Chapter 10
Autism Spectrum Disorders and Childhood-Onset Schizophrenia
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Autism Spectrum Disorders
 Autism spectrum disorders (autism): severe developmental
disorders characterized by abnormalities in social functioning,
language and communication, and unusual behaviors and
interests
 Description and History
 Pervasive developmental disorders (PDDs): characterized by
significant impairments in social and communication skills,
and by stereotyped patterns of interests and behaviors
 Autustic Disorder
 Asperger’s Disorder
 Pervasive Developmental Disorder, Not Otherwise
Specified (PDD-NOS)
 Rett’s Disorder
 Childhood Disintegrative Disorder
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Autism Spectrum Disorders (cont.)
 Description and History (cont.)
 Kanner (1943) coined the term “early infantile autism” to
describe young children with autistic symptoms
 preservation of sameness: anxious and obsessive
insistence on maintaining sameness in daily routines
and activities, which no one but the child may disrupt
 Kanner: autism is an inborn deficit in children whose
“refrigerator parents” are intelligent, obsessive, cold,
mechanical, and detached in their relationships
 Current view: biologically based lifelong developmental
disability that is present in the first few years of life
 Children with autism behave in bizarre ways, engaging in
stereotyped or repetitive motor activities for hours, or
focusing on miniscule details of their world
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
DSM-IV-TR Criteria for Autism
 Impairments in social interaction
 Impairments in communication
 Restricted repetitive and stereotyped patterns of behavior,
interests, and activities
 Delays or abnormal functioning in social interaction, social
communication, or symbolic or imaginative play prior to age 3
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
[INSERT VIDEO: “autism_diagnosis.mov”]
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Autism as a Spectrum Disorder
 Autism Across the Spectrum
 Symptoms, abilities, and characteristics of autism are
expressed in many different combinations and degrees of
severity
 Three factors contribute to the spectrum nature of autism:
 children with autism may differ in level of intellectual
ability, from profound retardation to above-average
intelligence
 children with autism vary in the severity of their
language problems
 the behavior of children with autism changes with age
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Core Deficits of Autism
 Social Impairments:
 deficits in social and emotional reciprocity
 unusual nonverbal behaviors (e.g., atypical facial expressions)
 lack of interest and/or difficulty relating to others
 failure to share enjoyment/interests with others
 social imitation, sharing focus of attention, make-believe play
 limited social expressiveness and sensitivity to social cues
 deficits in recognizing faces/facial expressions
 joint attention: ability to coordinate attention to a social partner
and object/event of mutual interest; impairment impedes later
language development
 although children with autism are attached to their parents, the
way they express attachment is unusual and difficult to read
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Core Deficits of Autism (cont.)
 Communication Impairments:
 One of the first signs of language impairment is
inconsistent use of early preverbal communications
 use protoimperative gestures (gestures or
vocalizations to express needs) not protodeclarative
gestures (those that direct visual attention of others to
objects of shared interest)
 miss other declarative gestures, such as showing
gesture
 about 50% do not develop any useful language
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Core Deficits of Autism (cont.)
 Communication Impairments (cont.)
 Those who begin to speak may regress between ages
12-30 months; those who do develop language do so
before age 5
 May use instrumental rather than expressive gestures
to convey feelings
 Qualitative language impairments: pronoun reversals,
echolalia, impairments in pragmatics
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Core Deficits of Autism (cont.)
 Repetitive Behaviors and Interests:
 Repetitive and stereotyped behaviors and narrow patterns
of interest
 Stereotyped body movements
 Self-stimulatory behavior (e.g., hand flapping)
 Different theories to explain self-stimulatory behaviors:
 a craving for stimulation to excite their nervous
system
 a way of blocking out/controlling unwanted
stimulation from environment that is too
stimulating
 it is reinforcing
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics of Autism
 Intellectual Deficits and Strengths
 About 70% of autistic children have co-occurring
intellectual impairment
 about 40% have severe to profound impairments
(IQ<50)
 30% have mild to moderate impairments (IQ 50-70)
 30% have average intelligence or above
 although the performance of children with autism is
uneven across WISC subtests, a common pattern is
low verbal/high nonverbal scores; WISC scores are
lower than on other tests of intellectual functioning
 about 25% have splinter skills/islets of ability; and 5%
(autistic savants) display isolated, remarkable talents
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics of Autism (cont.)
 Sensory and Perceptual Impairments
 Sensory abnormalities are common in children with
autism
 oversensitivities or undersensitivities to certain stimuli
 overselective/impaired shifting of attention to sensory
input
 impairments in mixing across sensory modalities (e.g.,
inability to see the movement and hear the sound of
someone clapping simultaneously)
 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 equally important features
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics of Autism (cont.)
 Cognitive and Motivational Deficits
 Deficits in Processing Social-Emotional Information
 do not understand pretense or engage in pretend play
 difficulty understanding social situations
 deficit in mentalization or theory of mind (ToM):
difficulty understanding others’ and their own mental
states; do not understand false beliefs
 General Deficits
 executive functioning (higher-order planning and
regulatory behaviors)
 weak drive for central coherence (strong human
tendency to interpret stimuli in a relatively global way
to account for broader context)
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics of Autism (cont.)
 Physical Characteristics
 Coexisting medical condition for about 10%
 Sleep disturbances and gastrointestinal symptoms are common
 Normal or attractive physical appearance, although they may
have subtle yet distinctive minor physical anomalies
 about 20% have a significantly larger-than-normal head
size, which is more common in those who are higher
functioning
 Accompanying disorders and symptoms: most common are MR
and epilepsy (25% or more may develop epilepsy)
 also: ADHD, learning disabilities, anxieties and fears, and
mood problems
 self-injurious behaviors, including head banging, hand or
arm biting, excessive scratching and rubbing
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Course of Autism
 Worldwide, about 1 child per 150 may suffer from some form
of autism; about 1 million individuals in the United States
 Autistic disorder: 22 of 10,000
 PPD-NOS: 33 of 10,000
 Asperger’s disorder: 10 of 10,000
 Occurs in all social classes and cultures
 3-4 times more common in boys; when girls are affected they
tend to have more severe intellectual impairments
 Extreme male brain theory of autism (Simon Baron-Cohen):
males are presumed to show relatively more systemizing and
females show more empathizing
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Course of Autism (cont.)
 Age of Onset
 Most often identified by parents in the months preceding
child’s second birthday, with diagnosis made in preschool
period or later
 Earliest point in development for reliable detection: 12-18
months
 AAP recommends that all children be screened at 1824 months
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Course of Autism (cont.)
 Course and Outcome
 Often gradual improvements with age, but likely to
continue to experience many problems, with some
symptoms worsening in adolescence
 Complex obsessive-compulsive rituals may develop in
late adolescence and adulthood
 Usually a chronic and lifelong condition with continuing
handicaps that do not allow for high levels of
independence
 Continuing problems in communication, stereotyped
behaviors and interests, poor reading and spelling abilities
 IQ and language development are the strongest predictors of
adult outcomes
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Autism
 It is generally accepted that autism is a biologically based
neurodevelopmental disorder with multiple causes
 Problems in Early Development
 Sometimes problems during pregnancy, at birth, or
immediately following birth
 Controversial proposal links autism to vaccinations
 Genetic Influences
 Chromosomal and Gene Disorders:
 fragile-X anomaly in 2-3% of children with autism
 5% elevated risk for chromosomal anomalies
 about 25% of children with tuberous sclerosis have
autism
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Autism (cont.)
 Genetic Influences (cont.)
 Family and Twin Studies
 3-7% of siblings and extended family members of
individuals with autism have the disorder
 Concordance rates
 60-90% in identical twins
 near 0% for fraternal twins
 heritability of an underlying liability to autism is
80%
 broader autism phenotype: non-autistic relatives of
individuals with autism display higher than normal
rates of social, language, and cognitive deficits
that are similar in quality to those found in autism,
but are less severe
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Autism (cont.)
 Genetic Influences (cont.)
 Molecular Genetics: Points to particular areas on many
different chromosomes as possible locations for
susceptibility genes for autism
 causally implicated but not a direct cause
 most cases result from multiple interacting genetic
factors
 expression of autism genes may be influenced by
environmental factors occurring primarily during fetal
brain development
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Autism (cont.)
 Genetic Influences (cont.)
 Brain Abnormalities
 Early disturbance in neural development prior to 30 weeks
before birth
 Observed deficits suggest involvement of multiple brain
regions at both cortical and subcortical levels
 Biological findings: frontal lobe cortex abnormalities;
structural abnormalities in cerebellum and medial temporal
lobe and related limbic system structures
 decreased blood flow in the frontal and temporal lobes;
elevated blood serotonin in 1/3 of cases
 Autism as a Disorder of Risk and Adaptation: The
relationship between early risk for autism and later
outcomes is mediated by alterations in how the child
interacts with/adapts to his or her environment
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment of Autism
 There is no known cure for autism
 Treatment goals: minimize core problems, maximize
independence and quality of life, and help the child and
family cope more effectively with the disorder
 Most benefit is likely to come from programs of
 early intervention that involve parents and use special
educational methods
 community-based education, community living options
 developmentally oriented
 Different Children, Different Treatments
 Treatment strategies, goals, and expectations vary for
different children with autism
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment of Autism (cont.)
 Overview
 Treatments focus on social, communication, cognitive,
and behavioral deficits associated with autism
 Strategies include:
 engaging children in treatment
 decreasing disruptive behaviors
 teaching appropriate social behavior (e.g., joint
attention, imitation, reciprocal interaction)
 increasing functional, spontaneous communication
 promoting cognitive skills (e.g., symbolic play and
perspective taking)
 teaching adaptive skills to increase responsibility and
independence
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment of Autism (cont.)
 Overview (cont.)
 Treatment components:
 Initial stages: build rapport, teaching learningreadiness skills
 discrete trial training: step-by-step approach to
presenting stimulus/requiring specific response
 incidental training: strengthen behavior by
capitalizing on naturally occurring opportunities
 Reduce disruptive behavior
 Teach appropriate social behavior
 Teach appropriate communication skills: operant
speech training
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treaetment of Autism (cont.)
 Early Intervention
 The most effective interventions include the following features:
 Early: begin as soon as diagnosis is seriously considered
 Intensive
 Low student-teacher ratio
 High structure
 Family inclusion
 Peer interactions
 Generalization
 Ongoing assessment
 The UCLA Young Autism Project: highly structured skillsoriented strategies tailored to the individual child; provide
education and supportive counseling for the family
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment of Autism (cont.)
 Medications
 Many children with autism receive psychotropic
medications:
 antidepressants, stimulants, tranquilizers/
antipsychotics
 benefits are limited, variable from child to child, and do
not alter the core deficits of these children
 risks, benefits, and costs must be carefully evaluated
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Other Pervasive Developmental Disorders (PDDs)
 Asperger’s Disorder (AD): major difficulties in social interaction and
unusual patterns of interests and behaviors in children with
relatively intact cognitive and communication skills
 compared to autism, children with AD have similar social
impairments and restricted, stereotyped interests but higher
verbal mental age, less language delay, and greater interest in
social contact
 lack empathy; inappropriate, one-sided social interaction; little
ability to form friendships; socially isolated; poor nonverbal
communication
 codisorders: anxiety disorders (especially social phobias and
obsessive-compulsive symptoms) and sleep difficulties
 higher intellectual functioning suggests better long-term
outcome than for autism
 brain abnormalities in the cerebellum and limbic system similar
to those for autism, but less severe
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Other PDDs (cont.)
 Rett’s Disorder: severe and disabling neurological developmental
disorder that predominantly affects females; characterized by:
 deceleration of head growth
 loss of previously acquired purposeful hand skills and
development of stereotyped hand movements
 early loss of social engagement (often develops later)
 appearance of poorly coordinated gait or trunk movements
 severely impaired language development and psychomotor
retardation
 Prevalence about 1 per 10,000 to 1 in 22,000 females
 Specific X-linked gene mutations found in up to 95% of those
affected (the mutations are usually lethal to the male fetus)
 Poor long-term prognosis: 25% may never walk and 50% of
those who do walk will later lose the ability
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Other PDDs (cont.)
 Childhood Disintegrative Disorder: characterized by a
significant loss of previously acquired expressive or receptive
language, social skills, and adaptive behavior prior to age 10
 regression follows a period of apparently normal
development
 only occurs in about .2 per 10,000 children, mostly boys
 symptoms, degree of impairment, and outcomes similar to
those of children with autism (except age of onset and the
period of normal development)
 Pervasive Developmental Disorder-Not Otherwise Specified
(PDD-NOS/atypical autism): Children who display the social,
communication, and behavioral impairments associated with
PDD but do not meet criteria for other PDDs, schizophrenia,
or other disorders
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood Onset Schizophrenia (COS)
 Schizophrenia: a disorder of the brain that is expressed in
abnormal mental functions and disturbed behavior
 Characterized by severe psychotic symptoms: bizarre
delusions, hallucinations, thought disturbances, grossly
disorganized behavior or catatonic behavior, extremely
inappropriate or flat affect, and significant deterioration or
impairment in functioning
 Historically, the term “childhood schizophrenia” was applied
to children who today would be diagnosed with autism and
other PDDs
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood-Onset Schizophrenia (cont.)
 Compared to autism, COS has later age of onset, less intellectual
impairment, less severe social and language deficits, hallucinations
and delusions, periods of remission and relapse
 A rarer and possibly more severe (not distinct) form of
schizophrenia
 Initial stages: problems concentrating, sleeping, doing schoolwork;
may avoid friends; as it progresses: incoherent speech,
hallucinations
 Key features:
 occurs during childhood
 gradual, rather than sudden, onset
 symptoms likely persist into adolescence/adulthood
 negative impact on developing social and academic
competence
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood-Onset Schizophrenia (cont.)
 DSM-IV-TR: Defining Features
 Continuous signs of disturbance for at least 6 months
and, after onset, significant decrement in one or more
areas of functioning or a failure to achieve expected
levels of interpersonal, academic, or occupational
achievement
 Positive Symptoms: delusions and hallucinations (most
common for children are auditory: 80% of cases with
onset prior to age 11; 40-60% experience visual
hallucinations, delusions, and thought disorder)
 Negative Symptoms: slowing of thinking, speech,
movement; indifference to social contact
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood-Onset Schizophrenia (cont.)
 Precursors and Comorbidities
 Gradual onset
 Almost 95% have history of behavioral, social, and psychiatric
disturbances before onset of psychosis
 Developmental precursors: speech and language problems,
problems in motor development, movement abnormalities,
social impairment, unusual thought content, suspicion/paranoia,
substance abuse, and genetic risk with recent deterioration in
function
 Other symptoms/disorders: anxiety and depression, ADHD,
conduct problems, movement abnormalities, suicidal
tendencies
 70% meet criteria for another diagnosis (commonly mood
disorder or ODD/CD)
 Do NOT show elevated risk of autism or other PDD
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood-Onset Schizophrenia (cont.)
 Prevalence
 Extremely rare in children under age 12; dramatic
increase in adolescence; modal age of onset: 20-25
 Estimated prevalence less than 1.0 per 10,000 children
(100 times more common in adults than in children)
 COS twice as common in boys and earlier age of onset
(by 2-4 years); gender differences disappear in
adolescence
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood-Onset Schizophrenia (cont.)
 Causes and Treatment of COS
 Causes
 Current views: based on a vulnerability-stress model that
emphasizes the interplay among vulnerability, stress, and
protective factors
 Neurodevelopmental model: a genetic vulnerability and
early neurodevelopmental insults result in impaired
connections between many brain regions that include the
prefrontal cortex and parts of the limbic system
 Biological factors: strong genetic contribution in COS with
heritability estimates around 80%
 Molecular genetic studies have identified several potential
susceptibility genes for COS that have previously been
linked with schizophrenia in adults
 CNS dysfunction and improvements with medication
suggest it is a disorder of the brain
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood-Onset Schizophrenia (cont.)
 Causes and Treatment of COS (cont.)
 Causes (cont.)
 Environmental factors: familial disorder; nongenetic
factors may play a role through interaction with a
genetic susceptibility
 High depression scores for parents on
communication deviance (a measure of
interpersonal signs of attention and thought
disturbance)
 Poor family environment and certain patterns of
communication interact with genetic risk
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Childhood-Onset Schizophrenia (cont.)
 Treatment
 Current treatments emphasize use of antipsychotic
medications combined with psychotherapy plus social and
educational support programs
 Medications (e.g., risperidone) help control psychotic
symptoms by blocking dopamine transmission
 adverse effects (which can be serious) reduce
adherence to treatment and require constant
monitoring
 Psychosocial treatments: family intervention, social skills
training, cognitive behavior therapy, and educational
support
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment of COS
 COS is a chronic disorder with a poor long-term prognosis
 Pharmacological treatments, particularly antipsychotic
medications, may be used to help control psychotic
symptoms
 Psychosocial treatments, such as social skills training, family
intervention, and educational supports are also important
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning