Autism, Childhood Schizophrenia, and Related Conditions

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Chapter 13

• Autism, Childhood Schizophrenia, and Related
  Conditions

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

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• Autism
• Retts disorder
• Childhood disintegrative disorder
• Aspergers disorder
• Pervasive development disorder not otherwise
  specified

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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

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

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The DSM-IV-TR diagnostic criteria

• The condition is characterized by an onset
  occurring before 3 years of age

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Aspergers Disorder

• Differences in language or communication between
  autism and Aspergers disorder.
• Aspergers disorder no clinically significant
  general delay in language
• Autism often has a delay or total lack of spoken
  language development

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• Autism has a marked impairment in initiating or
  sustaining conversations
• Aspergers syndrome does not show this impairment

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• Autism often involves a stereotyped and
  repetitive use of language or idiosyncratic
  language
• Aspergers disorder does not show this impairment

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Some abnormal social interactions characteristic
of autism and Aspergers disorder

• Those with autism may not engage in social
  communication at all, while Aspergers disorder
  may have limited or atypical social interactions

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

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Other Pervasive Developmental Disorders

• Retts 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

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• 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

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CHILDHOOD SCHIZOPHRENIA

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

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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

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• 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

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• Children with schizophrenia often suffer
  hallucinations
• Those with autism do not

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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

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• 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 )

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• 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

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Self-Stimulatory and Self-Injurious Behavior

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

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• 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

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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

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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

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Causation Theories for Autism and Childhood
Schizophrenia

• Psychodynamic Theories
• Biological Theories

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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 childs withdrawing from such rejection and
  erecting defensive barriers to the outside world
  to avoid psychological pain

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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

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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

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Genetic studies of both autism and childhood
schizophrenia

• Polygenic model (involving many recessive genes
  from both parents) as causative in some of the
  cases

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Treatment of Autism and Childhood Schizophrenia
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Psychoanalytic approaches

• Overall effectiveness in improving a severely
  impaired childs 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

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Behavioral Treatment

• Based on a thorough observation and evaluation of
  the childs 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

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

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• 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

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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

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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

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• 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