Pervasive Developmental Disorders

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Pervasive Developmental Disorders

  1. 1. PERVASIVEDEVELOPMENTALDISORDERS / AUTISTICSPECTRUM DISORDERSPresenter- Dr.D.Raj KiranChairperson- Dr.Keshava Pai
  2. 2. Case vignette• A child by name Donald, 5yrs of age brought byhis parents. He seemed to be self satisfied. Hasno apparent affection when patted. He does notobserve the fact that anyone comes or goes,never seems glad to see father or mother or anyplaymate. He seems almost to draw into his shell& live within himself. When left alone with a childof same age, he never interacted with him norplayed with him. He seldom comes to anyonewhen called.Ref- Leo Kanner. Autistic disturbance of affective contact. Pathology, 217-250.2
  3. 3. Headings• Introduction• History• Nosology• Prevalence• Etiology- Psychological & Biological theories• Individual disorders• Treatment3
  4. 4. Why the name PDD ???• Pervasive- development is disturbed over a rangeof different domains, rather than delineateddifficulties of specific developmental disorders orcognitive problems of MR.• Developmental- suffer from disturbances innormative unfolding of multiple developmentalcompetencies.3Willemsen-Swinkels, Buitelaar, PCNA 25 (2002) 811-836.
  5. 5. Introduction• The word Autism comes from the Greek word "autos,"meaning "self."• Three Cardinal features of Pervasive developmentalDisorders/ Autistic spectrum disorders1. Qualitative impairment in social interaction.2. Qualitative impairment in Verbal & Nonverbalcommunication.3. Restricted range of Interests.5Ref- Yosuke Kita, Toru Hosokawa. History of autistic spectrumdisorders: historical controversy over the diagnosis. Journal ofJapanese psychiatry; 59; vol 2; 2011
  6. 6. • First person to use the term“autismus” (german).• „Autismus‟- to loserelationship with externalworld & lead a life of one‟sown world.• Refer to one group ofsymptoms of dementiapraecox.6History- Eugen BleulerRef- Yosuke Kita, Toru Hosokawa. History of autistic spectrumdisorders: historical controversy over the diagnosis. Journal ofJapanese psychiatry; 59; vol 2; 2011
  7. 7. • In 1908, reported 6cases.• Coined the term“dementia infantilis”.• Later termed asChildhoodDisintegrative Disorder(CDD) / Heller‟sSyndrome.7History- Theodor HellerRef- Yosuke Kita, Toru Hosokawa. History of autistic spectrumdisorders: historical controversy over the diagnosis. Journal ofJapanese psychiatry; 59; vol 2; 2011
  8. 8. • In 1943, published acase report of 11 casesentitled “AutisticDisturbances ofAffective Contact”.• First time used the termAutism for clinical groupof children.• Later named EarlyInfantile Autism.8History- Leo KannerRef- Yosuke Kita, Toru Hosokawa. History of autistic spectrumdisorders: historical controversy over the diagnosis. Journal ofJapanese psychiatry; 59; vol 2; 2011
  9. 9. • In 1944, published acase report entitled “Die AutistischenPsychopathen imKindesalter” (German).• Proposed the term“Autistic Psychopathy”.• Late termed asAsperger„s syndrome.9History- Hans AspergerRef- Yosuke Kita, Toru Hosokawa. History of autistic spectrumdisorders: historical controversy over the diagnosis. Journal ofJapanese psychiatry; 59; vol 2; 2011
  10. 10. History- Andreas Rett• In 1966, described aclinical conditioncharacterized bywringing of hands.• It later came to beknown as Rett‟ssyndrome.10Ref- Yosuke Kita, Toru Hosokawa. History of autistic spectrumdisorders: historical controversy over the diagnosis. Journal ofJapanese psychiatry; 59; vol 2; 2011
  11. 11. History- Lorna Wing• In 1988, Proposed theconcept of AutisticSpectrum Disorders.• She is a mother ofAutistic daughter.• Founded NationalAutistic Society, UK.11Ref- Yosuke Kita, Toru Hosokawa. History of autistic spectrumdisorders: historical controversy over the diagnosis. Journal ofJapanese psychiatry; 59; vol 2; 2011
  12. 12. Nosology• DSM– I & II- Continuum of Schizophrenia– III- Concept of autism was introduced but lacked thedevelopmental orientation. CDD was not included.– III R- Set of 16 criteria were introduced, Multiaxialplacement of autism & PDD, condition was moved toAxis II, diagnostic concept was broadened to Autisticdisorder & PDD NOS.• ICD 9- Infantile autism was included in the category ofpsychosis with onset in childhoodRef- F R Volkmar, A Klin, R T Schultz, Mattew, State. Pervasive developmentaldisorders. Chapter 41,Kaplan & Sadock‟s Comprehensive textbook of psychiatry vol 2,page 3540- 3559.12
  13. 13. Nosology- PDDDSM IV TR• 299.00 Autistic disorder.• 299.80 Rett‟s syndrome.• 299.10 CDD.• 299.80 Asperger‟ssyndrome.• 299.80 PDD NOS(including AtypicalAutism).ICD 10 (F84)• F84.0 Childhood Autism• F84.1 Atypical Autism• F84.2 Rett‟s Syndrome• F84.3 Other CDD• F84.4 Overactive dis• F84.5 Asperger‟sSyndrome• F84.8 Other PDD• F84.9 PDD UnspecifiedDSM IV TR page- 69-84, ICD 10 page- 252- 259. 13
  14. 14. Nosology- ASDDSM V• Autistic Disorder.• CDD.• Asperger‟s Syndrome.• PDD NOS.• ASD Severity criteria oflevels- 1(mild),2(moderate), 3(severe) intwo symptom domains.ICD 11 (proposed draft)• Autism.• Disintegrative Disorder.• Social reciprocitydisorder.• Rett‟s Syndrome.Ref- H Kurita. How to deal with the transition from Pervasive Developmental Disorders in DSM-IV to Autism Spectrum Disorder in DSM-V. editorial, Psychiatry and ClinicalNeurosciences2011;65: 609–610 http://apps.who.int/classifications/icd11/browse/14
  15. 15. Prevalence• Increase in prevalence in recent decades.• The various causes could be due to- Increasing reference of children to specialist services. “Diagnostic Switching”. Decreased age at diagnosis. Repeat surveys in same geographical area. Changes in diagnostic criteria. Improved awareness. Service availability.Ref- ERIC FOMBONNE. Epidemiology of Pervasive Developmental Disorders. PEDIATRICRESEARCH . Vol. 65, No. 6, 2009 . 15
  16. 16. Prevalence• All PDDs- 63.7 / 10,000.• Autistic disorder- 20.6 / 10,000. M: F= 4-5 :1.• Asperger‟s syndrome- 6 / 10,000. M: F= 9 :1.• Rett‟s syndrome- 1/ 15,000 to 1/ 22,000. Reportedonly in females.• CDD- 2 / 1 lac. M > F.• PDD NOS- 37.1 / 10,000.Ref- ERIC FOMBONNE. Epidemiology of Pervasive Developmental Disorders.PEDIATRIC RESEARCH . Vol. 65, No. 6, 2009 . 16
  17. 17. Why PDD M>F ???• Same picture in ADHD, CD, SLD, dyslexia.• Various theories proposed are-1. Extreme Male Brain theory- F have stronger drive toempathize, M have stronger drive to systemize.2. Fetal Testosterone(fT) theory.3. X linked theory.4. Y linked theory.5. Autosomal penetrance theory- reduced penetrance infemales.Ref- Simon Baron-Cohen et al. Why Are Autism Spectrum Conditions More Prevalent inMales?. Plos biology, June 2011 | Volume 9 | Issue 6 | e1001081 17
  18. 18. Etiology1. Psychological theories1. Refrigerator mother theory.2. Theory of Mind Hypothesis.3. The Enactive Mind Hypothesis.4. Theory of Executive Dysfunction.5. Weak Central Coherence Theory.2. Biological theories1. Genetic.2. Neuroanatomical.3. Neurochemical.18Ref- G Rajendrana, P Mitchell. Cognitive theories of autism. Developmental Review,27 (2). pp. 224-260. ISSN 0273-2297.
  19. 19. Refrigerator mother theoryRef- G Rajendrana, P Mitchell. Cognitive theories of autism. Developmental Review,27 (2). pp. 224-260. ISSN 0273-2297. 19• Proposed by Bruno Bettelheim.• Mothers of children with autism arepsychologically cold & aloof → sorespond abnormally & psychologicallyharmful to normal child behaviors.• There is negativity & rejection in child →perceived as hostility & threat → leads towithdrawal.• This becomes a vicious cycle.
  20. 20. Theory of Mind (ToM)• Forwarded by Premack &Woodruff (1978).• Tasks involve reasoningabout misleading contents ofcontainers & the unexpectedlocations of objects.• States that individuals withautism fail to “impute mentalstatus to themselves &others”.20Sally Anne TaskRef- G Rajendrana, P Mitchell. Cognitive theories of autism. Developmental Review,27 (2). pp. 224-260. ISSN 0273-2297.
  21. 21. Theory of Executive Dysfunction• Executive Functioning- Ability to maintain anappropriate problem-solving set for attainment ofa future goal.• Includes behaviours- planning, impulse control,maintenance, organized search, flexibility ofthought and action.• EF tasks assess- Inhibition, Intentionality &Executive Memory.• Studies found 50-96% autistics not able toperform EF tasks.21Ref- G Rajendrana, P Mitchell. Cognitive theories of autism. Developmental Review,27 (2). pp. 224-260. ISSN 0273-2297.
  22. 22. Theory of Executive Dysfunction• Windows task- A child had to learn to inhibit theirpre potent response to point to chocolate locatedin one of two boxes. In order to win chocolatechild has to point to empty box.• Autistic child is unable to resist to point to box withchocolates.• That is they act impulsively.• Sally Anne task can also be explained in similarway.22Ref- G Rajendrana, P Mitchell. Cognitive theories of autism. Developmental Review,27 (2). pp. 224-260. ISSN 0273-2297.
  23. 23. Weak Central Coherence theory• Suggested by Prof Uta Firth (1989).• “A weakness in the operation ofcentral systems that are normallyresponsible for drawing togetherindividual pieces of information toestablish meaning, resulting in acognitive bias towards processinglocal parts of information rather thanthe overall context”.23Ref- K Plaisted. Towards an understanding of the mechanisms of weak central coherenceeffects: experiments in visual configural learning and auditory perception. Phil. Trans. R. Soc.Lond. B (2003) 358, 375–386Prof Uta Firth
  24. 24. Genetics• Monozygotic twins- 60%.• 1st degree relatives- 20-80 folds increase.• Heterogeneous genetic disorder.• Autism represents a behavioral phenotype.• It is a result of damage to one or more specificfunctional systems of brain.• Notable association with HLA-DRB1 alleles.Ref- A L Relss, C Felnstein,K N Rosenbaum. Autism and Genetic Disorders.Schizophrenia bulletin, vol 12, no 4, 1986. 24
  25. 25. Genetics1. Chromosomal disorders- Fragile X Syndrome(FMR1 gene). 47XXY, 48XXYY, 47XYY, 47XXX,Large Y chromosome, Trisomy 21.2. Single gene disorders- Phenylketonuria,Neurolipidosis, Hurler‟s syndrome, Histidinemia,Oculocutaneous Albinism, Neurofibromatosis,Tuberous Sclerosis, Noonan‟s Syndrome.3. Disorders of Unknown aetiology- Cornelia delange syndrome, William‟s syndrome, Moebiussyndrome, Marshall Smith syndrome.25Ref- A L Relss, C Felnstein,K N Rosenbaum. Autism and Genetic Disorders.Schizophrenia bulletin, vol 12, no 4, 1986.
  26. 26. Neuroanatomical• Most studies-– Generalisedenlargements ofCerebral Hemispheres,Cerebellum, CaudateNucleus– Reduction of Corpuscallosum & possiblyMidbrain & CerebellarVermal lobules.Ref- D G Amaral, C M Schumann, C W Nordahl. Neuroanatomy of autism: review, Trends inNeurosciences Vol.31 No.3. 26
  27. 27. Neurochemical• Wide array of transmitter have been studied.• Serotonin, Dopamine, Norepinephrine, ACh,Oxytocin, Endogenous Opioids, Cortisol,Glutamate, and GABA.• Serotonin-– Appears to have more empirical evidence for its role inautism.– Evidence for this is acute depletion of dietarytryptophan led to worsening of autistic symptomatology.Ref- K S L Lam et al. Neurochemical correlates of autistic disorder: A review of the literatureResearch in Developmental Disabilities 27 (2006) 254–289. 27
  28. 28. Neurochemical• Dopamine-– Observed that some DA blockers have been effective intreating some aspects of autism.– Animal research also shows that stereotypies &hyperactivity can be induced by ↑ DA.• Norepinephrine-– Studies show ↑ NE in autistic than controls.– Benefits from NE agonists or antagonists has beensparsely reported.28Ref- K S L Lam et al. Neurochemical correlates of autistic disorder: A review of the literatureResearch in Developmental Disabilities 27 (2006) 254–289.
  29. 29. Autistic disorder- c/f• Marked abnormality / impairment in developmentin Social interaction,• Marked abnormality / impairment inCommunication,• Restricted repertoire of activity & interests.• Disturbance prior to 3 years of age.• If there is a period of normal development itcannot extend beyond 3 years.Ref- DSM IV TR page- 69-8430
  30. 30. Autistic disorder- c/f• Impairment in reciprocal social interaction-1. Nonverbal behaviours (e.g., eye-to-eye gaze, facialexpression, body postures and gestures).2. Peer relationships appropriate to developmental level.3. Spontaneous seeking to share enjoyment, interests,or achievements with other people (e.g., showing,bringing, or pointing out objects they find interesting).4. Social or emotional reciprocity (e.g., simple social playor games, preferring solitary activities, or involvingothers in activities only as tools or "mechanical" aids).31Ref- DSM IV TR page- 69-84
  31. 31. Autistic disorder- c/f• Impairment in Communication-– Delay in, or total lack of the development of spokenlanguage (MC presenting complaint).– Who speak, may have marked impairment in the abilityto initiate or sustain a conversation with others.– Stereotyped and repetitive use of language oridiosyncratic language.– Lack of varied, spontaneous make-believe play orsocial imitative play appropriate to developmental level.When speech does develop, the pitch, intonation, rate,rhythm, or stress may be abnormal.32Ref- DSM IV TR page- 69-84
  32. 32. Autistic disorder- c/f• Restricted, repetitive & stereotyped patterns ofbehaviour, interests & activities– Preoccupation with one or more stereotyped andrestricted patterns of interest that is abnormal.– Inflexible adherence to specific, non-functional routinesor rituals.– Stereotyped and repetitive motor mannerisms.– A persistent preoccupation with parts of objects.Display a markedly restricted range of interests and areoften preoccupied with one narrow interest.33Ref- DSM IV TR page- 69-84
  33. 33. Imaginary City- UrvilleCreated by French Autistic savant Gilles Trehin34
  34. 34. Asperger’s Syndrome• Developmental disability.• Impairments in social relationships.• Restrictive, repetitive patterns of behaviour,interests, and activities.• But no impairment in language & communication.• Part of a continuum of autism, with AS placed onthe milder end of the spectrum.• They have special interests which are typicallynarrow & unusual focussed areas.Ref- Herman van Engeland and Jan K. Buitelaar. Chapter 46: Autistic spectrum disorders.Rutter‟s child & adolescent psychiatry, 5th edition, Blackwell publishers. Pg 759- 781. 35
  35. 35. Asperger’s Syndrome- c/f• Socially isolated but not withdrawn, approachingothers in an inappropriate & eccentric manner.• Speech- poor prosody, inflection & intonation notas rigid & monotonic as in autism. It may betangential & circumstantial. The patient may talkincessantly.• They typically amass a lot of factual information,without understanding of the broader phenomenainvolved.36Ref- DSM IV TR page- 69-84
  36. 36. Asperger’s Syndrome• Hans Asperger initially described a positiveoutcome to his patients, who were able to usetheir special talents for employment. But there areno systemic long term follow up studies.• Treatment– Supportive.– Great extent overlaps with treatment guidelinesof autism without mental retardation.37
  37. 37. Childhood Disintegrative Disorder• Marked regression in multiple areas ofdevelopment after several years of development.• Aetiology-– Cause is yet to be established.– Association with Addison-Schilder,metachromatic leukodystrophy, pertusis,neurolipidosis, and seizures.– ??? Genetic or Chromosomal abnormalities.Ref- M A Bray, T J Kehle, L A Theodore. Case study of CDD- Hellers syndrome. Psychology inthe Schools, Vol. 39(1), 2002. 38
  38. 38. CDD c/f• Both CDD and Autistic Disorder essentially have thesame criteria for diagnosis.• Hallmark of CDD- ubiquitous loss of speech,progressive deterioration of daily living skills,behaviour problems.• Normal development- minimum of 2 years.• Onset- between 2 & 10 years.• Some individuals with CDD appear clinically moreautistic than those with autistic disorder.39Ref- Herman van Engeland and Jan K. Buitelaar. Chapter 46: Autistic spectrum disorders.Rutter‟s child & adolescent psychiatry, 5th edition, Blackwell publishers. Pg 759- 781.
  39. 39. CDD Rx• Addressing the special needs.• Approaches designed for autistic children are aseffective in treating children with CDD.• Early intervention enhances the efficacy .• Most children with CDD undergo deteriorationsubsequent to the preschool years.40Ref- Herman van Engeland and Jan K. Buitelaar. Chapter 46: Autistic spectrum disorders.Rutter‟s child & adolescent psychiatry, 5th edition, Blackwell publishers. Pg 759- 781.
  40. 40. Rett’s Syndrome• Postnatal progressive neurodevelopmentaldisorder in Girls.• 99% sporadic.• Loss of MeCP2 function.• Mutations in MeCP2 in 95% of classic cases.Most arise de novo & often involve C to Ttransition at CpG dinucleotides.• Other mutations- R133C (mild), R270X.Ref- Maria chahrour, H Y Zoghbi. The Story of Rett Syndrome: From Clinic toNeurobiology. Neuron 56. Nov 8, 2007. 41
  41. 41. Rett’s Syndrome- c/fRef- Maria chahrour, H Y Zoghbi. The Story of Rett Syndrome: From Clinic toNeurobiology. Neuron 56. Nov 8, 2007. 42
  42. 42. Rett’s Syndrome• Prognosis– Progressive neurodegenerative condition.– Adults may be non ambulatory due to motor problems& scoliosis.– Increased risk of sudden death.• Treatment-– No specific treatment.– Special education, Behaviour modification, Physical &Respiratory therapies may be helpful.43Ref- Maria chahrour, H Y Zoghbi. The Story of Rett Syndrome: From Clinic toNeurobiology. Neuron 56. Nov 8, 2007.
  43. 43. Atypical Autism• Differs from autism in terms– Age of onset or– failure to fulfil all three sets of diagnostic criteria.• Arises in retarded individuals whose very low levelof functioning provides little scope for exhibition ofthe specific deviant behaviours required for thediagnosis.• It also occurs in individual with a specificdevelopmental disorder of receptive language.44
  44. 44. PDD Unspecified• Residual category that should be used fordisorders which fit the general description for PDDbut in which a lack of adequate information, orcontradictory findings, means that the criteria forany of the other F84 codes cannot be met.45
  45. 45. ASD- RxRef- Anne Bowker• Nadia M. D‟Angelo• Robin Hicks• Kerry Wells. Treatments for Autism:Parental Choices and Perceptions of Changes J Autism Dev Disord (2011) 41:1373–1382. 461st2nd3rd4th5th6th
  46. 46. Applied Behavior Analysis(ABA)Ref- Joel E. Ringdahl, Todd Kopelman, and Terry S. Falcomata. Chapter 2Applied Behavior Analysis and Its Application to Autism and Autism Related Disorders.Springer publishers.15-32.47• Symptoms can be grossly divided into-– Behavior of excess- vocal & motor stereotypy, rigidity.– Behavior of deficit- delay in communication, peerrelation, independent functioning.• Many of these are addressed by ABA.• It is based on Operant conditioning by Skinner.• It is a process through which the environment andbehaviour interact to shape the behaviouralrepertoire of an individual.
  47. 47. ABA concepts• There are several concepts upon which ABAtreatment is based.• They have been divided into-• Consequence based approaches- punishment,reinforcement.• Antecedent based approaches.• Combined approaches.48Ref- Joel E. Ringdahl, Todd Kopelman, and Terry S. Falcomata. Chapter 2Applied Behavior Analysis and Its Application to Autism and Autism Related Disorders.Springer publishers.15-32.
  48. 48. Consequence based approaches• Positive punishment- An aversive stimulus ispresented (positive = presented) contingent onthe target behaviour & results in a decreasedlikelihood of future responding.• Negative punishment- A stimulus is removed(negative = removed) contingent on the targetbehaviour & results in a decreased likelihood offuture responding.• Drawbacks- no new behavior learnt, desiredbehavior only in presence of punisher etc..,49Ref- Joel E. Ringdahl, Todd Kopelman, and Terry S. Falcomata. Chapter 2Applied Behavior Analysis and Its Application to Autism and Autism Related Disorders.Springer publishers.15-32.
  49. 49. Consequence based approaches• Token economy- refers to the delivery of aconditioned reinforcer that can later beexchanged for another reinforcer.• Extinction- the reinforcement for a particularresponse is withdrawn, unreinforced the behaviordisappears.• Differential reinforcement- giving positivereinforcement for desired behavior & withholding itin the absence.50Ref- Joel E. Ringdahl, Todd Kopelman, and Terry S. Falcomata. Chapter 2Applied Behavior Analysis and Its Application to Autism and Autism Related Disorders.
  50. 50. Consequence based approaches• Shaping- use of prompts & successiveapproximations.• Behavioural chains- they are collections ofdiscrete responses that are performed in rapidand accurate sequences.• Forward chaining- responses in a behaviouralchain are taught and reinforced in their naturallyoccurring order.• Backward chaining- reverse order reinforcement.51Ref- Joel E. Ringdahl, Todd Kopelman, and Terry S. Falcomata. Chapter 2Applied Behavior Analysis and Its Application to Autism and Autism Related Disorders.Springer publishers.15-32.
  51. 51. Antecedent approaches• These focus on manipulating antecedent relevanttarget behavior.• These include-1. Establishing operations- deprivation & satiation.2. Stimulus control procedures.3. Prompt procedures.4. Procedures that provide choice makingopportunities.52Ref- Joel E. Ringdahl, Todd Kopelman, and Terry S. Falcomata. Chapter 2Applied Behavior Analysis and Its Application to Autism and Autism Related Disorders.Springer publishers.15-32.
  52. 52. Catherine Maurice- Behavioralintervention for autism children• It is divided into three levels1. Beginning curriculum.2. Intermediate curriculum.3. Advanced curriculum.• Each curriculum has 6 skillsexcept advanced which has9 skills-1. Attending skills2. Imitation skills3. Receptive language skills4. Expressive language skills5. Pre academic/ academicskills6. Self help skills7. Abstract language8. Social skills9. School readiness“If they cant learn the way we teach, we teach the way they learn” ― O. Ivar Lovaas(Author of “ME BOOK”) 53
  53. 53. Catherine Maurice- Behavioralintervention for autism children• Attending skills- sits in chair independently,sustains eye contact, eye contact duringconversation.• Imitation skills- imitates gross motor movements,imitates gross motor movements from standingposition, imitates complex sequences.• Receptive language- follow 1 step instruction,identifies room, follow 3 step command."Don‟t underestimate persons with autism, try to understand."54
  54. 54. Catherine Maurice- Behavioralintervention for autism children• Expressive language- labels objects, labelsplaces, names items in a category.• Pre academic skills- identify colors, matchesidentical words, spells simple words.• Self help skills- drink from cup, puts on shirt,brushes teeth.• Abstract language- answers why..? Question.• Social skills- imitates action of peer.• School readiness- waits turn."My son has autism, but autism doesnt have him."55
  55. 55. Catherine Maurice- Behavioralintervention for autism children• For example- “maintaining eye contact”1. Make child sit on a chair facing you.2. Give the command “look at me” every 5-10sec.3. Reward the child with praise & food for correctly looking at theface.4. If child does not visually attend then look away for 5sec & thenrepeat the same command again.5. Prompt eye contact by holding a piece of food between vision ofchild & you. Then repeat the command.6. When eye contact occurs, gradually & systemically fade theprompt.7. To increase the duration of eye contact gradually delay giving offood while maintaining eye contact with praise."Though devastating at first, Autism isnt the end of the world. Its the beginning of a whole newone." 56
  56. 56. Medications• Risperidone(0.5–1.5 mg)- decreasing irritability,temper tantrums, hyperactivity, aggression andself-injurious behaviour.• Fluoxetine- reducing compulsive and repetitivebehaviours, stereotypies and rituals.• Methylphenidate(0.125-0.5mg/kg/day)ADHD.• Lithium and Valproic acid- Affective instability,impulsivity and aggression.• Buspirone(10-45mg/kg/day)- improving anxiety,temper tantrums and aggression.Ref- Herman van Engeland and Jan K. Buitelaar. Chapter 46: Autistic spectrum disorders.Rutter‟s child & adolescent psychiatry, 5th edition, Blackwell publishers. Pg 759- 781. 57
  57. 57. Take home message• No one theory explains these disorders. Still a lotscope for research to explain etiology.• No one treatment fits all these disorders.• Treatment should be tailored according to theindividual needs.• Outcome seems to be improved with earlierdetection & intervention.• Self help skills should be major aim of treatmentprograms.58
  58. 58. • World Autism Awareness Day-2nd April every year.• Theme- “Autism. More commonthan you think”…• Films on autism….59
  59. 59. 5/9/201360THANK YOU

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