PERVASIVE DEVELOPMENTAL

DISORDERS

 Lecturer: Dr. Sok Sedhaboth

 Reference : Synopsis of Psychiatry
 Autistic Disorder

 Characterized by marked abnormal

development in social interaction and
communication and restricted repertoire of
activities and interests.
 Autistic Disorder - Epidemiology
 Prevalence:
 Autistic disorder occurs at a rate of 2 to 5 cases

per 10,000 children (0.02 to 0.05 %) under age

12. If severe mental retardation with some
autistic features is included, the rate can rise as
high as 20 per 10.000. In most cases, autism
begins before the age of 36 months. Parents,
depending on their awareness and the severity of
the disorder, however, may not notice any
symptoms.
 Autistic Disorder - Epidemiology

 Sex Distribution:
Autistic disorder is found more frequently in
boys than in girls: 3 to 5 times more boys
than girls have the disorder. But autistic
girls tend to be more seriously affected and
more likely to have family histories of
cognitive impairment than do boys.
 Autistic Disorder - Epidemiology

 Socioeconomic Status: Early studies suggested that

a high socioeconomic status was common in
families with autistic children; however, these
findings were probably based on referral biases.
Over the past 25 years, an increasing proportion of
cases have been seen in low socioeconomic groups.
That finding may well be due to an increased
awareness of the disorder and the increased
availability of child mental health workers for
children from low socioeconomic status families.
 Autistic Disorder - Etiology and
Pathogenesis
 Psychodynamic & Family Factors: Children
with autism, as with children with other
disorders, can respond with an exacerbation of
symptoms to psychosocial stressors including
family discord, the birth of a new sibling, or a
family move.
 Autistic Disorder - Etiology and
Pathogenesis
 Neurological and Biological Factors: MRI
revealed hypoplasia of cerebellar vermal
lobules VI and VII, and cortical abnormalities,
particularly polymicrogyria.
 Autistic Disorder - Etiology and
Pathogenesis
 Genetic Factors: The nonautistic members of
families with autistic members have various
language or other cognitive problems, but less
severely. Fragile X syndrome appears to be
associated with autistic disorder.
 Autistic Disorder - Etiology and
Pathogenesis
 Immunological Factors: Immunological
incompatibility between the mother and the
embryo may contribute to autistic disorder
(Lymphocytes damage).
 Autistic Disorder - Etiology and
Pathogenesis
 Perinatal Factors: Perinatal complications
seems to occur in children with autistic
disorder. Maternal bleeding, meconium in the
amniotic fluid, a high incidence of medication
usage during pregnancy.
 Autistic Disorder - Etiology and Pathogenesis
 Neuroanatomical Factors:
 MRI studies comparing autistic subjects and normal

controls found that the total brain volume was increased

in those with autism.
 When the temporal region of animals is damaged,

expected social behaviour is lost , and restlessness,

repetitive motor behaviour, and a limited behavioural
repertoire are seen.
 Another finding in autistic disorder is a decrease in

Purkinje’s cells in the cerebellum, a decrease potentially

resulting in abnormalities of attention, arousal, and
sensory processes.
 Autistic Disorder - Etiology and
Pathogenesis
 Biochemical Factors:
 At least one third of patients have elevated

plasma serotonin.
 In some autistic increased cerebrospinal

fluid homovanillic acid is associated with

increased withdrawal and stereotypies.
Autistic Disorder – Diagnosis and Clinical Features
DSM-IV Diagnostic Criteria for Autistic Disorder
A. A total of six (or more) items from (1), (2), and (3), with
at least two from (1), and one each from (2) and (3):
(1) Qualitative impairment in social interaction, as manifested
by at least two of the following:
(a) marked impairment in the use of multiple
nonverbal behaviours 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 (e.g., by a lack of showing, bringing, or
pointing out objects of interest)
(d) lack of social or emotional reciprocity
 Autistic Disorder – Diagnosis and Clinical
Features
2. Qualitative impairments in communication as
manifested by at lest 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. in individuals with adequate speech, marked
impairment in the ability to initiate or sustain a conversation with
others
c. stereotyped and repetitive use of language or
idiosyncratic language
d. lack of varied spontaneous make-believe play or social
initative play appropriate to developmental level
 Autistic Disorder – Diagnosis and Clinical
Features
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,
non-functional routines or rituals
c. stereotyped and repetitive motor mannerisms
(e.g., hand or finger flapping or twisting, or complex
whole body movements)
d. persistent preoccupation with parts of objects
 Autistic Disorder – Diagnosis and Clinical
Features
B. Delays of abnormal functioning in at least one of
the following areas, with onset prior to age 3 years:
(1) social interaction
(2) language as used in social communication
(3) symbolic or imaginative play.

C. The disturbance is not better accounted for by

Rett’s disorder or childhood disintegrative disorder.
 Autistic Disorder – Differential Diagnosis

 Schizophrenia with Childhood Onset:

Schizophrenia is rare in children
under the age of 5. It is
accompanied by hallucinations with
a lower incidence of seizures and
mental retardation and a more even
IQ than in autistic children.
 Autistic Disorder – Differential Diagnosis

 MR with Behavioural Symptoms: Mentally

retarred children usually relate to adults and
other children in accordance with their mental
age; they use the language they do have to
communicate with others; and they have a
relatively even profile of impairments without
splinter functions.
 Autistic Disorder – Differential Diagnosis

 Mixed Receptive-Expressive Language

Disorder: A group of children with mixed
receptive-expressive language disorder have
autistic-like features.
 Autistic Disorder – Differential Diagnosis

 Acquired Aphasia with Convulsion: Children

with the condition are normal for several years
before losing both their receptive and their
expressive language over a period of weeks or
months.
 Autistic Disorder – Differential Diagnosis

 Congenital Deafness or Severe Hearing

Impairment: Autistic infants may babble only
infrequently, whereas deaf infants have a
history or relatively normal babbling that then
gradually tapers off and may stop from 6
months to 1 year of age. Deaf children respond
only to loud sounds, whereas autistic children
may ignore loud or normal sounds and respond
to soft or low sounds.
 Autistic Disorder – Differential Diagnosis

 Psychosocial Deprivation: Severe disturbances

in the physical and emotional environment
(such as maternal deprivation, psychosocial
dwarfism, hospitalism, and failure to thrive).
Children with these signs almost always
rapidly improve when placed in a favourite
and enriched psychosocial environment.
 Autistic Disorder – Course and Prognosis
 As a general rule, children with IQs above 70 and
those who use communicative language by ages 5
to 7 have best prognoses. The prognoses is
improved if the environment or the home is
supportive and capable of meeting the extensive
needs of such a child. Although a decrease of
symptoms is noted in many cases, severe self-
mutilation or aggressiveness and regression may
develop in others. About 4 to 32 % have grand
mal seizures in late childhood or adolescence, and
the seizures adversely affect the prognosis.
 Autistic Disorder – Treatment

 The goals of treatment are to increase socially

acceptable and prosocial behaviour, to
decrease odd behaviour symptoms, and to aid
in the development of verbal and nonverbal
communication.
 Autistic Disorder – Treatment
 Psychopharmacotherapy is a valuable adjunct
in comprehensive treatment programs to
ameliorate a variety of associated symptoms,
including aggression and severe temper
tantrums, self-injurious behaviours,
hyperactivity, and obsessive-compulsive
symptomatology and stereotypies. The
administration of haloperidol (Haldol) both
reduces behavioural symptoms and
accelerates learning.
 Autistic Disorder – Treatment

 The serotonin-specific reuptake inhibitors

(SSRIs) have been used as adjunctive
treatments to diminish and modify obsessive-
compulsive and stereotypical behaviours.
 Autistic Disorder – Treatment

 Naltrexone (Re Via), an opioid antagonism is

currently being investigated in the hope that
blocking endogenous opioids will reduce
autistic symptoms, Lithium (Eskalith) can be
tried for aggressive or self-injurious
behaviours when other medications fail./.