ASD PDD-NOS

ADD/PDD-NOS
By Gary Demedeiros, Tim Durkin and John Sawdon
With Special Presenter Michelle Cardy (Occupational Therapist)

Definition of Autism

Autism is defined by the Ministry of Education as follows:

Autism: a severe learning disorder that is characterized by:

a) disturbances in: rate of educational development; ability to relate to the environment; mobility; perception, speech and language;

b) lack of the representational symbolic behaviour that preceded language.

Diagnosis of Autism

In order for a diagnosis of Autism to be made, the child must present problems in three broad areas: social interaction, communication, and stereotyped patterns of behaviour. The child needs to exhibit 6 symptoms spanning 3 broad areas with at least 2 indicating social interaction deficits, and one symptom in each of the communication and stereotype behaviour categories.

The symptoms which fall under the social interaction category are:
1. marked impairment in the use of multiple nonverbal behaviours;
2. failure to develop age-appropriate peer relationships;
3. lack of spontaneous seeking to share interests with others;
4. lack of social or emotional reciprocity.

The symptoms which fall under the communication interaction category are:
1. delay in or lack of spoken language development;
2. marked impairment in conversational skills;
3. stereotyped and repetitive use of language;
4. lack of spontaneous age-appropriate social imitative play.

The symptoms which fall under the stereotyped patterns of behaviour category are:
1. inflexibility to nonfunctional routines;
2. preoccupation with at least one stereotyped and restricted pattern of interest;
3. stereotyped and repetitive motor movements;
preoccupation with parts of objects.

Asperger’s Disorder (ASD)

Asperger’s Disorder (ASD) - disorder in which children demonstrate normal cognitive and language development (though the onset of speech may be delayed). They are less socially impaired than children with severe autism. They may have unusual or elaborate preoccupations with objects or topics.

Hans Asperger published the first definition of Asperger’s Syndrome in 1944. In four boys, he identified a pattern of behaviour and abilities that he called autistic psychopathy, meaning autism (self) and psychopthy (personal disease). The patterned he observed were one-sided conversations, special interests and clumsy movements. He called the children
little professors because of their ability to talk about their favourite subject in great detail.

Causes- Doctors and researchers don't understand what causes Asperger's syndrome, although there seems to be a strong genetic component. The disorder also seems to be linked to structural abnormalities in several regions of the brain.

*Like Autism, not all individuals with Asperger’s Disorder are alike. Typical symptoms can manifest itself in different ways. As a result, there is no magic formula for classroom strategies for every ASD student.

General Characteristics/Symptons:

a. Inability to Cope with Change- ASD children are easily overwhelmed by minimal change and often over-react emotionally to change.

b. Poor Concentration- Often off task, and are usually disorganized. Attention is not necessarily poor but they have difficulty determining what is relevant. They have a tendency to withdraw into their own inner world.

c. Restricted Range of Interests- Eccentric preoccupations or odd, intense fixations. They have trouble letting go of ideas and follow their own inclinations.

d. Poor Motor Coordination- Children tend to be physically clumsy and awkward. Fine-motor deficits may cause penmanship problems.

e. Emotional Vulnerability- Children with ASD may have the intelligence to keep up in a regular classroom but they often do not have the emotional resource to cope with the demands of the classroom due to their inflexibility.

f. Academic Difficulties- Students with ASD usually have average to above-average intelligence, especially in the verbal sphere, but can lack abstract thinking and comprehension skills. They tend to be very literal and their generalizations of concepts are poor.

Rett’s Disorder

Rett’s Disorder (RS)– is a condition found only in females who have apparently normal pre- and perinatal development. Symptoms usually appear after five months of age. RS was first described by an Austrian physician, Andreas Rett, in 1966.

Causes- The cause of Rett's disorder is a genetic mutation on the long arm of the X chromosome (Xq28) at a locus known as MECP2. The mutation that causes Rett's disorder allows other genes to become or remain active at inappropriate points in the brain's development. These activated genes interfere with the normal pattern of development and maturation of the brain's functions. RS is less common than the other PDDs. Recent estimates of its prevalence range between 1:10,000 births and 1:15,000 births.

Symptoms

STAGE ONE, EARLY-ONSET (SIX–18 MONTHS OF AGE)
The early symptoms of RS are not always noticeable in Stage 1. The infant may not make eye contact with family members and may not show much interest in toys. She may be considered a "good baby" because she is so calm and quiet. On the other hand, there may be noticeable hand-wringing and slowing of head growth.

STAGE TWO, RAPID DETERIORATION (ONE–FOUR YEARS). This stage may be either rapid or gradual in onset. The child loses her ability to speak and to make purposeful hand movements. Hand-to-mouth movements may appear, as well as hand-wringing or hand-clapping gestures. There may be noticeable episodes of breath holding and hyperventilating (rapid shallow breathing). The child may have trouble sleeping, and may become irritable. If she is able to walk, she will start to look unsteady on her feet and may have periods of trembling or shaking. Slowed growth of the head is usually most noticeable during this stage.

STAGE THREE, PLATEAU (TWO–10 YEARS). Motor problems and seizures often appear during this stage. The child's behavior, however, often shows some improvement, with less irritability and crying. She may show greater interest in her surroundings, and her attention span and communication skills often improve. Many patients with RS remain in stage 3 for most of their lives.

STAGE FOUR, LATE DETERIORATION OF MOTOR SKILLS (USUALLY AFTER 10 YEARS OF AGE).
In stage 4, patients with RS gradually lose their mobility; some stop walking while others have never learned to walk. There is, however, no loss of cognitive or communication skills and the repetitive hand movements may decrease. The spine begins to develop an abnormal sideways curvature (scoliosis), and the patient may develop muscle rigidity.

Childhood Disintegrative Disorder

Characteristics

With CDD children develop a condition which resembles autism but only after a period of 2 to 4 years of clearly normal development. After which the child begins to demonstrate a severe loss of social, communication and other skills.

Affected children show clinically significant losses of earlier acquired skills (generally before the age of 10) in at least two of the following areas:
Ability to say words or sentences (expressive language)
Ability to understand verbal and nonverbal communication (receptive language)
Social skills and self-care skills (adaptive behavior)
Bowel and bladder control
Play skills
Motor skills (ability to voluntarily move the body in a purposeful way)

There is also a lack of normal function or impairment as seen in at least two of the following areas:
Social interaction. This may include impairment in nonverbal behaviors, failure to develop peer relationships, and lack of social or emotional reciprocity. Communication. This may include delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied imaginative or make-believe play.
Repetitive and stereotyped patterns of behavior, interests and activities. This may include hand flapping, rocking, spinning, development of specific routines and rituals; difficulty with transitions or changes in routine; maintaining a fixed posture or body position and preoccupation with certain objects or activities.

The outcome for children with childhood disintegrative disorder is usually very poor, and even worse than for children with autism.

Treatment

Treatment for childhood disintegrative disorder is similar to that for autism — a combination of medications for behavioral problems, behavior therapy and other treatments
Treatment options may include:
Medications.
Behavior therapy. This therapy technique may be used by psychologists, speech therapists, physical therapists and occupational therapists as well as parents, teachers and caregivers.

Case Illustration

John's early history was within normal limits. By age 2 he was speaking in sentences, and his development appeared to be proceeding appropriately. At age 30 months he was noted to abruptly exhibit a period of marked behavioral regression shortly after the birth of a sibling. He lost previously acquired skills in communication and was no longer toilet trained. He became uninterested in social interaction, and various unusual self-stimulatory behaviors became evident. Comprehensive medical examination failed to reveal any conditions that might account for this development regression. Behaviorally he exhibited features of autism. At follow-up at age 12 he still was not speaking, apart from an occasional single word, and had been placed in a school for the severely disabled.

Pervasive Developmental Disorder - Not Otherwise Specified

Description

Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) is a condition in which some - but not all - features of autism or another explicitly identified Pervasive Developmental Disorder are identified. PDD-NOS is often incorrectly referred to as simply "PDD." The term PDD refers to the class of conditions to which autism belongs. PDD is NOT itself a diagnosis, while PDD-NOS IS a diagnosis. which encompasses cases where there is marked impairment of social interaction, communication, and/or stereotyped behavior patterns or interest, but when full features for autism or another explicitly defined PDD are not met.

The term "PDD" is widely used by professionals to refer to children with autism and related disorders; however, there is a great deal of disagreement and confusion among professionals concerning the PDD label. The term "PDD" is not a specific diagnosis, but an umbrella term under which the specific diagnoses are defined.

Diagnosis

As no medical tests can be performed to indicate the presence of autism or any other PDD, the diagnosis is based upon the presence or absence of specific behaviors.

The essential features of PDD-NOS are: severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills; stereotyped behaviors, interests, and activities; and the criteria for Autistic Disorder are not met because of late age onset, atypical and/or sub threshold symptoms are present.
The limited available evidence suggest that children with PDD-NOS probably come to professional attention rather later than is the case with autistic children, and that intellectual deficits are less common.

Case Illustration

Leslie was the oldest of two children. She was noted to be a difficult baby who was not easy to console but whose motor and communicative development seemed appropriate. She was socially related and sometimes enjoyed social interaction but was easily overstimulated. She was noted to exhibit some unusual sensitivities to aspects of the environment and at times of excitement exhibited some hand flapping. Her parents sought evaluation when she was 4 years of age because of difficulties in nursery school. Leslie was noted to have problems with peer interaction. She was often preoccupied with possible adverse events. At evaluation she was noted to have both communicative and cognitive functions within the normal range. Although differential social relatedness was present, Leslie had difficulty using her parents as sources of support and comfort. Behavioral rigidity was noted, as was a tendency to impose routines on social interaction. Subsequently Leslie was enrolled in a therapeutic nursery school where she made significant gains in social skills. Subsequently she was placed in a transitional kindergarten and did well academically, although problems in peer interaction and unusual affective responses persisted. As an adolescent she describes herself as a `loner' who has difficulties with social interaction and who tends to enjoy solitary activities.

Treatment

Although it has no cure, PDD-NOS does respond to behavioral and educational treatment. Research suggests that early intervention is especially effective in achieving growth in cognitive and communication skills. There are a variety of intervention programs that have been designed specifically to work with children with PDD-NOS. Successful programs usually involve a mix of highly structured and more naturalistic activities and have the following properties:
Individualized care
Specialized curriculum for children with autism
Strong communication component
Family involvement
Systematic, structured teaching
Intensity of engagement (at least 20 hours/week)
Developmentally appropriate practice
Contact with typical peers

Rates of ADD/PDD-NOS Cases
Autism Statistics

Childhood Disintegrative Disorder (CDD)
Rare: ~0.2 in 10,000 = ~500 Canadians
Rett's Syndrome
Rare: ~1 in 10,000 = ~3,150 Canadians
50 % suffer from epilepsy as well
signs begin to show at about 6 - 18 months
According to a British study from 2004, 1.1 million to 1.6 million girls suffer from it (at least have been diagnosed) worldwide - second most common cause of severe and profound learning disability in girls

Autistic Disorder (AD)
Most common: ~20 in 10,000 = ~73,000 Canadians
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
Common: ~15 in 10,000 = ~47,000 Canadians
Also called atypical autism

Asperger Disorder (also called Asperger's Syndrome and AS)
Common: ~5 in 10,000 = ~15,000 Canadians
Usually diagnosed between 2 and 6 years, but has been diagnosed as late as adulthood
Males are 4 times as likely than females to have Asperger’s

2005 survey - 0.9% for autism spectrum disorders or 90 in 10,000

ASD rates among children ages 3-9 has more than doubled in the last decade.
Cases of Autistic Spectrum Disorder in the developed world used to be roughly 1 in 250 people in the 1980's, currently the diagnosed prevalence is closer to 1 in 150. This may be due to that more people are being born with Autistic Spectrum Disorders, or that diagnosis procedures have improved or become more concentrated. According to statistics there are 4 males for every 3 females diagnosed with some form ASD.

As of 2003 (which was the last available comprehensive study published), the number of people diagnosed with some form of ASD increased dramatically in both Canada and USA. This is shown in the fact that ASD is much more prevalent among children than the population as a whole.

Canada - Children - 1 in 165
Overall population - 1 in 260

USA - Children - 1 in 145
Overall population - one in 250
pdd - 15/10000 -47000, aspergers 5'10000 15000, cdd - 0.2/10000, 500 retts 1/10000 3150
autism overall - 20/10000 73000 IN CANADA

Famous people with autism:

Dan Aykroyd - Asperger’s
Darryl Hannah - non-specified
Jason MsElwain –PDD

Fictional Autistic Charachers:

Boo Radley (To Kill A Mockingbird)
Bert (Sesame Street)
Raymond Babbit (Rain Man)

People Strongly Speculated to have Autism:

Wolfgang Amadeus Mozart
Isaac Newton
Albert Einstein
Bob Dylan

Many people found in Biblical times who were said to be possessed showed clear autistic symptoms. It was not until the about 1800 that the consensus view among the educated population that Autistic characteristics were in fact considered a disability, rather than a supernatural phenomena.

Resources

Safran, Stephen. Asperger Syndrome: The Emerging Challenge to Special Education. Exceptional Children. Jan/Feb 2003.

www.autismontario.com

www.edu.gov.on.ca

http://www.autismsocietycanada.ca

The Complete Guide to Asperger's Syndrome by Tony Attwood

Does My child Have Autism by Wendy Stone

Straight Talk About Autism (DVD)

Autism Puzzle (TVO)

Yale Developmental Disabilities Center - http://www.med.yale.edu/chldstdy/autism/

Mayo Clinic - http://www.mayoclinic.com/health/autism/DS00348