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Chapter 10

Chapter 10 Autism Spectrum Disorders and Childhood-Onset Schizophrenia.docx

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Western University
Psychology 2320A/B
Elizabeth Hayden

Chapter 10: Autism Spectrum Disorders and Childhood-Onset Schizophrenia Autism Spectrum Disorders (ASD)  Autism/Autism spectrum disorder (ASD) – complex neurodevelopmental disorder characterized by abnormalities in social behaviour, language and communication skills, and unusual behaviours and interests  Description and history: o ASD refers to three DSM-IV-TR pervasive developmental disorders (PDDs) – all characterized by significant impairments in social/communication skills and by stereotyped patterns of interests and behaviours:  Autistic disorder  Asperger’s disorder  Pervasive developmental disorder, not otherwise specified (PDD-NOS) o Historically, autism and childhood-onset schizophrenia (COS) were thought of as a single condition; now recognized as separate disorders, recent research suggests that there may be more overlap between two disorders DSM-IV-TR: Defining Features of Autism  Diagnostic criteria for autistic disorder: o Qualitative impairment in social interaction o Qualitative impairments in communication o Restricted repetitive and stereotyped patterns of behaviour, interests, and activities  In addition to core symptoms, autistic disorder must also show delays/abnormal functioning in social interaction, in language, or in imaginative play prior to age 3  Autism is defined as a spectrum disorder, because its symptoms, abilities, and characteristics are expressed in many different combinations and in any degree of severity  Children with ASD not only vary in their social abilities, language, and behaviour, but may also display features not common to ASD – most commonly, intellectual disability and epilepsy  Three critical factors contribute to the differences in children with ASD: o Level of intellectual ability o Severity of language problems o Behaviour changes with age Core Deficits of ASD  Social impairments o Profound difficulties in relating to other people o Deficits in many skills crucial for social development – lack of monitoring of the social activities of others, lack of social/emotional reciprocity, unusual nonverbal, lack of social interaction, lack of interest and/or difficulty relating to others, and a failure to share enjoyment/interests with others o Social expressiveness/sensitivity to social cues are limited, recognition of complex emotions and mental states is impaired and little sharing of experiences or emotions takes place o Have great difficulty integrating social, communicative, and emotional behaviours required to greet a familiar person o Display atypical processing of faces/facial expressions o Display impairments in joint attention – ability to coordinate attention to a social partner and an object or event of mutual interest  Joint attention involves making a social connection with another person by directing that person’s attention to objects or people by pointing, showing, and looking, and by communicating shared interest  Children with ASD show little desire to share interest/attention with another person for the sheer pleasure of interaction o Deficit seems to be in their ability to understand and respond to social information o Own bodily expressions of emotion are often characterized by limited spontaneous use of expressive gestures, and bizarre, rigid, or mechanical facial expressions  Communication impairments o Display serious abnormalities in communication and language that appear early in their development and persist o Atypical early vocalizations are a sensitive indicator of heightened risk for ASD symptoms in infant with family history o One of the first signs of language impairment is the inconsistent use of early preverbal communications  Example: child with ASD may point to a stuffed animal she wants that is out of reach  Demonstrating protoimperative gestures – gestures/vocalization used to express needs – however, child fails to use protodeclarative gestures – gestures/vocalizations that direct visual attention of other people to objects of shared interest o Primary purpose of protodeclarative gestures is to engage other people in interaction  Requires social attention and implicit understanding of what other people are thinking – these abilities are lacking in children with ASD o As many as half of all children with ASD do not develop useful language – rely on primitive forms of communication  Children with autism use instrumental gestures to get someone to do something for them, but fail to use expressive gestures to convey feelings o Children with ASD who develop language usually do so before age 5  Rhythm and intonation of their speech is often unusual  Lack of social chatter – failure to use language for social communication  Communication is described as nonsensical, silly, incoherent, and irrelevant  Pronoun reversals – occur when the child repeats personal pronouns exactly as heard, without changing them to suit the situation  Echolalia – parrot-like repetition of words or word combinations that she/he has heard, can be either immediate or delayed o Primary problem is children with ASD display profound impairments in pragmatics – appropriate use of language in social and communicative contexts  Restricted and repetitive behaviours and interests o Behaviours are characterized by high frequency, repetition in a fixed manner, and desire for sameness in the environment o Self-stimulatory behaviors – stereotyped as well as repetitive body movements or movements of objects Associated Characteristics of ASD  Intellectual deficits and strengths o About 70% of children with autism have co-occurring intellectual impairment o Approx. 40% have severe to profound impairments with IQs less than 50, and 30% have mild to moderate impairments with IQs between 50 and 70 o Remaining 30% have average intelligence or above o Intelligence assessed using WISC-IV  Relatively low score on verbal subtests such as comprehension  Relatively high scores on nonverbal subtests involving short-term memory or specific patterns o Low intellectual ability associated with more severe symptoms and poorer long-term outcomes o Despite intellectual deficits, small but significant number of children with ASD develop splinter skills, or islets of ability – special talents may be in spelling, reading math, music or drawing  As many as 25% display special cognitive skill that is above average for general population  Special abilities of a few children with ASD has been viewed as a side effect of abnormal brain functioning, rather than a reflection of genuine intelligence  Sensory and perceptual impairments o 90% or more have problems in two or three sensory domains that continue well into adulthood o Includes oversensitivities or undersensitivities to certain stimuli, overselective and impaired shifting of attention to sensory input, and impairments in mixing across sensory modalities o May display sensory-perceptual deficits such as:  Sensory dominance – tendency to focus on certain types of sensory input over others  Stimulus overselectivity – tendency to focus on one feature of an object or event in the environment while ignoring other important features  Cognitive and motivational deficits o Two types of cognitive limitations proposed to underlie ASD are:  Specific cognitive deficits in processing social-emotional information  More general cognitive deficits in information processing, planning and attention o Deficits in processing social-emotional information  Mentalization (also known as theory of mind, ToM) – awareness of other people’s and one’s own mental states  ToM hypothesis of ASD begins with the premise that the ability to read intentions, beliefs, feelings and desire of others from their external behaviour has adaptive significance in human evolution  Primary problems of individuals with ASD stem from a deficit in their ToM mechanism o General deficits  Display a general deficit in higher-order planning and regulatory behaviours  These processes, called executive functions, permit us to maintain effective problem solving by inhibiting inappropriate behaviours, engaging in thoughtful actions, sustaining task performance and self-monitoring, using feedback and flexibility shifting from one task to another  Presence of general deficit in executive functioning is suggested by difficulties in cognitive functions  Another general cognitive deficit is weak drive for central coherence – refers to strong tendency of humans to interpret stimuli in relatively global way that takes broader context into account  Those with ASD tend to process information in bits and pieces rather than looking at the big picture  Mental conditions and physical characteristics o Small percentage have coexisting medical condition that may play causal role in their disorder  Include motor and sensory impairments, seizures, immunological and metabolic abnormalities, sleep problems and gastrointestinal symptoms o About 25% or more experience seizures o Sleep disturbances are common, occurring in about 65% of children with ASD o Children with ASD are usually described as having a normal or attractive physical appearance, and they do not display visible physical deviations o As many as 90% have a head size that is above average  More common in higher-functioning individuals and distinguishes them from individuals with intellectual disability, language disorder and ADHD  Accompanying disorders and symptoms o Two disorders that most often accompany ASD are intellectual disability and epilepsy o Additional behavioural/psychiatric symptoms may include ADHD and conduct problems o Some also engage in extreme and sometimes life-threatening self-injurious behaviour (SIB)  May occur for several reasons – self-stimulation, to gain attention, or to eliminate unwanted demands, or it may occur for no apparent reason  Rates are 7 times greater than for typically developing children Prevalence and Course of ASD  Prevalence rate of 1% (100 per 10,000) for all forms of ASD  Found in social classes and identified worldwide  3-4 times more common in boys than in girls o Sex difference is most apparent among children with IQs in the average or above range, as high as 10:1 in higher-functioning individuals o Among children with ASD and profound intellectual disability, numbers of boys and girls are similar o Although girls are less affected by ASD, when they are, they tend to have more severe intellectual impairments  Simon Baron-Cohen (2002) – extreme male brain theory of ASD o Those with ASD are presumed to fall at the extreme high end of a continuum of cognitive abilities associated with systemizing (understanding inanimate world), and at the extreme low end of abilities associated with empathizing (understanding our social world) o Both abilities present in males and females, but males are presumed to show relatively more systemizing and females show more empathizing  Prevalence is higher among Caucasian children than African American children, and estimates are lower for Hispanic children  Age of onset o Diagnosis of ASD usually made in preschool period or later o Period from 12 – 18 month seems to be the earliest point in development that ASD can be reliably detected o Diagnoses made around age 2-3 are stable for most children  Course and outcome o Children with ASD develop along different pathways  Some show abnormal behaviour soon after birth  Some, 25% or more, show normal development for first year, followed by regression (loss of previously acquired skills)  Some improve later significantly o Symptoms change over time  Most symptoms show gradual improvement with age  During adolescence, some symptoms such as hyperactivity, self-injury and compulsivity worsen Causes of ASD  Problems in early development o Experience more health problems during pregnancy, at birth or immediately following birth than others o Risk factors that affect prenatal environment may place fetus at increased risk for ASD – this includes parental age, maternal use of drugs, maternal illnesses during pregnancy, etc.  Genetic influences o Individuals with ASD have elevated risk of about 5% for chromosomal anomalies o Associated with tuberous sclerosis, a rare single-gene disorder  25% or more of children with tuberous sclerosis also have ASD o As many as 15-20% of siblings of individuals with ASD also have the disorder
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