Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Chapter 10
Autism and Childhood Onset Schizophrenia
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Historical Background of Autism
 Autism and childhood-onset schizophrenia were
previously lumped together as a single condition
 In 1943, Kranner coined the term “early infantile
autism”
 Kranner believed autism resulted from an inborn
inability to form loving relationships with other people
and described parents of these children as being cold
and detached
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
DSM-IV Criteria for Autism
 Impairments in social interaction
 Impairments in communication
 Restricted repetitive and stereotyped patterns of
behavior, interests, and activities
 Delays or abnormal functioning is social interaction,
social communication, or symbolic or imaginative
play prior to age 3
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Autism as a Spectrum Disorder
 The symptom patterns 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 possess any level of
intellectual ability
 children with autism vary in the severity of their
language problems
 the behavior of children with autism changes with
age
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Core Characteristics
 Social impairments include deficits in:
 social imitation
 make-believe play
 social expressiveness
 orienting to social stimuli
 responsiveness to others
 processing of emotional information or sharing
emotions with others
 joint social attention
 ability to see others as social agents
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Core Characteristics (cont.)
 Communication impairments include:
 may use protoimperative, but not protodeclarative
gestures
 may use instrumental, but not expressive gestures
 about 50% of children with autism do not develop
any useful language
 use qualitatively deviant forms of communication
 impairments in the pragmatic use of language
 difficulty communicating emotion and engaging in
narrative discourse
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Core Characteristics (cont.)
 Watch the following video clip about Christina.
Because Christina is basically a non-verbal child, the
teacher’s aid describes how she uses a
communication book as a vehicle to express her
needs
 What is the role of the communication book for
Christina?
 What aspects of autism are exemplified in this clip?
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Figure 10.1 Instrumental and expressive gestures: Children may use gestures to get
others to do something for them but not to convey feelings.
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Figure 10.2 Children with autism have difficulty with the pragmatic use of language.
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Core Characteristics (cont.)
 Repetitive Behaviors and Interests:
 perseveration or abnormal preoccupations
 ritualistic behavior
 stereotyped body movements
 insistence of sameness
 self-stimulatory behavior
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Core Characteristics (cont.)
 Watch the following video about Rebecca, a firstgrader with autistic disorder. Rebecca’s teacher
discusses her adjustment to school. Rebecca
illustrates some of the classic emotional difficulties
seen in autistic disorder
 How does Rebecca’s behavior in school illustrate the
discomfort with changes in routine that many autistic
individuals exhibit?
 What specific psychological strategies do Rebecca’s
teachers use to encourage more appropriate
behavior in the classroom?
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Associated Characteristics
 Intellectual Deficits and Strengths
 about 70% of autistic children are mentally
retarded, with particular weaknesses in verbal IQ
 about 25% have splinter skills and 5% have
savant abilities
 Sensory and Perceptual Impairments
 oversensitivities or undersensitivities to certain
stimuli
 sensory dominance
 stimulus overselectivity
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Associated Characteristics (cont.)
 Cognitive Deficits
 difficulty understanding social situations
 impairments in the ability to understand others’
and their own mental states (Theory of Mind)
 deficits in executive functions
 lack of drive for central coherence
 Physical Characteristics
 development of epilepsy in 25%
 abnormally large head circumference in 20%
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Associated Characteristics (cont.)
 Family Stress
 raising a child with autism is stressful
 may be frustrated and experience delays in
receiving help
 parents may be socially ostracized by friends and
strangers
 Accompanying Disorders and Symptoms
 most often associated with MR and epilepsy
 other common co-occurring symptoms include
hyperactivity, learning disabilities, anxieties, mood
problems, self-injurious behavior
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Differential Diagnosis
 Children with MR but not autism do not display
deficits in joint attention or theory of mind, and are
often able to display social behaviors appropriate for
their mental age
 Compared to children with developmental language
disorders, children with autism use more deviant
forms of language, display less spontaneous social
conversation, and show greater impairments in
nonverbal communication
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Prevalence
 16 children per 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
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Developmental Course
 Most often identified around age 2
 Often gradual improvements with age, but likely to
continue to experience many problems
 Usually a chronic and lifelong condition
 IQ and language development are the strongest
predictors of adult outcomes
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Causes of Autism
 Sometimes problems during pregnancy and birth
 Genetic Influences
 family and twin studies suggest the heritability of
an underlying liability to autism is above 90%
 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
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Causes of Autism (cont.)
 Brain Abnormalities
 elevated rates of epilepsy and EEG abnormalities
in about 50% of individuals with autism suggest
abnormal brain functioning
 observed deficits suggest involvement of multiple
brain regions at both cortical and subcortical levels
 structural abnormalities in frontal lobe cortex,
cerebellum, 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
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Treatment of Autism
 Comprehensive treatment programs often include:
 early intervention
 techniques to reduce self-injurious, selfstimulation, or other disruptive behaviors
 teaching social and communication skills
 interventions that involve the parents to the
greatest degree possible
 interventions to help the parents cope with the
demands of having a child with autism
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Treatment of Autism (cont.)
 Dr. Mark Durand’s research program, as discussed in
the following video, deals with motivation behind
problem solving and how communication training
maybe used to lessen such behavior
 What are the specific strategies that the teacher’s aid
uses to successfully persuade Christina to stop
crying?
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Other PDDs
 Asperger’s Disorder (AD)
 characterized by major difficulties in social interaction and
by unusual patterns of interests and behaviors in children
with relatively intact cognitive and communication skills
 compared to autism, children with AD seem to have higher
verbal mental age, less language delay, and greater
interest in social contact
 prevalence about 2.5 per 10,000; boys more likely to be
affected
 better long-term outcome than for autism
 brain abnormalities in the cerebellum and limbic system
similar to those for autism, but less severe
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Other PDDs (cont.)
 Rett’s Disorder
 neurological developmental disorder characterized by:
 deceleration of head growth
 loss of previously acquired purposeful hand skills and
development of stereotyped hand movements
 loss of social engagement
 appearance of poorly coordinated gait or trunk
movements
 severely impaired language development
 psychomotor retardation
 prevalence about 1-4 per 10,000 females
 caused by specific X-linked gene mutations found in more
than 80% of those affected
 poor long-term prognosis
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Other PDDs (cont.)
 Childhood Disintegrative Disorder
 characterized by a significant loss of previously
acquired 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
 symptoms, degree of impairment, and outcomes
similar to those of children with autism (except age
of onset and the period of normal development)
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Childhood Onset Schizophrenia (COS)
 Historically, the term “childhood schizophrenia” was
applied to children who today would be diagnosed
with autism and other PDDs
 In comparison to autism, COS is associated with a
later age of onset, less intellectual impairment, less
severe social and language deficits, hallucinations
and delusions, periods of remission and relapse
 COS is not distinct from adult schizophrenia, rather, it
is a more severe form
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
DSM-IV Features of COS





Hallucinations- often auditory
Delusions
Disorganized speech
Disorganized or catatonic behavior
“Negative” symptoms (e.g., flat affect, alogia,
avolition)
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Prevalence and Course
 Extremely rare in children under age 12
 Estimated prevalence about .14 - 1 per 10,000
children
 COS twice as common in boys (gender differences
disappear in adolescence)
 Gradual onset- 90% show a clear history of
behavioral and psychiatric disturbances prior to onset
of psychosis
 High comorbidity with conduct problems and
depression
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
Causes of COS
 Current views emphasize a vulnerability-stress model
 Preliminary evidence suggest a strong genetic
contribution in COS, even more so than for adults
 COS appears to be particularly associated with family
stress
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 10: Autism and Childhood Onset Schizophrenia
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