Autism and Childhood Schizophrenia

I think this is is a particularly good video to watch in trying to understand differential diagnosis and the need for symptoms to independent to each individual diagnosis, as opposed to overlapping between more than one.  In observing the behaviors Jani displayed in the video and listening to the comments made by her parents it is fairly easy to see how some of her behaviors and symptoms might be mistaken as falling under an autism diagnosis, but truly fit better under a diagnosis of childhood schizophrenia. 

To begin with, I had some difficulty qualifying her for a diagnosis of Autism.  A few times in the video we saw some impairments in eye contact, facial expressions and gestures, but she does have developed peer relationships, points out objects (and animals) of interest to other (although others cannot see them) and seems to exhibit social reciprocity, trying to involve others in her play.  It could be determined that she is only trying to involve others as tools in her “imaginary” play, but I think this is occurring as more of a by-product of her hallucinations, as opposed to as a function of an autism diagnosis.  (I want to note that I think the same case is true with her lack of eye contact and impaired facial expressions.)  In regards to communication, Jani has spoken language which she seems to initiate and can sustain conversation, and though some of it is repetitive and her pretend play is not all that varied, these impairments again appears to be a function of the hallucinatory “world” she is surrounded by.  In terms of stereotyped patterns of behavior, her interests are somewhat restricted to the animals she “sees”, but there is no clear mention of strict adherence to routine and no preoccupation with parts of objects, though she does exhibit some repetitive motor behavior.  Actually, from my perspective, the only symptom displayed that clearly points to autism, from what I can see is the repetitive motor behavior, and that is not enough to qualify for an autism diagnosis.

In considering the diagnostic criteria for childhood schizophrenia on the other hand, Jani clearly fits.  She presents with hallucinations of animals and delusions of them biting her and telling her to hit her brother, disorganized behavior, failure to achieve appropriate levels of social performance (as displayed by her relationship with her brother and what later becomes of her families situation), and signs lasting for more than six months.  (I’m operating under the assumption that other mental health disorders have been ruled out.)

I do think Jani’s diagnosis could have been made earlier than age 7, as it sounds like the symptoms have been present.  I assume I would have approached it the same way I did here, by observing her behavior, gathering information from parents and gathering information from previous assessments when possible.  It is clearer to me now why doctors often wait to give such diagnosis; there are a lot of factors to consider, it is not a diagnosis that can be handed out lightly and sometimes symptoms can fit under the criteria of two or more diagnoses.  It’s important to find the diagnoses under which the symptoms fit best.