Chapter 12 Pervasive Developmental Disorders and Schizophrenia TRUE OR FALSE 1. Autism is classified by the DSM IV as a pervasive psychotic disorder. Answer: False 2. Autism spectrum disorder includes autism, childhood disintegrative disorder, and childhood schizophrenia. Answer: False 3. According to Kanner, the fundamental disturbance in autism is the inability to relate to people. Answer: True 4. The three DSM-IV diagnostic features of autism are impaired communication, impaired social interaction, and restricted, stereotyped behaviors and interests. Answer: True 5. By definition, children with autism have insecure attachment. Answer: False 6. Although language deficits are common in youth with autism, those who acquire language are especially competent in the pragmatics of communication. Answer: False 7. Hyperlexia is when a child reads for hours on end in the form of an obsessive hobby. Answer: False 8. A youth who is disturbed by the sound of a vacuum cleaner may be displaying oversensitivity to stimuli. Answer: True 9. Jimmy is shown a toy car. He hyper-focuses on the wheels spinning them round and round. He does not use the car as a toy and ignores a role model trying to show him how to move the car around on the ground. This is an example of over selectivity. Answer: True 10. Approximately 70% of children with autism exhibit intellectual disability. Answer: False 11. Splinter skills are skills that are strikingly better than those seen in normally developing youth. Answer: True 12. On adaptive behavior scales, youth with autism and higher intelligence tend to have a mismatch between their intellectual abilities and their adaptive skills (adaptive skills lower than expected). Answer: True 13. Faux pas stories are designed to test adaptive behavior. Answer: False 14. Another term for theory of mind is mindblindness. Answer: True 15. There is evidence that youth with autism tend to process perceptual information in a more holistic, global way than do nonautistic children. Answer: False 16. Executive dysfunction is evident in toddlers and late preschool-age children with autism. Answer: False 17. Research by Totsika et al., (2011) found no differences in hyperactivity, emotional symptoms, or conduct problems between youth with autism and typically developing youth. Answer: False 18. The theory that “refrigerator” parenting causes autism is no longer accepted. Answer: True 19. Genetic studies imply that autism should be considered on a continuum (varying levels of severity) rather than conceptualized as categorical (yes or no). Answer: True 20. Advanced paternal age can increase the risk of autism. Answer: True 21. Later born children (e.g., third or fourth in a family) are more likely to have autism. Answer: False 22. About 25% of those with autism have seizure disorder. Answer: True 23. Current research supports the idea that the MMR vaccine is a possible cause of autism. Answer: False 24. Compared to autism, Asperger’s disorder has a later age of onset. Answer: True 25. Social behavior in youth with Asperger’s disorder tends to be active and odd; whereas in autism it is passive and aloof. Answer: True 26. According to the case study on Nicholas, the young boy with childhood disintegrative disorder, at 48 months of age his repetitive behaviors ceased, his social gaze increased and his spontaneous language remained the same. Answer: False 27. A “wait and see” approach to assessment of autism is recommended by the American Medical Association. Answer: False 28. The Autism Diagnostic Observation Schedule (ADOS) is sensitive to the differences between autism and PDD-NOS. Answer: True 29. Research on the Early Start Denver Model (ESDM), an early intervention program for autism, found that toddlers in the program demonstrated better adaptive skills than children who did not have intervention, but did not improve on language performance. Answer: False 30. Risperidone is used to reduce irritability, aggression, self-injury and temper tantrums. Answer: True 31. Goals for the first 2 to 4 weeks of treatment in the Young Autism Project included imitating speech sounds, labeling objects, and expanding self-help skills. Answer: False 32. Schriebman’s (2000) summary of well established facts notes that intensive treatments for many hours a day and in many environments can be extremely effective. Answer: True 33. Nearly 40% of young adults with autism receive no services during the first few years after high school. Answer: True 34. A majority of schizophrenia cases are diagnosed before age 10. Answer: False 35. Hallucinations are false perceptions that occur in the absence of identifiable stimuli. Answer: True 36. Hearing a command such as “murder your mother” is an example of a delusion. Answer: False 37. When applied to schizophrenia, the term thought disorder refers to false beliefs such as the belief that someone intends to bring harm. Answer: False 38. With regard to the onset of childhood schizophrenia, nonpsychotic symptoms often occur prior to psychotic symptoms. Answer: True 39. A majority of children and adolescents with schizophrenia have good outcomes with only mild impairments. Answer: False 40. Schizophrenia is associated with risk for premature death. Answer: True 41. A relatively common finding is that the brain ventricles are larger than average in persons with schizophrenia. Answer: True 42. The COMT gene (chromosome 22) is implicated in dopamine regulation. Answer: True 43. Birth complications have been associated with enlarged ventricles. Answer: True 44. There is little evidence that psychosocial stress contributes to schizophrenia. Answer: False 45. Early identification and treatment has little impact on the outcome for schizophrenia. Answer: False 46. Clozapine, an anti-psychotic medication that is especially effective for children and adolescents with schizophrenia, carries a greater risk for serious side effects than other anti-psychotics. Answer: True MULTIPLE CHOICE 47. Who is credited with first describing infantile autism as a disorder different from other childhood disorders? A. Kanner B. Kraepelin C. Lovaas D. Rett Answer: A 48. The DSM-IV classifies autistic disorder under the category of A. Childhood Disintegrative Disorders. B. Childhood Psychoses. C. Childhood Schizophrenias. D. Pervasive Developmental Disorders. Answer: D 49. Which of the following is most likely for a very young child with autism? A. They are overly visually responsive. B. They often fail to respond to their names. C. They crave touch and will often cling to their mothers. D. They have an expressive gaze, even if they are mute. Answer: B 50. Autistic children have been found to show deficits in joint attention interactions. A clear example of a joint attention interaction is A. expressing friendship by hugging a person. B. expressing a command verbally by saying "be quiet." C. showing especially high interest in a stimulus, for example, by visually attending to it. D. drawing someone’s attention to an object by pointing to it. Answer: D 51. Kevin’s doctor is evaluating him for symptoms of autism. The doctor asks Kevin, “How are you today?” Kevin says, “How are you today?” This is possibly a sign of A. repetitive behavior. B. vocal tics. C. echolalia. D. low intelligence. Answer: C 52. Kyle’s doctor is evaluating him for symptoms of autism. The doctor asks Kyle, “How are you today?” Kyle says, “He is fine.” This might be a sign of A. morphological deficits. B. expressive language disorder. C. auditory processing disorder. D. pronoun reversal. Answer: D 53. About what percent of children with autism do not develop spoken language? A. 30 B. 50 C. 65 D. 85 Answer: A 54. Lower level repetitive sensorimotor behaviors include: A. an obsession with numbers. B. toe walking. C. hoarding. D. over focus on hobbies. Answer: B 55. With regard to the intelligence test performance of children with autism, A. there is relative strength in visual-spatial ability. B. there is relative strength in verbal ability. C. scores are remarkably even across the different kinds of tasks. D. most children with autism score somewhat above average. Answer: A 56. _________ is the ability to infer mental states in others and in one’s self. A. Joint attention B. Pragmatic communication C. Central coherence D. Theory of mind Answer: D 57. By what age do children typically have first-order theory of mind abilities? A. 6 months B. 12 months C. 1 to 2 years D. 3 to 4 years Answer: D 58. Brent appears to understand that Jim can understand some of what Ted is thinking. Brent thus seems to have which ability? A. First-order theory of mind B. Second-order theory of mind C. First-order inhibition D. Second-order inhibition Answer: B 59. Deficiencies in central coherence are demonstrated by children’s inability to A. plan ahead when problem solving. B. pay attention to the task at hand. C. integrate parts into wholes. D. become attached to their caretakers. Answer: C 60. On the Wechsler intelligence measure, Kendra, who has autism, performs in the superior range on block design and the impaired range on every other subtest. This is indicative of her being able to see parts of design. However, this means she make be weak in A. verbal abilities. B. theory of the mind. C. central coherence. D. splinter skills. Answer: C 61. _________ is a special awareness that persons have of each other that motivates them to communicate with the emotions and interests of others. A. Intersubjectivity B. Empathy C. Sympathy D. Objectivity Answer: A 62. Which of the following is true regarding children with autism? A. They are more likely to exhibit minor physical anomalies B. If they are clumsy (which is rare), they usually outgrow it my age 8 C. They are good eaters D. They are less likely than typically developing youth to exhibit sleep problems Answer: A 63. Which of the following is true regarding the prevalence of autism? A. The CDC (2012) indicates that 1 in 88 U.S. children has been diagnosed with autism B. Males and females are equally likely to be diagnosed with autism C. Autism is more prevalent in upper social classes D. U.S. African American children are more likely to be diagnosed with autism Answer: A 64. Research on the developmental course of autism has revealed that A. for most children the symptoms of autism are not evident until about age 6. B. regression occurs in less than 5% of cases. C. symptoms rarely persist into adulthood and most individuals with autism live independently. D. higher intellectual ability is associated with better outcomes. Answer: D 65. Which of the following parts of the brain has been especially implicated in autism? A. Medulla B. Temporal lobe-limbic system C. Pituitary gland D. Hypothalamus Answer: B 66. Which has been found with regard to autism? A. Low levels of serotonin in blood platelets B. Unusually large brain size in toddlers C. Reduced volume of gray and white tissue in the cerebellum D. Elevated activity in the amygdala Answer: B 67. In regard to genetics, which of the following is true? A. The concordance rate is higher in dizygotic twin pairs. B. The rate of autism in the siblings of a child with autism is about the same as the rate in the general population. C. A higher than expected rate for all pervasive developmental disabilities is found in families of children with autism. D. Adoption studies have not supported a genetic relationship in autism. Answer: C 68. Asperger’s disorder is characterized by: A. significant language delay. B. deficits in intelligence. C. problems in social interaction. D. adaptive behavior deficits in all areas. Answer: C 69. Which clinical manifestation best differentiates autism and Asperger’s disorder? A. Language skills B. Stereotypic behaviors C. Social impairments D. Restricted interests Answer: A 70. Which pervasive developmental disorder is often viewed as high-functioning, or mild, autism? A. Childhood disintegrative disorder B. Asperger’s disorder C. Tuberous sclerosis D. Rett’s disorder Answer: B 71. PDD-NOS is diagnosed when A. the child has impaired communication but strong social interaction skills. B. the child is female with early onset. C. the child shows a regressive pattern in development. D. the child has impaired social interaction and either impaired communication or stereotyped behavior. Answer: D 72. Which of the following is true regarding childhood disintegrative disorder? A. This diagnosis is more common than autism. B. The impairments are generally mild compared to other pervasive developmental disorders. C. These children are more likely to be mute and have very low IQ scores. D. These children tend to improve over time. Answer: C 73. Shanda developed normally the first few months of life, but by 18 months she had slowed head growth and stereotyped hand movements. She became socially disengaged and lost language. Genetic testing revealed a mutation in the MECP2 gene. Shanda has A. autism. B. PDD-NOS. C. childhood disintegrative disorder. D. Rett syndrome. Answer: D 74. Treatment of autism with traditional antipsychotic medications A. may result in adverse motor side effects. B. is the primary treatment for this disorder. C. aims at reducing levels of the opiates. D. has proven to be effect for adolescents and adults with autism. Answer: A 75. In regard to Pivotal Response Treatment (PRT), which of the following is true? A. Reducing aggression is the key component. B. Intervention occurs in naturalistic settings and involves parents and teachers. C. Activities are selected by the adult based on what the child needs to learn. D. Treatment gains have occurred for targeted behaviors only. Answer: B 76. The Young Autism Project A. found that participants receiving less than 10 hours a week of treatment performed as well as participants receiving 40 hours a week of treatment. B. found no differences in IQ between participants receiving treatment and those not receiving treatment. C. found that treatment gains were maintained for children who had received more intensive training. D. found that all of the participants benefited from the treatment. Answer: C 77. The TEACCH intervention program A. was initiated by professionals committed to psychoanalytic treatment. B. is designed primarily for preschool-age children. C. is widely recognized as having the strongest scientific design for evaluation research. D. is a comprehensive education, family, and community intervention for autistic children. Answer: D 78. With regard to the education of children with autism, A. the TEACCH program is now mandated by the federal government. B. there is wide agreement that full school inclusion is the best setting. C. autism is not included in the Individuals with Disabilities Education Act. D. peers can be active participants in intervention and model good social behavior. Answer: D 79. An example of a negative symptom of schizophrenia is A. a hallucination. B. lack of goal-directed activity. C. disorganized, loose speech. D. a delusion. Answer: B 80. An example of a positive symptom of schizophrenia is A. lack of emotion. B. lack of goal-directed behavior. C. disorganized speech. D. language that contains little information. Answer: C 81. Which kind of hallucination is most common in youth with schizophrenia? A. Auditory B. Touch C. Visual D. Smell Answer: A 82. Tory believes he has special powers that make him strong like the Incredible Hulk or the X-men. This is an example of A. a complex hallucination. B. a command hallucination. C. a grandiose delusion. D. thought disorder. Answer: C 83. Neologisms and loose associations are evidence of A. language impairment. B. hallucinations. C. delusions. D. thought disorder. Answer: D 84. Which of the following is true regarding the secondary features of childhood schizophrenia? A. Motor abnormalities are rare. B. Impaired communication is common. C. Intelligence scores tend to average to above average. D. Negative symptoms are less likely to occur compared to adult onset schizophrenia. Answer: B 85. In regard to epidemiology A. childhood onset schizophrenia is more common than adolescent or adult onset schizophrenia. B. childhood onset schizophrenia is more common in boys. C. research clearly demonstrates that childhood onset schizophrenia more common in less educated families. D. schizophrenia is evident only in westernized cultures. Answer: B 86. When schizophrenia occurs in childhood, A. it has more favorable prognosis than later-occurring cases. B. it usually occurs abruptly. C. hallucinations are identical to those found in adult schizophrenia. D. the severity of symptoms tends to be higher than in adult schizophrenia. Answer: D 87. Negative symptoms have been associated with: A. increased frontal lobe activity. B. enlarged ventricles. C. a highly reactive autonomic nervous system. D. cerebellum dysfunction. Answer: B 88. Which structural brain anomaly is found in schizophrenia? A. Densely packed neurons with fewer synaptic connections B. Increased volume of several areas, such as the thalamus and frontal areas C. Accelerated growth during childhood in a front to back (of the brain) pattern D. There are no brain anomalies in children with schizophrenia Answer: A 89. Genetic studies of adult schizophrenia indicate A. a 40 percent risk for youth with one schizophrenic parent. B. a concordance rate of 90 percent in identical twins. C. that inheritance does not fully account for the disorder. D. that single-gene inheritance rather than multiple genes are more likely involved in the disorder. Answer: C 90. With regard to the assessment of schizophrenia in youth, A. it is especially difficult to evaluate hallucinations and delusions in young children. B. medical evaluation has no reasonable place in assessment. C. the presence of distorted perceptions is a clear sign of schizophrenia in young children. D. assessment of adolescents for the disorder is more difficult than assessment of children. Answer: A 91. Which is true with regard to the psychopharmacological treatment of youth with schizophrenia? A. Medications are largely ineffective for youth with schizophrenia B. Typical antipsychotic medications tend to reduce negative but not positive symptoms. C. Atypical antipsychotic medications are promising but they have greater adverse motor effects than typical antipsychotic medications. D. The side effects associated with medications may lead patients to discontinue use. Answer: D BRIEF ESSAY QUESTIONS 92. According to the DSM-IV, what are the three major behavioral manifestations of autistic disorder? Describe these behaviors. Answer: According to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), the three major behavioral manifestations of autistic disorder are: 1. Qualitative impairment in social interaction: This includes a lack of social or emotional reciprocity, such as not engaging in back-and-forth conversation, sharing interests or emotions, and a failure to develop peer relationships appropriate to developmental level. There may also be a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people. 2. Qualitative impairments in communication: This can manifest as a delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime), marked impairment in the ability to initiate or sustain a conversation with others, stereotyped and repetitive use of language or idiosyncratic language, and lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level. 3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities: This includes encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus, adherence to specific, nonfunctional routines or rituals, stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements), and persistent preoccupation with parts of objects. These behaviors are typically evident before the age of three and significantly impair social, occupational, or other important areas of functioning. 93. Distinguish between splinter skills and savant skills. Answer: Splinter skills and savant skills are both terms used to describe certain abilities or behaviors that can be observed in individuals with autism spectrum disorder (ASD), but they represent different phenomena: 1. Splinter Skills: Splinter skills refer to areas of ability that are significantly better developed than the person's overall level of functioning. These skills are often seen as "islands of ability" within a sea of deficits. For example, a person with ASD may have exceptional memory for certain types of information, such as trivia or specific facts, while struggling with other cognitive tasks. 2. Savant Skills: Savant skills are exceptional abilities or areas of expertise that are far beyond what would be considered normal, even in the general population. Savant skills are often seen in individuals with ASD but are relatively rare. These skills can include extraordinary memory, artistic talent, mathematical ability, or musical ability. Savant skills are typically accompanied by significant challenges in other areas of functioning. In summary, splinter skills are areas of relative strength within the individual's overall profile of abilities, while savant skills are exceptional abilities that are rare and far beyond what would be expected based on the individual's overall level of functioning. 94. What is theory of mind? In what way is theory of mind considered important to the functioning of children with autism? Answer: Theory of mind refers to the ability to attribute mental states—beliefs, intents, desires, emotions, knowledge—to oneself and others, and to understand that others have beliefs, desires, intentions, and perspectives that are different from one's own. It allows individuals to understand and predict behavior based on these mental states. Theory of mind is considered important to the functioning of children with autism because deficits in theory of mind are a core feature of the disorder. Children with autism often have difficulty understanding that others have different thoughts, beliefs, and perspectives than their own. This can lead to challenges in social interactions, as they may have difficulty interpreting social cues, understanding others' emotions, and engaging in reciprocal social interactions. The inability to understand and predict others' behavior based on their mental states can also impact communication and relationships. For example, a child with autism may not understand why a peer is upset, leading to difficulties in offering comfort or support. Similarly, they may have trouble understanding sarcasm or humor, which can affect their ability to engage in social interactions effectively. Interventions aimed at improving theory of mind in children with autism can help enhance their social skills, improve their ability to interpret and respond to social cues, and facilitate more successful social interactions. 95. What is weak central coherence? How does this impact an individual with autism? Answer: Weak central coherence is a concept used to describe a cognitive style where individuals focus on details rather than the overall context or meaning of information. This can manifest as a tendency to pay attention to small, isolated parts of a stimulus while missing the larger picture or context. In individuals with autism, weak central coherence is often observed as a cognitive processing style. They may excel at processing and remembering details but struggle with tasks that require integrating information into a coherent whole. This cognitive style can impact various aspects of their functioning: 1. Social Communication: Weak central coherence can affect how individuals with autism process social information. They may focus on individual words or phrases in conversation, missing the overall meaning or intent behind the communication. This can lead to difficulties in understanding non-literal language, such as sarcasm or idioms. 2. Learning and Academics: In academic settings, weak central coherence can result in difficulties with tasks that require understanding the main idea or theme, such as summarizing a passage or identifying the main point of a lecture. Instead, individuals may become overly focused on details, which can impact their ability to grasp the broader concepts being presented. 3. Repetitive Behaviors: Some repetitive behaviors commonly seen in individuals with autism, such as lining up objects or repeating certain phrases, may be related to weak central coherence. These behaviors may reflect a need for predictability and a focus on individual details rather than the overall context of a situation. 4. Strengths and Abilities: Despite the challenges it presents, weak central coherence can also be associated with strengths in certain areas. Individuals with autism may demonstrate exceptional abilities in tasks that require attention to detail, such as pattern recognition, memorization, or certain types of problem-solving. Overall, understanding and addressing weak central coherence can be important in supporting individuals with autism in various aspects of their lives, including social interactions, learning, and daily functioning. Strategies that help individuals integrate details into a broader context, such as visual supports or structured routines, can be beneficial in addressing this cognitive style. 96. Discuss the issues surrounding autism and prevalence rate. What may account for the steadily increasing rates? Answer: The prevalence of autism spectrum disorder (ASD) has been a topic of significant interest and debate in recent years. There are several issues surrounding the prevalence rate of autism, including the way it is diagnosed, changes in diagnostic criteria over time, increased awareness and screening, and potential environmental factors. 1. Diagnostic Criteria: The definition of autism and the diagnostic criteria used to identify individuals with the disorder have evolved over time. The broadening of the diagnostic criteria, especially with the introduction of the term "autism spectrum disorder" in the DSM-5, has led to more individuals being diagnosed with ASD. 2. Increased Awareness and Screening: There has been a significant increase in awareness of autism in recent years, leading to more parents, teachers, and healthcare providers recognizing the signs and symptoms of the disorder. Increased awareness has also led to more widespread screening and evaluation, resulting in more individuals being diagnosed. 3. Changes in Reporting Practices: Changes in how data on autism prevalence are collected and reported can also impact the perceived prevalence rate. For example, improvements in record-keeping and data collection practices can result in more accurate and complete reporting of cases. 4. Environmental Factors: Some researchers have suggested that environmental factors, such as exposure to certain chemicals or pollutants, may play a role in the increasing rates of autism. However, more research is needed to understand the potential impact of these factors. 5. Other Factors: There are also other factors that may contribute to the increasing rates of autism, such as genetic predisposition and the interaction between genetic and environmental factors. Additionally, factors such as access to healthcare and diagnostic services can influence the prevalence rate by affecting the likelihood of individuals being diagnosed. Overall, the increasing prevalence of autism is likely due to a combination of factors, including changes in diagnostic criteria, increased awareness and screening, changes in reporting practices, and potential environmental factors. It is important to continue research in this area to better understand the factors contributing to the rising rates of autism and to improve early detection and intervention strategies. 97. What is the controversy associated with vaccines and autism? What does the current research indicate about these concerns? Answer: The controversy surrounding vaccines and autism stems from a now-discredited study published in 1998 that suggested a link between the MMR (measles, mumps, and rubella) vaccine and the development of autism. Despite the study being widely discredited and retracted due to serious methodological flaws and ethical concerns, the idea that vaccines, particularly the MMR vaccine, could cause autism has persisted in some communities. Current research overwhelmingly supports the safety and effectiveness of vaccines, including the MMR vaccine, and has consistently found no link between vaccines and autism. Numerous large-scale studies involving hundreds of thousands of children have found no association between vaccines and autism. The overwhelming scientific consensus is that vaccines do not cause autism. The consequences of the vaccine-autism controversy have been significant, leading to a decrease in vaccination rates in some communities and subsequent outbreaks of vaccine-preventable diseases. Public health officials and medical professionals continue to emphasize the importance of vaccines in preventing serious and potentially life-threatening diseases and urge parents to follow the recommended vaccination schedule for their children. 98. Discuss the Dawson and Faja (2008) developmental model of autism. What are the genetic and environmental factors that contribute to autism? Answer: Dawson and Faja (2008) proposed a developmental model of autism that emphasizes the early emerging behavioral features of the disorder and how they impact later development. The model highlights the importance of understanding the early developmental trajectory of autism and how it can inform interventions and support strategies. The Dawson and Faja model suggests that early impairments in social attention and engagement, as well as repetitive and stereotyped behaviors, are core features of autism that emerge within the first few years of life. These early deficits can lead to disruptions in the development of higher-order cognitive and social skills, such as language, theory of mind, and social cognition. The model also suggests that there is considerable heterogeneity in the developmental trajectories of individuals with autism, with some showing improvement over time and others experiencing more persistent difficulties. Genetic factors play a significant role in the development of autism, with estimates suggesting that genetic factors account for around 80% of the risk. Several genes have been implicated in autism, and research suggests that there is a complex interplay between multiple genetic variants that contribute to the disorder. Environmental factors also play a role, though their contribution is less well understood. Factors such as prenatal exposure to certain chemicals or medications, maternal health during pregnancy, and birth complications have been studied as potential environmental risk factors for autism. Overall, the Dawson and Faja model highlights the importance of early identification and intervention for children with autism, as well as the need for personalized approaches that take into account the heterogeneity of the disorder. Understanding the genetic and environmental factors that contribute to autism can help inform early intervention strategies and support services for individuals with autism and their families. 99. Compare the diagnostic and clinical features of autism, Rett’s disorder, childhood disintegrative disorder, and Asperger’s disorder. Answer: Autism, Rett's disorder, childhood disintegrative disorder, and Asperger's disorder are all classified as autism spectrum disorders (ASDs), but they have distinct diagnostic and clinical features. Here is a comparison of their key characteristics: 1. Autism Spectrum Disorder (ASD): • Diagnostic Criteria: Characterized by persistent deficits in social communication and social interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. • Clinical Features: Individuals with ASD may have difficulty with social interactions, communication, and behavior. They may also exhibit sensory sensitivities and engage in repetitive behaviors. 2. Rett's Disorder: • Diagnostic Criteria: Primarily affects females and is characterized by a period of normal development followed by a loss of acquired skills, particularly in motor and language abilities. • Clinical Features: Individuals with Rett's disorder often experience a regression in skills, such as loss of purposeful hand skills and the development of repetitive hand movements. They may also have breathing irregularities, cognitive impairment, and seizures. 3. Childhood Disintegrative Disorder (CDD): • Diagnostic Criteria: Rare condition characterized by a significant loss of previously acquired skills, such as language, social, and motor skills, after a period of normal development. • Clinical Features: Children with CDD typically exhibit a marked regression in multiple areas of functioning, including language, social skills, and bowel or bladder control. They may also show repetitive behaviors and have difficulty with social interactions. 4. Asperger's Disorder: • Diagnostic Criteria: Characterized by difficulties in social interaction and restricted, repetitive patterns of behavior, but without significant language or cognitive delays. • Clinical Features: Individuals with Asperger's disorder may have average to above-average intelligence and often have a strong interest in specific topics. They may have difficulty understanding social cues and norms, leading to challenges in social interactions. In summary, while all four disorders are classified as ASDs, they have distinct diagnostic criteria and clinical features. Autism is characterized by deficits in social communication and interaction, Rett's disorder by a period of normal development followed by regression, childhood disintegrative disorder by a significant loss of skills after normal development, and Asperger's disorder by difficulties in social interaction without significant language delays. 100. Assume you are a clinical psychologist who suspects autistic disorder in a 6-year-old child. How would you proceed in assessment for this disorder? Answer: As a clinical psychologist suspecting autistic disorder in a 6-year-old child, I would proceed with a comprehensive assessment to determine if the child meets the criteria for autism spectrum disorder (ASD). This assessment would typically involve the following steps: 1. Initial Interview: Conduct an interview with the child's parents or caregivers to gather information about the child's developmental history, including any concerns or observations related to social communication, behavior, and developmental milestones. 2. Observation: Observe the child in various settings, such as at home, in school, or during play, to assess their social interactions, communication skills, and repetitive behaviors. 3. Standardized Assessments: Administer standardized assessments, such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS), which are specifically designed to assess for ASD. 4. Developmental and Cognitive Testing: Conduct developmental and cognitive testing to assess the child's overall development and intellectual functioning. 5. Speech and Language Assessment: Evaluate the child's speech and language skills to assess for any deficits or delays in communication. 6. Behavioral Assessment: Assess for any repetitive behaviors, restricted interests, or sensory sensitivities that are characteristic of ASD. 7. Medical Evaluation: Consider referring the child for a medical evaluation to rule out any underlying medical conditions that may be contributing to their symptoms. 8. Collateral Information: Gather information from other sources, such as teachers or other caregivers, to obtain a comprehensive understanding of the child's behavior and functioning across different settings. Based on the results of these assessments, I would then determine if the child meets the criteria for ASD according to the DSM-5 and provide recommendations for intervention and support. This may include behavioral therapies, speech and language therapy, and educational interventions tailored to the child's specific needs. 101. Describe the Early Start Denver Model. What does the outcome data tell us about the effectiveness of that program? Answer: The Early Start Denver Model (ESDM) is an early intervention program designed for young children (ages 12-48 months) with autism spectrum disorder (ASD). It combines developmental and behavioral approaches, with a focus on providing intensive, individualized therapy in a naturalistic and play-based setting. The goal of ESDM is to promote social communication, language, and cognitive skills, as well as reduce the core symptoms of ASD. Key components of the Early Start Denver Model include: 1. Naturalistic and Developmental: ESDM uses naturalistic teaching strategies that are embedded into everyday activities and routines. It also incorporates principles of developmental psychology to tailor interventions to the child's individual developmental level. 2. Joint Attention and Social Engagement: The program emphasizes the development of joint attention skills, which are important for social interactions and communication. It also focuses on promoting social engagement and interaction with others. 3. Parent Involvement: ESDM involves parents as active participants in therapy sessions and provides them with training and support to implement strategies at home. 4. Intensive and Individualized: The program is typically delivered in a one-on-one format, with therapists providing intensive, individualized intervention based on the child's unique strengths and needs. Research on the Early Start Denver Model has shown promising results in terms of its effectiveness in improving outcomes for children with ASD. Several studies have reported significant improvements in areas such as social communication, language development, and cognitive skills following participation in ESDM. For example, a randomized controlled trial published in 2010 found that children who received ESDM showed greater improvements in IQ, language, and adaptive behavior compared to children who received community interventions. Overall, the outcome data suggest that the Early Start Denver Model can be an effective early intervention approach for young children with autism spectrum disorder, particularly when delivered intensively and early in development. 102. Briefly describe the Young Autism Project, including treatment stages and outcome data. Answer: The Young Autism Project (YAP) was one of the earliest intensive behavioral intervention programs for children with autism, developed by Dr. O. Ivar Lovaas in the 1970s. The treatment was based on applied behavior analysis (ABA) principles and aimed to teach language, social, and daily living skills to children with autism. The treatment stages typically included: 1. Assessment: A comprehensive assessment of the child's skills and deficits was conducted to develop an individualized treatment plan. 2. Intensive Behavioral Intervention (IBI): This involved one-on-one sessions between a therapist and the child, focusing on teaching specific skills such as language, social interaction, and daily living skills. The therapy was highly structured and intensive, often involving 20-40 hours per week. 3. Generalization: Skills learned in therapy were practiced and generalized to different settings and people to ensure they were maintained over time. 4. Parent Training: Parents were trained to continue the therapy techniques at home and to support their child's ongoing development. Outcome data from the YAP and similar ABA-based early intervention programs have shown significant improvements in language skills, IQ, adaptive behavior, and social skills in children with autism. Many children who received early intensive behavioral intervention in programs like the YAP showed substantial gains and were able to transition to mainstream education with reduced support. 103. Briefly describe the TEACCH psychoeducational treatment of autism. Answer: The Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is a structured program developed by the University of North Carolina at Chapel Hill for individuals with autism spectrum disorder (ASD). TEACCH is based on the idea that individuals with ASD benefit from structured environments and visual cues. Key features of TEACCH include: 1. Structured Environment: TEACCH emphasizes the use of structured and organized physical environments to help individuals with ASD understand and predict their surroundings. 2. Visual Supports: Visual supports, such as visual schedules, task organization systems, and visual cues, are used to enhance understanding and communication. 3. Individualized Programming: TEACCH emphasizes individualized programming tailored to the strengths and needs of each person with ASD. 4. Functional Skills Development: The program focuses on developing functional skills that are relevant to daily life, such as self-care, communication, and social skills. 5. Parent and Professional Training: TEACCH provides training for parents and professionals to implement the program's strategies effectively. Outcome data for TEACCH has shown improvements in adaptive behavior, communication skills, and independence in individuals with ASD. The program is widely used and has been adapted for use in schools, homes, and community settings around the world. 104. What are the pros and cons of including children with autism in mainstream classrooms? Answer: Pros: 1. Social Interaction: Inclusion in mainstream classrooms can provide children with autism opportunities for social interaction with typically developing peers, which can improve social skills and promote acceptance and understanding among classmates. 2. Academic Progress: Some children with autism may benefit academically from being in a mainstream classroom, as they have access to the general education curriculum and may receive more individualized instruction and support. 3. Peer Modeling: Being in a mainstream classroom allows children with autism to observe and learn from their peers, potentially improving their communication, behavior, and academic skills. 4. Inclusive Environment: Inclusion promotes a sense of belonging and acceptance for children with autism, fostering positive self-esteem and emotional well-being. Cons: 1. Social Challenges: Mainstream classrooms can be overwhelming for some children with autism, leading to difficulties in social interaction, making friends, and coping with social expectations. 2. Academic Challenges: The general education curriculum may be too advanced or fast-paced for some children with autism, leading to academic struggles and frustration. 3. Behavioral Issues: Children with autism may experience behavioral challenges in mainstream classrooms, such as difficulty following instructions, sensory sensitivities, and emotional outbursts, which can disrupt learning for themselves and others. 4. Resource Strain: Inclusion may require additional resources and support, such as specialized teachers, aides, and accommodations, which can strain school budgets and personnel. In conclusion, while inclusion in mainstream classrooms can offer numerous benefits for children with autism, it also presents challenges that need to be carefully considered and addressed to ensure a successful and positive experience for all students. 105. Describe the secondary symptoms of schizophrenia. What motor, communication, cognitive and emotional impairments are evident? Answer: Schizophrenia is a complex mental disorder that can manifest in a variety of symptoms, including secondary symptoms that impact motor functioning, communication, cognition, and emotions. These secondary symptoms are often referred to as negative and cognitive symptoms. Motor Impairments: • Catatonia: Some individuals with schizophrenia may exhibit catatonic behavior, which can include a lack of movement or extreme agitation. • Motor Skills: Fine and gross motor skills may be affected, leading to difficulties in coordination and performing daily tasks. Communication Impairments: • Speech Disorders: Individuals may experience speech disorders such as alogia (reduced speech), poverty of speech (limited speech content), or disorganized speech. • Social Communication: Difficulties in social communication, including interpreting non-verbal cues and maintaining appropriate social interactions, are common. Cognitive Impairments: • Memory: Both short-term and long-term memory can be affected, leading to difficulties in learning and retaining information. • Attention: Individuals may have trouble focusing attention and may be easily distracted. • Executive Functioning: Deficits in executive functioning, including planning, organizing, and problem-solving, are common. Emotional Impairments: • Blunted Affect: Some individuals may exhibit a blunted or flat affect, where their emotional expression is reduced or lacking. • Anhedonia: Anhedonia refers to the inability to experience pleasure, which can lead to a lack of interest in activities that were once enjoyable. • Emotional Dysregulation: Fluctuations in mood and difficulty regulating emotions are common. It's important to note that the presentation of these symptoms can vary widely among individuals with schizophrenia, and not all individuals will experience the same combination or severity of symptoms. Treatment for schizophrenia often involves a combination of medication, psychotherapy, and support services to help manage symptoms and improve overall functioning. 106. Trace the general developmental course of schizophrenia of childhood and adolescence, including its onset, nature of symptoms, and outcome. Answer: Childhood-Onset Schizophrenia (COS): • Onset: Typically between ages 5 and 12. • Symptoms: Similar to adult schizophrenia but may be harder to recognize due to developmental factors. • Nature of Symptoms: Hallucinations, delusions, disorganized thinking, social withdrawal, emotional flatness, cognitive deficits. • Outcome: Can vary, with some experiencing chronic symptoms and impairment, while others may have periods of remission. Adolescent-Onset Schizophrenia: • Onset: Late adolescence to early adulthood, peak onset in late teens to early 20s. • Symptoms: Similar to adult schizophrenia. • Nature of Symptoms: Delusions, hallucinations, disorganized speech/behavior, negative symptoms, cognitive deficits. • Outcome: Varies; early identification and intervention crucial. Treatment includes medications, therapy, and support services. 107. Discuss three findings that point to structural and physiological brain abnormalities in individuals with schizophrenia. Answer: 1. Enlarged Ventricles: Studies have consistently found that individuals with schizophrenia tend to have enlarged brain ventricles compared to those without the disorder. Ventricles are fluid-filled spaces in the brain, and their enlargement is thought to reflect a loss of brain tissue. This structural abnormality is often associated with poorer outcomes and more severe symptoms in individuals with schizophrenia. 2. Reduced Gray Matter Volume: Research using magnetic resonance imaging (MRI) has shown that individuals with schizophrenia often have reduced gray matter volume in various brain regions compared to healthy individuals. Gray matter plays a crucial role in processing information in the brain, and these reductions are thought to contribute to the cognitive deficits seen in schizophrenia, such as problems with memory and attention. 3. Hypofrontality: Another common finding in individuals with schizophrenia is reduced activity in the prefrontal cortex, known as hypofrontality. The prefrontal cortex is involved in executive functions such as decision-making, planning, and working memory. Reduced activity in this region is believed to contribute to the disorganized thinking, impaired reasoning, and difficulty with planning and problem-solving seen in schizophrenia. These findings suggest that structural and physiological abnormalities in the brain are associated with schizophrenia and may contribute to the symptoms and cognitive deficits characteristic of the disorder. However, it's important to note that the exact nature of these abnormalities and their relationship to the development of schizophrenia is still not fully understood and is the subject of ongoing research. 108. What psychosocial factors have been investigated regarding the etiology of schizophrenia? What evidence or argument supports or questions their influence? Answer: Several psychosocial factors have been investigated regarding the etiology of schizophrenia. These factors include: 1. Family Environment: Research has examined the role of family environment, including high levels of expressed emotion (EE), in the development of schizophrenia. High EE refers to families that are overly critical, hostile, or emotionally overinvolved. Studies have found a correlation between high EE and increased risk of relapse in individuals with schizophrenia, suggesting that family dynamics may play a role in the course of the illness. However, the exact nature of this relationship and whether high EE contributes to the onset of schizophrenia itself is still debated. 2. Stressful Life Events: Stressful life events, such as trauma, loss, or severe life changes, have been investigated as potential triggers for the onset of schizophrenia in vulnerable individuals. Some studies have found an association between stressful life events and the development of schizophrenia, particularly in individuals with a genetic predisposition to the disorder. However, the exact mechanism by which stress may contribute to schizophrenia is not well understood. 3. Urbanicity: Growing up in urban areas has been associated with an increased risk of developing schizophrenia. Some researchers suggest that this may be due to factors such as social isolation, exposure to toxins, or increased levels of stress in urban environments. However, other studies have found conflicting results, and the relationship between urbanicity and schizophrenia is still not fully understood. 4. Social Support: Adequate social support has been proposed as a protective factor against the development of schizophrenia or as a factor that can improve outcomes for individuals with the disorder. Strong social support networks may help individuals cope with stress and reduce feelings of isolation, which are common in schizophrenia. However, more research is needed to understand the exact role of social support in the etiology and course of schizophrenia. Overall, while these psychosocial factors have been investigated in relation to schizophrenia, the evidence for their influence is mixed and often complex. The exact role of psychosocial factors in the development and course of schizophrenia is still not fully understood, and further research is needed to clarify these relationships. 109. Review the neurodevelopmental model of schizophrenia posited by Bearden et al., (2006). How is the vulnerability-stress model depicted in this theory? Answer: The neurodevelopmental model of schizophrenia posited by Bearden et al. (2006) suggests that schizophrenia is the result of abnormal brain development that begins before birth and continues into early adulthood. According to this model, genetic and environmental factors interact to disrupt normal brain development, leading to the onset of schizophrenia symptoms later in life. The vulnerability-stress model, depicted in this theory, suggests that individuals have a vulnerability or predisposition to developing schizophrenia due to genetic or early developmental factors. This vulnerability interacts with environmental stressors, such as trauma, substance abuse, or stressful life events, which can trigger the onset of schizophrenia in vulnerable individuals. In the neurodevelopmental model, the vulnerability-stress model is depicted as a dynamic interplay between genetic and environmental factors that influence brain development. Genetic factors, such as specific gene variants associated with schizophrenia, may increase an individual's vulnerability to the disorder. These genetic vulnerabilities interact with environmental stressors, such as prenatal infections, maternal stress during pregnancy, or childhood trauma, which can disrupt normal brain development and increase the risk of developing schizophrenia. Overall, the neurodevelopmental model of schizophrenia posited by Bearden et al. (2006) emphasizes the complex interplay between genetic and environmental factors in the development of schizophrenia. The vulnerability-stress model is an important component of this theory, highlighting the role of both predisposing factors and environmental triggers in the onset of the disorder. 110. Why might it be particularly difficult to evaluate children with regard to the psychotic manifestations of schizophrenia? Answer: Evaluating children for psychotic manifestations of schizophrenia can be particularly challenging due to several reasons: 1. Developmental Differences: Children's cognitive and language abilities are still developing, making it difficult for them to express their experiences and symptoms accurately. They may not have the vocabulary or cognitive skills to describe hallucinations or delusions, which are common symptoms of schizophrenia. 2. Symptom Variation: Symptoms of schizophrenia can vary widely among individuals and may be different in children compared to adults. Children may experience hallucinations or delusions that are less complex or less frequent than those seen in adults, making them harder to recognize. 3. Overlap with Other Disorders: Symptoms of schizophrenia in children can overlap with other developmental disorders, such as autism spectrum disorder or attention-deficit/hyperactivity disorder (ADHD). This can make it challenging to differentiate between these disorders and schizophrenia. 4. Limited Diagnostic Criteria: The diagnostic criteria for schizophrenia were developed based on symptoms seen in adults and may not fully capture the range of symptoms seen in children. As a result, there may be delays or difficulties in diagnosing schizophrenia in children. 5. Stigma and Misunderstanding: There is often stigma and misunderstanding surrounding mental health disorders, including schizophrenia. This can lead to delays in seeking help and reluctance to consider schizophrenia as a possible diagnosis in children. 6. Developmental Context: Children's symptoms and behaviors are often viewed within the context of their developmental stage, which can make it challenging to recognize symptoms of schizophrenia. Behaviors that may be considered unusual in adults, such as imaginary friends or magical thinking, are more common and developmentally appropriate in children. Overall, evaluating children for psychotic manifestations of schizophrenia requires a thorough understanding of developmental norms and a careful assessment of symptoms and behaviors to differentiate between normal developmental variations and symptoms of schizophrenia. Collaboration between mental health professionals, pediatricians, and educators is essential to ensure early identification and appropriate treatment for children with schizophrenia. 111. Describe both pharmacological and psychosocial treatments for schizophrenia, especially for children and adolescents. Answer: Pharmacological Treatments: 1. Antipsychotic Medications: Antipsychotic medications are the primary treatment for schizophrenia. They help reduce or control symptoms such as hallucinations, delusions, and disorganized thinking. Some common antipsychotics used in children and adolescents include risperidone, aripiprazole, and olanzapine. These medications are typically prescribed at lower doses for children and adolescents than for adults, and regular monitoring is required to manage potential side effects. 2. Antidepressants or Mood Stabilizers: In some cases, antidepressants or mood stabilizers may be prescribed to help manage symptoms of depression or mood swings that can occur alongside schizophrenia. However, these medications are usually used in conjunction with antipsychotics and under close supervision. Psychosocial Treatments: 1. Cognitive Behavioral Therapy (CBT): CBT can help children and adolescents with schizophrenia manage their symptoms and improve their coping skills. It focuses on identifying and changing negative thought patterns and behaviors. 2. Family Therapy: Family therapy can be beneficial for children and adolescents with schizophrenia, as it can help improve communication within the family, reduce stress, and enhance support for the individual with schizophrenia. 3. Social Skills Training: Social skills training can help children and adolescents with schizophrenia develop and improve their social skills, which can improve their relationships and quality of life. 4. Education and Support: Education about schizophrenia and support from mental health professionals can help children and adolescents and their families better understand the disorder and cope with its challenges. 5. Supported Employment or Education: Programs that provide supported employment or education can help individuals with schizophrenia, including children and adolescents, achieve their educational and vocational goals while receiving the necessary support. It's important for treatment to be individualized based on the needs and symptoms of the child or adolescent with schizophrenia. A comprehensive treatment approach that includes both pharmacological and psychosocial interventions is often most effective in managing the disorder and improving outcomes. Regular monitoring and communication between the treatment team, the individual, and their family are essential for successful management of schizophrenia in children and adolescents. Test Bank for Abnormal Child and Adolescent Psychology Rita Wicks-Nelson, Allen C. Israel 9781317351344, 9780205036066, 9780205901128
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