CHAPTER FIFTEEN Pervasive Developmental Disorders.

CHAPTER CHAPTER FIFTEENFIFTEEN

Pervasive Pervasive Developmental Developmental

DisordersDisorders

OverviewOverview Definitions

Symptoms

Subtypes

Epidemiology & Course

Etiology

Treatment

OverviewOverview Definitions

SymptomsSymptoms

SubtypesSubtypes

Epidemiology & CourseEpidemiology & Course

EtiologyEtiology

TreatmentTreatment

DefinitionsDefinitions

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.

OverviewOverview DefinitionsDefinitions

Symptoms

SubtypesSubtypes


EtiologyEtiology

TreatmentTreatment

SymptomsSymptoms

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

T.O.M.: Sally-Ann T.O.M.: Sally-Ann TaskTask

Symptoms: OthersSymptoms: Others Apparent sensory

deficits

Self-injury

Savant performance


SymptomsSymptoms

Subtypes


EtiologyEtiology

TreatmentTreatment

SubtypesSubtypes Asperger’s DisorderAsperger’s Disorder

Childhood Disintegrative Childhood Disintegrative DisorderDisorder

Rett’s DisorderRett’s Disorder

SubtypesSubtypes

Asperger’s DisorderChildhood

Disintegrative Disorder

Rett’s Disorder

Descriptively identical to Autism

No Major Communication Problems

Higher intellectual functioning

Is this a separate disorder?

Poorly understood

Severe problems in social interaction and communication

Stereotyped behaviors

Onset – after 2 years of normal development

Clearly distinct condition 5 Months of normal

development, then: Decrease head growth Loss of purposeful

hand movements Loss of social

engagement Poor coordination Marked delay in

language Typically only in

females


Symptoms Symptoms

SubtypesSubtypes

Epidemiology & Course

EtiologyEtiology

TreatmentTreatment

EpidemiologyEpidemiology 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?

Prevalence in the Prevalence in the U.S.U.S.

Prevalence in IllinoisPrevalence in Illinois

EpidemiologyEpidemiology

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.

Course & Course & OutcomesOutcomes

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

Course & Course & OutcomesOutcomes

Two Important Developmental Periods Two Important Developmental Periods Early PreschoolEarly Preschool

Developed Language Skills by 5 or 6Developed Language Skills by 5 or 6 Early AdolescenceEarly Adolescence

Cognitive and social skills may improveCognitive and social skills may improve No way to predict path for a given childNo way to predict path for a given child Seizure disordersSeizure disorders

Higher IQ during early school years also Higher IQ during early school years also positive prognostic indicatorpositive prognostic indicator


Symptoms Symptoms

SubtypesSubtypes


Etiology

TreatmentTreatment

Etiology: Etiology: PsychosocialPsychosocial

Parental hostility and/or inappropriate reinforcement

“Refrigerator Parents”

No evidence to support this claim!

Lack of empirical evidence to support psychological causal factors.

Etiology: Etiology: BiologicalBiological

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


Concordance Rates

MZ = 60%

DZ = 0%

But why are DZ twin But why are DZ twin concordance rates so concordance rates so low?low?

Combination of genes Combination of genes or spontaneous genetic or spontaneous genetic mutationmutation


NeurochemicalsNeurochemicals

EndorphinsEndorphins Elevated levelsElevated levels

Critics argue this theory Critics argue this theory is too narrowis too narrow

Self-Destructive Self-Destructive Behavior?Behavior?

NeuropeptidesNeuropeptides

Oxytocin & Oxytocin & VasopressionVasopression


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


Symptoms Symptoms

SubtypesSubtypes


EtiologyEtiology

Treatment

TreatmentTreatment 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

TreatmentTreatment Facilitated CommunicationFacilitated Communication

Touted as cure for AutismTouted as cure for Autism Systematic studies show Systematic studies show

treatment may not be effectivetreatment may not be effective ““Ouija Board” effectOuija Board” effect

Applied Behavior Analysis (ABA)Applied Behavior Analysis (ABA) Intensive behavior modification Intensive behavior modification

using operant conditioningusing operant conditioning Most promising treatmentMost promising treatment

Treatment: ABATreatment: ABA

GoalsGoals

1. Identify specific target behaviors 1. Identify specific target behaviors

2. Gain control of behaviors2. Gain control of behaviors

3. Gradually set more difficult goals3. Gradually set more difficult goals

ABA has been successful in ABA has been successful in teaching self-care skills, but less teaching self-care skills, but less successful in teaching social successful in teaching social responsiveness. responsiveness.

Treatment: ABATreatment: ABA

Lovaas (1987) compared Lovaas (1987) compared outcomes for three groups outcomes for three groups of children with Autismof children with Autism

19 Received intensive ABA 19 Received intensive ABA (40 hrs. wk. for 2 yrs.)(40 hrs. wk. for 2 yrs.)

19 Less intensive19 Less intensive

21 Were treated 21 Were treated somewhere elsesomewhere else

Treatment: ABATreatment: ABA Findings:Findings:

9 children from the intensive ABA group (47%) 9 children from the intensive ABA group (47%) completed first grade in normal schoolcompleted first grade in normal school

8 more from the intensive group (42%) passed 8 more from the intensive group (42%) passed first grade in special classesfirst grade in special classes

Only 1 (2%) in other groups completed first Only 1 (2%) in other groups completed first grade in normal schoolgrade in normal school

18 (45%) completed first grade in special 18 (45%) completed first grade in special classesclasses

Follow-up studies indicate that many gains Follow-up studies indicate that many gains continues into late childhood and adolescence continues into late childhood and adolescence (McEachlin et al., 1993) (McEachlin et al., 1993)

CHAPTER FIFTEEN Pervasive Developmental Disorders.

Documents

Transcript of CHAPTER FIFTEEN Pervasive Developmental Disorders.