Pervasive Development Disorder of Childhood complete
Pervasive Development Disorder of Childhood
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Child development is a fascinating topic that has been studied extensively by many researchers. Any deviation from normal pattern of development can lead to various problems in different spheres of life. Childhood pervasive development disorders or autistic spectrum disorders are a group of developmental disorders that encompass problems related to communication, language and imagination. This term includes Autism, Asperger’s syndrome, Childhood disintegrative disorder, Rett syndrome and Pervasive Disorders NOS. The exact etiology of these disorders is still debatable. The treatment of these disorders needs a multi disciplinary approach that involves pediatricians, neurologists, psychologists and supporting health staff. Parents have to be educated about the special needs of a child diagnosed with such a disorder and they also have to be provided support to deal with the diagnosis. Early diagnosis, proper counseling and continuous support are the cornerstones of managing these disorders.
Keywords: Development, Autism, Asperger’s Syndrome, Rett syndrome, Pervasive Disorders.
From the moment a newborn comes out of the mother’s womb and receives his first stimulus the process of development begins. Gradually the newborn acquires milestones and becomes more accomplished. Healthy development is defined as an ongoing process that usually follows a set course (Quinn et al., 2000) Since the process of development is affected by a variety of factors both in utero and after birth, certain aberrations in development may develop at any stage. The term pervasive development disorder is a term that refers to all the disorders that affect language development, interpersonal communication, social skills and use of imagination. In May 2013, DSM-5(Diagnostic and Statistical Manual) has grouped Pervasive disorders NOS, Autism and Asperger’s syndrome under the term Autism Spectrum Disorders. This paper will discuss the various disorders included under PDD and also touch upon the etiology and management of these disorders.
Spectrum of Pervasive Development Disorder
The word autism is derived from the Greek language and means self thus pointing towards the characteristic feature in autistic children of being preoccupied with one self. These children usually are born normally and appear to grow as per normal standards. The initial symptoms might develop earlier in life but are usually noticed by parents around the age of three years when they are faced with a non communicating child who prefers his own company. The characteristic symptoms of autism are impairment in social interaction, communication and limitation of interests. The range of verbal impairment may vary from to being totally non verbal to some amount of speaking ability.
There are no specific diagnostic criteria for classifying a child as autistic but a thorough developmental assessment is a must. The gold standard tests for diagnosis of this disorder are: Autism Diagnostic Interview, Autism Diagnostic Observation Schedul (Kliegman et al., 2012). The characteristic symptoms of this disorder include decreased or no eye contact, a preference for fixed routine, resistance to change, lack of pretend play, poor language development and impaired social skills (Seroussi et al., 2000) Around 75% of autistic children have associated intellectual disability.
This disorder is considered by many as a milder variant of autism or high performing autism. In this disorder there are problems related to social interaction and narrow range of interests. Their intelligence levels and language skills are not as impaired as autistic children but they are mostly not used appropriately (Attwood et al., 1997). The children may be clumsy and have abnormal gait.
The child grows normally up to the age of 2 years but then shows signs of neurological regression with loss of acquired milestones. There is also decreased growth of head circumference. While all the rest of the PDD’s are more common in boys, this is the only disorder that is more common in girls (Lewis et al., 1998)
Childhood Disintegrative Disorder
Normal pattern of growth is maintained till 2 -10 years then the child loses many skills and may also show loss of bladder and bowel functions.
Pervasive Development Disorders –not otherwise specified (PDD-NOS)
This is the most common diagnosis under PDD covering almost 47% patients diagnosed with PDD. In this category patients have problems related to communication, play, interaction but are not as socially impaired as autistic children
Disorders associated with PDD
Many children diagnosed with PDD may have other associated problems as well. Attention deficit hyperactivity syndrome, epilepsy, EEG abnormalities and obsessive compulsive disorders are usually seen in such children.
Pointers towards diagnosis
Certain characteristic behavior patterns are considered as possible warning signs and children exhibiting such patterns should be evaluated thoroughly.
1. Decreased interaction with peers and preference for own company.
2. Strict adherence to routine and violent reaction to any change in surroundings.
3. Repetitive stereotyped behavior like hand flapping, head banging and spinning.
4. Inability to tolerate physical contact even with the primary caregiver.
5. Unusual method of playing with toys.
Causes of PDD
The exact etiology of PDD is still not clear. Certain scientists have postulated that there is some insult to the developing brain which leads to a change in the brain functioning and thus causes these disorders. Some have said that the problem lies with both brain and the spinal cord. There are also studies which have proposed a role of parenting or vaccines like the MMR vaccine but these theories are unproven and are debatable. It has also been seen that Autism and Asperger’s syndrome runs in the families so a possible genetic component behind the disease also remains a possibility. Various chromosomal loci like 16p11.2, 15q 24,11p12-p13 have been implicated in abnormal growth of nerve cells and defective myelination. A latest hypothesis proposes the role of spontaneous mutations either in maternal or paternal chromosomes which can cause these disorders.
Diagnosis of PDD
The characteristic behavioral pattern as described above and complete physical examination along with developmental screening questionnaire and detailed history from the parents can help in making the diagnosis of PDD. Physical disorders should be excluded by blood tests and imaging if needed. Various screening tests like Checklist for Autism in Toddlers (CHAT), Modified Checklist for Toddlers (M-CHAT) and Pervasive Developmental Disorders Screening test (PDSST) are available to help in early diagnosis of these disorders.
Management of PDD
First and foremost the diagnosis of PDD should be conveyed in a sympathetic and professional manner to the parents and they should be supported in accepting that their child has this problem. All questions should be answered patiently and if possible parents should be informed about support groups.
The management of a child with PDD is complicated and an ongoing process. Parents, peer group, pediatricians, psychologists, pediatric neurologist have to work as team to help their patient. It must be remembered that just like no two normal children are alike in all ways, no two patients with PDD are similar and hence a blanket approach cannot be used in all patients. A tailor made and individualized treatment programme is a must to help patients lead as normal a life as their condition permits. Positive stimulus, motivation and using innovative techniques like picture exchanges must be made a part of the treatment programme. Cognitive therapy including physical, occupational and speech therapy should be a part of the treatment. For children with mild forms of PDD the environment should be such that they deal with understanding normal role models who can help improve their language and communication skills. If the child has any associated problem like ADHD, Epilepsy or OCD then theses should be treated with appropriate drugs. Certain examples of programs that cover most aspects of treatment are: treatment and education of Autistic and related Communication –handicapped Children (TEACH).
The long term course of these disorders depends on the severity and type of the disorder along with the environment and stimulation provided to the child.
The childhood pervasive development disorders are a group of disorders related to impaired language, communication and social skills. Such children should be timely diagnosed and provided specialized care to make them as self sufficient as possible. The social stigma of a mental illness should not be attached to such disorders and they should be encouraged to develop normally making the best use of their abilities.
Attwood. Tony, Asperger’s Syndrome. A guide for Parents and Professionals. Philadelphia: Jessica Kingsley Publishers, 1997.
Barbara Quinn, Anthony F. Malone, Pervasive Development Disorder; An Altered Perspectives: Jessica Kingsley Publishers, 2000.
Lewis, Jackie and Debble Wilson. Pathways to Learning in Rett Syndrome. London: David Fulton, 1998.
Seroussi, Karyn. Unraveling the Mystery of Autism and Pervasive D D: A Mothers Story of Research and Recovery. New York: Simon and Schuster, 2000.
Kliegman,R.Stanton B,Schor N, Behrman R: The Nelson Textbook of Pediatrics,pPhiladelphia:Elseiver 2012.