Transcript Chapter 15 (Pervasive Developmental Disorders)

CHAPTER
FIFTEEN
Pervasive Developmental
Disorders
Overview
 Definitions
 Symptoms
 Subtypes
 Epidemiology & Course
 Etiology
 Treatment
Overview
 Definitions
 Symptoms
 Subtypes
 Epidemiology & Course
 Etiology
 Treatment
Definitions
 Pervasive Developmental Disorders (PDDs)
or Autistic Spectrum Disorders
… are disorders that involve profound
disturbances in relationships, stereotyped
activities and unusual behaviors, and
communication difficulties.
 PDDs begin early in life and involve severe
impairments in particular areas of functioning.
 Autistic Disorder is the most researched PDD.
Overview
 Definitions
 Symptoms
 Subtypes
 Epidemiology & Course
 Etiology
 Treatment
Symptoms
Autism is characterized by…
 Early onset
 Profound indifference to social relationships
(impaired social interactions)
 Odd or stereotypical behavior
 Severely impaired or nonexistent
communication skills
 Disorder typically has chronic and
unremitting course
T.O.M.: Sally-Ann Task
Symptoms: Others
 Apparent sensory
deficits
 Self-injury
 Savant
performance
Overview
 Definitions
 Symptoms
 Subtypes
 Epidemiology & Course
 Etiology
 Treatment
Subtypes
 Asperger’s Disorder
 Childhood Disintegrative Disorder
 Rett’s Disorder
Subtypes
Asperger’s Disorder
 Descriptively
identical to Autism
 No Major
Communication
Problems
 Higher intellectual
functioning
 Is this a separate
disorder?
Childhood
Disintegrative
Disorder
 Poorly understood
Rett’s Disorder
 Clearly distinct condition
 5 Months of normal
 Severe problems in
development, then:
social interaction and
 Decrease head growth
communication
 Loss of purposeful
 Stereotyped
hand movements
behaviors
 Loss of social
engagement
 Onset – after 2 years
of normal
 Poor coordination
development
 Marked delay in
language
 Typically only in
females
Overview
 Definitions
 Symptoms
 Subtypes
 Epidemiology & Course
 Etiology
 Treatment
Epidemiology
 Frequency of Autism and PDDs
 Between 30 to 60 in 10,000
children suffer from autism
 Why such an increase?
 Environment (MMR
vaccinations)?
 Broadened diagnostic criteria
(i.e. Asperger’s)?
 Increased awareness?
Prevalence in the U.S.
Prevalence in Illinois
Epidemiology
 Gender Differences
 Three to four times as
many boys as girls
 Autism also is much
more common among
siblings of a child with
autism, suggesting
possible genetic causes.
Course & Outcomes
 Lifelong Disorder
 One study followed 63 children
with autism into adulthood.
 One person functioning in
“normal” range
 22 achieved fair to good
adjustment
 The remainder lived in institutions
or other special settings
 Asperger’s Disorder has better
prognosis
Course & Outcomes
 Two Important Developmental Periods
 Early Preschool
 Developed Language Skills by 5 or 6
 Early Adolescence
 Cognitive and social skills may improve
 No way to predict path for a given child
 Seizure disorders
 Higher IQ during early school years also
positive prognostic indicator
Overview
 Definitions
 Symptoms
 Subtypes
 Epidemiology & Course
 Etiology
 Treatment
Etiology: Psychosocial
 Parental hostility and/or
inappropriate reinforcement
 “Refrigerator Parents”
 No evidence to support this
claim!
 Lack of empirical evidence
to support psychological
causal factors.
Etiology: Biological
 A number of findings indicate that biological
abnormalities play an important role in the
etiology of autism.
 Seizure disorders by adolescence or early adult
life
 Increases in the prevalence of autism among
children with genetic and infectious diseases
 Prevalence of autism higher among immediate
relatives
 Prevalence is particularly high among twin pairs
 A disproportionate number of neurological
abnormalities have been identified among
children with autism
Etiology: Biological
 Concordance Rates
 MZ = 60%
 DZ = 0%
 But why are DZ twin
concordance rates so
low?
 Combination of genes
or spontaneous genetic
mutation
Etiology: Biological
 Neurochemicals
 Endorphins
 Elevated levels
 Critics argue this theory
is too narrow
 Self-Destructive
Behavior?
 Neuropeptides
 Oxytocin & Vasopression
Etiology: Biological
 Abnormalities in brain structure
 Left cerebral hemisphere?
 Subcortical brain structures
 Limbic System
 Cerebellum
 Front Lobe
 Several different sites may be
damaged
 Structural abnormalities result of
abnormal brain development
Overview
 Definitions
 Symptoms
 Subtypes
 Epidemiology & Course
 Etiology
 Treatment
Treatment
 Medications
 Antipsychotics, antidepressants,
amphetamines, psychedelics,
and megavitamins
 None of these effective
 Secretin
 Neurotransmitter for digestion
 No better then placebo
 SSRI
 Obsessive Compulsive Disorder
 Stereotyped behaviors
Treatment
 Facilitated Communication
 Touted as cure for Autism
 Systematic studies show
treatment may not be effective
 “Ouija Board” effect
 Applied Behavior Analysis (ABA)
 Intensive behavior modification
using operant conditioning
 Most promising treatment
Treatment: ABA
 Goals
1. Identify specific target behaviors
2. Gain control of behaviors
3. Gradually set more difficult goals
 ABA has been successful in
teaching self-care skills, but less
successful in teaching social
responsiveness.
Treatment: ABA
 Lovaas (1987) compared
outcomes for three groups
of children with Autism
 19 Received intensive ABA
(40 hrs. wk. for 2 yrs.)
 19 Less intensive
 21 Were treated
somewhere else
Treatment: ABA
 Findings:
 9 children from the intensive ABA group (47%)
completed first grade in normal school
 8 more from the intensive group (42%) passed
first grade in special classes
 Only 1 (2%) in other groups completed first
grade in normal school
 18 (45%) completed first grade in special
classes
 Follow-up studies indicate that many gains
continues into late childhood and adolescence
(McEachlin et al., 1993)