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Running Head: AUTISM SPECTRUM DISORDER and SCHIZOPHRENIA 1 Running head: AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA 1 Autism Spectrum Disorder and Schizophrenia A Literature Review Presented to The Faculty of the Adler Graduate School ____________________ In Partial Fulfillment of the Requirement for The Degree of Master of Arts in Adlerian Counseling and Psychotherapy ____________________ By Björn Walter ____________________ Chair: Richard Close, DMin, LPCC, LMFT Reader: Meghan Williams, MA, LMFT ____________________ August, 2017 AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA 2 Abstract This literature review sets out to compare the similarities and the differences between autism spectrum disorder and schizophrenia. To understand the relationship between the two disorders, this project includes an examination of the historical timeline, an analysis of the diagnostic criteria, the impact and effectiveness of various treatments for autism spectrum disorder and schizophrenia. Emphasis is on Adlerian therapy, pharmacological treatment through antipsychotic medications, and the legal and ethical issues as a result of misdiagnosis. To achieve understanding around ethical and legal concerns regarding misdiagnosis, this project includes a hypothetical case study to demonstrate potential harm after the wrong treatment. The primary purpose of this paper is to increase awareness of the problematic situations that arise when the autism spectrum disorder and schizophrenia are misdiagnosed. Keywords: autism spectrum disorder, schizophrenia, Adlerian therapy, antipsychotic medication, DSM-5 AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA 3 Acknowledgements I would first like to thank my colleagues at the Autism Society of Minnesota. I would like to particularly extend my gratitude to Dr. Barbara Luskin. You inspired me to complete this project, and I will always be grateful for the support you gave me. I would also like to thank my family for always being there for me. I would not be where I am without you. Lastly, I would like to express the deepest gratitude to Ari Leuthner for his support and wisdom. AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA 4 Autism Spectrum Disorder and Schizophrenia Copyright © 2017 Björn Walter All rights reserved AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA 5 Table of Contents Adlerian Theory ....................................................................................................................... 7 Social Interest .................................................................................................................... 7 Belonging .......................................................................................................................... 9 Mistaken Beliefs .............................................................................................................. 12 Autism spectrum disorder ...................................................................................................... 14 DSM-5 Diagnostic Criteria ............................................................................................. 14 History of Autism Spectrum Disorder ............................................................................ 16 History of Asperger’s Syndrome..................................................................................... 19 Treatment for Autism Spectrum Disorder ....................................................................... 20 Therapeutic. ...............................................................................................................20 Pharmacological. ........................................................................................................23 Schizophrenia ........................................................................................................................ 25 DSM 5 Diagnostic Criteria .............................................................................................. 25 History of Schizophrenia ................................................................................................. 27 Treatment for Schizophrenia ........................................................................................... 30 Therapeutic. ...............................................................................................................30 Pharmacological. ........................................................................................................32 Comparison ........................................................................................................................... 34 Similarities ...................................................................................................................... 35 Differences ...................................................................................................................... 37 Ethical .................................................................................................................................... 40 Legal ................................................................................................................................ 40 Ethical.............................................................................................................................. 41 Case Study ............................................................................................................................. 43 Discussion .............................................................................................................................. 45 Recommendations for Future Research ................................................................................. 46 Conclusion ............................................................................................................................. 47 AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA 6 Autism Spectrum Disorder and Schizophrenia According to The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM- 5; American Psychiatric Association, 2013a), the previously named autism disorder, along with other disorders such as Asperger’s syndrome, were placed into an umbrella category called autism spectrum disorder. However, individuals with autism spectrum disorder are still subjected to receiving wrongful treatment or treatment more suitable for those diagnosed with schizophrenia (Owen, et al., 2009). Wrongful treatment for those diagnosed with autism spectrum disorder includes antipsychotic medications that focus on symptoms not present in individuals with autism spectrum disorder, including hallucinations, delusions, and confused thoughts (Rapoport, Chavez, Greenstein, Addington, & Gogtay, 2009). These symptoms are common in schizophrenia and are positive symptoms (thoughts and behaviors present within a mental disorder, but not in the population without it) (American Psychiatric Association, 2013a). Antipsychotic medication may have side-effects, which can be worse than the problems associated with autism spectrum disorder (LeClerc & Easley, 2015). In addition, there is no correlation between the use of antipsychotic medication and improvement in areas such as social withdrawal, apathy, and being able to live a meaningful life (Volkmar & Wiesner, 2013). Woodbury-Smith, Boyd, and Szatmari (2010) found that therapy had a greater success rate with schizophrenia and autism spectrum disorder than antipsychotic medication. Additionally, therapy would eliminate potential side effects of medication. One successful approach has been Adlerian therapy. This approach helps the client work around their mistaken beliefs, gain social interest, and feel belonging. By working on these components, clients of both disorders can improve their quality of life. This is done through not only helping others but also by helping themselves. Adlerian therapy is encouraging in nature AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA 7 and it places a great emphasis on finding belonging in society. Both schizophrenia and autism spectrum disorder have problems rooted in lack of belonging and lack of social interest. In addition, mistaken beliefs often hinder them from living meaningful lives. That is not to say there are other problems that come up. There are still difficulties with the basics of everyday life, not following through tasks, and in the case of individuals with schizophrenia: positive symptoms, such as hallucinations and delusions. However, clients can get guidance through these problems with Adlerian therapy (Ansbacher & Ansbacher, 1964). The following sections will show why pharmacological treatment with antipsychotic medication is not a sustainable treatment of autism spectrum disorder. Additionally, the reasons why therapy, particularly Adlerian therapy, are beneficial forms of treatment. Furthermore, one section will show a hypothetical scenario in which a person gets the wrong diagnose and the problems associated with the misdiagnosis. Adlerian Theory Social Interest The word social interest comes from the German word “Gemeinschaftgefūhl”, which can be translated as “community feeling” or social interest (Ansbacher, 1991). Adler proposed that social interest was the personality trait reflecting the relationship between an individual and its environment (Ansbacher & Ansbacher, 1964). The actions and characteristics of humans are all impacted by the degree of social interest the person has. Adler believed the desirable traits of humans are affected by how much social interest a person has. For example, a person described as optimistic, caring, courageous, and empathetic would have more social interest.
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