Autism and Schizophrenia
Autism and schizophrenia: This is a topic far beyond what one blog post can even begin to discuss, and this post is simply a note on the topic after reflecting on what Dr. Nancy Minshew said in a February 6th article in the Pittsburgh Post-Gazette and puzzling over the as-usual excessive response by those who believe that a vaccine or mercury or something in a vaccine causes autism. Dr. Minshew, who is the Director of the University of Pittsburgh’s Center for Excellence in Autism Research, was quoted in a January 31st article about the ABC comedic legal drama, Eli Stone, which aired last week. Pittsburgh Post-Gazette writer Mark Roth noted that Dr. Minshew, concerned about the TV show’s suggesting that there might be a link between autism and vaccines, had decided to “take a personal stand” and speak out and publicly that autism is not caused by vaccinations.
Roth again quoted Dr. Minshew in a February 6th article about the increase in the prevalence rate of autism: It was literally one year ago that the CDC announced new figures for the autism rate in the US: 1 in 150. Says Dr. Minshew:
…..She is now convinced that the higher numbers are “not an increase in the number of cases, but are an improvement in recognition.”
In past decades, she said, it was often hard to get doctors or schools to diagnose higher-functioning children as having autism. They were often labeled as having “behavior difficulties.”…..
And when people say they don’t remember seeing so many autistic children when they were growing up, or ask where all the adults with autism are, there are two possible explanations, Dr. Minshew said.
One is that many autistic children in the past were never sent to school. In what she called the “Forrest Gump era, you didn’t even go to school, or you went to a totally separate school.”
The other phenomenon was that some autistic children were labeled as schizophrenic, and many may have ended up in state hospitals or other institutions, she said.
There is even a kind of logic to that, Dr. Minshew said, because some of the hallmarks of schizophrenia — behaving oddly, a lack of facial expressions, poor eye contact, speaking in a monotone and using fewer gestures than normal — are “essentially the same” in both autism and schizophrenia.
The term “autistic” was first used in 1912 by psychiatrist Dr. Eugen Bleuler to describe some people who were then diagnosed with schizophrenia; their behavior seemed as if they were “disengaged from everything except their internal world.” In Chapter 2, “Theme and Variation: The ‘Discovery’ of Autism” of Unstrange Minds: Remapping the World of Autism (2007), anthropologist Roy Richard Grinker notes that “large numbers of people with autism would be diagnosed as ’schizophrenic childhood type,’ even into the 1970s, because that was the only official category of the American Psychiatric Association in which the word ‘autistic’ appeared.” Leo Kanner, who first described 11 children as having “infantile autism” in a 1943 article, thought that these children were “fundamentally different from people with schizophrenia”:
In practice, clinicians distinguished autism from schizophrenia with the name “infantile autism” and occasionally “Kanner’s syndrome,” but the official name for autism was still “schizophrenia.” Two of Kanner’s original eleven patients had come to him after having already received a diagnosis of schizophrenia from another doctor. (pp. 45)
Both the DSM-I (1952) and the DSM-II (1968) do not mention autism as a distinct syndrome; autism is mentioned as “Schizophrenic reaction, childhood type” and “Schizophrenia, childhood type.” The DSM-III (1980) provides specific diagnostic criteria for Infantile Autism. In the past, autistic individuals might have received a diagnosis of schizophrenia (or mental retardation, or something else); they could not be diagnosed with autism because autism as we understand it today did not exist as a diagnostic category. That is, for much of the history of autism—if we posit that autism has always existed and was only very recently identified as such—-autistic persons did not have an “autism diagnosis,” but were considered “something else.”
And that is one reason why I am thankful that my son is living today and that he is understood not as having one of those “something elses”—feeble-minded, insanity, idiocy, many more can be named—but autism.
Tags: asd, asperger, autism, autism spectrum disorder, children, eli stone, eugen bleuler, leo kanner, mercury, pdd-nos, pittsburgh, Psychiatry, Psychology, schizophrenia, VaccinesRelated Stories
POSTED IN: Diagnosis, History, Psychiatry
26 opinions for Autism and Schizophrenia
Regan
Feb 8, 2008 at 5:34 am
Kristina,
Apologies if this has already been posted elsewhere in your blog. I thought it was an interestng piece of history, possibly relevant to the point of view that autism is a “new phenomenon”,
From 1887:
“On investigating, however, a large number of cases I became familiar with many instances which it was impossible to include in either of these categories…
Under what head, therefore, were they to be placed? I found that the history was somewhat of the following. Their early months of babyhood were perfectly uneventful; there had been nothing to cause the slightest anxiety; intelligence had dawned in the accustomed way, when, first dentition proceeding, a change had come over the aspect of the child. Its look had lost its wonted brightness; it took less notice of those around it; many of its movements became rhythmical and automatic, and with or without convulsions there was a cessation of the increasing intelligence which had marked its early career; anxiety was felt on account of the deferred speech, still more from the lessened responsiveness to all the endearments of its friends…”
On Some of the Mental Affections of Children and Youth. J. Langdon Down. 1887. J & A Churchill, London. 307pp.
Regan
Feb 8, 2008 at 6:51 am
Sorry. Relevant to the point of view that autism is NOT a “new phenomenon”.
Translating Autism
Feb 8, 2008 at 11:18 am
Hi Kristina. I see in the past when the issue of vaccines comes up, some parents bring up the argument about the major change they noticed after obtaining the vaccines. I just want to provide a brief observation. Yes, there is significant published evidence of a “regressive type” of autism. This refer to children that seem to be developing normally until a specific age (usually around18 to 24 months) when they begin to actually regress (lose of skills). The University of Michigan program has been a leader in the identification of this phenomenon. There are a number of reasons why this can happen during this time, and the current major hypothesis looks at functional migration in the brain during this period. This is another well researched area. As we develop, our brain re-organizes itself and specific functions that were controlled by some areas of the brain are now controlled by a different area. The idea is that for these kids, early in development, the social and language skills were controlled by specific regions, but as these skills migrate in the brain something happens and these skills are lost. Unfortunately, this migration time also coincides with vaccination time, and these two are likely completely unrelated. Yet, the “observable event” is that during the same time (months) that some kids receive the vaccine this natural migration (and loss of skills) was taking place. This would be an excellent example of when correlation does not imply causation.
Nestor.
Translating Autism
Nestor L. Lopez-Duran PhD.
RAJ
Feb 8, 2008 at 11:21 am
Minshew is simply wrong when she attributes the autism epidemic to better recognition. After Kanner described the syndrome in his original article, autism had its first epidemic rise. By the early sixties Kanner voiced his objection to the over diagnosis of autism as follows in 1965:
“This sage advice was not heeded by many authors. While the majority of the Europeans were satisfied with a sharp delineation of infantile autism as an illness sui generis, there was a tendency in this country to view it as a developmental anomaly ascribed exclusively to maternal emotional determinants. Moreover, it became a habit to dilute the original concept of infantile autism by diagnosing it in many disparate conditions which show one or another isolated symptom found as a part feature of the overall syndrome. Almost overnight, the country seemed to be populated by a multitude of autistic children, and somehow this trend became noticeable overseas as well. Mentally defective children who displayed bizarre behavior were promptly labeled autistic and, in accordance with preconceived notions, both parents were urged to undergo protracted psychotherapy in addition to treatment directed toward the defective child’s own supposedly underlying emotional problem”.
From the late 1960’s to the early 1980’s there was a clear differentiation between ‘autism’ and a host of neurological disorders, psychological disorders and developmental disorders that featured ‘autistic-like’ symptoms but did not possess the core defining feature of autism as Kanner defined it.. A profound indifference to the existence of other people, including parents, siblings and other primary caregivers that was most profoundly observed in the toddler years.
In the mid 1980’s with the introduction of DSM-III-R, ICD-10 and the gold standard diagnostic tools ADOS-R, ADI, AUT-F and others, the concept of autism became more ambiguous, and subjective, with children whose primary diagnoses in the past would have been mental retardation, specific developmental disorders, ADHD and various personality disorders had enough ‘autistic-type’ behaviors included on the ever expanding checklist of autistic behaviors to qualify or an ASD diagnosis. The inability of the new criteria has now enbaled a diagnosis of an ASD to be conferred on children who suffered extreme emotional deprivation, abuse and neglect (Romanian orphans).
Schopler also commented on the vast expansion of the concept of autism and thought it would result in an autism explosion and the diagnostic label would become a passkey to special education services, which he and others welcomed.
Science will never be able to make any progress on research in the ’causes’ of autism until it can clearly define autism.
RAJ
Feb 8, 2008 at 11:31 am
“Translating Autism
Nestor L. Lopez-Duran PhD”.
Interesting observation about ‘regressive’ autism. There are other neurological conditions where the origins are though to be prenatal, schizophrenia for example. Schizophrenia can be also thought of as ‘regressive’ since the symptoms do not manifest themselves until decades later. Could that be the explanation of ‘regressive’ autism? A prenatal insult that could lead to a period of normal behavior followed by a regression of lost behaviors?
Amanda
Feb 8, 2008 at 12:49 pm
It doesn’t have to be an “insult” (i.e. damage to a more typical brain) that causes a brain to develop differently. I mean it can, obviously, but I think it is a mistake to ascribe all neurological variance to some kind of change enacted on a typical brain.
Chuck
Feb 8, 2008 at 1:26 pm
Kanner was a John Hopkins professional, and yet it took him three years and multiple states to find his ELEVEN subjects. How many days would it take him today within one state and using the same criteria he used in his original study to find eleven? The prevalence has changed.
Autismville
Feb 8, 2008 at 1:30 pm
I’m with you Dr. Chew… Thankful that Jack is living today …
Hala
Feb 8, 2008 at 1:42 pm
This is really interesting to me–I was at one point diagnosed, way back in the late-70s, with “childhood schizophrenia,” as were many (if not most) of the autistic adults I know. This diagnosis, as I understand it, simply doesn’t exist anymore. Has anyone run the numbers–correlated the number of “childhood schizophrenics” and non-specific “emotionally disturbed” children that there used to be in the 70s and 80s with the “rise” in autism diagnoses?
Translating Autism
Feb 8, 2008 at 1:42 pm
Amanda, I completely agree that it is not always brain insults, especially during the prenatal period, that is the cause of changes in brain development. Now, as to neurological variance (I see where this goes and I want to stay out of it, but I see it will be difficult) I will just comment on the position of people in my field. The difference between neural variance, or differences in brain processes that make us unique, and a disorder (I know this is a taboo word for some people), relates to “functional impairment”. When different brain developmental processes result in reduced abilities or capacities and clear impairment in our social, personal, educational, and occupational lives, our field views those brain differences as reflecting an underlying “disorder” or syndrome, to the extend that it explains limited capacities and an inability to function as is typically expected in our social context. This is not something that only applies to Autism. It applies to every neurological and most medical disorders. When does depressed mood ceases to be “feeling blue” and becomes clinical depression? When it results in functional impairment (losing one’s job and family, personal distress, inability to do school work, suicidal thoughts, drug and alcohol abuse, etc). Thus clinical depression is not an arbitrary concept that ignores our diversity. It is a label that allows people (clinicians, researchers, and the people experiencing it) to come together and find solutions so that those people who experience clinical depression can have, or regain, as much functional capacity (including less personal distress) as possible.
But none of this has anything to do with love or the inherit value of each person. I have seen parents who approach autism as a purely medical disorder and seek “treatments”, and I have seen parents who reject all medical implications while seeking “assistant” for their kids, and I have never felt that any family loved their kids any less, or that any of these families failed to cherish every moment they have with their kids. And I can’t say the same thing about some parents of typically developing kids I know.
Nestor
Nestor Lopez-Duran PhD
Translating Autism
Marla
Feb 8, 2008 at 4:03 pm
Wow. The comments on this one are very interesting.
emily
Feb 8, 2008 at 4:38 pm
Very interesting. Twice in the past ten years I’ve corresponded with parents whose children had “childhood schizophrenia,” and both times it turned out to be AS or HFA.
Kristina Chew, PhD
Feb 8, 2008 at 6:46 pm
@Emily, do you mean that the children first received the childhood schizophrenia diagnosis and then this was changed?
Just got back from the neurologist……..
RAJ
Feb 8, 2008 at 9:36 pm
Regarding the question of “is autism caused by an early insult to the developing brain”. The answer is yes. There have now been published dozen of autopsy studies. In those autopsies which have examined the ‘autistic’ brain microscopically 100% of them have found structural abnormalities. In many cases the damage is microscopic but can not be seen using imaging tools such as MRI.
The one controversy where the genetic theorists and the environmental theorists are in complete agreement, is that ‘autism’ is caused by a disruption in normal brain development. The vitriolic arguments between these two competing theories is whether the disruption is the consequence of faulty genetic programming or the consequence of an environmental insult.
http://aut.sagepub.com/cgi/content/abstract/2/1/45
Kristina Chew, PhD
Feb 8, 2008 at 10:59 pm
@Hala—-good questions—trying to find some answers—
One reason that this question intrigues me is my own study of the ancient world, where, of course, there were no such “diagnoses” as autism, or schizophrenia. It’s hard to read ancient texts and post-diagnose people; certainly the Greek dramas (drawn from the myths) present characters whose seem by their actions to be, perhaps, not “sane” or “sound of mind. (Or soul——Orestes after he kills his mother, Klytemnestra, in the Libation Bearers). And, in the 20th and 21st centuries, we have developed such different ways of talking about disease, about “mental” “illness,” about epilepsy—once called the sacred disease—-than at other times.
AnneC
Feb 9, 2008 at 12:55 am
TranslatingAutism said: The difference between neural variance, or differences in brain processes that make us unique, and a disorder (I know this is a taboo word for some people), relates to “functional impairment”. When different brain developmental processes result in reduced abilities or capacities and clear impairment in our social, personal, educational, and occupational lives, our field views those brain differences as reflecting an underlying “disorder” or syndrome, to the extend that it explains limited capacities and an inability to function as is typically expected in our social context.
(NOTE: I’m veering off on a bit of a tangent, and the following should not be taken to be a direct response to TranslatingAutism’s comment. It isn’t — that comment just made me think of a bunch of things I thought were worth writing out.)
The key phrase for me in the above quote is “as is typically expected in our social context”. I don’t see the current social context as anything sacred, and I can see a lot of ways in which it might be changed to better enable a greater range of brain/body types. Getting that to happen seems to be largely a matter of getting people to realize that the way things are currently set up, some people are systematically excluded in ways that they wouldn’t be if certain structures and elements were altered.
This is not a claim that the society should ALWAYS change and not the individual, in every case, or a claim that individuals don’t sometimes have attributes or issues that they themselves would prefer to mitigate. But to imply that social structures are immovable, or that we’re all living in a zero-sum “lifeboat” situation (as was recently discussed in some of the comments on Amanda’s blog) is to engage in weirdly superlative thinking of a sort that doesn’t actually reflect reality very well.
I would like to think that if more people can come to understand the various ways in which making social environments and systems and places more flexible and accessible will help everyone (not just autistics, not just any particular group of disabled people, and not just disabled people to begin with), more people will want to move things in that direction.
TomsMom
Feb 9, 2008 at 1:38 pm
A fascinating thread here . . . AnneC’s point about society vs individual change really resonates with me. In the US there is an “ideal” of sociality, if I can make up a word, that not only is not sacred, it’s not even consistent across cultures. But I’m willing to bet the one constant in functioning societies is that individuals and groups must and do make accommodations for one another. However, depnhding on the society some kinds of accommodation are off the scale. For example, failure to make appropriate eye contact which given the situation could result in any number of negative outcomes for Tommy, from his peer group labelling him weird to a potential employer thinking him shifty to a cop thinking he’s hiding something. This is troubling to me as I don’t know–no one knows–how or if Tommy will be able, even with the best available help, to achieve whatever “minimums” of socially acceptable behavior even an enlightened and tolerant society might have.
Translating Autism
Feb 9, 2008 at 2:03 pm
Yes, there is a reason why “typically expected in our social context” is included in current understanding of medical conditions. We can not separate “intended functioning” from the expectations of our social context. Tomsmom example is perfect. If her son lived in a society (which exists) where eye contact is a sign of disrespect, then his limited use of eye contact would never present the very real problems she describes. However, the fact that the utility and effectiveness of our cognitive and affect regulatory capacities are clearly related to the expectations of the society where we live should not be used to minimize the struggle of people with autism (specially severe forms of autism) as simply due to unique or diverse social or neurocognitive skills that our society fails to understand and accommodate. Such idea, although it serves to bring needed public awareness to issues of inclusion and acceptance, does not really help the children and adults whose struggles and limitations go way beyond simple social uniqueness and society’s lack of understanding or acceptance… people who struggle to obtain the needed services and interventions that would help them to minimize personal distress and gain and improve the skills necessary to function in our (mostly broken) society. Nestor
Nestor L. Lopez-Duran Ph.D.
Translating Autism
Kristina Chew, PhD
Feb 9, 2008 at 3:16 pm
@Anne C and TomsMom,
I’m always hopeful that societal mores can be changed or evolve and that we can learn to better understand how everyone is liable to misinterpret what might seem like “anti-social” behavior. It’s difficult for Charlie not to be constantly humming, vocalizing, saying what sound like non-verbal “noises.” I’ve learned he needs to do some of these to help stay focused and to self-calm, and I’ve also noted that he needs to learn to be silent at certain times, for instance if he were at a job some day, where a little humming might be all right—a little, though, not a lot.
gfcfmom
Feb 11, 2008 at 1:10 am
Have you read “Evidence of Harm”? It is a fascinating account of the PROOF that vaccines cause autism and this is constantly covered up by the government because they don’t want the public to become afraid of vaccines. It is a such an unbelievable mess I don’t know where to begin. Read the book and then get back to me.
isles
Feb 16, 2008 at 2:46 am
RAJ wrote:
“In those autopsies which have examined the ‘autistic’ brain microscopically 100% of them have found structural abnormalities. In many cases the damage is microscopic but can not be seen using imaging tools such as MRI.”
Were any non-autistic brains examined in a similar manner? (This might sound snarky but I don’t mean it that way.) I think that a lot - if not all - people’s brains would show some kind of small irregularity if examined microscopically.
And sheesh, gfcfmom, the only remarkable thing about “Evidence of Harm” is that David Kirby doesn’t seem to have grown an extra four inches of nose while writing it.
This and Last’s Weeks Top Posts
Feb 17, 2008 at 2:02 am
[…] Autism and SchizophreniaIn the past, autistic individuals might have received a diagnosis of schizophrenia (or mental retardation, or something else); they could not be diagnosed with autism because autism as we understand it today did not exist as a diagnostic category. That is, for much of the history of autism—if we posit that autism has always existed and was only very recently identified as such—-autistic persons did not have an “autism diagnosis,” but were considered “something else.” […]
About the Love Hormone and About Love
Feb 17, 2008 at 2:05 pm
[…] adds that people with schizophrenia or autism often avoid eye-to-eye gaze, focus on less relavent areas of the face, and avoid meaningful social […]
Regina
Feb 22, 2008 at 11:45 pm
gfcfmom…I will check that book out and read it..sounds interesting…years before autism affected our lives I was concerned about the large number of vaccinations given to children at such a young age! It would not be the first (or will it be the last) time that the government covered something and/or caused something to happen in the name of research.
Regan
Apr 6, 2008 at 7:45 pm
Just a history piece that is not relevant to perhaps current DSM, but might relate to the distinction of schizophrenia and autism, and the difficulties therein, and why someone might say that some autistic children were labelled as schizophrenic. I also have a comment on some administrative category and public count changes using IDEA data (also see Laidler, 2005) that seem to have relevance to these discussions.
DeMyer, M.K., Churchill, D.W., Pontius, W., Gilkey, K.M. (1971). A comparison of five diagnostic systems for childhood schizophrenia and infantile autism. Journal of Autism and Childhood Schizophrenia, 1, 175-189.
http://www.neurodiversity.com/library_demyer_1971.pdf
(BTW–thanks to and courtesy of Neurodiversity.com!)
The short version is that just scanning the criteria among the 5 different instruments, depending on which was used, Eleanor, if diagnosed at that time, could have easily diagnosed with BOTH childhood schizophrenia and infantile autism, and there was some variability even across instruments assessing for the same diagnosis. There is also the distinct possibility that the primary diagnosis for her could have been mental retardation.
This is interesting to me historically and because it does illustrate some issues with comparing past to present when the criteria differ, the instruments change and there is also observer/assessor differences. Reading some of the old literature on autism associated with congenital rubella, there were differences of assessment there, with some identifying autism, some autistic features and some mental retardation.
Prior to Public Law 94-142 (Education of All Handicapped Children Act) (1975), now colloquially known when referring to IDEA, or FAPE. At that time, while some districts did admit special needs students, many also did not and they were not obligated to teach such students in the normal public system, or in some cases at all. Hence large placements in private or state-sponsored special schools or institutions (ex: Willowbrook, Fernald School, many more).
Prior to the introduction of the traumatic brain injury (TBI) and autism categories in 1990, IDEA served students with TBI and autism, but they were reported in a different disability service category, i.e, mental retardation, hearing impairments including deafness, speech or language impairments, visual impairments including blindness, emotional disturbance, orthopedic impairments, other health impairments, multiple disabilities, deaf-blindness, and specific learning disabilities.
In 1997 Developmental Delay was added as an optional category for children ages 6-9.
The 2000-2001 school year was the first that disability was collected for children ages 3-5.
IDEA Part B Data Fact Sheet-October 2006
http://www.ideadata.org/docs/bfactsheetcc.pdf
Autism and Parents with Psychiatric Disorders
May 5, 2008 at 8:09 am
[…] autism was called childhood schizophrenia. Tags: asd, asperger, autism, autism blog, insanity, mental health blog, mental illness, mother, […]
Have an opinion? Leave a comment: