This presentation consist of the details of pervasive developmental disorders : Childhood autism, Asperger's disease, CDD, Rett;'s syndrome

1. Childhood Autism
K. Kavindya M. Fernando
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2. Pervasive Developmental
Disorders
• characterized by deficits and delays
• in social and communicative development,
which are
• associated with restricted patterns of
interest and behaviour.
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3. Pervasive Developmental
Disorders
• autistic disorder (childhood autism);
• Rett’s disorder;
• childhood disintegrative disorder;
• Asperger’s syndrome;
• pervasive developmental disorder not
otherwise specified (PDD-NOS, atypical
autism).
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4. Childhood Autism
• Classical autism is characterized by
difficulties in 3 areas
• “triad of impairment”
• Social deficit
• Communication deficit
• Restricted/ repetitive interests and behaviours
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5. Social deficits
• Babies who don’t like being held
• Reduced eye contact
• Unusual facial expressions
• Lack of gesture
• Poor understanding of other’s feelings
• Lack of empathy
• Few peer relationships
• Child does not respond to affection
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6. Communicate deficits
• May be completely absent speech
• Merely show unusual or asocial qualities
• Echolalia
• Odd prosody (unusual pitch/ stress/ rhythm/
intonation)
• Pronoun reversal (referring themselves as he or
she)
• They have problems in 2 way conversations
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7. Restricted/ repetitive
interest & behaviours
• Show a deep interest in things others regard as
very mundane
• Washing machines / licence plates
• Reject other toys
• Stereotypies
• Repetitive movements often triggered by stress
• Hand flapping / head rolling
• Self harming is not uncommon
• Includes biting and hitting
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8. Clinical features
• Must be present by 3 years in older to
diagnose
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9. Epidemiology
Diagnosis Prevelance Gender Ratio
(male: female)
Overall pervasive
developmental
disorders
2 per 1000 4:1
Autism 13 per 10 000 4:1
Asperger’s syndrome 1 per 2000 4-20 :1
Rett’s syndrome 1 per 12-15 000 Females only
Childhood
disintergrative
disorder
1 per 12 000 Unknown but males
predominate
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10. ICD 10 Childhood autism
• A type of pervasive developmental disorder that is
defined by:
a. the presence of abnormal or impaired development that
is manifest before the age of 3 years;
b. the characteristic type of abnormal functioning in all the
three areas of psychopathology: reciprocal social
interaction, communication, and restricted, stereotyped,
repetitive behaviour.
• In addition to these specific diagnostic features, a
range of other non-specific problems are common,
such as
• phobias,
• sleeping and eating disturbances,
• temper tantrums,and (self-directed) aggression.
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11. Differential Diagnosis
• Asperger’s syndrome
• Deafness
• Specific developmental language disorder
• Learning disability
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12. Aetiology
• Multifactorial with a strong polygenic
genetic component
• Genetic factors
• Twins – 90% heritability
• If a sibling have autism – 2-20% change of other
getting the disease
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13. Aetiology
• Organic brain disorders
• Seizures +
• Cognitive abnormalities
• Symbolic thinking and language
• Inability to judge correctly what other people
are thinking
• Abnormal parenting has not been shown to
be a case
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14. Aetiology
• Organic brain disorders
• Seizures +
• Cognitive abnormalities
• Symbolic thinking and language
• Inability to judge correctly what other people
are thinking
• Abnormal parenting has not been shown to
be a case
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15. Asperger’s syndrome
• Characteristic impairment in social
interaction, &
• Repetitive behaviors or restricted interests
• But has normal speech & intellectual abilities
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16. Characteristics
• Developmentally appropriate speech & language
• Unusual use of language (prosody, abnormal
rate/rhythm/volume, novel works)
• Motor clumpsiness
• Unusually deep interest in one particular topic
• rigid behaviour and stereotypes
• Social awkwardness
• Difficulty in making close friends
• Often shows high level performance in one
interested topic
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17. Characteristics
• Does not become obvious until around 4-8
years
• Autism can diagnose before this age
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18. Co-morbidities
• Mood disorders
• Anxiety disorders
• Associate with
• Tics
• Tourette’s syndrome
• ADHD
• OCD
• Bipolar disorder
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19. Course & prognosis
• Majority can go to normal schools
• Some extra classroom support may need
• In interested areas
• Can show outstanding performance
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20. Rett’s syndrome
• Rare developmental disorder of females
• Resembles neurodegenerative disorder
• Thought to be caused by a mutation in genes
on X-chromosome
• They usually develop normally until 6-8
months
• Then start to regress developmentally
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21. Rett’s syndrome
• They loss speech
• Purposeful hand movements
• Motor skills
• Head growth – stops
• Stereotypies starts to develop
• Handwashing
• Bruxism
• flapping
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22. Rett’s syndrome
• Breathing problems are common
• Hyperventilation
• Breath holding
• Sighing
• Help in distinguish between autism
• Physical problems are abundant
• Epilepsy (80%)
• Constipation
• Poor growth
• Scoliosis
• Cardiac & motor problems
• Average life expectancy -30 years
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23. Childhood disintegrative
disorder
• Entirely normal development for the 1st 2
years
• Followed by marked regression &
• Loss of skills in multiple areas of
development over a few months
• Develops deficits in
• Social skills
• Communication skills
• Repititive/restrictive interests & behaviour
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24. Management of PDD
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25. Management
• PDD/ASDs will never be curative
• General measures
• Psychoeducation
• Finding an appropriate educational setting
• Treating psychiatric and physical co-morbidities
• Parental training courses
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26. Biological treatment
• Atypical antipsychotics (risperidone)
• Effective in reducing
• Aggression, tantrums
• Stereotypies & self-injuries
• Stimulants or atomaxotine
• Effective in child co-morbid ADHD
• SSRI
• Decrease repetitive or obsessive behaviour
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27. Biological treatment
• Melatonin
• In affecting sleep cycle
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28. Psychological treatment
• Speech and language therapy
• Social skill training
• Behaviour modification programmes
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29. Thank You!
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