pervasive developmental disorders
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Pervasive Developmental Disorders
Pervasive developmental disorders include five different conditions: Asperger's syndrome, autistic disorder, childhood disintegrative disorder (CDD), pervasive developmental disorder not otherwise specified (PDDNOS), and Rett's syndrome. They are grouped together because of the similarities between them. The three most common shared problems involve communication skills, motor skills, and social skills. Since there are no clear diagnostic boundaries separating these conditions it is sometimes difficult to distinguish one from the other for diagnostic purposes.
Asperger's syndrome, autistic disorder, and childhood disintegrative disorder are four to five times more common in boys, and Rett's syndrome has been diagnosed primarily in girls. All of these disorders are rare.
Children afflicted with Asperger's syndrome exhibit difficulties in social relationships and communication. They are reluctant to make eye contact, do not respond to social or emotional contacts, do not initiate play activities with peers, and do not give or receive attention or affection. To receive this diagnosis the individual must demonstrate normal development of language, thinking and coping skills. Due to an impaired coordination of muscle movements, they appear to be clumsy. They usually become deeply involved in very few interests, which tend to occupy most of their time and attention.
Autistic disorder is frequently evident within the first year of life, and must be diagnosed before age three. It is associated with moderate mental retardation in three out of four cases. These children do not want to be held, rocked, cuddled or played with. They are unresponsive to affection, show no interest in peers or adults and have few interests. Other traits include avoidance of eye contact, an expressionless face and the use of gestures to express needs. Their actions are repetitive, routine and restricted. Rocking, hand and arm flapping, unusual hand and finger movements, and attachment to objects rather than pets and people are common. Speech, play, and other behaviors are repetitive and without imagination. They tend to be overactive, aggressive, and self-injurious. They are often highly sensitive to touch, noise, and smells and do not like changes in routine. Autism and several disorders classified with it have increased significantly in recent years so that they now are diagnosed more often in children than spina bifida, cancer, or Down syndrome. This may be due partly to improved recognition and diagnosis.
Childhood disintegrative disorder
Childhood disintegrative disorder is also called Heller's disease and most often develops between two and ten years of age. Children with CDD develop normally until two to three years of age and then begin to disintegrate rapidly. Signs and symptoms include deterioration of the ability to use and understand language to the point where they are unable to carry on a conversation. This is accompanied by loss of control of the bladder and bowels. Any interest or ability to play and engage in social activities is lost. The behaviors are nearly identical with those that are characteristic of autistic disorder. However, childhood disintegrative disorder becomes evident later in life and results in developmental regression, or loss of previously attained skills, whereas autistic disorder can be detected as early as the first month of life and results in a failure to progress.
Pervasive developmental disorder not otherwise specified
The term pervasive developmental disorder not otherwise specified (PDDNOS) is also referred to as atypical personality development, atypical PDD, or atypical autism. Individuals with this disorder share some of the same signs and symptoms of autism or other conditions under the category of pervasive developmental disorders, but do not meet all of the criteria for diagnosis for any of the four syndromes included in this group of diseases. Because the children diagnosed with PDDNOS do not all exhibit the same combination of characteristics, it is difficult to do research on this disorder, but the limited evidence available suggests that patients are seen by medical professionals later in life than is the case for autistic children, and they are less likely to have intellectual deficits.
Rett's syndrome was first described in 1966 and is found almost exclusively in girls. It is a disease in which cells in the brain experience difficulty in communicating with each other. At the same time the growth of the head falls behind the growth of the body so that these children are usually mentally retarded. These conditions are accompanied by deficits in movement (motor) skills and a loss of interest in social activities.
The course of the illness has been divided into four stages. In stage one the child develops normally for six to 18 months. In stage two, development slows down and stops. Stage three is characterized by a loss of the speech and motor skills already acquired. Typically this happens between nine months and three years of age. Stage four begins with a return to learning that will continue across the lifespan, but at a very slow rate. Problems with coordination and walking are likely to continue and even worsen. Other conditions that can occur with Rett's syndrome are convulsions, constipation, breathing problems, impaired circulation in the feet and legs, and difficulty chewing or swallowing.
Causes and symptoms
The causes of these disorders are unknown although brain structure abnormalities, genetic mutation, and alterations in brain function are believed to play a role. Still, no single brain abnormality or location has been connected to a cause. In 2004, scientists reported finding the gene mutation (on gene MECP2) that is present in 80% of people affected with Rett's syndrome. In 2004, comprehensive review of research on twins revealed that interactions between multiple genes may play a role in the cause of autism. A number of neurological conditions, such as convulsions, are commonly found to accompany these disorders.
The diagnosis of pervasive developmental disorder is made by medical specialists based on a thorough examination of the patient, including observing behavior and gathering information from parents and caregivers. Because many symptoms are common to more than one condition, distinctions between conditions must be carefully made. The following summary describes the distinction between three common disorders.
- impairment of two-way social interaction
- Repetitive and predictable behavior patterns and activities
- all listed for PDDNOS
- severe impairment in communication
- abnormal social interaction and use of language for social communication or imaginative play before age of three
- not better accounted for by another psychiatric order
- all listed for PDDNOS
- clinically significant impairment in social, occupational, or other areas of functioning
- no general delay in language
- no delay in cognitive development, self-help skills, or adaptive behavior
- not better accounted for by another pervasive developmental disorder or schizophrenia
- a period of normal development between 6-18 months
- normal head circumference at birth, followed by a slowing of head growth
- repetitive hand movements
- normal development for at least two years
- loss of skills in at least two of the following areas: language, social skills, bowel or bladder control, play, movement skills
- abnormal functioning in at least two of the following areas: social interaction, communication, behavior patterns
- not better accounted for by another PDD or mental illness
Treatment for children with pervasive developmental disorders is limited. Those who can be enrolled in educational programs will need a highly structured learning environment, a teacher-student ratio of not more than 1:2, and a high level of parental involvement that provides consistent care at home. Psychotherapy and social skills training can prove helpful to some. There is no specific medication available for treating the core symptoms of any of these disorders, though research is promising. Some psychiatric medications may be helpful in controlling particular behavior difficulties, such as agitation, mood instability, and self-injury. Music, massage, and hydrotherapy may exert a calming effect on behavior. Treatment may also include physical and occupational therapy.
In general, the prognosis in all of these conditions is tied to the severity of the illness.
The prognosis for Asperger's syndrome is more hopeful than that for other diseases in this cluster. These children are likely to grow up to be functional independent adults, but will always have problems with social relationships. They are also at greater risk for developing serious mental illness than the general population.
The prognosis for autistic disorder is not as good, although great strides have been made in recent years in its treatment. The higher the patient's IQ (intelligence quotient) and ability to communicate, the better the prognosis. However, many patients will always need some level of custodial care. In the past, most of these individuals were confined to institutions, but many are now able to live in group homes or supervised apartments. The prognosis for childhood disintegrative disorder is even less favorable. These children will require intensive and long-term care. Children diagnosed with PDDNOS have a better prognosis because their initial symptoms are usually milder, IQ scores are higher, and language development is stronger.
The causes of pervasive developmental disorders are not understood, although research efforts are getting closer to understanding the problem. Until the causes are discovered, it will remain impossible to prevent these conditions.
"MECP2 Open Reading Framd Defines Protein Linked to Rett Syndrome." Biotech Week June 9, 2004: 300.
Muhle, Rebecca, Stephanie V. Trentacoste, and Isabelle Rapin. "The Genetics of Autism." Pediatrics May 2004: 1389-1391.
Autism Society of America. 7910 Woodmont Avenue, Suite 300, Bethesda, Maryland 20814-3067. (800) 328-8476. http://www.autism-society.org.
International Rett Syndrome Association. 9121 Piscataway Road, Suite 2B, Clinton, MD 20735. (800) 818-7388. http://www.rettsyndrome.org.
Learning Disabilities Association of America. 4156 Library Road, Pittsburg, PA 15234. (412) 341-1515. http://www.ldanatl.org.
National Organization for Rare Disorders. P.O. Box 8923, New Fairfield, CT 06812-8923. (800) 999-6673. http://www.rarediseases.org.
Boyle, Thomas D. "Diagnosing Autism and Other Pervasive Personality Disorders." INJersye.com Page. http://www.injersey.com.
"Childhood Disintegrative Disorder." HealthAnswers.com. 〈http://www.healthanswers.com/database/ami/converted/001535.html〉.
"Information on Childhood Disintegrative Disorder." Yale-New Haven Medical Center Page. http://info.med.yale.edu.
The International Rett Syndrome Association. 9121 Piscataway Road, Suite 2B, Clinton, MD 20735. (800) 818-7388 http://www.rettsyndrome.org.
Koenig, Kathy. "Frequently Asked Questions." Yale-New Haven Medical Center Page. http://info.med.yale.edu.
Hydrotherapy — This term literally means "water treatment" and involves the use of water in physical therapy as well as treatment of physical and emotional illness.
Mutation — A mutation is a change in a gene. Since genes determine how a body is structured and functions, any change in a gene will produce some change in these areas.
Neurological conditions — A condition that has its origin in some part of the patient's nervous system.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
pervasive developmental disorders
a group of disorders characterized by impairment of development in multiple areas, including the acquisition of reciprocal social interaction, verbal and nonverbal communication skills, and imaginative activity, and by stereotyped interests and behaviors; included are autistic disorder and various less common conditions.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
Patient discussion about pervasive developmental disorders
Q. Is pervasive developmental disorder (PDD) or autism is fatal……what exactly it is……?
A. Autism is not fatal in its symptom and progression but it can become fatal as it does impair normal physiological function it CAN BE a fatal condition. It’s a group of illness which involves delays in the development of basic skills. It happens to children below age 3. It affects the child`s ability to communicate and interact. Autism affected children are also found to be mentally retarded.More discussions about pervasive developmental disorders
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