Disorders usually first diagnosed in infancy, childhood, or adolescence

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Disorders usually first diagnosed in infancy,
childhood, or adolescence

• Mental Retardation
• Learning Disorders
• Motor Skills Disorder
• Communication Disorders
• Pervasive Developmental Disorders
• Attention-Deficit/Hyperactivity Disruptive
  Behavior Disorders
• Feeding and Eating Disorders of Infancy/Early
  Childhood
• Tic Disorders
• Elimination Disorders
• Others (Separation Anxiety, Selective Mutism,
  etc.)

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Pervasive Developmental Disorders

• Severe/pervasive impairment in
• Reciprocal social interaction skills
• Communication skills
• Or Stereotyped behavior, interests, activities
• Often associated with Mental Retardation
• Often also have other medical conditions
  (chromosomal abnormalities, seizures, abnormal
  CNS structure, primitive reflexes, delayed hand
  dominance, etc.)

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Pervasive Developmental Disorders

• Autistic Disorder (onset lt age 3)
• Impairments in social interaction language
• Repetitive/stereotyped behaviors, interests
• Aspergers Disorder
• Impairments in social interaction
• Repetitive behavior, interests
• No early language delays
• Retts Disorder
• Normal early development but deterioration in
  motor, social, language functioning as well as
  slowed head growth between 5-48 months
• Motor hand-wringing/washing, incoordination
  (gait), psychomotor slowing
• Social interest in others may increase in
  adolescence and adulthood
• Severe receptive and expressive language deficits
  persist
• Typically associated with severe or profound
  mental retardation
• Rare, and reported only in females
• Childhood Disintegrative Disorder
• Loss of previously acquired skills after age 2
  but before age 10 (language, social, play, motor
  skills bowel/bladder control)
• Typically associated with severe mental
  retardation
• Very rare

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Autistic Disorders

• First identified in 1943
• By definition, symptoms appear before 3
• Prevalence rates are increasing
• At least one in 600 may have autism
• Majority are male (4-5 more boys than girls)

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Autism

• Central feature lack of responsiveness,
  including extreme aloofness and lack of interest
  in people
• Lack of eye contact, reciprocal interaction
• Failure to develop peer relationships
• Solitary playing (can be oblivious of others)
• Language/communication problems
• May be lack of language or problems
  starting/maintaining
• Echolalia, exact echoing of phrases
• Tone, pitch, rate, rhythm, inflexion may be flat
  or inappropriate
• Language comprehension delayed (and arrested)
• No or inimal appreciation of humor, irony,
  figurative langauge
• Limited imaginative play, repetitive/rigid
  behavior
• Become very distressed when routine is broken

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Autism

• May become strongly attached to
• Particular objects (e.g., buttons, piece of
  string)
• Specific interests (names, dates)
• Unusual motor movements
• Self-stimulatory behaviors jumping, arm
  flapping
• Self-injurious behaviors head-banging
• Nonsensical gesturing
• Other stereotyped movments rocking, swaying,
  clapping
• At times seem overstimulated and/or
  understimulated by their environments
• Range of related behavioral symptoms
  hyperactivity, poor attention span, impulsivity,
  aggressiveness, temper tantrums

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Aspergers Disorder

• Similar social deficits, impairments in
  expressiveness, idiosyncratic interests, and
  restricted and repetitive behaviors as Autism
• Relatively well-developed language and other
  cognitive abilities
• Not usually associated with Mental Retardation
• More prevalent than autism
• Approximately 1 in 250 individuals
• Again, majority are male

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Case ExampleAspergers Disorder

• 23 year-old student at a technical college
  studying computer networks
• Diagnosed with Autism (high functioning) at age
  10 by neurologist
• Served as student with Specific Learning
  Disabilities grades 2-11
• Repeated 6th grade

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Developmental History

• No pregnancy/birth complications
• Developmental milestones met
• Normal early language development
• Generalized tonic-clonic seizures diagnosed at
  age 6 (none for 2 years)
• Seizures aggravated by excitement,
  photosensitivity, MSG, sensitivity to noise

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Developmental History

• Mom he has always been different
• Impaired social interactions/no close friends
• Bullied in school because of unusual behaviors
• Stereotyped interests
• Stereotyped patterns
• By age 9, speech sounded like he was reading a
  book
• Self-injurious and aggressive behaviors
  (head-butted walls, hit other kids)

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Self-reported Problems

• Receiving information
• Lot of words he does not know
• Hard to pay attention
• Slow at thinking, like a personal computer over
  packed with information
• Basic, concrete tasks easier those requiring
  abstraction more difficult
• Better communicating through writing because no
  backspace key in conversation
• Periods of low mood, loss of interest in things,
  trouble concentrating, thoughts of death

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Behavioral Observations

• Flat affect (smiled and laughed occasionally)
• Initiated conversation but in long, tangential
  (but fluent) monologues
• Situationally inappropriate comments and
  questions
• Monotonous/pedantic speech pattern (like
  lecturing)
• Many questions clarifying test instructions

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Aspergers Criteria

• Impaired social interaction skills (gt2 of the
  following)
• Nonverbal behaviors (eye contact, facial
  expression, body posture, gestures)
• Development of peer relationships
• Spontaneous seeking to share with others
• Social or emotional reciprocity

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Aspergers Criteria

• Restricted repetitive and stereotyped patterns of
  behavior, interests, activities (gt 1 of the
  following)
• Preoccupation with interests that is abnormal in
  intensity or focus
• Inflexible routines, rituals
• Stereotyped and repetitive motor mannerisms
  (e.g., hand flapping, twisting, body movements)
• Preoccupation with parts of objects

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Aspergers Criteria continued

• Clinically significant impairment in social,
  occupation, other functioning
• No general delay in early language development
• No delay in cognitive development, self-help
  skills, adaptive behavior, curiosity about the
  environment
• Not another Pervasive Developmental Disorder or
  Schizophrenia

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Test Results

• Average overall abilities
• Deficits
• Understanding figurative, non literal, abstract
  language
• Understanding complex syntax
• Vocabulary
• Processing Speed
• Motor Functioning
• Academic Fluency
• Reading Comprehension
• Math calculation and reasoning

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Test Results

• Strengths
• Visual-Spatial Abilities
• Nonverbal Reasoning (solving logic puzzles)
• Verbal Analogies(?)

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Test Results

• Other Areas Assessed
• Working Memory
• Learning
• Word Retrieval
• Reading Decoding
• Spelling
• Mechanics of Writing

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Test Results

• Asperger Syndrome Diagnostic Scale Quotient 105
  (likely)
• BASC-2 - Mother
• Attention Problems
• Social Skills
• Leadership
• Atypical Thoughts
• Withdrawal

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Test Results

• BASC-2 Father
• Anxiety
• Depression
• Leadership
• Withdrawal
• Activities of Daily Living

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Some Accommodations

• Note taking help (note-taker and/or digital/tape
  recorder)
• Written instructions
• Use of digital camera to capture class
  assignments
• Reduced course load
• Priority registration

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Other Recommendations

• Continue with Vocational Rehabilitation
• Therapy for social skills, daily living skills,
  easing need for routines
• Speech/language therapy for vocabulary building,
  understanding figurative language, prosody/tone
  regulation
• Online or hybrid courses when available
• Vocabulary building tools (flashcards, word-a-day
  calendars/e-mails)

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Some possible areas forteams to explore

• Biological factors
• Psychological and sociocultural contributors
• Treatment approaches
• Community resources for caregivers
• Comparison of Autism, Aspergers, Retts,
  Disintegrative Disorder on any combo of above
• Social development in Aspergers compared to
  other Pervasive Developmental Disorders
• Other famous individuals with Pervasive
  Developmental Disorder