Understanding Pervasive Developmental Disorders: Symptoms, Subtypes, Treatment

1. CHAPTER FIFTEEN Pervasive Developmental Disorders

2. Overview • Definitions • Symptoms • Subtypes • Epidemiology & Course • Etiology • Treatment

3. Overview • Definitions • Symptoms • Subtypes • Epidemiology & Course • Etiology • Treatment

4. 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.

5. Overview • Definitions • Symptoms • Subtypes • Epidemiology & Course • Etiology • Treatment

6. 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

7. T.O.M.: Sally-Ann Task

8. Symptoms: Others • Apparent sensory deficits • Self-injury • Savant performance

10. Overview • Definitions • Symptoms • Subtypes • Epidemiology & Course • Etiology • Treatment

11. Subtypes • Asperger’s Disorder • Childhood Disintegrative Disorder • Rett’s Disorder

12. Subtypes

13. Overview • Definitions • Symptoms • Subtypes • Epidemiology & Course • Etiology • Treatment

14. 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?

15. Prevalence in the U.S.

16. Prevalence in Illinois

17. 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.

18. 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

19. 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

20. Overview • Definitions • Symptoms • Subtypes • Epidemiology & Course • Etiology • Treatment

21. 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.

22. 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

23. Etiology: Biological • Concordance Rates • MZ = 60% • DZ = 0% • But why are DZ twin concordance rates so low? • Combination of genes or spontaneous genetic mutation

24. Etiology: Biological • Neurochemicals • Endorphins • Elevated levels • Critics argue this theory is too narrow • Self-Destructive Behavior? • Neuropeptides • Oxytocin & Vasopression

25. 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

26. Overview • Definitions • Symptoms • Subtypes • Epidemiology & Course • Etiology • Treatment

27. 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

28. 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

29. 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.

30. 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

31. 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)