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Pervasive Developmental Disorders

Pervasive Developmental Disorders are also called Autism Spectrum Disorders (ASD). These disorders are typically diagnosed in early childhood or infancy and can range from severe autistic disorder to a much milder form of disorder called Asperger’s Syndrome to mild pervasive developmental disorders that are not otherwise specified (called Pervasive Developmental Disorders Not Otherwise Specified, or PDD-NOS). The PDD or ASD class also includes two rare disorders; Rett’s Syndrome and Childhood Disintegrative Disorder. The diagnostic category of Pervasive Developmental Disorders (PDD or ASD) is a group of disorders that is characterized by delayed development of socialization and communication skills. These disorders cause impairment in thinking, feeling, language, and the ability to relate to others and to interact with the environment. Parents may recognize symptoms as early as infancy, though typically the onset is anytime prior to age three.

Children may have problems with speaking or understanding language, and may find it difficult to relate to people, objects, events or their environment in general. They may exhibit unusual behavior when playing with toys and may experience extreme difficulty when coping with changes in routine or surroundings. Some children will exhibit repetitive body movements, or behaviors. The disorders included in this category include Autism, Asperger's Syndrome, Childhood Disintegrative Disorder, and Rett's Syndrome. All children with ASD will demonstrate deficits in social interaction, verbal and nonverbal communication, and will exhibit repetitive behaviors or interests, and they will often have unusual responses to sensory experiences, like specific sounds or objects. Each child may respond differently, but will display communication, social, and behavioral patterns that fit the overall ASD diagnosis. The earlier the disorder is diagnosed, the sooner the child can begin treatment and intervention.

What are the symptoms?

For detailed information on these specific disorders, see the related title article. The following symptoms summarize those exhibited in Autistic Spectrum Disorders. Patients may exhibit some or all of these symptoms, depending on the specific disorder:

• Child does not babble, point or gesture with meaning by 1 year
• Does not speak by 16 months
• Unusual play, uses toys or objects oddly
• Is overly attached to one object or toy
• Seems hearing impaired
• Exhibits strange physical behaviors like arm-flapping, walking on toes, freezing in position, repetitive motions
• Exhibits inappropriate outbursts and behavior in social situations
• Resists touch, hugs and human contact, seems passive when hugged
• Resists changes to routine
• Loses acquired language or social skills with age
• May not respond to name
• Poor eye contact
• May be hypersensitive to touch, smell or sound
• Does not smile, shows little range of emotion
• Orders or lines up toys or objects
• Seems oblivious to tone of voice, facial expression or other communication cues or signals
• Facial expression, body language and gestures do not seem to match emotion
• May speak in a high-pitched, sing-song voice, or in a robotic fashion.
• Interacts poorly with people and surroundings

How is it diagnosed and treated?

Pediatricians, family doctors, and parents may dismiss signs of PDD, thinking the child is slow and will catch up to peers. Early intervention has a significant impact on symptoms and can increase a child's ability to acquire life skills. Yet it is estimated that only 50% of ASD children are diagnosed before kindergarten. Well child check-ups should include developmental screening. Doctors will rule out other medical and mental disorders, including mental retardation and tuberous sclerosis. ASD screening tools are also used to gather information about social and communication skills: (Checklist of Autism in Toddlers (CHAT), Modified Checklist for Autism in Toddlers (M-CHAT), Screening Tool for Autism in Two-Year-Olds (STAT), and the Social Communication Questionnaire (SCQ). For specific diagnostic criteria, see the related title article for each disorder. The following summary includes areas of diagnostic focus:

• Social Behavior
• Speech/Language Recognition
• Resistance to Change
• Non-Verbal Communication
• Speech Development
• Disturbance of movement
• Daily Living Skills
• Rituals or compulsive behaviors
• Abnormal attachment/behaviors
• Odd response to sensory stimuli
• Intelligence/Cognitive Deficits

Where PDD symptoms exist and a specific disorder is not diagnosed, the doctor may diagnose Pervasive Development Disorder Not Otherwise Specified and treat the patient accordingly.

For specific care and treatment of these disorders, see the related article for that disorder. General ASD treatment(s) can include:

• Adults: Foster Homes, Supervised Group Living
• Adults: Sheltered workshop employment, job training, social security disability and supplemental security income, Medicaid waivers
• Children: as appropriate, facilitated communication, auditory integration therapy, applied behavior analysis, vitamin therapy, dietary intervention, anti-yeast therapy
• Family Counseling, Parent Support Group
• Medication as appropriate to disorder (for seizures, aggression, self-injury, tantrums, behavioral, inattention-hyperactivity)
• Children: Special Education Programs and Related Services required by law and provided under Individuals with Disabilities Education Act (IDEA)
• Children: Behavior Modification, Speech Therapy, occupational therapy, physical therapy

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