William Singletary, An Integrative Model of Autism Spectrum Disorder, Part 1
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An Integrative Model of Autism Spectrum Disorder
Saturday, March 4, 2017
Presenter: William Singletary, M.D.
Discussant: Maggie Zellner, Ph.D.
Recent convergences within neurobiology, and between neurobiology and psychoanalysis, allow us to view autism through a new lens, seeing biological risk factors that might operate through final common pathways to produce the ASD syndrome. This talk integrates and elaborate upon this confluence of findings, developing a working model of ASD that could parsimoniously account for central aspects of ASD, promote greater collaboration in research, and lead to more effective treatment. ASD can be seen as a potentially reversible neurodevelopmental disorder in which neurobiological factors – not poor parenting – interfere with the child–caregiver interaction. The infant then experiences deprivation of growth-promoting parental input, even though it is available. This model adds what seems to have been largely unrecognized in the field of autism: the child’s experience of social deprivation and isolation signals threat to the child, and may result in overwhelming stress ("allostatic overload") that damages the body and predisposes one to the development of disease. Critically, this model proposes that allostatic overload may amplify the neurobiological vulnerabilities thought to be involved with development of autism. The model also supports successful intervention that may promote the reversal of this process via adaptive coping and neuroplasticity, by providing an enriched environment, increasing social and emotional connection, and decreasing anxiety, stress, and allostatic load. Making sense of the child’s experience of isolation and threat helps the ASD child feel understood and less afraid. Clinical material will illustrate how, for some children on the higher end of the autism spectrum, recovery is made more likely by increasing the sense of connection and decreasing the experience of stress.