Chapter 12 - ONLINE

Psych 2042A 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 Kanners 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 persons developmental level - DSM includes 5 disorders under PDD Autistic Disorder (autism) Aspergers Disorder Retts Disorder Childhood Disintegrative Disorder Pervasive Developmental Disorder Not Otherwise Specied (PDD-NOS) 3 of the PDDs (Autistic Disorder, Aspergers disorder and PDD-NOS) are believe to fall into a continuum of autism 1 Autistic Disorder DSM Classication and Diagnosis Kanners early description: communication decits, 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-sufcient, like in a shell, happiest when left alone, and acting as if people werent 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: Autisms 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 gaze decits 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 difculty processing photos of faces that appear upside down, whereas typical children do have difculty 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 2 pronoun reversal - the child with autism may refer to others as I or me, and to the self as he, she, them, or you difculties in syntax, vocabulary, comprehension, and other forms of language most notable is the decit 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 inexible adherence to routines or rituals repetitive, stereotyped motor behaviours include rocking; walking on the toes; whirling; and arm,hand, or nger apping - 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: Autisms 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 stuck 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 decits in abstract and conceptual thinking, language, and social understanding 3 relative strengths appear in rote learning, rote memory, and visual-spatial skills performance scores are usually higher than verbal scores in IQ range a small minority of youth exhibit so-called splinter skills - abilities much higher than expected on the basis of their general intelligence and savant abilities - that are strikingly better than among normally developing youth Adaptive Behaviour difculties with the comings and goings of everyday life Self-help and daily living skills are expected to be correlated with mental ability communication skills fall somewhat short, and social skills are below the expected level Other Features some show minor physical anomalies some have poor balance, uncoordinated gait, and motor awkwardness in adolescence behaviourally, autistic chi