About Autism and Asperger’s Syndrome
The term pervasive developmental disorders (PDDs) refers to a group of developmental conditions that affect children and involve delays or impairments in communication and social skills. Autism is the most well-known of the pervasive developmental disorders, so PDDs also are known as autism spectrum disorders.
PDDs also include Asperger syndrome and two less common conditions called childhood disintegrative disorder and Rett syndrome. Typically, PDDs are first diagnosed during infancy, toddlerhood, or early childhood.
All pervasive developmental disorders affect communication and social skills, as well as cognitive skills and behavior. All PDDs have things in common, but each has specific characteristics that set it apart from the others.
Signs of a PDD
Signs of a PDD are usually recognizable before a child is 3 years old. However, symptoms can range from severe to so subtle that they seem to be normal aspects of a young child's development. For that reason, it may take a few years for a PDD to be fully identified.
Early signs of a PDD can include:
trouble interacting, playing with, or relating to others avoiding eye contact; not looking at people not pointing to objects to direct a parent's attention to things unusual movements, such as hand flapping, spinning, or tapping delays in developmental milestones or loss of milestones already achieved playing with the same toy in a way that seems odd or repetitive not using or understanding language not exploring environment with curiosity or interest
Children who show a pattern of these behaviors should be evaluated by their psychiatric provider. There are no blood tests or brain tests (such as MRIs) that diagnose PDDs, although such tests may be used to check for other conditions besides a PDD.
A diagnosis is made by a psychiatric provider with expertise in PDDs, such as a pediatric neurologist, developmental pediatrician, pediatric psychiatric provider/nurse practitioner, or pediatric psychologist. Parent questionnaires, educational and cognitive assessments, language assessments, or play and behavior assessments might be used to help diagnose a PDD.
What Causes PDDs?
Causes of pervasive developmental disorders are not yet well understood. Scientists believe they are complex neurobiological (brain biology) problems, which may have a genetic basis like other conditions that stem from abnormalities in the chromosomes a child inherits.
Some studies have suggested that PDDs might stem from a host of causes, including food allergies, excessive amounts of yeast in the digestive tract, and exposure to environmental toxins. However, these theories have not been scientifically proven.
The weight of scientific evidence indicates that there is not a link between vaccines – or any of their ingredients – and autism. All in all, the risks of serious reactions to vaccinations are small compared with the health risks associated with the often-serious diseases they're intended to prevent. But if you have concerns about any vaccine for your child, don't hesitate to talk to your psychiatric provider. Ask about the benefits and risks of each vaccine and why they're so important for kids of all ages.
It's also important to remember that PDDs are not caused by parenting or bad experiences. Earlier notions that suggested this have been debunked.
Treating PDDs
Although there's no cure for children with PDDs, early intervention and treatment can help them develop skills and achieve their best potential. No medications can cure PDDs, but sometimes they're used to treat certain symptoms, such as aggressive behavior toward self or others, problems of inattention, obsessive-compulsive behaviors, and mood swings.
Individually tailored programs can include behavior modification, and educational interventions can help shape a child's behaviors and improve speech and communication.
Therapy should be individualized because each child's disorder is distinct and presents specific needs, and PDDs can range from mild to severe. Some kids do well in small classes with lots of one-on-one attention. Others do well in standard classrooms with support.
The goal of treatment is to get kids with PDDs to a point where they can be mainstreamed into a regular classroom, although they also might require special programs and support services, including speech-language therapy.
Gluten-free and casein-free diets have been reported to show some positive results in treating some children with PDD, although more research needs to be done. Other vitamin and herbal remedies have not been scientifically proven, although they may have value for some kids. Families who are considering using these or other treatments will want to discuss any possible benefits or risks with their psychiatric provider before beginning.
Helping Your Child
Once you learn your child has a PDD, it's important to get help. Kids with disabilities are entitled to free preschool services at 3 years of age under the Individuals with Disabilities Education Act (IDEA). Check out the services offered by your local school district, Intermediate Unit, or organizations such as Easter Seals and the United Cerebral Palsy Association. Also under the IDEA, states provide services for children with disabilities from birth through age 2 years through federally mandated early intervention programs.
Because the needs of kids with pervasive development disorders vary, any education program must be tailored to the individual child. You can set up an individualized education plan (IEP) for your child though your local school district. An IEP should incorporate social skills and communication and have a high degree of structure. Maximized speech and language intervention is important, as is the use of behavior modification and rewards to try to stop problem behaviors and to encourage all types of communication. For children younger than age 3, parents will work with the state's early intervention program to develop an Individualized Family Service Plan (IFSP) instead of an IEP.
As with all developmental concerns, talk with your psychiatric provider about how to find local resources for the services your child needs.
Support your child with hugs and verbal praise. Use rewards that stimulate social interaction (like a trip to the playground). If your child is in school, talk with his or her teachers to find out what rewards and behavior modification techniques help in the classroom and try using some of these at home. That way, your child will get a consistent message at home and at school.
Reviewed by: Anne M. Meduri, MD, and D'Arcy Lyness, PhD
