Autism and schizophrenia

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In Schizophrenia and Related Syndromes by R.J. McKenna, Routledge, London and New York (2nd edition 2007) there is a chapter entitled Childhood schizophrenia, autism and Asperger's syndrome.

It includes a case study of a young man taken from Potter, H.W. (1933) Schizophrenia in Childhood, American Journal of Psychiatry, 12, 1253-1270.

He was

He made regular progress at school until about age nine, when his behaviour worsened.

Afer about a year he showed improvement and became more communicative. He went to a summer camp where he fitted in reasonably well, returned home and re-entered school where he made mediocre progress.

Cases of childhood schizophrenia described by Potter (1933) and Despert, J.L. Schizophrenia in Childhood , New York (1968), beginning before the age of 7

Mr. McKenna asks if there is a relationship between autism and schizophrenia, and if there are areas of overlap between the two conditions.

Rumsey, J et al. (1986) Thought, language, communication and affective flattening in autistic adults Archives of General Psychiatry, 43, 771-77, studied 14 adults who met the DSM III criteria for autism (six of whom had originally been diagnosed by Kanner). None were taking medication at the time of the study. These included such features as "unchanging facial expression", "paucity of expressive gestures" and "lack of vocal inflections".

The study also assesed thought disorder in their 14 autistic patients. 10 showed "poverty of speech", 8 showed perseveration and seven "poverty of content of speech". These were the only areas of thought disorder where the autistics scored significantly higher than the normals.

Wing, L. and Shah, A. (2000) Catatonia in autistic spectrum disorders British Journal of Psychiatry, 176, 357-362, found that out of 506 individuals diagnosed with an autistic spectrum disorder, 30 (6 per cent) meet their criteria for catatonia. These criteria

Last edited by Woodpeace on 28 Apr 2008, 1:14 pm, edited 2 times in total.

On that last bit, please note that catatonia is a neurologic movement-related state quite separate from the (later) psychiatric (mis)construct of schizophrenia that hijacked it as their own.

This is one of the main reasons I believe in the importance of an accurate diagnosis, so that if people don't have AS they can get the help they really need.

Couldn't have said it better myself.

Agreed.

My cousin has schizophrenia. While i don't think they are the same, and shouldn't be treated as such there is definitely some connection and overlap. Schizophrenia is not one condition but many conditions that fall under that loose banner.

Continuation of the quote from Wing and Shah in my previous message:

In Schizophrenia and Related Syndromes there is a reference to Sporn, A.L. et al. (2000) Pervasive developmental disorder and childhood-onset schizophrenia: Comorbid disorder or a phenotypic variant of a very early onset illness? Biological Psychiatry, 55, 989-994.

In a sample of 75 schizophrenic patients, one met the DSM IV criteria for autism, two met the DSM IV criteria for Asperger syndrome and a further 16 met the criteria for PDD-NOS.

The current orthodoxy that autism and schizophrenia are completely separate conditions oversimplifies a more complex situation. They are not in two completely separate boxes, but overlap to some extent. I would represent autism (the autism spectrum) by this line:

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and schizophrenia by this line:

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The degree of overlap shown between the two conditions is approximate.

Schizoid Personality Disorder and Asperger syndrome are not entirely unrelated. They merge to some extent.

There have been autistic children who have developed schizophrenia in adolescence or adulthood.

If childhood schizophrenia does not exist, then all the children diagnosed with that condition from the 1930s onwards were really autistic or had some other condition. But there have been cases of children diagnosed with schizophrenia who had hallucinations and/or delusions, such as some of those described in the 1933 study by Potter.

I have been diagnosed with both schizophrenia (actually schizoaffective) and high functioning autism but I don't agree with the schizophrenia diagnosis at all. I believe there are similarities between the two disoders though mainly the "negative" symptoms like flat affect and poverty of speech. By the way, I have been diagnosed with schizoaffective not because of "voices" even though I had that when I was young, but rather stupid "delusions."

Interestingly, Woodpeace, you do not make mention of the 'classic signs' pertinent to a diagnosis of childhood schizophrenia, such as the psychotic symptoms. A marginal amount of evidence document such, with respect to ASDs. Of course there is overlap, the same is true for practically every condition concerning mental health.

That's exactly the problem: You can't just claim that a movement disorder (one that already resembles trouble that autistic people have with movement anyway) is the same thing as a loss of reality contact, or even related to a loss of reality contact. Especially since the drugs normally given for "schizophrenia" are especially dangerous to anyone with the catatonia-like/parkinson-like movement disorder that Wing and Shah describe. (Not that they're not dangerous to everyone, but they're more likely to prove fatal to people with a pre-existing movement disorder of that sort.)

Also, autism seems to actually be a valid grouping based on similar core traits. Schizophrenia, on the other hand, does not.

There's certainly always been a shared sociological history, which has been elaborated on in other threads here. But catatonia is a red herring, it's not in any way specific to the non-entity known as "schizophrenia" any more than autism is. It's a problem of voluntary movement that can happen in anything from autistic people to encephalitis survivors and doesn't have any specific connections to loss of reality contact except in popular superstition. As someone who, as a result of movement difficulties, has been presumed out of touch with reality while very much in touch with reality, and as someone who's experienced life-threatening reactions to neuroleptics (and apparent permanent brain damage from same, although that can happen to anyone who takes them long enough) prescribed for supposed loss of reality contact, I can't stress enough how making or reinforcing that connection is dangerous.

I think these both are interrelated.

Notice if you would the number of those who were diagnosed schizophrenic once, and autistic later. Growing up, I had a different doctor tell me one thing, and another tell me something completely else.

Where and how should the accountability lie?

To the observer, some aspects of autism may resemble some aspects of schizophrenia. There are probably some unique experiences shared by autistics and schizophrenics as well. This does not mean that autism and schizophrenia are similar or even related. The differences between the two are significant.

Autism is constant and does not involve psychosis. Schizophrenia varies in intensity over the course of a person's life, often becoming more severe as time goes on. Schizophrenia usually begins in early adulthood. A childhood onset of schizophrenia is rare, though not unheard of. Autism is classified as a Developmental Disorder; schizophrenia is considered a Thought Disorder.

Actually, it can.

What do you mean? Psychosis is not said to be a feature of autism, so if an autistic person experienced psychosis, wouldn't that point to a different condition? Even if it was a condition related to the autism? For example, ASDs are sometimes associated with depression, which can cause psychosis in some people.

Regarding changing over time:

Although, autistic traits, especially surface traits, can wax and wane over a lifetime too, there is plenty of evidence of that in outcome studies. The two most common periods for autistic traits to become more intense and/or obvious are infancy and adolescence, with adolescent "regression" taking place (in one study, for example) in somewhere between 1/3 to 1/6 of autistic people, and progressive difficulty with voluntary motor functioning taking place in somewhere between 1/10 and 1/20 of autistic people (from the studies I've looked at, anyway).

Sometimes they're really becoming more intense, sometimes things stay the same, or even get better, but not at the expected rate, or there are too many responsibilities put into a system that can't handle doing them all, and then it can look like loss of abilities when it's really just the same abilities confronted with new expectations. It's also very common for an autistic person to have abilities that fluctuate greatly over the course of a day, a week, whatever, and especially depending on how familiar the environment is, and other factors like that.

The person remains just as autistic as ever, but can look more so or less so (in stereotype-land anyway) over time, depending on a whole lot of factors. So I guess autism itself doesn't wax and wane, but expression of certain traits does.

There are also a number of things an autistic person can do that look like loss of reality contact, and can be indistinguishable from it from the outside. Not that that makes it the same thing as loss of contact with reality (or I guess, atypical loss of contact with reality, since everyone's out of touch with it to some degree), but it can be harder to distinguish than one would expect. And then there are neurological conditions autistic people can have (such as migraines and seizures) that there's debate over whether we have more than the usual or not, but those can all result in hallucinations and such too if they're the wrong kind.

Schizophrenia itself is too nebulous a term to generalize about.

I always look at it like this: Imagine that all these psych labels were different kinds of fruit.

Autism would be like saying "citrus fruit". There's different kinds of citrus fruit but they all have certain things in common.

Schizophrenia would be like saying, "lemons, bananas, yellow tomatoes, kumquats, apricots, summer squash, and cloudberries". Because it's like some guy a long time ago decided that any fruit yellow or vaguely yellowish-looking had something in common beyond the color.

This is interesting; I went through a period of regression in my adolescence. Thanks for writing this piece of information.