Chapter 10 Autism and Childhood Onset Schizophrenia

Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe Chapter 10: Autism and Childhood Onset Schizophrenia

Chapter 10

Autism and Childhood Onset Schizophrenia


Historical Background of Autism

Autism and childhood-onset schizophrenia were previously lumped together as a single condition

In 1943, Kranner coined the term “early infantile autism”

Kranner believed autism resulted from an inborn inability to form loving relationships with other people and described parents of these children as being cold and detached


DSM-IV Criteria for Autism

Impairments in social interaction Impairments in communication Restricted repetitive and stereotyped patterns of

behavior, interests, and activities Delays or abnormal functioning is social interaction,

social communication, or symbolic or imaginative play prior to age 3


Autism as a Spectrum Disorder

The symptom patterns and characteristics of autism are expressed in many different combinations and degrees of severity

Three factors contribute to the spectrum nature of autism: children with autism may possess any level of

intellectual ability children with autism vary in the severity of their

language problems the behavior of children with autism changes with

age


Core Characteristics

Social impairments include deficits in: social imitation make-believe play social expressiveness orienting to social stimuli responsiveness to others processing of emotional information or sharing

emotions with others joint social attention ability to see others as social agents


Core Characteristics (cont.)

Communication impairments include: may use protoimperative, but not protodeclarative

gestures may use instrumental, but not expressive gestures about 50% of children with autism do not develop

any useful language use qualitatively deviant forms of communication impairments in the pragmatic use of language difficulty communicating emotion and engaging in

narrative discourse



Watch the following video clip about Christina. Because Christina is basically a non-verbal child, the teacher’s aid describes how she uses a communication book as a vehicle to express her needs

What is the role of the communication book for Christina?

What aspects of autism are exemplified in this clip?


Figure 10.1 Instrumental and expressive gestures: Children may use gestures to get others to do something for them but not to convey feelings.


Figure 10.2 Children with autism have difficulty with the pragmatic use of language.



Repetitive Behaviors and Interests: perseveration or abnormal preoccupations ritualistic behavior stereotyped body movements insistence of sameness self-stimulatory behavior



Watch the following video about Rebecca, a first-grader with autistic disorder. Rebecca’s teacher discusses her adjustment to school. Rebecca illustrates some of the classic emotional difficulties seen in autistic disorder

How does Rebecca’s behavior in school illustrate the discomfort with changes in routine that many autistic individuals exhibit?

What specific psychological strategies do Rebecca’s teachers use to encourage more appropriate behavior in the classroom?


Associated Characteristics

Intellectual Deficits and Strengths about 70% of autistic children are mentally

retarded, with particular weaknesses in verbal IQ about 25% have splinter skills and 5% have

savant abilities Sensory and Perceptual Impairments

oversensitivities or undersensitivities to certain stimuli

sensory dominance stimulus overselectivity


Associated Characteristics (cont.)

Cognitive Deficits difficulty understanding social situations impairments in the ability to understand others’

and their own mental states (Theory of Mind) deficits in executive functions lack of drive for central coherence

Physical Characteristics development of epilepsy in 25% abnormally large head circumference in 20%


Associated Characteristics (cont.)

Family Stress raising a child with autism is stressful may be frustrated and experience delays in

receiving help parents may be socially ostracized by friends and

strangers Accompanying Disorders and Symptoms

most often associated with MR and epilepsy other common co-occurring symptoms include

hyperactivity, learning disabilities, anxieties, mood problems, self-injurious behavior


Differential Diagnosis

Children with MR but not autism do not display deficits in joint attention or theory of mind, and are often able to display social behaviors appropriate for their mental age

Compared to children with developmental language disorders, children with autism use more deviant forms of language, display less spontaneous social conversation, and show greater impairments in nonverbal communication


Prevalence

16 children per 10,000 Occurs in all social classes and cultures 3-4 times more common in boys; when girls are

affected they tend to have more severe intellectual impairments


Developmental Course

Most often identified around age 2 Often gradual improvements with age, but likely to

continue to experience many problems Usually a chronic and lifelong condition IQ and language development are the strongest

predictors of adult outcomes


Causes of Autism

Sometimes problems during pregnancy and birth Genetic Influences

family and twin studies suggest the heritability of an underlying liability to autism is above 90%

non-autistic relatives of individuals with autism display higher than normal rates of social, language, and cognitive deficits that are similar in quality to those found in autism, but are less severe


Causes of Autism (cont.)

Brain Abnormalities elevated rates of epilepsy and EEG abnormalities

in about 50% of individuals with autism suggest abnormal brain functioning

observed deficits suggest involvement of multiple brain regions at both cortical and subcortical levels

structural abnormalities in frontal lobe cortex, cerebellum, medial temporal lobe, and related limbic system structures

decreased blood flow in the frontal and temporal lobes

elevated blood serotonin in 1/3 of cases


Treatment of Autism

Comprehensive treatment programs often include: early intervention techniques to reduce self-injurious, self-

stimulation, or other disruptive behaviors teaching social and communication skills interventions that involve the parents to the

greatest degree possible interventions to help the parents cope with the

demands of having a child with autism


Treatment of Autism (cont.)

Dr. Mark Durand’s research program, as discussed in the following video, deals with motivation behind problem solving and how communication training maybe used to lessen such behavior

What are the specific strategies that the teacher’s aid uses to successfully persuade Christina to stop crying?



Other PDDs

Asperger’s Disorder (AD) characterized by major difficulties in social interaction and

by unusual patterns of interests and behaviors in children with relatively intact cognitive and communication skills

compared to autism, children with AD seem to have higher verbal mental age, less language delay, and greater interest in social contact

prevalence about 2.5 per 10,000; boys more likely to be affected

better long-term outcome than for autism brain abnormalities in the cerebellum and limbic system

similar to those for autism, but less severe


Other PDDs (cont.) Rett’s Disorder

neurological developmental disorder characterized by: deceleration of head growth loss of previously acquired purposeful hand skills and

development of stereotyped hand movements loss of social engagement appearance of poorly coordinated gait or trunk

movements severely impaired language development psychomotor retardation

prevalence about 1-4 per 10,000 females caused by specific X-linked gene mutations found in more

than 80% of those affected poor long-term prognosis


Other PDDs (cont.)

Childhood Disintegrative Disorder characterized by a significant loss of previously

acquired language, social skills, and adaptive behavior prior to age 10

regression follows a period of apparently normal development

only occurs in about .2 per 10,000 children symptoms, degree of impairment, and outcomes

similar to those of children with autism (except age of onset and the period of normal development)


Childhood Onset Schizophrenia (COS)

Historically, the term “childhood schizophrenia” was applied to children who today would be diagnosed with autism and other PDDs

In comparison to autism, COS is associated with a later age of onset, less intellectual impairment, less severe social and language deficits, hallucinations and delusions, periods of remission and relapse

COS is not distinct from adult schizophrenia, rather, it is a more severe form


DSM-IV Features of COS

Hallucinations- often auditory Delusions Disorganized speech Disorganized or catatonic behavior “Negative” symptoms (e.g., flat affect, alogia,

avolition)


Prevalence and Course

Extremely rare in children under age 12 Estimated prevalence about .14 - 1 per 10,000

children COS twice as common in boys (gender differences

disappear in adolescence) Gradual onset- 90% show a clear history of

behavioral and psychiatric disturbances prior to onset of psychosis

High comorbidity with conduct problems and depression


Causes of COS

Current views emphasize a vulnerability-stress model Preliminary evidence suggest a strong genetic

contribution in COS, even more so than for adults COS appears to be particularly associated with family

stress


Treatment of COS

COS is a chronic disorder with a poor long-term prognosis

Pharmacological treatments, particularly antipsychotic medications, may be used to help control psychotic symptoms

Psychosocial treatments, such as social skills training, family intervention, and educational supports are also important

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Chapter 10 Autism and Childhood Onset Schizophrenia