Pervasive Developmental Disorders

1
Pervasive Developmental Disorders
2
Autistic Disorder

• A total of six or more items from 1, 2 and 3 with
  a t least two from 1 and one from 2 and 3
• 1) qualitative impairment in social interaction
• Nonverbal behaviours (eye to eye gaze, facial
  expression, body postures, gestures
• Failure to develop peer interactions appropriate
  to developmental level
• Lack of spontaneous seeking of sharing enjoyment
  interests or achievements with other people

3
Autistic Disorder

• 2) Qualitative impairments in communication
• Delay in or total lack of development of spoken
  language without attempts to compensate
• Inability to start a conversation or sustain a
  conversation once language has been developed
• Stereotyped or repetitive use of language or
  idiosyncratic language
• Lack of varied spontaneous make believe play or
  social imitative play according to developmental
  stage

4
Autistic Disorder

• 3) Restricted repetitive and stereotyped patterns
  of behaviour, interests and activities
• Encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  abnormal in intensity and focus
• Inflexible adherence to specific, nonfunctional
  routines and rituals
• Repetitive and stereotyped motor mannerisms
• Preoccupations with part of objects

5
Autistic Disorder

• Delays or abnormal functioning in
• Social interaction
• Language as used in social communication
• Symbolic or imaginative play
• .. have started prior to age 3
• Disturbance not accounted for by Retts Sx or
  disintegrative disorder

6
Autistic Disorder

• Frequency of 2 to 5/ 10,000 under age 12
• Up to 20/10,000 if including MR
• Starts before age 36 months
• More common in boys than girls
• Girls more seriously affected
• Associated with neurological conditions (PKU,
  tuberous sclerosis, congenital rubella, Retts
  syndrome, grand mal seizures, ventricular
  enlargement, cerebellar vermal hypoplasia,
  polymacrogyria, abnormal cell migration, etc)

7
Autistic Disorder

• Perinatal complications maternal bleeding after
  1st. trimester, meconium, respiratory distress
  syndrome, neonatal anemia, medication use
• Temporal lobe damage autistic like symptoms
• Hyperserotoninemia, and high dopamine metabolites
• Severity is proportional to 5HIAA/HVA or
  inversely proportional to 5HT

8
Attention Deficit Hyperactivity Disorder

• Inattention six or more persisted for at least
  6months causing malfunctioning
• Fails to give attention to details, careless
  mistakes in schoolwork, work or other activities
• Difficulty in sustaining attention
• Does not seem to listen
• Does not follow instructions, fails to finish
  without being oppositional
• Difficulties organizing tasks
• Avoids or dislikes activities that require
  sustained mental effort
• Looses things necessary for work
• Easily distracted
• Forgetful in daily activities

9
Attention Deficit Hyperactivity Disorder

• Hyperactivity
• Fidgets with hands or squirms in seat
• Can not remain seated
• Runs around or climbs inappropriately
  (restlessness)
• Difficulty playing or engaging in leisure
  activities quietly
• Often on the go or driven by a motor
• Talks excessively

10
Attention Deficit Hyperactivity Disorder

• Impulsivity
• Blurts out answers before the question is
  finished
• Difficulty awaiting turns
• Interrupts or intrudes others
• Symptoms have been present before age 7
• Impairment in two or more settings
• Clinically significant impairment in social,
  academic or occupational environments
• Not present only when a pervasive disorder is
  occurring

11
Attention Deficit Hyperactivity Disorder

• No anatomical findings consistent with disorder
• No environmental factors associated to causes
• Dopaminergic and NE disorders?
• 15-20 persist after childhood
• Persistent ADHD gt high risk CD
• 50 CD adolescent onset ASPD