Understanding abnormal behaviour

1. UNDERSTANDING ABNORMAL BEHAVIOUR
PERVASIVE DEVELOPMENTAL
DISORDERS

3. DIAGNOSTIC CODE:299.00

4. CLINICAL PICTURE IN AUTISTIC SPECTRUM
DISORDER
• A social Deficit
• An absence of speech “Echolalia”
• Self –stimulation
• Intellectual ability
• Maintaining sameness

5. B)DEFINITION
• Autism spectrum disorder (ASD) is a general term for
a group of complex disorders of brain development.
• These disorders are characterized, in varying degrees,
by difficulties in social interaction, verbal and
nonverbal communication and shows repetitive
behaviors.
• Autism appears to have its roots in very early brain
development
• However, the most obvious signs of autism and
symptoms of autism tend to emerge between 2 and 3
years of age.
• Both children and adults with autism typically show
difficulties in verbal and non-verbal communication,
social interactions, and leisure or play activities.

6. • ASD occurs in all racial, ethnic, and
socioeconomic groups, but are almost five times
more common among boys than among girls.
• Although autism can be diagnosed at any age, it
is said to be a “developmental disorder” because
symptoms generally appear in the first two years
of life.
• Autism is known as a “spectrum” disorder
because there is wide variation in the type and
severity of symptoms people experience.
• Although ASD can be a lifelong disorder,
treatments and services can improve a person’s
symptoms and ability to function.

7. SUBTYPES
According to DSM IV ,there are four different types of
Autism Spectrum Disorders:
a)Asperger’s Syndrome
• This is on the milder end of the autism spectrum.
• A person with Asperger's may be very intelligent and
able to handle her daily life.
• He/ She may be really focused on topics that interest
him/her and discuss them nonstop. But he/she has a
much harder time socially.

8. b)Atypical Autism or Pervasive
developmental disorder, not otherwise
specified (PDD-NOS).
• People with PDD-NOS usually have fewer and
milder symptoms than those with autistic
disorder and are severe symptoms than
Asperger’s syndrome.
• The symptoms might cause only social and
communication challenges.

9. c)Autistic Disorder (also called "classic"
autism)
• This is what most people think of when
hearing the word "autism."
• People with autistic disorder usually have
significant language delays, social and
communication challenges, and unusual
behaviors and interests.
• Many people with autistic disorder also have
intellectual disability.

10. d)Childhood disintegrative disorder.
• This was the rarest and most severe part of
the spectrum.
• It described children who develop normally
and then quickly lose many social, language,
and mental skills, usually between ages 2 and
4.
• Often, these children also developed a
seizure disorder.

11. Is Rett Syndrome an ASD?
• Children with Rett syndrome often have
behaviors similar to autism, and experts used
to group it among spectrum disorders.
• But now that it’s known to be caused by a
genetic mutation, it’s no longer considered as
ASD.

12. A Look at the Brain of a Person with Autism
• Brain imaging techniques, such as magnetic resonance
imaging (MRI), have been used to examine the brains
of people with autism. However, results have been
inconsistent. Abnormal brain areas in people with
autism include the:
• Cerebellum - reduced size in parts of the cerebellum.
• Hippocampus and Amygdala - smaller volume. Also,
neurons in these areas are smaller and more tightly
packed (higher cell density).
• Lobes of the Cerebrum - larger size than normal.
• Ventricles - increased size.
• Caudate nucleus - reduced volume.

13. C)DIAGNOSTIC CRITERIA

14. A. A total of six (or more) items from (1), (2), and (3). with
at least two from (1). and one each from (2) and (3):
(1) qualitative impairment in social interaction, as
manifested by at least two of the
following:
(a) marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye gaze, facial
expression, body postures, and gestures to regulate
social interaction
(b) failure to develop peer relationships appropriate to
developmental level
(c) a lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people (e.g.,
by a lack of showing, bringing. or pointing out objects
of interest)
(d) lack of social or emotional reciprocity

15. (2) qualitative impairments in communication as
manifested by at least one of the
following:
(a) delay in, or total lack of, the development of spoken
language (not accompanied by an attempt to
compensate through alternative modes of
communication such as gesture or mime)
(b) in individuals with adequate speech, marked
impairment in the ability to initiate or sustain a
conversation with others
(c) stereotyped and repetitive use of language or
idiosyncratic language
(d) lack of varied, spontaneous make-believe play or
social imitative play appropriate to developmental level

16. (3) restricted repetitive and stereotyped patterns of
behavior, interests, and activities, as manifested
by at least one of the following:
(a) encompassing preoccupation with one or
more stereotyped and restricted
patterns of interest that is abnormal either in
intensity or focus
(b) apparently inflexible adherence to specific,
nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms
(e.g., hand or finger flapping or twisting, or
complex whole-body movements)
(d) persistent preoccupation with parts of objects

17. B. Delays or abnormal functioning in at least one
of the following areas, with onset prior to age
3 years:
(1) social interaction
(2) language as used in social communication
(3) symbolic or imaginative play.

18. SEVERITY

19. D)ETIOLOGY
• The exact cause of autism is currently
unknown.
• Autism is a complex neuro developmental
condition. The causes are still being
investigated.
• Current evidence suggests that autism may be
caused by many factors that affect the way the
brain develops.
• These include:
• genetics
• environmental triggers

20. GENES
• Most researchers believe that certain genes a child
inherits from their parents could make them more
likely to have autism. This is called a genetic
predisposition.
• Autism is known to run in families. For example,
younger siblings of autistic children can also be autistic.
It's also common for identical twins to both be autistic.
• Although scientists are still trying to identify the genes
involved. Signs of autism may be a feature of some rare
genetic syndromes.
• These include:
• Fragile X syndrome
• Williams syndrome
• Angelman syndrome

21. ENVIRONMENTAL TRIGGERS
• Very few conditions are caused only by genes. Most are
caused by a combination of genes and environmental
factors or triggers.
• Environmental triggers include lifestyle factors, such as
diet and exercise.
• Researchers believe that there are some possible
triggers that may increase the likelihood of being
autistic.
• These include:
• being born prematurely (before 35 weeks of
pregnancy)
• being exposed to alcohol in the womb
• being exposed to certain medicines, such as sodium
valproate (sometimes used to treat epilepsy), in the
womb

22. E)PREVALENCE
• The median rate of Autistic Disorder in
epidemiological studies is 5 cases per 10,000
individuals, with reported rates ranging from 2
to 20 cases per 10,000 individuals. It remains
unclear whether the higher reported rates
reflect differences in methodology or an
increased frequency of the condition.

23. F)COURSE
• By definition, the onset of Autistic Disorder is
prior to age 3 years.
• In some instances, parents will report that they
have been worried about the child since birth or
shortly afterward because of the child's lack of
interest in social interaction.
• In a minority of cases, the child may be reported
to have developed normally for the first year (or
even 2 years) of life. Autistic Disorder follows a
continuous course.

24. • Available follow up studies suggest that only a
small percentage of individuals with the
disorder go on as adults to live and work
independently.
• In about one-third of cases, some degree of
partial independence is possible.
• The highest functioning adults with Autistic
Disorder typically continue to exhibit
problems in social interaction and
communication along with markedly restricted
interests and activities.

25. G)PROGNOSIS
• Some children with autism may improve at 4-6 years of age
especially those with mild autism who have been treated at an
early age. These children who improve may be able to include
themselves among their normal peers. Current policy of inclusion
within the education system helps to support the majority of ASD
sufferers within mainstream schools.
• Results from surveys show that 49% of adults with autism still living
with parents and only around 12% have full time employment.
• A 2004 review of autistic adults diagnosed as autistic children with
IQ above 50 in UK found that 12% autistic adults achieved a high
level of independence as adults. 10% had a social life and some
employment but required some support, 19% had some
independence but were living at home. 46% needed specialist
residential provision and 12% needed high-level hospital care.
• In another Swedish study in 2005, it was noted that of all adults
with autism only 4% achieved independence. This study included all
sufferers of ASD irrespective of IQ.

26. • Prognosis also depends on co-existing mental retardation.
25% to 70% of ASD sufferers may have varying degrees of
mental retardation. For ASD other than autism, the
association with mental retardation is much weaker.
• With rising awareness about autism more and more
parents are amenable to early screening especially of high
risk children
• It is also seen that reported cases of autism increased
dramatically in the 1990s and early 2000s. This increase is
largely attributable to improvements in diagnostic practices
and public awareness. Other factors such as environmental
toxins, advanced parental age at the time of pregnancy etc.
may also be important.
• Prognosis also depends on diseases that co-exist with
autism. These include genetic disorders like Fragile X
syndrome, Down’s syndrome etc. About 10–15% of autism
cases have an identifiable chromosomal abnormality.

27. H)DIFFERENTIAL DIAGNOSIS
• Autistic Disorder must be differentiated from other
Pervasive Developmental Disorders.
• Rett's Disorder differs from Autistic Disorder in its
characteristic sex ratio and pattern of deficits.
• Rett's Disorder has been diagnosed only in females,
whereas Autistic Disorder occurs much more frequently in
males.
• In Rett's Disorder, there is a characteristic pattern of head
growth deceleration, loss of previously acquired purposeful
hand skills,and the appearance of poorly coordinated gait o
r trunk movements.
• Particularly during the preschool years, individuals with
Rett's Disorder may exhibit difficulties in social interaction
to those observed in Autistic Disorder, but these tend to be
transient.

28. • Autistic Disorder differs from Childhood
Disintegrative Disorder, which has a distinctive
pattern of severe developmental regression in
multiple areas of functioning following at least 2
years of normal development.
• In Autistic Disorder, developmental
abnormalities are usually noted within the first
year of life.
• When information on early development is
unavailable or when it is not possible to
document the required period of normal
development, the diagnosis of Autistic Disorder
should be made.

29. • Asperger's Disorder can be distinguished from Autistic
Disorder by the lack of delay or deviance in early
language development.
• Asperger's Disorder is not diagnosed if criteria are met
for Autistic Disorder.
• Schizophrenia with childhood onset usually develops
after years of normal, or near normal, development.
• An additional diagnosis of Schizophrenia can be made
if an individual with Autistic Disorder develops the
characteristic features of Schizophrenia with active-
phase symptoms of prominent delusions or
hallucinations that last for at least 1 month.

30. • Symptoms of over activity and inattention are
frequent in Autistic Disorder, but a diagnosis
of Attention-Deficit/Hyperactivity Disorder is
not made if Autistic Disorder is present.

31. I)MANAGEMENT
1)PSYCHOTHERAPY
2)PHARMECOTHERAPY

32. 1)PSYCHOTHERAPY
• ASD is a spectrum disorder and each child
who has it is unique, there are a variety of
treatments.
• They can include different kinds of therapies
to improve speech and behavior.
• the goal is to reduce the symptoms and
improve learning and development.

33. A)BEHAVIOR AND COMMUNICATION TREATMENTS
1)Applied Behavior Analysis (ABA). ABA is often used in
schools and clinics to help the child learn positive
behaviors and reduce negative ones. This approach can
be used to improve a wide range of skills, and there are
different types for different situations, including:
• Discrete trial training (DTT) uses simple lessons and
positive reinforcement.
• Pivotal response training (PRT) helps develop
motivation to learn and communicate.
• Early intensive behavioral intervention (EIBI) is best
for children under age 5.
• Verbal behavior intervention (VBI) focuses on
language skills.

34. 2)Developmental, Individual Differences, Relationship-Based
Approach (DIR).
• This kind of treatment is better known as Floortime. That’s
because it involves the parents getting on the floor with
their child to play and do the activities he/she likes.
• It’s meant to support emotional and intellectual growth by
helping the child to learn skills around communication and
emotions.
3)Treatment and Education of Autistic and Related
Communication-handicapped Children (TEACCH).
• This treatment uses visual cues such as picture cards to
help the child learn everyday skills like getting dressed.
Information is broken down into small steps so the child
can learn it more easily.
4)The Picture Exchange Communication System (PECS).
• This is another visual-based treatment, but it uses symbols
instead of picture cards. The child learns to ask questions
and communicate through special symbols.

35. B) OCCUPATIONAL THERAPY
This kind of treatment helps the child learn life
skills like feeding and dressing himself,
bathing, and understanding how to relate to
other people. The skills he learns are meant to
help him live as independently as he can.
C)SENSORY INTEGRATION THERAPY.
If the child is easily upset by things like bright
lights, certain sounds, or the feeling of being
touched, this therapy can help him learn to
deal with that kind of sensory information.

36. 2)PHARMECOTHERAPY
• There is no cure for autism spectrum disorder, and
there’s currently no medication to treat it. But some
medicines can help with related symptoms
like depression, seizures, insomnia, and trouble
focusing.
• Studies have shown that medication is most effective
when it’s combined with behavioral therapies.
• Risperidone (Risperdal) is the only drug approved by
the FDA for children with autism spectrum disorder. It
can be prescribed for children between 5 and 16 years
old to help with irritability.

37. THANKYOU