Pervasive Developmental Disorders and Mental Retardation

Pervasive Developmental Disorders: Symptoms become apparent early in a child’s development and results in long-lasting impairment in several aspects of a child’s expected development (i.e., cognitive, behavioral, social, language skills).

Autistic Spectrum disorder

The presence of markedly abnormal or impaired development in social interaction or social communication and a markedly restricted repertoire of activity and interests, manifested by 6 or more of the following symptoms. At least one symptom prior to age 3.

(1) Qualitative impairment in social interaction as characterized by (a) marked impairment in the use of multiple nonverbal behaviors (i.e., 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 (i.e., not seeking out an adult for comfort if they are hurt or upset), and (d) a lack of social or emotional reciprocity.

(2) Qualitative impairments in communication as characterized by (a) delay or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative mode of communication such as nonverbal behaviors), (b) marked impairment in the ability to initiate or sustain a conversation with others in children with adequate speech, (c) stereotypes and repetitive use of language or idiosyncratic language, (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

(3) Restricted repetitive and stereotyped patterns of behavior, interests, and activities as characterized by (a) encompassing preoccupation with one or more of stereotyped and restricted patterns of interests that is abnormal either in intensity or focus, (b) inflexible adherence to specific, nonfunctional routines or rituals, (c) stereotyped and repetitive, motor mannerisms (i.e., hand or finger flapping or twisting, spinning objects, rocking their bodies), (d) persistent preoccupation with parts of objects,

*Prevalence rate: 0.02 to 0.05% (2 to 5 children out of 10,000)

*About 70% of autistic children are mentally retarded (IQ below 70).

*4 to 5 times higher in boys.

*Other characteristics: Preoccupation with the sameness, resistance to changes, avoiding being held by caregivers, avoiding eye-contact, not enjoying parent-child-kiss- and –cuddle routines.

*Four key symptoms: eye contact, showing an object to another person, pointing to objects, and response to their own names.

*Why?

(A). Cognitive deficits

(a) Cognitive impairment in interpreting the intentions, beliefs, and behaviors of others. (EX) Theory of Mind or “mind-blindness”: Showing two dolls placing a marble in a basket and relocating the marble in a box.

(b) Deficits in executive functioning such as planning, inhibition of a response, attention shifting, organizing, working memory, flexibility.

(d) Savant abilities (surprising abilities in some areas while serious deficits in other areas).

(2) Language difficulties: From an inability to speak to stereotyped, repetitive, and idiosyncratic ways of speaking. Difficulty understanding others and jokes. Not listening but lecturing their interests.

(3) Social and affective deficits: Deficits in the use of Joint Attention Behavior (i.e., a game involving the coordination of attention between the child, another person, and objects). Difficulty following another’s behaviors or initiating the behavior. Can’t learn social skills.

(B) Biological:

(a)Twin studies: 82% of monozygotic twins and only 10% in dizygotic twins.

(b) Brains structure and function: A larger brain due to the greater size of parietal, temporal, and occipital lobes.

*Difference between A.D. and Schizophrenia: Onset (2 vs. after 7 to 8), Prevalence rate (rare vs. more rare), IQ (mostly retarded vs. average), Psychotic symptoms (no vs. yes), social interaction and interests (no vs. yes).

*Treatment: Skeptical. Only 5% grew out of it: social skills training, communication skills training, sensory integration training.

Asperger’s Disorder (Not anymore in the DSM-V)

Similar to A.D (i.e., long-lasting impairment in social interaction and restricted and repetitive patterns of behavior and interests), but no significant delays in language and cognitive development, curiosity about the environment, or self-help skills and other adaptive functioning.

(1) Qualitative impairment in social interaction manifested by marked impairment in the use of multiple nonverbal behaviors (i.e., 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 (i.e., not seeking out an adult for comfort if they are hurt or upset), and (d) a lack of social or emotional reciprocity.

(2) Restricted repetitive and stereotyped patterns of behavior, interests, and activities as characterized by (a) encompassing preoccupation with one or more of stereotyped and restricted patterns of interests that is abnormal either in intensity or focus, (b) inflexible adherence to specific, nonfunctional routines or rituals, (c) stereotyped and repetitive, motor mannerisms (i.e., hand or finger flapping or twisting, spinning objects, rocking their bodies), (d) persistent preoccupation with parts of objects,

Childhood Disintegrative Disorder

(1) Apparently normal development for at least the first 2 years after birth

(2) Before age 10, significant loss of previously acquired skills ach as (a) expressive or receptive language, (b) social skills or adaptive behavior, (c) bowel or bladder control, (d) play, (e) motor skills.

(3) Abnormalities of functioning in social interaction (i.e., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity), communication (i.e., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play), and (c) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.

Rett’s Disorder

(1)Apparently normal prenatal and perinatal development,

(2)Apparently normal psychomotor development through the first 5 months after birth,

(3)Normal head circumference at birth,

(4)Deceleration of head growth between ages4 and 5.

(5)Loss of previously acquired purposeful hand skills between ages 2.5 and 5 and subsequent development of stereotyped hand movements (i.e., hand-wringing or washing),

(6)Loss of social engagement,

(7)Appearance of poorly coordinated gait or trunk movement,

(8)Severely impaired expressive and receptive language development with severe psychomotor retardation.

*Mostly in girls.

*Possibly deficit in the programmed normal growth of nervous system.

*Some abnormalities in the development of the dendrites in the brain cortex.

Intellectual Disability (Mental Retardation)

Not anymore in the DSM-V

Mild (70 to 50-55): 85%,

Moderate (50-55 to 35-40): 10%,

Severe (35-40 to 20-25): 3-4%

Profound (below 20-25): 1%

*Gene mutation  PKU disorder (impaired function of a specific enzyme called phenylalain)inability to oxidize the phenylalain makes the chemical accumulate in the bodyM.R.

*Fragile X syndrome:

*Down syndrome: Chromosomal abnormality involving 21st chromosome pair.

*Children born with a dominant gene disorder such as Tuberous sclerosis.