Psychology 2042A/B Chapter Notes - Chapter 12: Pervasive Developmental Disorder, Autism, Leo Kanner
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18 Nov 2011
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Chapter 12: Pervasive Developmental Disorders and Schizophrenia
•the disorders that are about to be discussed have pervasive problems in emotional,
social, and cognitive functioning, which have a basis of neurobiological abnormality
•pervasive developmental disorders (PDD) and schizophrenia are considered
independent from each other but they share a rich history
A Bit of History
•these disorders, PDD and schizophrenia were associated with adult psychoses -
disruptive disturbances implying abnormal perceptions of reality
•psychotic disturbances were noted by Kraeplin in the 20th century
•Bleuler applied the term schizophrenias to these psychotic disturbances in reality,
which involve hearing voices and seeing images that do not exist
•some described children with early onset schizophrenia, and other pointed to
syndromes that appeared similar, but not identical, to schizophrenia
•some diagnostic terms such as “disintegrative psychoses” and “childhood psychoses”
were used
•in 1930 and onwards, childhood schizophrenia served as a general label, while
numerous subcategories were employed
•1943 - Leo Kanner: described it as early infantile autism arguing that it was different
from other cases of severe disturbances - which had later onsets
•1944 - Hans Asperger - described a group of children whose symptoms overlapped
with Kannerʼs cases
•today, autism and Asperger syndrome are viewed as similar disorders
•large number of cases appearing before age 3, remarkably low prevalence in
childhood, and increased prevalence in adolescence
•a distinction was made between schizophrenia and a group of related disorders -
referred to as PDD today
•Schizophrenia is a psychotic disturbance that affects a small number of children, rises
in frequency in adolescence, and increases still more in early adulthood
•Pervasive developmental disorders are early-occurring, nonpsychotic disturbances
that are qualitatively deviant from a personʼs developmental level - DSM includes 5
disorders under PDD
•Autistic Disorder (autism)
•Aspergerʼs Disorder
•Rettʼs Disorder
•Childhood Disintegrative Disorder
•Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
•3 of the PDDs (Autistic Disorder, Aspergerʼs disorder and PDD-NOS) are believe to fall
into a continuum of autism
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Autistic Disorder
•DSM Classification and Diagnosis
•Kannerʼs early description: communication deficits, good but atypical cognitive
potential, and behavioural problems such as obsessiveness, repititious actions,
and unimaginative play
•fundamental disturbance was the inability to relate to people and situations from
the beginning of life
•parents describe their children with Autistic Disorder as “self-sufficient”, “like in a
shell”, “happiest when left alone”, and “acting as if people werenʼt there”
•Table 12-1 (p.328) shows the symptoms of Autistic Disorder
•primary symptoms include impaired social interaction, disturbed communication,
and the presence of restrictive and repetitive behaviours and interests
•referred to as triad of impairments - DSM requires 6 symptoms, with all 3
features present
•Description: Autismʼs Triad of Impairments
•Social Interaction
•this can begin very early - even before 1yr, some of the infants are less likely
that others to be visually responsive, less likely to respond to their names, and
more likely to show aversion to being touched by another person
•older infants avoid eye contact, fail to respond to others with emotional
expression and positive affect, and show little interest in being held
•some exhibit an empty ʻgazeʼ
•deficits in joint attention interactions, which in typical youngsters begin right
after 6 months - these interactions include pointing and eye contact
•children with autism also imitate the actions of others less than typical youth
•lack of attachment to parents - secure attachment evident in the Strange
Situation - all types of attachment have been noted in autistic children
•abnormal processing of stimuli is also evident - typical infants are attracted to
the human face and rapidly recognize the face of their mothers
•children with autism show impairment in recognizing faces, matching
emotional faces, and memorizing faces
•they also process faces in a typical way - ie. autistic children focus on mouth
rather than eyes where typical children do
•autistic children do NOT have difficulty processing photos of faces that
appear upside down, whereas typical children do have difficulty
•lack of understanding social cues and inappropriate social actions are also
evident
•Communication
•disturbed communication - both verbal and nonverbal- is an aspect of autism
•30% of children with autism never develop spoken language
•in those who do acquire language with autism, it is often delayed and abnormal
•babbling and verbalization may be abnormal in pitch, tone, rhythm
•echolalia and pronoun reversal are commonly observed
•echolalia - person echoes back what another has said - also observed in
schizophrenia, blindness, and other language disorders
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•pronoun reversal - the child with autism may refer to others as I or me, and
to the self as he, she, them, or you
•difficulties in syntax, vocabulary, comprehension, and other forms of language
•most notable is the deficit in pragmatics, the social use of language
•conversations can be characterized with irrelevant details, inappropriate shifts
in topic or disregard of the normal give-and-take of conversation - or there may
be an overall failure to develop conversation
•some exhibit hyperlexia - a little-understood feature in which single-word
reading is extraordinary but comprehension of what is read is problematic
•Restricted, Repetitive, Stereotyped Behaviour and Interests
•atypical and often off behaviours, interests, and activities that are described as
restricted, repetitive, and stereotyped
•encompass repetitive motor behaviours, obsession with parts of objects,
preoccupation with restricted interests, and inflexible adherence to routines or
rituals
•repetitive, stereotyped motor behaviours include rocking; walking on the toes;
whirling; and arm,hand, or finger flapping - occur in autism more severely than
other pervasive developmental disorders
•more common in younger children with autism and those with lower
intelligence
•repetitive, obsessive activities and interests - include unusual preoccupations
with aspects of the environment
•children may be obsessed with numbers of some object, may compulsively
collect articles or be overly absorbed in hobbies
•may adopt motor routines, such as rearranging objects, and insist on
following rituals for eating and going to bed
•minor changes in the environment such as rearrangement of furniture or
schedules, can cause them to be very upset
•obsessive behaviours may be more common in older children with autism
•Description: Autismʼs Associated Impairments
•not necessary for the diagnosis of autism, but are usually associated with it
•Sensory/perceptual impairments
•sensory organs are intact but abnormal responses to stimuli
•some appear over sensitive to stimulation
•sensory input may be disliked, feared or avoided
•undersensitivity may be a more common problem - fail to respond to stimuli
•ie. a child may seem unaware of a loud noise but fascinated by the quiet
ticking of a watch - some parents think their child is deaf
•Overselectivity - may seem ʻstuckʼ on a particular stimulus while ignoring
competing stimuli, which may implicate attentional processes
•Intellectual Performance
•70-75% of autism cases show mental retardation (IQ of 70 or below)
•there are some who have above average and exceptional intelligence
•higher IQ is associated with less severe autistic symptoms, different
educational needs, and greater chance of normal functioning in later life
•deficits in abstract and conceptual thinking, language, and social understanding
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