Child Psychopathology Reorganising the course Autism Diagnosis and description Etiology and treatment Schizophrenia Reading for today: Chapter 10

Diagnostic criteria for Autism Impairments in social interaction –deficits in social imitation, joint attention, eye contact, unusual play, orienting to social stimuli Qualitative impairments in communication –pronoun reversals, echolalia, speech restrictions Restricted, repetitive, and stereotyped patterns of behavior, interests and activities –perseveration, sameness, self-stimulatory behaviors, flapping Onset prior to age 3

Associated characteristics Intellectual strengths and deficits –80% are mentally retarded, esp. VIQ –25% have “splinter skills”, 5% “savant” Sensory and perceptual impairments, stimulus overselectivity Cognitive deficits, Theory of Mind Physical characteristics, 25% epilepsy Family stress is high: What came first?

Other Pervasive Developmental Disorders Asperger’s Syndrome Later age of onset Higher verbal mental age Less language delay Less social deficit Poor gross motor coordination Rett’s Disorder Girls only Deceleration of head growth Loss of hand skills Severe language deficit Loss of social engagement

Genetic Contributions About 10% have an identifiable medical condition including Fragile X Tuberous sclerosis is associated 3-9% of the time Family and twin studies show strong relationship There are likely several genetic influences in autism

Neuro- and psychobiology Structural abnormalities in cerebellum, medial temporal, limbic, and frontal lobes –Demonstrated through blood flow analyses Megalencephaly and increased brain volume in some children Epilepsy, EEG abnormalities in 50% Elevated serotonin in 1/3 of individuals Reticular Activating System and overselectivity

Overview of interventions Maresa Moyles

Music therapy and autism Lori-Beth MacEwen

Summary of interventions for autism Low functioning children need behavioral interventions –SIB, self-help skills, social compliance, basic social-emotional behaviors such as eye contact High functioning children need language, social skills; preschool period Most effective treatments are highly structured and skills-oriented –Include family support and early intervention

Communication skills What is appropriate social behavior? What basic skills are important? Eye contact, introducing yourself, expressing affection, turn-taking in conversations Reduction of behaviors inconsistent with communication, e.g., flapping Operant speech training: Imitation, receptive labelling, sign language for some children

Case of Joey What is the most appropriate diagnosis and why? What treatments goals would you suggest? What priorities would you set and why?

Case Summary: Joey Appropriate Diagnosis –Autism; Not Retts or Aspergers; Query MR Treatment Options –SIB; Communication; Positive reading; Special(?) School; Parent support/ coping Priorities –1. SIB; 2. Parent-child relationship; 3. Support

Childhood-Onset Schizophrenia Compared to autism: –onset is later, intelligence is less impaired, social deficits are less severe, language deficits less severe –hallucinations and delusions are present, there are periods of remission and relapse Compared to adult schizophrenia: –onset more insidious, child not distressed by symptoms, outcome poorer Diagnosis: –hallucinations, esp. auditory hallucinations –delusions, disorganized speech, disorganized or catatonic behavior –Comorbid with depression and conduct/oppositional disorder

Associated characteristics Extremely rare in children under age 12, some prevalence in adolescence Boy:Girl ration = 2:1, earlier onset in boys Causes: –Diathesis-Stress model –Genetic vulnerability and stressful environment –Low expressed emotion in families, trauma Treatment is pharmacological, e.g., neuroleptics such as chloropromazine