Transcript Pervasive Developmental Disorders

Disorders usually first diagnosed in
infancy, childhood, or adolescence
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Mental Retardation
Learning Disorders
Motor Skills Disorder
Communication Disorders
Pervasive Developmental Disorders
Attention-Deficit/Hyperactivity & Disruptive Behavior
Disorders
Feeding and Eating Disorders of Infancy/Early Childhood
Tic Disorders
Elimination Disorders
Others (Separation Anxiety, Selective Mutism, etc.)
Pervasive Developmental
Disorders
• Severe/pervasive impairment in:
– Reciprocal social interaction skills
– Communication skills
• Or Stereotyped behavior, interests, activities
• Often associated with Mental Retardation
• Often also have other medical conditions
(chromosomal abnormalities, seizures, abnormal
CNS structure, primitive reflexes, delayed hand
dominance, etc.)
Pervasive Developmental
Disorders
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Autistic Disorder (onset < age 3)
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Asperger’s Disorder
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Impairments in social interaction & language
Repetitive/stereotyped behaviors, interests
Impairments in social interaction
Repetitive behavior, interests
No early language delays
Rett’s Disorder
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Normal early development but deterioration in motor, social, language functioning as well as
slowed head growth between 5-48 months
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Motor: hand-wringing/washing, incoordination (gait), psychomotor slowing
Social: interest in others may increase in adolescence and adulthood
Severe receptive and expressive language deficits persist
Typically associated with severe or profound mental retardation
Rare, and reported only in females
Childhood Disintegrative Disorder
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Loss of previously acquired skills after age 2 but before age 10 (language, social, play, motor
skills; bowel/bladder control)
Typically associated with severe mental retardation
Very rare
Autistic Disorders
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First identified in 1943
By definition, symptoms appear before 3
Prevalence rates are increasing
At least one in 600 may have autism
Majority are male (4-5 more boys than
girls)
Autism
• Central feature: lack of responsiveness, including
extreme aloofness and lack of interest in people
– Lack of eye contact, reciprocal interaction
– Failure to develop peer relationships
– Solitary playing (can be oblivious of others)
• Language/communication problems
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May be lack of language or problems starting/maintaining
Echolalia, exact echoing of phrases
Tone, pitch, rate, rhythm, inflexion may be flat or inappropriate
Language comprehension delayed (and arrested)
• No or inimal appreciation of humor, irony, figurative langauge
• Limited imaginative play, repetitive/rigid behavior
– Become very distressed when routine is broken
Autism
• May become strongly attached to
– Particular objects (e.g., buttons, piece of string)
– Specific interests (names, dates)
• Unusual motor movements
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“Self-stimulatory” behaviors: jumping, arm flapping
Self-injurious behaviors: head-banging
Nonsensical gesturing
Other stereotyped movments: rocking, swaying, clapping
• At times seem overstimulated and/or understimulated by
their environments
• Range of related behavioral symptoms: hyperactivity,
poor attention span, impulsivity, aggressiveness, temper
tantrums
Asperger’s Disorder
• Similar social deficits, impairments in
expressiveness, idiosyncratic interests, and
restricted and repetitive behaviors as Autism
• Relatively well-developed language and other
cognitive abilities
• Not usually associated with Mental Retardation
• More prevalent than autism
– Approximately 1 in 250 individuals
– Again, majority are male
Case Example
Asperger’s Disorder
• 23 year-old student at a technical college
studying computer networks
• Diagnosed with Autism (high functioning)
at age 10 by neurologist
• Served as student with Specific Learning
Disabilities grades 2-11
• Repeated 6th grade
Developmental History
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No pregnancy/birth complications
Developmental milestones met
Normal early language development
Generalized tonic-clonic seizures
diagnosed at age 6 (none for 2 years)
• Seizures aggravated by excitement,
photosensitivity, MSG, sensitivity to noise
Developmental History
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Mom: “he has always been different”
Impaired social interactions/no close friends
Bullied in school because of unusual behaviors
Stereotyped interests
Stereotyped patterns
By age 9, speech “sounded like he was reading
a book”
• Self-injurious and aggressive behaviors (headbutted walls, hit other kids)
Self-reported Problems
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“Receiving information”
“Lot of words” he does not know
Hard to pay attention
Slow at thinking, “like a personal computer
over packed with information”
• Basic, concrete tasks easier; those requiring
abstraction more difficult
• Better communicating through writing
because “no backspace key in conversation”
• Periods of low mood, loss of interest in
things, trouble concentrating, thoughts of
death
Behavioral Observations
• Flat affect (smiled and laughed occasionally)
• Initiated conversation but in long, tangential
(but fluent) monologues
• Situationally inappropriate comments and
questions
• Monotonous/pedantic speech pattern (like
lecturing)
• Many questions clarifying test instructions
Asperger’s Criteria
Impaired social interaction skills (>2 of the
following):
– Nonverbal behaviors (eye contact, facial
expression, body posture, gestures)
– Development of peer relationships
– Spontaneous seeking to share with others
– Social or emotional reciprocity
Asperger’s Criteria
Restricted repetitive and stereotyped
patterns of behavior, interests, activities (>
1 of the following):
– Preoccupation with interests that is
abnormal in intensity or focus
– Inflexible routines, rituals
– Stereotyped and repetitive motor mannerisms
(e.g., hand flapping, twisting, body
movements)
– Preoccupation with parts of objects
Asperger’s Criteria continued
• Clinically significant impairment in social,
occupation, other functioning
• No general delay in early language
development
• No delay in cognitive development, selfhelp skills, adaptive behavior, curiosity
about the environment
• Not another Pervasive Developmental
Disorder or Schizophrenia
Test Results
• Average overall abilities
• Deficits:
– Understanding figurative, non literal, abstract
language
– Understanding complex syntax
– Vocabulary
– Processing Speed
– Motor Functioning
– Academic Fluency
– Reading Comprehension
– Math calculation and reasoning
Test Results
• Strengths
– Visual-Spatial Abilities
– Nonverbal Reasoning (solving logic puzzles)
– Verbal Analogies(?)
Test Results
• Other Areas Assessed
– Working Memory
– Learning
– Word Retrieval
– Reading Decoding
– Spelling
– Mechanics of Writing
Test Results
• Asperger Syndrome Diagnostic
Scale Quotient = 105 (“likely”)
• BASC-2 - Mother
– Attention Problems
– Social Skills
– Leadership
– Atypical Thoughts
– Withdrawal
Test Results
• BASC-2 – Father
– Anxiety
– Depression
– Leadership
– Withdrawal
– Activities of Daily Living
Some Accommodations
• Note taking help (note-taker and/or
digital/tape recorder)
• Written instructions
• Use of digital camera to capture class
assignments
• Reduced course load
• Priority registration
Other Recommendations
• Continue with Vocational Rehabilitation
• Therapy for social skills, daily living skills,
easing need for routines
• Speech/language therapy for vocabulary
building, understanding figurative
language, prosody/tone regulation
• Online or hybrid courses when available
• Vocabulary building tools (flashcards,
word-a-day calendars/e-mails)
Some possible areas for
teams to explore
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Biological factors
Psychological and sociocultural contributors
Treatment approaches
Community resources for caregivers
Comparison of Autism, Asperger’s, Rett’s,
Disintegrative Disorder on any combo of above
• Social development in Asperger’s compared to
other Pervasive Developmental Disorders
• Other famous individuals with Pervasive
Developmental Disorder