6. autism spectrum disorder and childhood-onset schizophrenia

homotypic continuity vs heterotypic continuity

homotypic: same type of symptoms persist over time, even as their intensity or context may shift

heterotypic: form of symptoms changes over time, even though the underlying vulnerability or dysregulation persists

organize ASD, ADHD, conduct disorder, IDD, and ODD into homotypic and heterotypic continuity

homotypic: ASD, IDD

heterotypic: ADHD, conduct disorder, ODD

ASD is a DSM-5-TR diagnosis characterized by 2 core features:

• significant and persistent differences in social interaction and communication skills

• highly intense and repetitive patterns of interests and behaviors

preservation of sameness

a very strong preference on the maintenance of sameness in daily routines and activities, which no one but the child may change

5 diagnostic criteria for ASD

• persistent deficits in social communication and social interaction across multiple contexts

• restricted, repetitive patterns of behavior, interests, or activities

• symptoms must be present in early dev period

• symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

• these disturbances are not better explained by IDD or global developmental delay

3 critical factors which contribute to differences in the way ASD is presented in children

• lvl of intellectual ability

• differences in language

• behavior changes w age

why is ASD defined on a spectrum?

its symptoms, abilities, and characteristics are expressed in many different combos and in any degree of specific behavior

some examples of social interaction and communication differences

• preference to attend to one’s own activity

• preference for reduced lvls of eye-contact

• preference to use neutral facial expressions

• preference for parallel play and interaction

• demonstrates a monotropic cognitive style that’s characteristic of neurodivergent children

restricted repetitive behaviors

repetitive sensory and motor behaviors and preference for on sameness behaviors

joint attention

a coordinating attention to a social partner and an object or event of mutual interest

• involves making a social connection w another person by directing that person’s attention to objects or ppl by pointing, showing, and looking, and by communicating shared interest

protoimperative gestures (autistic children do better at this)

gestures or vocalizations that are used to express needs

protodeclarative gestures

gestures or vocalizations that direct the visual attention of other ppl to objects of shared interest

instrumental gestures

used to get someone else to do smth for them immediately

pronoun reversal

common language use in autistic children which occurs when child repeats personal pronouns exactly as heard, without changing them to suit the situation

echolalia

child’s repetition of words or word combos that they’ve heard, either immediately after hearing them, or at a later time

perseverative speech

repetitive talking about one topic and insistent questioning

self-stimulatory behaviors

repetitive body mvmts or mvmts of objects

theory 1 of why autistic children engage in self-stimulatory and other repetitive behaviors: understimulation

they need stimulation, and self-stimulation serves to excite their nervous system

theory 2 of why autistic children engage in self-stimulatory and other repetitive behaviors: overstimulation

their env may be too stimulating and so they engage in repetitive self-stimulation as a way of blocking out and controlling unwanted stimulation

intervention design based on theory 1 to reduce self-injurious behavior (SIB): understimulation

goal: provide alt, safe, and engaging sensory input to reduce reliance on SIB

• offer access to stimulating activities

• build predictable routines w sensory-rich experiences to preempt self-stimulation

• teach alternative behaviors that serve the same sensory function (e.g., clapping, squeezing a stress ball)

• use positive reinforcement when the child engages in safe, stimulating alternatives

intervention design based on theory 2 if no or limited response to approach 1: overstimulation

goal: reduce env overload and teach regulation strategies to manage sensory input

• reduce noise, visual clutter, or unpredictable stimuli (e.g., noise-cancelling headphones, dim lighting)

• create quiet zones or offer calming activities (e.g., deep pressure, rhythmic movement)

• teach self-regulation strategies like breathing, requesting a break, or using visual supports

• help the child express discomfort or request help before escalation

special cognitive skills

a cognitive strength that is above average compared to the general population. often in visual-spatial reasoning, memory, pattern recognition, or attention to detail

savant talents

an isolated and remarkable ability that far exceeds age-matched peers and typical dev. often in music, art, calculation, calendar recall, or mechanical skills

why do autistic children not understand pretend play?

pretend play requires flexible thinking and symbolic representation — areas often impacted in autism

theory of mind + how do autistic children struggle w it?

theory of mind - the ability to understand that other have thoughts, feelings, and perspective different from one’s own

autistic indivs may have difficulty attributing mental states to others, leading to challenges in empathy, deception detection, or predicting behavior

what 2 things can help scaffold understanding

social scripts and explicit instruction

false-belief tasks + how do autistic children struggle w it?

assess whether a child understands that someone can hold a belief that is incorrect

autistic children struggle do to delays/differences in ToM development

autistic children have difficulty w executive functions, which includes

higher-order planning and regulatory behaviors

autistic children have difficulty in central coherence, which means

to interpret stimuli in a relatively global way to account for broader context

• autistic indivs tend to process info in bits and pieces rather than looking at the big picture

2 highly specific symptoms of ASD

• ToM deficits - difficulty understanding others’ beliefs, intentions, and emotions

• restricted and repetitive behaviors (RRBs) - includes stereotyped mvmts, insistence on sameness, and circumscribed interests

3 symptoms of ASD shared across other conditions

• EF deficits - challenges w planning, inhibition, cognitive flexibility

• socio-emotional processing difficulties - misreading social cues, emotional dysregulation, poor peer relationships

• sensory sensitivities - hyper or hyporeactivity to sensory input

social motivation theory

suggests that autistic children may have reduced intrinsic drive to engage socially

broader autism phenotype

social differences such as monotropic thinking style, preference for space from body proximity, direct language use, and preference for sameness and routine pragmatic language differences such as over-communicativeness or under-communicativeness; and limited verbal comprehension

4 shared co-occurring disorders btwn ASD and ADHD

• high rates of anxiety disorders

• learning disabilities

• oppositional and conduct problems

• mood disturbances

2 co-occurring disorders distinctive to ASD (less common in ADHD)

• IDD

• epilepsy

earliest point in dev at which ASD can be reliably detected

12-18 months

in the brain, does ASD result from any localized brain difference or from a lack of normal connectivity across brain network?

lack of normal connectivity

3 neurobiological causes

• cerebral gray and white matter overgrowth

• decreased blood flow in frontal and temporal lobes

• atypical patterns of connectivity in DMN

discrete trial training

step-by-step approach to presenting a stimulus and requiring a specific response

• controversial due to the use of punishment in its approach

incidental training

attempts to strengthen behavior by capitalizing on naturally occurring opportunities

AIM HI

evidence-based intervention program that’s a caregiver and child skill-building intervention, targets tantrums and aggressive behaviors

operant speech training

step-by-step approach that first increases the child’s vocalizations and then teaches imitation of sounds and words, the meaning of words, labeling objects, making verbal requests, and expressing desires, targets communication skills

there is a growing consensus that the most effective early interventions for autistic children include 7 characteristcs

• intensive: at least 25 hrs a week, 12 months a year

• low student-teacher ratio: one-on-one time

• high structure: use predictable routines, schedules, and boundaries

• family inclusion: include a family component

• peer interactions: promote opportunities for interactions

• generalization: teach child to apply learned skills

• ongoing assessment: monitor child’s progress and adjust

what kind of medications do autistic children receive?

psychotropic medication - antipsychotics, antidepressants, and stimulants