Chapter 10 Autism and Childhood Onset Schizophrenia

1. Chapter 10Autism and Childhood Onset Schizophrenia

2. 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

3. 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

4. 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

5. 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

6. 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

7. Core Characteristics (cont.) • 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?

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

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

10. Core Characteristics (cont.) • Repetitive Behaviors and Interests: • perseveration or abnormal preoccupations • ritualistic behavior • stereotyped body movements • insistence of sameness • self-stimulatory behavior

11. Core Characteristics (cont.) • 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?

12. 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

13. 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%

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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?

23. 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

24. 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

25. 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)

26. 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

27. DSM-IV Features of COS • Hallucinations- often auditory • Delusions • Disorganized speech • Disorganized or catatonic behavior • “Negative” symptoms (e.g., flat affect, alogia, avolition)

28. 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

29. 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

30. 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