The benefit of directly comparing autism and schizophrenia for revealing mechanisms of social cognitive impairment
J Neurodevelop Disord
The benefit of directly comparing autism and schizophrenia for revealing mechanisms of social cognitive impairment
Noah J. Sasson 0 1 2 4
Amy E. Pinkham 0 1 2 4
Kimberly L. H. Carpenter 0 1 2 4
Aysenil Belger 0 1 2 4
0 K. L. H. Carpenter
1 A. E. Pinkham Department of Psychology, Southern Methodist University , Dallas, TX , USA
2 N. J. Sasson (
3 School of Behavioral and Brain Sciences, University of Texas at Dallas , GR41, 800 W. Campbell Rd, Richardson, TX 75080 , USA
4 K. L. H. Carpenter Curriculum in Neurobiology, University of North Carolina , Chapel Hill, NC , USA
Autism and schizophrenia share a history of diagnostic conflation that was not definitively resolved until the publication of the DSM-III in 1980. Though now recognized as heterogeneous disorders with distinct developmental trajectories and dissociative features, much of the early nosological confusion stemmed from apparent overlap in certain areas of social dysfunction. In more recent years, separate but substantial literatures have accumulated for autism and schizophrenia demonstrating that abnormalities in social cognition directly contribute to the characteristic social deficits of both disorders. The current paper argues that direct comparison of social cognitive impairment can highlight shared and divergent mechanisms underlying pathways to social dysfunction, a process that can provide significant clinical benefit by informing the development of tailored treatment efforts. Thus, while the history of diagnostic conflation between autism and schizophrenia may have originated in similarities in social dysfunction, the goal of direct comparisons is not to conflate them once again but rather to reveal distinctions that illuminate disorder-specific mechanisms and pathways that contribute to social cognitive impairment.
Social cognition; Face processing; Emotion; Amygdala; Superior temporal sulcus; Fusiform gyrus
-
In his seminal 1943 paper “Autistic Disturbances of Affective
Contact”, Leo Kanner described a group of 11 children who
shared a constellation of behavioral and affective symptoms,
most notably “a powerful desire for aloneness and sameness”
(Kanner 1943)
. A year later, the Austrian pediatrician Hans
Asperger independently characterized several children he
deemed “little professors” who exhibited “a lack of empathy,
little ability to form friendships, one-sided conversations
[and] intense absorption in a special interest”
(Asperger
1944/1991)
. Both Kanner and Asperger, without apparent
knowledge of each other’s work, selected the term
“autism” (from the Greek autos meaning “self”) to capture
the characteristic egocentrism in the children they were
observing. The simultaneous choice of label, however,
was not mere coincidence: “autism” had a long history in
the psychiatric literature, dating back to 1911 when Eugen
Bleuler used the word to describe social withdrawal in
patients with schizophrenia:
Schizophrenics, who have no more contact with the
outside world, live in a world of their own. They have
encased themselves with their desires and wishes...;
they have cut themselves off as much as possible
from any contact with the external world. This
detachment from reality, together with the relative
and absolute predominance of the inner life, we term
autism
(Bleuler 1911)
.
Both Kanner and Asperger thus grounded their clinical
descriptions of autism within the context of established
psychiatric nomenclature. Each was keenly aware of
Bleuler’s use of the term and deliberately selected an
accepted psychiatric label that connoted social
disconnection. Although the application of such a recognized term
had the intended result of facilitating understanding of the
affective impairments they were describing, its close
association with schizophrenia inadvertently resulted in
considerable nosological confusion. Kanner and Asperger
each appeared to struggle with this tradeoff. While Kanner
maintained that autism was a distinct clinical syndrome
from schizophrenia, separated by its apparent presence from
birth, its peculiarities in repetitive interaction with objects,
and its characteristic insistence on familiarity and routine,
he believed the term “autism” was warranted because of a
shared presentation of social isolation:
Nevertheless, in full recognition of [the differences], I
was unable to find a concise expression that would be
equally or more suitably applicable. After all, these
children do start out in a state which, in a way,
resembles the end results of later-life withdrawal, and
there is a remoteness at least from the human portion
of the external world
(Kanner 1973)
.
Similarly, Asperger argued that “autism” was an appropriate designation for the children he was studying given their similarities with certain negative symptoms of schizophrenia:
I have chosen the label autism in an effort to define
the basic disorder that generates the abnormal
personality structure of the children we are c (...truncated)