Chapter 6 – Autism Spectrum Disorder and Childhood-Onset Schizophrenia
Autism spectrum disorder (ASD)
Autism or autism spectrum disorder (ASD): a DSM-5 neurodevelopmental disorder
characterized by significant and persistent deficits in social communication and interaction
skills and restricted, repetitive patterns of behaviors, interests, or activities.
Historically, autism and childhood-onset schizophrenia (COS) were thought of as a single
condition. Subsequently, they came to be viewed as distinct disorders, with different family
histories, outcomes, and associated features. However, findings from recent studies using newer
research methods suggest that there may be more overlap between autism and COS than
previously thought.
Preservation of sameness: a characteristic of children with ASD who show an anxious and
obsessive insistence on the maintenance of sameness that no one but the child may disrupt.
Changes in daily routine, arrangement of objects, or the wording of requests, or the sight of
anything broken or incomplete will produce tantrums or despair.
Autism is nowadays recognized as a strongly biologically based lifelong neurodevelopmental
disorder that is present in the first few years of life.
• Children with ASD behave in unusual and frequently puzzling ways.
• Some children with ASD display extreme fear or avoidance of noisy or moving objects.
• Other children with ASD may have extraordinary perceptual abilities.
Autism Spectrum Disorder (ASD) – Section Summary
- ASD is DSM-5 neurodevelopmental disorder characterized by significant and persistent deficits in
social communication and interaction skills and restricted, repetitive patterns of behaviors,
interests, or activities.
- Historically, autism and COS were lumped together as a single condition; now recognized as
separate disorders, recent research suggests that there may be more overlap of the 2 disorders
than was previously thought.
- ASD has increasingly come to be recognized as a biologically based lifelong neurodevelopmental
disorder that is present in the first few years of life.
- Children with ASD behave in unusual and frequently puzzling ways.
- They may spend hours engaging in stereotyped or repetitive motor activities or focus on
minuscule details of their world rather than their entire environment.
DSM-5: Defining features of ASD
2 symptom domains of ASD:
1. Social communication and interaction
2. Restricted, repetitive patterns of behavior, interests, or activities
à The child must display symptoms in both domains to receive a diagnosis of ASD.
• Must be persistent, occur in multiple settings
• Must be present early in development
3 symptom types in the first category social communication and interaction:
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communication behaviors used for social interaction
3. Deficits in developing, maintaining and understanding relationships
4 symptom types in the category of restrictive and repetitive behaviors. At least two types are
required for an ASD diagnosis:
1. Stereotyped or repetitive motor movements, use of objects, or speech
, 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal
or nonverbal behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects
of the environment
ASD is defined as a spectrum disorder: a disorder whose symptoms, abilities, and characteristics
are expressed in many different combinations and in any degree of severity.
DSM-5: Defining Features of ASD – Section Summary
- In DSM-5, autism or ASD is a severe neurodevelopmental disorder with an onset in early
development, which is characterized by significant and persistent deficits in social interaction and
communication skills and by stereotyped patterns of behaviors, interests, and activities.
- ASD is a spectrum disorder, which means that is symptoms and characteristics are expressed in
many different combinations and in any degree of severity.
Core deficits of ASD
Social interaction and communication deficits
Children with ASD experience profound difficulties in relating to other people, imitating other’s
social behavior, sharing a focus of attention with others, and engaging in make-believe play.
• Children with ASD have limited social expressiveness and sensitivity to social cues,
impaired recognition of complex emotions and mental states in everyday life, and
experience little sharing of experiences or emotions with other people.
• They display atypical processing of faces and facial expressions.
• They display deficits in recognizing facial expressions of emotion, particularly in
detecting fear.
• They display impairments in joint attention: the ability to coordinate one’s focus of
attention on another person and an object of mutual interest.
• Most children with ASD are more responsive to their caregivers than to unfamiliar adults
• Children with ASD do not have a global deficit in their ability to form attachments.
• Children with ASD have difficulty processing emotional information contained in body
language, gestures, facial expressions, or voice.
Children with ASD display serious abnormalities in communication and language that appear
early in their development and persist.
• One of the first signs is the inconsistent use of early preverbal communications.
• Protoimperative gestures: gestures or vocalizations used to express needs, such as
pointing to an object that one desires but cannot reach.
• Protodeclarative gestures: gestures or vocalizations that direct the visual attention of
other people to objects of shared interests, such as pointing to a dog; done with the
prime purpose of engaging another person in interaction.
• Pronoun reversal: the repetition of personal pronouns exactly as heard, without
changing them according to the person being referred to. E.g., if asked “Are you hungry?”
one might reply, “You are hungry”, rather than, “I am hungry.”
• Pragmatics: the aspect of language that focuses on its appropriate use in social and
communicative contexts.
Restricted and repetitive behaviors and interests
Restricted and repetitive behaviors: behaviors that are characterized by their high frequency,
repetition in a fixed manner, and desire for sameness in the environment.
• Echolalia: a child’s immediate or delayed parrot-like repetition of words or word
combinations. This is a common type of repetitive speech in children with ASD.
Autism spectrum disorder (ASD)
Autism or autism spectrum disorder (ASD): a DSM-5 neurodevelopmental disorder
characterized by significant and persistent deficits in social communication and interaction
skills and restricted, repetitive patterns of behaviors, interests, or activities.
Historically, autism and childhood-onset schizophrenia (COS) were thought of as a single
condition. Subsequently, they came to be viewed as distinct disorders, with different family
histories, outcomes, and associated features. However, findings from recent studies using newer
research methods suggest that there may be more overlap between autism and COS than
previously thought.
Preservation of sameness: a characteristic of children with ASD who show an anxious and
obsessive insistence on the maintenance of sameness that no one but the child may disrupt.
Changes in daily routine, arrangement of objects, or the wording of requests, or the sight of
anything broken or incomplete will produce tantrums or despair.
Autism is nowadays recognized as a strongly biologically based lifelong neurodevelopmental
disorder that is present in the first few years of life.
• Children with ASD behave in unusual and frequently puzzling ways.
• Some children with ASD display extreme fear or avoidance of noisy or moving objects.
• Other children with ASD may have extraordinary perceptual abilities.
Autism Spectrum Disorder (ASD) – Section Summary
- ASD is DSM-5 neurodevelopmental disorder characterized by significant and persistent deficits in
social communication and interaction skills and restricted, repetitive patterns of behaviors,
interests, or activities.
- Historically, autism and COS were lumped together as a single condition; now recognized as
separate disorders, recent research suggests that there may be more overlap of the 2 disorders
than was previously thought.
- ASD has increasingly come to be recognized as a biologically based lifelong neurodevelopmental
disorder that is present in the first few years of life.
- Children with ASD behave in unusual and frequently puzzling ways.
- They may spend hours engaging in stereotyped or repetitive motor activities or focus on
minuscule details of their world rather than their entire environment.
DSM-5: Defining features of ASD
2 symptom domains of ASD:
1. Social communication and interaction
2. Restricted, repetitive patterns of behavior, interests, or activities
à The child must display symptoms in both domains to receive a diagnosis of ASD.
• Must be persistent, occur in multiple settings
• Must be present early in development
3 symptom types in the first category social communication and interaction:
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communication behaviors used for social interaction
3. Deficits in developing, maintaining and understanding relationships
4 symptom types in the category of restrictive and repetitive behaviors. At least two types are
required for an ASD diagnosis:
1. Stereotyped or repetitive motor movements, use of objects, or speech
, 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal
or nonverbal behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects
of the environment
ASD is defined as a spectrum disorder: a disorder whose symptoms, abilities, and characteristics
are expressed in many different combinations and in any degree of severity.
DSM-5: Defining Features of ASD – Section Summary
- In DSM-5, autism or ASD is a severe neurodevelopmental disorder with an onset in early
development, which is characterized by significant and persistent deficits in social interaction and
communication skills and by stereotyped patterns of behaviors, interests, and activities.
- ASD is a spectrum disorder, which means that is symptoms and characteristics are expressed in
many different combinations and in any degree of severity.
Core deficits of ASD
Social interaction and communication deficits
Children with ASD experience profound difficulties in relating to other people, imitating other’s
social behavior, sharing a focus of attention with others, and engaging in make-believe play.
• Children with ASD have limited social expressiveness and sensitivity to social cues,
impaired recognition of complex emotions and mental states in everyday life, and
experience little sharing of experiences or emotions with other people.
• They display atypical processing of faces and facial expressions.
• They display deficits in recognizing facial expressions of emotion, particularly in
detecting fear.
• They display impairments in joint attention: the ability to coordinate one’s focus of
attention on another person and an object of mutual interest.
• Most children with ASD are more responsive to their caregivers than to unfamiliar adults
• Children with ASD do not have a global deficit in their ability to form attachments.
• Children with ASD have difficulty processing emotional information contained in body
language, gestures, facial expressions, or voice.
Children with ASD display serious abnormalities in communication and language that appear
early in their development and persist.
• One of the first signs is the inconsistent use of early preverbal communications.
• Protoimperative gestures: gestures or vocalizations used to express needs, such as
pointing to an object that one desires but cannot reach.
• Protodeclarative gestures: gestures or vocalizations that direct the visual attention of
other people to objects of shared interests, such as pointing to a dog; done with the
prime purpose of engaging another person in interaction.
• Pronoun reversal: the repetition of personal pronouns exactly as heard, without
changing them according to the person being referred to. E.g., if asked “Are you hungry?”
one might reply, “You are hungry”, rather than, “I am hungry.”
• Pragmatics: the aspect of language that focuses on its appropriate use in social and
communicative contexts.
Restricted and repetitive behaviors and interests
Restricted and repetitive behaviors: behaviors that are characterized by their high frequency,
repetition in a fixed manner, and desire for sameness in the environment.
• Echolalia: a child’s immediate or delayed parrot-like repetition of words or word
combinations. This is a common type of repetitive speech in children with ASD.
