Pervasive spectrum disorders Tammy Marie Baker RN Pediatric Series 2012
299.80 Pervasive Developmental Disorder299.80 Pervasive Developmental Disorder, Not Otherwise Speciﬁed (PDD-NOS)This category should be used when there is a severe and pervasiveimpairment in the development of reciprocal social interaction or verbal andnonverbal communication skills, or when stereotyped behavior, interests, andactivities are present, but the criteria are not met for a speciﬁc pervasivedevelopmental disorder, schizophrenia, schizotypal personality disorder, oravoidant personality disorder. For example, this category includes "atypicalautism" --presentations that do not meet the criteria for autistic disorder becauseof late age of onset, atypical symptomatology, or sub threshold symptomatology,or all of these.
pervasive developmental disorders (PDD)Group of disorders characterized by delays in the development of socialization and communication skills.Symptoms as early as infancy, typical age of onset is before 3 years of ageSymptoms may include problems with understanding and using language; difficulty relating to people, objects, and eventsCharacteristics include difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patternsevidencedAutism is the most characteristic and best studied PDDOther Classifications of PDD include Aspergers Syndrome, Childhood Disintegrative Disorder, and Retts SyndromeAbilities, intelligence, and behaviors vary widely Children with PDDSome children do not speak others speak in limited phrases or conversations, and some have relatively normal language development.Repetitive play skills and limited social skills are generally evidentUnusual responses to sensory information, such as loud noises and lights, are also common.
Treatment:There is no known cure for PDDMedications are used to treat speciﬁcbehavioral problemsTherapies are individualized to childs needsIEP for individual childs needs
Diagnosis of PDDThere are no blood tests or brain tests (EEG,CAT scan, MRI, PET scan) that conclusively identify the presence of autism.Diagnosis is based on DSM criteria andmultidisciplinary Evaluations
Evaluation Process Autism Spectrum Disorder Diagnosing an autism spectrum disorder is not a brief process. There is no single medical test and multiple evaluations and tests are necessary.Parent interviewIn the first phase of the diagnostic evaluation, you will give your doctor background information about your child’s medical, developmental,and behavioral history. If you have been keeping a journal or taking notes on anything that concerned you, turn over that information.The doctor will also want to know about your family’s medical and mental health history.Medical examThe medical evaluation includes a general physical, a neurological exam, lab tests, and genetic testing. Your child will undergo this fullscreeningto determine the cause of his or her developmental problems and to identify any co-existing conditions.Hearing testSince hearing problems can result in social and language delays, they need to be excluded before an autism spectrum disorder can bediagnosed. Your child will undergo a formal audiological assessment where he or she is tested for any hearing impairments, as well as any other hearingissues or sound sensitivities that sometimes co-occur with autism.ObservationDevelopmental specialists will observe your child in a variety of settings to look for unusual behavior associated with the autism spectrumdisorders.They may watch your child playing or interacting with other people.Lead screeningBecause lead poisoning can cause autistic-like symptoms, the National Center for Environmental Health recommends that all children withdevelopmental delays be screened for lead poisoning.
prognosis and interventionsEarly intervention is essentialIEP for SchoolSupportive Educational and Medical servicesare individualizedLife expectancy is not affected
other evaluations Speech and language evaluation – A speech pathologist will evaluate your childs speech and communication abilities for signs of autism, as well as looking for any indicators of specific language impairments or disorders.■ Cognitive testing – Your child may be given a standardized intelligence test or an informal cognitive assessment. Cognitive testing can help differentiate autism from other disabilities.■ Adaptive functioning assessment – Your child may be evaluated for their ability to function, problem-solve, and adapt in real life situations. This may include testing social, nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing and feeding him or herself.■ Sensory-motor evaluation – Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your childs fine motor, gross motor, and sensory processing skills.
the ﬁve Pervasive Developmental DisordersListed below are the diagnostic criteria for the ﬁve Pervasive Developmental Disorders(PDDs), also known as Autism Spectrum Disorders (ASDs), as deﬁned by the Diagnostic andStatistical Manual of Mental Disorders - Fourth Edition (DSM-IV), published by theAmerican Psychiatric Association, Washington D.C., 1994, the main diagnostic reference ofmental health professionals in the U.S. Autistic Disorder 299.80 Pervasive Developmental Disorder, Not Otherwise Speciﬁed 299.80 Aspergers Disorder 299.80 Retts Disorder 299.10 Childhood Disintegrative Disorder
299.10 Childhood Disintegrative Disorder299.10 Childhood Disintegrative DisorderA. Apparently normal development for at least the ﬁrst 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbalcommunication, social relationships, play, and adaptive behavior.B. Clinically signiﬁcant loss of previously acquired skills (before age 10 years) in at least two of the following areas:(1) expressive or receptive language(2) social skills or adaptive behavior(3) bowel or bladder control(4) play(5) motor skillsC. Abnormalities of functioning in at least two of the following areas:(1) qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotionalreciprocity)(2) qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitiveuse of language, lack of varied make-believe play)(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerismsDD. The disturbance is not better accounted for by another speciﬁc pervasive developmental disorder or by schizophrenia.
299.80 Retts Disorder A. All of the following:(1) apparently normal prenatal and perinatal development(2) apparently normal psychomotor development through the ﬁrst 5 months after birth(3) normal head circumference at birthB. Onset of all of the following after the period of normal development:(1) deceleration of head growth between ages 5 and 48 months(2) loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development ofstereotyped hand movements (i.e., hand-wringing or hand washing)(3) loss of social engagement early in the course (although often social interaction develops later)(4) appearance of poorly coordinated gait or trunk movements(5) severely impaired expressive and receptive language development with severe psychomotor retardation