Transcript Psychology 4053X1: Advanced Seminar in Child Psychopathology

Child Psychopathology
Reorganising the course
Autism
Diagnosis and description
Etiology and treatment
Schizophrenia
Reading for today: Chapter 10
Diagnostic criteria for Autism
• Impairments in social interaction
– deficits in social imitation, joint attention, eye
contact, unusual play, orienting to social stimuli
• Qualitative impairments in communication
– pronoun reversals, echolalia, speech restrictions
• Restricted, repetitive, and stereotyped patterns of
behavior, interests and activities
– perseveration, sameness, self-stimulatory behaviors,
flapping
• Onset prior to age 3
Associated characteristics
• Intellectual strengths and deficits
– 80% are mentally retarded, esp. VIQ
– 25% have “splinter skills”, 5% “savant”
• Sensory and perceptual impairments,
stimulus overselectivity
• Cognitive deficits, Theory of Mind
• Physical characteristics, 25% epilepsy
• Family stress is high: What came first?
Other Pervasive Developmental
Disorders
• Asperger’s
Syndrome
• Later age of onset
• Higher verbal mental
age
• Less language delay
• Less social deficit
• Poor gross motor
coordination
• Rett’s Disorder
• Girls only
• Deceleration of head
growth
• Loss of hand skills
• Severe language
deficit
• Loss of social
engagement
Genetic Contributions
• About 10% have an identifiable medical
condition including Fragile X
• Tuberous sclerosis is associated 3-9% of the
time
• Family and twin studies show strong
relationship
• There are likely several genetic influences
in autism
Neuro- and psychobiology
• Structural abnormalities in cerebellum,
medial temporal, limbic, and frontal lobes
– Demonstrated through blood flow analyses
• Megalencephaly and increased brain
volume in some children
• Epilepsy, EEG abnormalities in 50%
• Elevated serotonin in 1/3 of individuals
• Reticular Activating System and
overselectivity
Overview of interventions
Maresa Moyles
Music therapy and autism
Lori-Beth MacEwen
Summary of interventions for autism
• Low functioning children need behavioral
interventions
– SIB, self-help skills, social compliance, basic
social-emotional behaviors such as eye contact
• High functioning children need language,
social skills; preschool period
• Most effective treatments are highly
structured and skills-oriented
– Include family support and early intervention
Communication skills
• What is appropriate social behavior? What
basic skills are important?
• Eye contact, introducing yourself, expressing
affection, turn-taking in conversations
• Reduction of behaviors inconsistent with
communication, e.g., flapping
• Operant speech training: Imitation,
receptive labelling, sign language for some
children
Case of Joey
• What is the most appropriate diagnosis and
why?
• What treatments goals would you suggest?
• What priorities would you set and why?
Case Summary: Joey
• Appropriate Diagnosis
– Autism; Not Retts or Aspergers; Query MR
• Treatment Options
– SIB; Communication; Positive reading;
Special(?) School; Parent support/ coping
• Priorities
– 1. SIB; 2. Parent-child relationship; 3.
Support
Childhood-Onset Schizophrenia
• Compared to autism:
– onset is later, intelligence is less impaired, social deficits are less
severe, language deficits less severe
– hallucinations and delusions are present, there are periods of
remission and relapse
• Compared to adult schizophrenia:
– onset more insidious, child not distressed by symptoms,
outcome poorer
• Diagnosis:
– hallucinations, esp. auditory hallucinations
– delusions, disorganized speech, disorganized or catatonic
behavior
– Comorbid with depression and conduct/oppositional disorder
Associated characteristics
• Extremely rare in children under age 12,
some prevalence in adolescence
• Boy:Girl ration = 2:1, earlier onset in boys
• Causes:
– Diathesis-Stress model
– Genetic vulnerability and stressful environment
– Low expressed emotion in families, trauma
• Treatment is pharmacological, e.g.,
neuroleptics such as chloropromazine