Common comorbidities are mental retardation (in up to 80%), seizure disorder (in 25%), anxiety disorders, OCD, and attention-deficit/hyperactivity disorder. Seizures often start around the onset of puberty. Higher IQ and better language skills are related to improved prognosis. Good communication by the age of 6 years and average nonverbal cognitive skills predict the likelihood of living independently or in a less structured group living situation.
The earliest studies of autism suggested a relatively poor prognosis, with only a small number of individuals (1% to 2%) being able to function independently as adults. Recent research reveals major gains, but not a cure, with early diagnosis and treatment.
Schizophrenia generally presents in adolescence or early adulthood. The same diagnostic criteria are applied as in adults but must be interpreted in terms of the developmental stage of the child (Table 20-3).
Childhood-onset schizophrenia is a rare disorder (<1 in 10,000 children) and usually indicates a more severe form of schizophrenia. The frequency increases between 13 and 18 years of age. Boys tend to be affected about twice as often as girls, regardless of ethnic or other cultural factors. The etiology of schizophrenia is unknown. Numerous studies have shown genetic predisposition and linkages for the disorder. In addition, family studies consistently show a higher risk in monozygotic twins compared with dizygotic twins and siblings. First-degree relatives of patients with schizophrenia have a 10-fold higher risk.
The symptoms of schizophrenia typically fall into four broad categories: • Positive symptoms include hallucinations and delusions. Hallucinations are auditory or visual misperceptions that occur without external stimuli. Delusions are fixed false
A. Six or more items from (1), (2), and (3), with at least two from (1) and one each from (2) and (3) 1. Qualitative impairment in social interaction, as manifested by at least two of the following: a.
Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction b.
Failure to develop peer relationships appropriate to developmental level c.
A lack of spontaneously seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) d.
Lack of social or emotional reciprocity 2. Qualitative impairments in communication as manifested by at least one of the following: a.
Delay in, or total lack of, the development of spoken language (not accompanied by attempts to compensate through alternative modes of communication, such as gesture or mime) b.
In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others c.
Stereotyped and repetitive use of language or idiosyncratic language d.
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, as manifested by at least one of the following: a.
Encompassing preoccupation with stereotyped and restricted patterns of interest that is abnormal either in intensity or focus b.
Apparently inflexible adherence to specific, nonfunctional routines or rituals c.
Stereotyped and repetitive motor mannerisms (e.g., handor finger-flapping or twisting or complex whole body movements) d.
Persistent preoccupation with parts of objects
B. Delays or abnormal functioning in at least one of the following areas, with onset before age 3 yr 1.
2.
Language as used in social communication 3.
C. The disturbance is not better accounted for by Rett syndrome or childhood disintegrative disorder.
beliefs and can be bizarre or non-bizarre, depending on cultural norms.