Journal of the American Academy of Child & Adolescent Psychiatry
ReviewAutism Spectrum Disorders and Childhood-Onset Schizophrenia: Clinical and Biological Contributions to a Relation Revisited
Section snippets
Phenomenology of COS in Relation to autism/PDD
Childhood-onset schizophrenia is defined as onset of psychosis before age 13 years and is a rare and severe form of schizophrenia. Onset is usually after age 7 years, positive and negative symptoms are prominent, and prognosis is poor.10 In contrast, autism is defined by abnormal behavior in the spheres of communication, social relatedness, and stereotyped behaviors within the first 3 years of life. The broader category, PDD (subsuming autism, Rett syndrome, Asperger syndrome, and childhood
Brain Imaging
The growing literature on brain imaging abnormalities in COS is not reviewed here. In autism, the best agreed on finding is increased head size/total brain volume seen in the first 3 years of age based on crosssectional studies.31, 32 This brain overgrowth that precedes or coincides with the appearance of signs and symptoms of autism suggests that it may be a fundamental aspect of the pathological process.33 There remains controversy, however, as to whether the brain anatomic developmental
Genetics
There are numerous direct and indirect genetic data linking autism and schizophrenia.39, 40, 41, 42 Specifically, various candidate gene and linkage studies and expression studies using postmortem brain samples, as well as studies of copy number variants (CNVs) in schizophrenia, have yielded a handful of genetic associations that have also been reported for autism.43, 44 Large alterations in chromosome region or number are increased in COS.45 Genomic microduplications and deletions or CNVs
Discussion
The subtle developmental delays that are seen in large prospective cohort studies of adult-onset schizophrenia are seen in exaggerated form in childhood-onset cases.10, 75 Early-onset schizophrenia has also shown strong comorbidity with PDDs in two of the three large studies in which this was measured systematically, although, until now, this has received less attention. Comorbidity is the most straightforward way to describe such findings, but as previously noted, this association does not
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Support for this work has come from the National Institute of Mental Health intramural program.