The benefit of directly comparing autism and schizophrenia for revealing mechanisms of social cognitive impairment

Journal of Neurodevelopmental Disorders, Jun 2011

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.

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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)


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Noah J. Sasson, Amy E. Pinkham, Kimberly L. H. Carpenter, Aysenil Belger. The benefit of directly comparing autism and schizophrenia for revealing mechanisms of social cognitive impairment, Journal of Neurodevelopmental Disorders, 2011, pp. 87-100, Volume 3, Issue 2, DOI: 10.1007/s11689-010-9068-x