Transcript 13 - Cengage

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