Chapter 13 Autism, Childhood Schizophrenia, and Related Conditions

5 categories of pervasive developmental disorders according to DSM-IV-TR.

Autism Rett’s disorder Childhood disintegrative disorder Asperger’s disorder Pervasive development disorder not otherwise specified

Autism General prevalence estimate for autism? –4 to 8 cases per 10,000 individuals –Some estimates based on the autistic spectrum concept range from 6 to over 20 per 10,000

4 areas of functional challenge often found in children with autism. –Language –Interpersonal skills – Intellectual functioning –Emotional or affective behaviors

The DSM-IV-TR diagnostic criteria The condition is characterized by an onset occurring before 3 years of age

Asperger’s Disorder Differences in language or communication between autism and Asperger’s disorder. –Asperger’s disorder: no clinically significant general delay in language –Autism: often has a delay or total lack of spoken language development

Autism has a marked impairment in initiating or sustaining conversations Asperger’s syndrome does not show this impairment

Autism often involves a stereotyped and repetitive use of language or idiosyncratic language Asperger’s disorder does not show this impairment

Some abnormal social interactions characteristic of autism and Asperger’s disorder Those with autism may not engage in social communication at all, while Asperger’s disorder may have limited or atypical social interactions

Autism is characterized by a lack of varied, spontaneous play or social imitative play at an appropriate developmental level Asperger’s is not

Other Pervasive Developmental Disorders Rett’s Disorder: A pervasive developmental disorder characterized by seemingly normal development through about the first 5 months but a slowing of development thereafter, a loss of purposeful hand movements followed by the development of stereotyped hand activity, accompanied by serious impairment of language development

Childhood Disintegrative Disorder: Characterized by significant regression in several areas of functioning following at least 2 years of normal development. Affected areas may include language and communication skills, social skills, motor skills, and bowel or bladder control

CHILDHOOD SCHIZOPHRENIA No separate Category in DSM-IV Difficult to study using criteria of adult schizophrenia

Primary differences between autism and childhood schizophrenia Autism is defined as basically a condition in which social relationships are greatly disturbed; chs is characterized by thought disorder and hallucinations

Difference in age of onset. Autism tends to early in life (before 2 ½ ). Schizophrenia appears between 7 – 15 years Children with autism often have mental retardation – those with schizophrenia tend to develop normally and then withdraw into fantasy world

Children with schizophrenia often suffer hallucinations Those with autism do not

Social Sensitivity and Social Skills inability to form personal relationships and to relate socially to other human beings is considered the core characteristic of children with autism atypical patterns of eye contact and gaze aversion, approach and avoidance tendencies, play skills, and social skills training

Social withdrawal and avoidance of others Disturbance of language is a basic symptom of childhood autism Echolalia: repeating sentences or questions addressed to them ( “parrot speech” )

Type and quality of language of children with autism contrasted with the language of children having schizophrenia First, the language of children with autism is generally delayed or disrupted in its normal development. The language of children with schizophrenia does not consistently show impaired development Second, the language of children with autism confused and the content impoverished; Children with schizophrenia generally use correct language structure but may communicate bizarre thoughts. Intelligence

Self-Stimulatory and Self-Injurious Behavior Self-stimulatory, or stereotypic, behavior repetitive, apparently purposeless behavior that occurs in normal, psychotic, and developmentally disordered children

Differences in self-stimulatory and self-injurious behavior between children with autism and those having schizophrenia not thoroughly investigated Both types of behaviors can occur in both types of conditions One basic difference is the frequency of occurrence. Generally, children with autism engage in self-stimulatory and self-injurious behaviors at much higher rates than do children with schizophrenia

Stimulus Overselectivity Child focuses on only a part of a stimulus, perhaps an irrelevant cue or at least one that is not a central feature, and ignores other important features hinders children as they attempt to learn complex discriminations in language and the subtle choices involved in developing social skills

Family Characteristics Early theorists characterized the mothers of children with autism as being cold and rejecting The view that parents of children with autism, as a group, are characteristically rejecting and cold receives little research or clinical support

Causation Theories for Autism and Childhood Schizophrenia Psychodynamic Theories Biological Theories

Psychodynamic Theories Development of schizophrenia caused by a fixation of the libido (sexual energy) at an early stage Suggests that causation of autism is related to the child’s withdrawing from such rejection and erecting defensive barriers to the outside world to avoid psychological pain

Biological Theories Biological theorists view the causes of autism and schizophrenia as functions of birth trauma, viral infections such as German measles, and metabolic problems Genetic factors have also attracted considerable attention as a cause of both autism and schizophrenia Establishment of a solid database is still in progress

Diseases affecting the central nervous system Rubella or influenza The herpes simplex virus has also been suspected of attacking the neurological system, resulting in symptoms of both autism and schizophrenia

Genetic studies of both autism and childhood schizophrenia Polygenic model (involving many recessive genes from both parents) as causative in some of the cases

Treatment of Autism and Childhood Schizophrenia

Psychoanalytic approaches Overall effectiveness in improving a severely impaired child’s behavior is questionable The length of time required for such treatment is very long and thus not considered cost-effective Psychoanalytic assumption that parents cause the conditions is fundamentally in error

Behavioral Treatment Based on a thorough observation and evaluation of the child’s behavior, treats problem behaviors directly, and includes parents as part of the treatment team The most dramatic effects of the use of behavior management techniques have occurred in the treatment of severe self- stimulation, self-injury, and other discrete, targeted behaviors

Central among the important gains in treating autistic children has been the inclusion of parents as active members of the treatment

Techniques employing the basic principles of applied behavior analysis are effective, but they do not cure children with autism or schizophrenia They effectively manage problematic behaviors and teach needed survival behaviors The main effects of such treatments are teaching children some self-help skills and successfully keeping the children in the community

Medical Treatment Psychosurgery (mostly abandoned) Electro convulsive shock (mostly abandoned) Drug therapies The major advances in antipsychotic and other medications directed at controlling behavior and managing symptoms

Prognosis for Children with Autism or Schizophrenia Without adequate treatment, children with autism or schizophrenia will not improve a great deal as they develop and grow older Specific treatment programs may substantially improve functional skills and independent functioning

Intelligence level is one of the most important predictors of future outcome for children with autism Language seems to be a critical element when IQ is above 50