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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 selfstimulation, 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