The most common disorders are Autism Spectrum Disorder, Espalier’s syndrome, childhood disintegrative disorder, and Retest’s Syndrome. Some children display symptoms of one of the above disorders, but they may not be severe enough to diagnose. For these cases, a simple diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified (PDP;NO’S). In many other cases, a child may be genetically predisposed to mental retardation. This (in some cases) can be considered PDP if accompanying symptoms resemble those of other Pads. The first, and most prevalent of the Pervasive Developmental Disorders, Is
Autism Spectrum Disorder. Derived from Greek “autos” meaning self, and -ism, the literal meaning of the disorder is “self-ism”. This can be explained by the apparent egocentrics that autistic children involuntarily display. Autism is a developmental brain disorder characterized by impaired social Interaction, limited communication skills, and a limited range of Interests. Autistic children tend to respond inappropriately during conversation, are unable to interpret non-verbal interactions. And have a great difficulty establishing appropriate friendships.
The symptoms of Autistic children fall on a continuum or spectrum, with labels from mild to moderate to severe. Other common symptoms of Autism are described by the ADSM-IV and used as diagnostic criteria: 1) Qualitative Impairment in social Interaction, as manifested by at least two of the following: a. Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction b. Failure to develop peer relationships appropriate to developmental level c.
A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people d. Lack or social or emotional reciprocity 2) Qualitative impairments in communication as manifested by at least one of the following a. Delay In, or total lack of. The development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) b. Len individuals with adequate speech, marked impairment in the ability to Initiate or sustain conversation with others c. Stereotyped and repetitive use of language or Idiosyncratic language d.
Lack of varied, spontaneous make-believe play or social imitative play appropriate to placement level 3) Restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following: a. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either In Intensity or focus b. Apparently Inflexible adherence to specific, nonfunctional routines or rituals c. Stereotyped and d. Persistent preoccupation with parts of objects Autism is the most prevalent of the Pads and affects nearly 1 in 88 children.
Autism also affects children from all racial, ethnic and socioeconomic groups. The interesting thing about Autism is that it is more common among boys than girls (nearly 5:1). Scientists are still studying the causes of SAD, and many cases of autism are considered idiopathic. The farthest that research has come to linking autism with a cause is still not solid. Some researchers have linked SAD with the MR.. Vaccine. Others claim that the mercury based preservative found in most vaccines causes Autism. Another possible cause is genetics.
Many cases of SAD have been linked to spontaneous genetic mutation. Also, about 10% of children with SAD are identified as avian a genetic or chromosomal disorder such as Down syndrome, Fragile X syndrome, or tuberous sclerosis. There is no cure for SAD. The most successful treatment for children suffering from SAD is individualized therapy in the form of ABA (Applied Behavioral Analysis) therapy or another form of behavioral therapy. These types of treatments seem to improve the behaviors and outbursts that autistic children display, but does not reach the underlying cause.
In many cases, play therapy is useful. Many autistic children benefit greatly from social skills or life skills classes and individualized education plans. Espalier’s Disorder is another Pervasive Development Disorder characterized by social impairment. Unlike SAD, children that are diagnosed with Espalier’s develop curiosity, cognitive skills and language skills normally. The main similarities between SAD and Espalier’s are that children develop restricted, repetitive patterns of behavior and have limited interests.
The diagnostic criteria in the ADSM-IV for Espalier’s are identical to those of SAD. The main difference is that children diagnosed with Espalier’s develop cognition normally and there is no significant delay in language. There is no clinically significant delay in age-appropriate self-help skills, adaptive behavior, or curiosity about the environment in childhood. Due to this, treatment for Espalier’s is not usually necessary. In many cases, social skills sessions and mild therapy is sufficient to allow the child to function normally in society.
When children display many characteristic symptoms of SAD but are not as socially limited, they are placed in a category of Pervasive Developmental Disorders called PDP-NO’S (not otherwise specified). Being labeled as PDP-NO’S does not mean there aren’t enough symptoms to diagnose the child, but rather, he/she simply does to meet the diagnostic criteria in the ADSM to receive the same treatment as children with autism. PDP-NO’S is a sub-threshold disorder because there are no specific guidelines for diagnosis. Another prevalent PDP is known as Ret syndrome.
Ret syndrome is a nonrepresentational disorder that affects girls almost exclusively. It is characterized by normal early growth and development followed by a slowing of development, loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking, seizures, and intellectual disability. Girls suffering from this disorder generally appear to grow and develop normally, although there are often subtle abnormalities even in early infancy, such as loss of muscle tone (hypotonic), difficulty feeding, and Jerkiness in limb movements.
Then, gradually, purposeful use of her hands and the ability to speak. Other early symptoms may include problems crawling or walking and diminished eye contact. The loss of functional use of the hands is followed by compulsive hand movements such as wringing and washing. Children that suffer from this disorder also display praxis, he inability to perform motor functions. This is perhaps the most severely disabling feature of Ret syndrome as it interferes with every body movement, including eye gaze and speech.
Other symptoms may include walking on the toes, sleep problems, a wide-based gait, teeth grinding and difficulty chewing, slowed growth, seizures, cognitive disabilities, and breathing difficulties while awake such as hyperventilation, apneas (breath holding), and air swallowing. Scientists generally describe four stages of Ret syndrome. Stage l, called early onset, typically begins between 6 and 18 months of age. This stage is often overlooked because symptoms of the disorder may be somewhat vague. It is characterized by: less eye contact, reduced interest in toys. There may be delays in gross motor skills such as sitting or crawling.
This stage usually lasts for a few months but can continue for more than a year. Stage II, or the rapid destructive stage, usually begins between ages 1 and 4 and may last for weeks or months. The child loses purposeful hand skills and spoken language. Characteristic hand movements such as washing, clapping, or tapping often begin during this stage. Breathing irregularities such as episodes of apneas and hyperventilation may occur, although breathing usually improves during sleep. Some girls also display autistic-like symptoms such as loss of social interaction and communication.
Slowed head growth is usually noticed during this stage. Stage Ill, or the plateau or pseudo-stationary stage, usually begins between ages 2 and 10 and can last for years. Praxis, motor problems, and seizures are prominent during this stage. However, there may be improvement in behavior, with less irritability, crying, and autistic-like features. A girl in stage Ill may show more interest in her rounding’s and her alertness, attention span, and communication skills may improve. Many girls remain in this stage for most of their lives. Stage IV, or the late motor deterioration stage, can last for years or decades.
Prominent features include reduced mobility, curvature of the spine (scoliosis) and muscle weakness, rigidity, spastic, and increased muscle tone with abnormal posturing of an arm, leg, or top part of the body. Girls who were previously able to walk may stop walking. Cognition, communication, or hand skills generally do not decline in stage ‘V. Repetitive hand events may decrease and eye gaze usually improves. Although Ret syndrome is a genetic disorder, less than 1 percent of recorded cases are inherited or passed from one generation to the next.
Most cases are spontaneous, which means the mutation (in a methyl binding protein) occurs randomly. However, in some families of individuals affected by Ret syndrome, there are other female family members who have a mutation of thermometric gene but do not show clinical symptoms. These females are known as “asymptomatic female carriers. ” There is no cure for Ret syndrome. Treatment for the disorder is symptomatic ; sousing on the management of symptoms ; and supportive, requiring a multidisciplinary approach.
Medication may be needed for breathing irregularities and motor difficulties, and to control seizures. Occupational therapy can help dressing, feeding, and practicing arts and crafts). Some children may require special equipment and aids such as braces to arrest scoliosis, splints to modify hand movements, and nutritional programs to help them maintain adequate weight, Childhood disintegrative (or disintegration) disorder, also known as Heeler syndrome, is characterized by a loss of previously acquired language and social skills ND results in a persistent delay in these areas.
The symptoms of this disorder include a regression in social and emotional development, resulting in an impaired ability to relate with others. For example, a child who was previously able to accept reassurance from his or her parent (ex. A hug) loses the ability to be consoled and may even withdraw from human (tactile) contact. Overall, the social, communicative, and behavioral features of childhood disintegrative disorder resemble those of autistic disorder. Affected children have distinct qualitative impairments in social interaction and communication.
In addition, restricted, repetitive, or stereotyped patterns of behavior, interests, and activities occur. Previously acquired motor skills are lost (egg, a child who was toilet-trained begins to soil during the day and night, or a child who was able to pedal a tricycle or draw shapes can no longer do so). Additional symptoms may include the onset of difficulty in the transition to waking from sleep. Social interactions become compromised (as manifested by aggressiveness, tantrums, or withdrawal from peers), as does motor function, resulting in poor coordination and possible awkwardness of gait.
Family home movies can be very helpful in early identification of autistic spectrum disorders (Cads), including childhood disintegrative disorder. In the United States, childhood disintegrative disorder is very rare (affecting 2 per 100,000 children), much rarer than autistic disorder (which affects 20 per 10,000 children). Childhood disintegrative disorder, as defined by the ADSM-IV, occurs only after a period of at least 2 years of normal development, when the child is younger than 10 years. Onset generally occurs in children aged 3-4 years and may be insidious or abrupt. The average age at diagnosis is 3. Ears, comparable to that of autistic disorder (average age, 3. 1 years). Childhood disintegrative disorder is slightly more common in males than in females. No single causative factor for childhood disintegrative disorder has been identified. Research suggests that a combination of genetic susceptibility, including possibly abnormal autoimmunity, and prenatal (or environmental) stress may explain the pathology. Environmental risk factors for childhood disintegrative disorder include the following: ; Viral exposure (and possibly bacterial infectious exposure for some vulnerable children) ; Birth trauma
Toxin exposure ; Prematurely Territoriality (relating to substances or agents that can interfere with normal embryonic development) The principles of therapy for childhood disintegrative disorder are generally supportive in nature but do include specific behavioral interventions designed to halt behavioral deterioration and to improve communication, self-help, and social skills, thereby stabilizing the child’s reality testing scores and global functional level. No known medications address the core disorder; generally, medications only address specific symptoms (like Girls) Novel Therapies
Additional randomized placebo-controlled trials are necessary to determine whether novel interventions such as hyperbolic oxygen therapy are safe and effective in patients with childhood disintegrative disorder. Consultations A child psychiatrist or a behavioral/developmental pediatrician should be consulted in conjunction with the pediatrician, family, or caregivers to assist with appropriate educational placement, therapeutic interventions, psychophysiology interventions, and psychotherapeutic interventions.
Consider specific family support therapy for each individual with childhood disintegrative disorder. Consultation with a speech pathologist should be sought, especially if language delay is significant (delay of 25% or more). In many cases, Mental retardation (MR..), or intellectual disability (ID), is diagnosed as a PDP. MR.. Or ID are descriptive terms for below average intelligence and impaired adaptive functioning arising in the developmental period (< 18 y). In general, an IQ score of below 70-75 is an indicator of MR/ID.
Patients with MR../ID and developmental delays may demonstrate the following symptoms: ; Language delay: including delays in expressive language (speech) and exceptive language (understanding) ; Fine motor/adaptive delay: Significant delays in activities such as self-feeding, toileting, and dressing ; Cognitive delay: Difficulties with memory, problem-solving, and logical reasoning ;Social delays: Lack of interest in age-appropriate toys and delays in imaginative play and reciprocal play with age-matched peers ; Gross motor developmental delays: Infrequently accompany the cognitive, language, and fine motor/adaptive delays. Behavioral disturbances: difficult temperaments, hyperactivity, disordered sleep, and colic crying for more than 3 hours a day); associated behaviors may include aggression, self-injury, defiance, inattention. ; Neurological and physical abnormalities: Prevalence of MR.. Is increased among children with seizure disorders, microscopically, macrophage, prematurely, and congenital anomalies. Severe MR.. Affects more boys than girls. The frequency of MR../ID of all degrees ranges from 1-3% of the population. The ADSM describes 4 categories of MR../ID. They are mild, moderate, severe, and profound.
Nearly 85% of the MR../ID population is labeled as mild, meaning their IQ score is between 50-70. About 10% of the population is labeled as moderate, with IQ scores between 35-55. Severe MR.. Means the IQ score ranges from 20-40 and affects only 3-4% of the population. The most rare category is the profoundly MR.., affecting only 1-2% of the population with IQ scores below 25. Anytime something interferes with normal brain development, intellectual disability can be a result. However, a specific cause for ID can only be pinpointed about a third of the time. The most common causes of intellectual disability are: – Genetic conditions.
These include things like Down syndrome and fragile X syndrome. Problems during pregnancy. Things that can interfere with fetal brain development include alcohol or drug use, malnutrition, and certain infections. – Problems during childbirth. Intellectual disability may result if a baby is deprived of – Illness or injury. Some infections can lead to intellectual disability. Severe head injury, near-drowning, extreme malnutrition, exposure to toxic substances such as lead, and severe neglect or abuse can also cause it. The mainstay of MR../ID treatment is the development of a comprehensive management plan for the condition.
