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Autism spectrum disorder Autism spectrum disorders (ASDs) are a group of neurodevelopmental disabilities that can cause significant social, communication, and behavioral challenges (Understanding Autism, 2003). ASDs can also cause imaginative abnormalities and can range from mild to severe, especially in sensory-motor, perceptual and affective dimensions. Children with ASD may struggle with self-awareness and self acceptance. Their different thinking patterns and brain processing functions in the area of social thinking and actions may compromise their ability to understand themselves and social connections to others (Autism Asperger’s Digest, 2010). About 75% diagnosed autistics are mentally handicapped in some general way and the other 25% diagnosed with Asperger's Syndrome show average to good cognitive functioning (Mcgeer, 2004). When we compare our own behavior to the morals and values that we were taught, we can focus attention on ourselves increasing self-awareness. In understanding the many effects of autism spectrum disorders on those afflicted have led many scientists to theorize what level of self-awareness occurs and in what degree. It is well known that children suffering from varying degrees of Autism struggle in social situations. Scientists have produced evidence that self-awareness is a main problem for people with ASD. Researchers used functional magnetic resonance scans (FMRI) to measure brain activity in 66 male volunteers in which half have been diagnosed in the autism spectrum. The volunteers were monitored while being asked to make judgments about their own thoughts, opinions, preferences, as well as about someone else's. By scanning the volunteers' brains as they responded to these questions, the researchers were able to see differences in the brain activity between those with and without autism. One area of the brain closely examined was the ventromedial pre-frontal cortex (vMPFC) which is known to be active when people think about themselves (Dyslexia United, 2009). This study showed that those afflicted with ASD did not have much of a separation of the brain activity when speaking about themselves as opposed to someone else like their normal counterparts did. This research suggests that the autistic brain struggled to process information about themselves. Self-awareness requires being able to keep track of the relationship one has with themselves and to understand what make them similar to others or in what ways different from others. "This research has shown that children with autism may also have difficulty understanding their own thoughts and feelings and the brain mechanisms underlying this, thus leading to deficits in self-awareness" (Dyslexia United, 2009). A study out of Stanford University has tried to map out brain circuits with understanding self-awareness in Autism Spectrum Disorders. This study suggests that self-awareness is primarily lacking in social situations but when in private they are more self-aware and present. It is in the company of others while engaging in interpersonal interaction that the self-awareness mechanism seems to fail. Higher functioning individuals on the ASD scale have reported that they are more self-aware when alone unless they are in sensory overload or immediately following social exposure (Progress in Autism, 2011). Self-awareness dissipates when an autistic is faced with a demanding social situation. This theory suggests that this happens due to the behavioral inhibitory system which is responsible for self-preservation. This is the system that prevents human from self-harm like jumping out of a speeding bus or putting our hand on a hot stove. Once a dangerous situation is perceived then the behavioral inhibitory system kicks in and restrains our activities. "For individuals with ASD, this inhibitory mechanism is so powerful, it operates on the least possible trigger and shows an over sensitivity to impending danger and possible threats. (Progress in Autism, 2011). Some of these dangers may be perceived as being in the presence of strangers, or a loud noise from a radio. In these situations self-awareness can be compromised due to the desire of self preservation, which trumps social composure and proper interaction. The Hobson hypothesis reports that autism begins in infancy due to the lack of cognitive and linguistic engagement which in turn results in impaired reflective self-awareness. In this study ten children with Asperger's Syndrome were examined using the Self-understanding Interview. This interview was created by Damon and Hart and focuses on seven core areas or schemas that measure the capacity to think in increasingly difficult levels. This interview will estimate the level of self understanding present. "The study showed that the Asperger group demonstrated impairment in the 'self-as-object' and 'self-as-subject domains of the Self-understanding Interview, which supported Hobson's concept of an impaired capacity for self-awareness and self-reflection in people with ASD." (Jackson, Skirrow, Hare, 2012). Self-understanding is a self description in an individual’s past, present and future. Without self-understanding it is reported that self-awareness is lacking in people with ASD. Joint attention (JA) was developed as a teaching strategy to help increase positive self-awareness in those with Autism Spectrum Disorders (Wehmeyer and Shogren, 2008). JA strategies were first used to directly teach about reflected mirror images and how they relate to their reflected image. Mirror Self Awareness Development (MSAD) activities were used as a four step framework in which to measure increases in self-awareness in those with ASD. Self-awareness and knowledge is not something that can simply be taught through direct instruction. Instead, students acquire this knowledge by interacting with their environment (Wehmeyer and Shogren, 2008). Mirror understanding and its relation to the development of self leads to measurable increases in self-awareness in those with ASD. It also proves to be a highly engaging and highly preferred tool in understanding the developmental stages of self- awareness. There have been many different theories and studies done on what degree of self-awareness is displayed among people suffering from Autism Spectrum Disorders. Scientists have done research about the various parts of the brain associated with understanding self and self-awareness. Studies have shown evidence of areas of the brain that are impacted by ASD. Other theories suggest that helping an individual learn more about themselves through Joint Activities, such as the Mirror Self Awareness Development may help teach positive self-awareness and growth. In helping to build self-awareness it is also possible to build self-esteem and self acceptance. This in turn can help to allow the individual with ASD to relate better to their environment and have better social interactions with others. References Autism Asperger’s Digest. (2002, May/June) Retrieved from http://autismdigest.com/self-awareness-and-self-acceptance-in-school-age-students-with-asd/ Autism-“children with autism have problem with self awareness” Retrieved December 14, 2009, from http://dyslexiauntied.blogspot.com/2009/12/autism-children-with-autism-have.html Jackson, P., Skirrow, P., Hare, DJ. (2012, May). Asperger through the looking glass: an exploratory study of self-understanding in people with Asperger’s syndrome. http://www.ncbi.nlm.nih.gov/pubmed/21647793 McGeer, V Philosophy, Psychiatry, & Psychology, 11.3 (2004) 235-251 http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/v011/11.3mcgeer.html Progress in Autism: Self-awareness and regulation, a worthy challenge Retrieved January 13, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/21207316?dopt=Abstract Understanding Autism. (2003, March 1) Retrieved from http://www.atooftexas.org/understanding.html Wehmeyer and Shogren, (2008) Retrieved from http://legacy.uphs.upenn.edu Schizophrenia Schizophrenia is a chronic psychiatric illness characterized by excessive dopamine activity in the mesolimbic tract and mesocortical tract leading to symptoms of psychosis along with poor cognition in socialization. Under the DSM-V, schizophrenics have a combination of positive, negative and psychomotor symptoms. These cognitive disturbances involve rare beliefs and/or thoughts of a distorted reality that creates an abnormal pattern of functioning for the patient. Multiple studies have investigated this issue. Although it has been studied and proven that schizophrenia is hereditary, most patients that inherit this gene are not self-aware of their disorder, regardless of their family history. The level of self-awareness among patients with schizophrenia is a heavily studied topic. Schizophrenia as a disease state is characterized by severe cognitive dysfunction and it is uncertain to what extent patients are aware of this deficiency. In a study published in Schizophrenia Research by Medalia and Lim (2004),[35] researchers investigated patients’ awareness of their cognitive deficit in the areas of attention, nonverbal memory, and verbal memory. Results from this study (N=185) revealed large discrepancy in patients’ assessment of their cognitive functioning relative to the assessment of their clinicians. Though it is impossible to access ones’ consciousness and truly understand what a schizophrenic believes, regardless in this study, patients were not aware of their cognitive dysfunctional reasoning. In the DSM-V, to properly diagnose a schizophrenic, they must have two or more of the following symptoms in the duration of one month: delusions*, hallucinations*, disorganized speech*, grossly disorganized/catatonic behavior and negative symptoms (*these three symptoms above all other symptoms must be present to correctly diagnose a patient.) Sometimes these symptoms are very prominent and are treated with a combination of antipsychotics (i.e. haloperidol, loxapine), atypical antipsychotics (such as clozapine and risperdone) and psychosocial therapies that include family interventions and socials skills. When a patient is undergoing treatment and recovering from the disorder, the memory of their behavior is present in a diminutive amount; thus, self-awareness of diagnoses of schizophrenia after treatment is rare, as well as subsequent to onset and prevalence in the patient. The above findings are further supported by a study conducted in The American Journal of Psychiatry in 1993 by Amador, et al. (N=43).[36] The study suggests a correlation exists between patient insight, compliance and disease progression. Investigators assess insight of illness was assessed via Scale to Assess Unawareness of Mental Disorder and was used along with rating of psychopathology, course of illness, and compliance with treatments in a sample of 43 patients. Patients with poor insight are less likely to be compliant with treatment and are more likely to have a poorer prognosis. Patients with hallucinations sometimes experience positive symptoms, which can include delusions of reference, thought insertion/withdrawal, thought broadcast, delusions of persecution, grandiosity and many more. These psychoses skew the patient’s perspectives of reality in ways in which they truly believe are really happening. For instance, a patient that is experiencing delusions of reference may believe while watching the weather forecast that when the weatherman says it will rain, he is really sending a message to the patient in which rain symbolizes a specific warning completely irrelevant to what the weather is. Another example would be thought broadcast, which is when a patient believes that everyone can hear their thoughts. These positive symptoms sometimes are so severe to where the schizophrenic believes that something is crawling on them or smelling something that is not there in reality. These strong hallucinations are intense and difficult to convince the patient that they do not exist outside of their cognitive beliefs, making it extremely difficult for a patient to understand and become self-aware that what they are experiencing is in fact not there. Furthermore, a study by Bedford and Davis [37](2013) was conducted to look at the association of denial vs. acceptance of multiple facets of schizophrenia (self reflection, self perception and insight) and its effect on self-reflection (N=26). Study results suggest patients with increased disease denial have lower recollection for self evaluated mental illnesses. Disease denial, to a great extent, creates a hardship for patients to undergo recovery because their feelings and sensations are intensely outstanding. But just as this and the above studies imply, a large proportion of schizophrenics do not have self-awareness of their illness for many factors and severity of reasoning of their diagnoses. |
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