui sont responsables pour les processus d’information. Il y a des indications pour une interaction inhibée entre des fonctions serotonergiques et dopaminergiques, qui ont pour conséquence une balance troublée entre des fonctions inhibitives et actives. Il en résulte l’incapacité des enfants autistes, d’établir des répresentations symboliques adéquates de leur entourage et d’établir des relations normales. Pour le développement et l’évaluation des stratégies de recherche et de thérapie au future, il est important de mettre en relation les plans différents psychologiques, neurophysiologiques, biochimiques, neuroanatomiques et d’arriver à une vue globale psychobiologique.
Zusammenfassung
Die Unfähigkeit autistischer Patienten, Beziehungen zum Anderen herzustellen und aufrechtzuerhalten, d.h.adäquat mit ihm zu kommunizieren, stellt für nahe und entferntere Bezugspersonen ein erhebliches Problem dar. Daß das abnorme Beziehungsverhalten durch abnorme perzeptive und kognitive Funktionen, mitbedingt ist, ist inzwischen durch experimentelle Untersuchungen belegt. Auf der psychologischen Ebene resultiert dadurch eine beeinträchtigte Fähigkeit zur Etablierung adäquater Vorstellungs- und Verweisungszusammenhänge im Sinne beeinträchtigter “second order representations”. Eine andere Betrachtungsebene ist die neurobiologische: Störunger der neurotransmitter-funktionen, die auf neurophysiologischen Ebene einhergehen mit Hinweisen für eine gestörte Reizverarbeitung (ablesbar in veränderten ERP). Tomographische Untersuchungen weisen auf eine gestörte Interaktion zwischen verschiedenen zentral-nervösen Strukturen, die für die Informationsverarbeitung zuständig sind. Es gibt Hinweise für eine gestörte Interaktion zwischen serotonergen und dopa minergen Funktionen mit der Folge einer gestörten Balance zwischen reaktionshemmenden und-fördernden Mechanismen. Möglicherweise könnte damit die Schwierigkeit autistischer Kinder zusammenhängen, adäquate symbolische Repräsentationen der Umwelt aufzubauen und normale kommunikative Bezüge zu ihr herzustellen. Es ist wichtig für die Entwicklung und Evaluation zukünftiger Forschungs- und Behandlungstherapien, die verschiedenen Betrachtungsebenen (psychologisch., neurophysiologisch, biochemisch, neuroanatomisch) miteinander in Beziehung zu setzen, und dadurch zu einer ganz-heitlichen, psycho-biologischen Betrachtungsweise zu gelangen.
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Oades, R.D., Eggers, C. Childhood autism: An appeal for an integrative and psychobiological approach. European Child & Adolescent Psychiatry 3, 159–175 (1994). https://doi.org/10.1007/BF02720323
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DOI: https://doi.org/10.1007/BF02720323