At the Threshold: The Developing Adolescent

Studies of families ascertained through a single autistic proband suggest that the genetic liability for autism may be expressed in nonautistic relatives in a phenotype that is milder but qualitatively similar to the defining features of autism. The objective of this study was to examine behaviors that may define this broader phenotype in relatives ascertained through two autistic siblings. The authors used a semistructured family history interview to compare the rates of social and communication deficits and stereotyped behaviors in relatives ascertained through two autistic siblings (families with multiple-incidence autism; 25 families) with the rates in relatives of Down syndrome probands (30 families). Higher rates of social and communication deficits and stereotyped behaviors were found in the relatives in the families with multiple-incidence autism. These data suggest that further studies should be undertaken to delineate the boundaries of the broader autism phenotype and that this broader phenotype should be included in some future genetic analyses of this disorder.

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The subjects of this study were 19 children and 11 adolescents who had been psychotic since childhood and who satisfied DSM-III criteria for schizophrenia except for the stipulation that a "deterioration from a previous level of functioning" must have occurred. Seven subjects had had documented signs of psychosis before the age of 30 months. The presence of thought disorder precluded giving these 7 subjects the diagnosis of early infantile autism. The authors argue that only symptoms and signs, not age at onset, can define a disorder. They also emphasize that in children and adolescents, developmental issues influence the clinical presentation.

In the last several decades, considerable evidence has suggested that autism and schizophrenia are unrelated. However, recent reports have suggested that individuals with autism may be at greater risk for schizophrenia and that the conditions may be more closely related than generally believed. The authors examined detailed case records of 163 adolescents and adults with well-documented histories of autism. These cases included 139 males and 24 females. Only one individual had an unequivocal history of schizophrenia. If the present study group is taken to be representative, it appears that the frequency of schizophrenia among autistic patients (0.6%) is roughly comparable to the frequency of schizophrenia in the general population. It does not appear that the two conditions are more commonly observed together than would be expected on a chance basis; therefore, the current (DSM-III-R) approach to dual diagnosis of these conditions appears reasonable.

Back to table of contents Previous article Next article ArticleNo AccessThe Child's World of Illness: The Development of Health and Illness BehaviourFRED R. VOLKMARFRED R. VOLKMARSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.148.1.136-aAboutSections ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "The Child's World of Illness: The Development of Health and Illness Behaviour." American Journal of Psychiatry, 148(1), pp. 136-a–136 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByPsychometric properties of the Psychopathology in Autism Checklist (PAC)19 April 2021 | International Journal of Developmental Disabilities, Vol. 67, No. 5mTADA is a framework for identifying risk genes from de novo mutations in multiple traits10 June 2020 | Nature Communications, Vol. 11, No. 1Checklists and Structured Interviews25 July 2020Der Nervenarzt, Vol. 90, No. 5A Predictive Coding Account of Psychotic Symptoms in Autism Spectrum Disorder10 February 2017 | Journal of Autism and Developmental Disorders, Vol. 47, No. 5Developmental Neurorehabilitation, Vol. 18, No. 4Neurocase, Vol. 19, No. 6Journal of Neurodevelopmental Disorders, Vol. 4, No. 1Neuropsychiatry, Vol. 2, No. 5Decreased Mitochondrial Function and Increased Brain Inflammation in Bipolar Disorder and Other Neuropsychiatric DiseasesJournal of Clinical Psychopharmacology, Vol. 31, No. 6Der Nervenarzt, Vol. 81, No. 11Journal of Intellectual & Developmental Disability, Vol. 35, No. 3Journal of Autism and Developmental Disorders, Vol. 39, No. 10BMC Psychiatry, Vol. 9, No. 1Behavioral and Brain Sciences, Vol. 31, No. 3Psychiatric Disorders in Individuals Diagnosed with Infantile Autism as Children: A Case Control StudyJournal of Psychiatric Practice, Vol. 14, No. 1Advances in Mental Health and Learning Disabilities, Vol. 1, No. 4Tourette syndrome: treatmentJournal of Autism and Developmental Disorders, Vol. 36, No. 7Journal of Autism and Developmental Disorders, Vol. 36, No. 8American Journal of Medical Genetics Part A, Vol. 135A, No. 2Psychopathology, Vol. 38, No. 3Journal of Psychiatric Practice, Vol. 10, No. 3Journal of Psychiatric Practice, Vol. 9, No. 2Das Asperger Syndrom. Eine aktuelle ÜbersichtZeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, Vol. 29, No. 1American Journal of Medical Genetics, Vol. 96, No. 6Psychiatry and Clinical Neurosciences, Vol. 53, No. 5Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 38, No. SupplementPsychiatry and Clinical Neurosciences, Vol. 52, No. 4European Child & Adolescent Psychiatry, Vol. 6, No. 4Journal of Autism and Developmental Disorders, Vol. 26, No. 2Journal of Autism and Developmental Disorders, Vol. 26, No. 2Current Opinion in Psychiatry, Vol. 9, No. 4Journal of Child Psychology and Psychiatry, Vol. 37, No. 1Journal of Autism and Developmental Disorders, Vol. 24, No. 4Journal of Child Psychology and Psychiatry, Vol. 35, No. 8Journal of Autism and Developmental Disorders, Vol. 23, No. 2European Child & Adolescent Psychiatry, Vol. 2, No. 2European Child & Adolescent Psychiatry, Vol. 1, No. 4 Volume 148Issue 1 January 1991Pages 136-a-136 Metrics History Published online 1 April 2006 Published in print 1 January 1991

Clomipramine, a serotonin reuptake blocker that has unique antiobsessional properties, was hypothesized to have a different effect from that of desipramine, a tricyclic antidepressant with selective adrenergic effects, for the stereotyped, repetitive behaviors in autism. Seven subjects, ages 6-18 years, with autistic disorder completed a 10-week double-blind, crossover trial of clomipramine and desipramine following a 2-week single-blind, placebo phase. Clomipramine was superior to desipramine and placebo, as indicated by standardized ratings of autism and anger as well as ratings of repetitive and compulsive behaviors. Clomipramine and desipramine were equally superior to placebo for ratings of hyperactivity. Parents of all seven subjects elected to have their children continue to take clomipramine after the study. Clomipramine and desipramine are differentially effective in treating the obsessive-compulsive and core symptoms in autistic disorder. Biological links between compulsions and stereotyped, repetitive behaviors in autistic disorder should be explored.

The authors review the clinical features and behavioral characteristics of autism; differential diagnosis of the syndrome; clinical, neurophysiological, and biochemical research; and its medical management and treatment. They conclude that autism is a behaviorally defined, specific syndrome that is manifested at birth or shortly thereafter. Its symptoms are expressive of an underlying neuropathophysiological process that affects developmental rate; modulation of perception; language, cognitive, and intellectual development; and the ability to relate. The long-term prognosis is guarded; almost all patients manifest severe symptomatology throughout their lives. Further basic research into the neuropathophysiological process underlying the syndrome is necessary in order to reach the ultimate goal of developing etiologically specific treatment programs.

The types and expectancy of mental disorders in the siblings of 74 probands with chronic schizophrenia were examined. The siblings were classified according to whether 1) both parents had schizotypal personality disorder, 2) one parent had the disorder and one was normal, or 3) both parents were normal. Siblings whose parents both had the disorder were at significantly greater risk for schizophrenia and schizotypal personality disorder than siblings with at least one normal parent. Similarly, the expectancy of schizotypal personality disorder alone and combined with schizophrenia was higher among siblings with one parent with the disorder than in siblings with two normal parents. The data suggest that schizotypal traits may be genetically related to schizophrenia.

This report examines the impact of panic disorder and/or generalized anxiety disorder on quality of life and the implications of these findings on nosological categories. A total of 357 subjects with a current episode of panic disorder and/or generalized anxiety disorder were diagnosed according to DSM-III-R criteria, using structured clinical interviews, as part of a prospective, naturalistic, longitudinal, multicenter study of a clinical population with anxiety disorders. There was a high degree of coexistence of anxiety disorders and major depressive disorder. Subjects with generalized anxiety disorder almost universally had other disorders, were the most likely to have at least one other anxiety disorder or major depressive disorder at intake, had the earliest age at onset, and had the worst emotional health rating. Subjects with panic disorder without agoraphobia had the most likelihood of a history of alcohol abuse. Nine percent of the subjects had a history of suicide attempts or gestures. The subjects showed significant impairment in quality of life. The highly frequent coexistence of other anxiety disorders with generalized anxiety disorder and the overall lack of differences on many quality of life measures raise questions of nosology, particularly for generalized anxiety disorder.

The authors used data from an earlier nonblind study to identify 16 autistic-type child outpatients who had apparently improved when given vitamin B6 (pyridoxine). In a double-blind study each child's B6 supplement was replaced during two separate experimental trial periods with either a B6 supplement or a matched placebo. Behavior was rated as deteriorating significantly during the B6 withdrawal.

Mental Retardation and Developmental Disabilities: An Annual Review, Vol. XI

Minor physical anomalies occur with increased frequency in retarded, hyperactive, and autistic children, which suggests the effects of genetic influences or a toxic early uterine environment. The author's findings concur with previously published reports concerning hyperactive and autistic children. Extending these studies to adult patients, they found an increased incidence of minor physical anomalies in schizophrenic adults. Alcoholic adults did not have a greater number of anomalies than normal adults, but the distribution among alcoholics appeared to be bimodal, suggesting heterogeneity within this group.

Three mechanisms (eidetic imagery, high-speed calculation, and substitute compensation for normal learning) were investigated and rejected as possible explanations for the calendar-calculating ability of a particular idiot savant. Reaction times for calendar calculations indicated that he used neither an idiosyncratic nor a calendar-based system. Rote memory and a special ability to concentrate for extended periods of time were postulated to explain this individual's performance.