Pervasive Development Disorders

=Objectives= These objectives are student defined.

Describe the cardinal features of PDD
Pervasive developmental disorders (PDD) are characterized by:
 * 1) Profound lack of social reciprocal interaction skills
 * 2) Communication skills are lacking, with a delay of language. Sometimes autistic patients never develop language
 * 3) Presences of stereotyped behavior and quirks (of diminished importance in DSM-V)
 * 4) Functional impairment

Describe the defining characteristics of the pervasive developmental disorders

 * Autistic Disorder (DSM-IV)
 * 1) Marked impairment in the use of multiple nonverbal behaviors,
 * 2) Failure to develop peer relationships appropriate to developmental level
 * 3) Lack spontaneous enjoyment of sharing interests, achievements, etc
 * 4) Lack of social or emotional reciprocity, prefers simple social play or games, impaired awareness of others
 * 5) Qualitative impairment in communication, language, ability to sustain a conversation, lack of spontaneous play


 * Asperger Disorder (aka "high functioning autism")
 * 1) Impairment in social interactions and social communication
 * 2) Restricted, repetitive and stereotyped behavior, interests, activities, etc.
 * 3) Clinically significant impairment in social and occupational functioning
 * 4) No clinically significant delay in language
 * 5) No clinically significant delay in cognitive development, self-help skills, and adaptive behavior.
 * 6) Lack of empathy or 'Theory of Mind', the ability to understand other minds or points of view in social interactions. Difficulty predicting other behavior and explaining one's own behavior.
 * Rett Disorder
 * X-linked genetic disorder characterized by 6 - 18 months normal infant development followed by decelerated cranial growth in females, autism, retardation/dementia, ataxia, loss of purposeful hand movements, and respiratory irregularities. Lyonization (X-inactivation) resulting in variable severity.  1 in 20,000.   Neonatal lethal in males.  Defective function of the gene leads to an alteration in synaptogenesis and neural connectivity (MECP2 gene).


 * Childhood Disintegrative Disorder
 * Period of normal development for greater than 2 years with a subsequent loss of previously acquired skills. Characterized by abnormalities in 2 of three areas (social, communication, repetitive behaviors).


 * PDD-NOS
 * Pervasive developmental disorder not otherwise specified not meeting other criteria because of:
 * *late age of onset, atypical symptoms, sub-threshold symptomatology

Describe the concept of 'Theory of Mind'
'Theory of Mind' is lacking in kids with autism-spectrum disorders
 * "Mind blindness" or not able to realize that people aren't necessarily interested in what you're thinking.
 * Lack of empathy or 'Theory of Mind', the ability to understand other minds or points of view in social interactions.
 * Results in difficulty predicting other's behavior and explaining one's own behavior.
 * Difficulty discerning fact from fiction.

Describe tenants of autism-spectrum disorder treatments

 * No medical treatment for lack of social skills and social communication. Medical therapy is targeted at comorbid motor hyperactivity, repetitive behaviors, aggression.
 * No drugs effective in treating "social impairment", the core impairment
 * Early intervention intensive behavioral therapy can improve language, but very very expensive
 * Stimulants effective for hyperactivity aspects of PDD, though some risk of making things worse.
 * Repetitive behavior in autism treated by SSRIs
 * Fluvoxamine good in adults
 * Fluoxetine in children
 * but no efficacy with citalopram
 * Significant behavior problems and irritability treated effectively by risperidone

Difference Between Rett's Disorder and Childhood Disintegrative Disorders

 * Rett's only occurs in females and features a deceleration of head growth
 * Rett's has some stereotyped hand movements, loss of purposeful hand skills, loss of social engagement, severe language impairment and severe to profound mental retardation
 * Childhood Disintegrative Disorders affects both genders.  There is normal development for >2 years of age followed by a significant loss of previously acquired skills.
 * Childhood Disintegrative Disorders have abnormalities in 2 of 3 areas: social, communication and repetitive behaviors

Other good tid bits

 * There are no pharmaceutical interventions approved for Pervasive Developmental Disorders
 * You cannot diagnose a kid as having both PDD and ADHD
 * Citalopram has not been shown to work as a treatment for PDD
 * No drugs treat the social withdrawal symptoms of PDD/autism

=Links=
 * DSM-5 Manual