1. Pervasive Developmental Disorders
Chapter 12
Pervasive Developmental Disorders
Bilge Yağmurlu
PSYC 330
Developmental Psychopathology

2. History DSM Pervasive developmental disorders Autism Asperger’s Rett’s
Childhood Disintegrative
PDD NOS

3. Autistic Disorder Characterized by impairments in: Social interaction
Communication
Behavior and interests

4. A diagnosis of autistic disorder is made when the following criteria from A, B, and C are all met.
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):
Qualitative impairment in social interaction, as manifested by at least two of the following:
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
failure to develop peer relationships appropriate to developmental level
a lack of spontaneous seeking to share enjoyment, interests, or achievements with others (e.g., by a lack of showing, bringing, or pointing out objects of interest)
lack of social or emotional reciprocity
Qualitative impairments in communication as manifested by at least one of the following:
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)
in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
stereotyped and repetitive use of language or idiosyncratic language
lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

5. A diagnosis of autistic disorder is made when the following criteria from A, B, and C are all met.
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):
3. Restricted, repetitive, and stereotyped patterns of behavior, interest, and activities, as manifested by at least one of the following:
encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
persistent preoccupation with parts of objects
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, or (3) symbolic or imaginative play.
The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

6. Triad of Impairments Restricted behavior and interests
Social Interaction
Deficits in joint attention behavior
Poor eye contact
Poor processing of social stimuli
Lack of social reciprocity
Communication
Mutism or echolalia and pronoun reversals
Poor pragmatics
Restricted behavior and interests
Stereotyped behaviors
Unusual preoccupations/obsessions

7. Symptoms Reciprocal social interaction Language
Aberrant activities, restricted range, rigid adherence to routines
Secondary symptoms: mental retardation, attention
Spectrum disorder
Unclear borders
PDD
“autistic spectrum”

8. Etiology Biological factors Heterogeneous set of organic factors
Twin studies and concordance for autism
Language and communication impairments
Brain abnormalities
Primary and secondary

9. Social and Emotional Development
Attachment
Requesting or eliciting aid (e.g., to obtain objects)
Affiliative interactions (to achieve ongoing interaction)
Joint attention
Social referencing
Play

10. Self-awareness
Classic test: dab some rouge on the nose and expose to mirror
Own perception
Emotions
Lack awareness of others’ perception of them
Less likely to combine smiling and looking

11. Social Behavior Prosocial behaviors Antisocial behaviors
Empathy and distress
Peer interaction
Apply social rules inflexibly and incorrectly

12. Underlying Cognitive Deficits
Weak central coherence: tendency to use context to weave together bits of information to make a whole, to give global meaning
Executive dysfunction

13. Underlying Cognitive Deficits
Theory of mind
Longitudinal evidence
Unexpected Change Paradigm (Wimmer & Perner, 1983)
Misinformation Task (Perner el al., 1994)
Unexpected Contents Task (Perner et al., 1987)

14. Unexpected Contents Task
Show the child M&M box: “What’s inside this box?”
Following the answer, open the box, show there is a pencil in it. Put the pencil back inside the box, close it:
“X has not seen inside this box. Now I’m going to invite her into the room and show her the box all closed up like this, in the same way I showed you. Then, I’ll ask what’s inside the box. Will she think there are candies in it or will she think there is pencil in it ?”

15. Associated Impairments
Sensory/perceptual
Oversensitivity or undersensitivity
Overselectivity
Higher IQ associated with better prognosis
Performance scores better than verbal scores
Adaptive behavior deficits
Motor problems
Behavioral problems
See accent on savant skills and autism

16. Epidemiology Prevalence rate has been increasing
More prevalent in males
Unrelated to social class

17. Developmental Course Developmental course quite variable
Better prognosis with higher IQ, better verbal skills and early intervention

18. Neurobiological Abnormalities
Abnormal EEG
Temporal lobe-limbic link
Frontal lobes
Cerebellum
Large brain size in toddlers
Issues with number of cells, branching, migration
Reduced activity in frontal lobes, limbic system, amygdala
Biochemical abnormalities

19. Researchers at UCLA have found a possible explanation for why autistic children act and think differently than their peers. For the first time, they've shown that the connections between brain regions that are important for language and social skills grow much more slowly in boys with autism than in non-autistic children.

20. Etiology Refrigerator mother - debunked Birth complications
Medical conditions
Occur in 10% of cases
25% of seizure disorders
Fragile X
Tuberous sclerosis
Exposure to toxins/infections in the womb (2nd trimester in particular)

21. Etiology Genetics Twin, family, and adoption studies
Molecular genetics
Figure From Szatmari et al., Shows higher rates of problems in biological rather than adoptive families of children with PDD-points to genetics.

22. Other Pervasive Developmental Disorders
Asperger’s Disorder
Deficits in social interaction
Stereotyped behavior and interests
No language delays
No cognitive delays
May have other behavioral problems
Prognosis more favorable than other PDD
Distinguishing from high functioning autism has been difficult

23. Other Pervasive Developmental Disorders
Rett’s Disorder
Normal development for first months of life
Distinctive regression
More common in females, linked to specific area on X chromosome
More negative outcome than autism
Childhood Disintegrative Disorder
Normal development for at least 2 years
Deterioration begins before age 10
Abnormal brain waves common
More severe than autism
See Table 12-2

24. Assessment Good history Observations
Standardized checklists for autistic behaviors
CHAT
CARS
ADI-R
ADOS
Intellectual assessment
Adaptive behavior assessment

25. Intervention Pharmacological treatment Behavioral interventions
Atypical antipsychotics used to improve behavior
Side effects
Stimulant medication, can help, higher likelihood of side effects in this population
Behavioral interventions
Pivotal Response Training
Lovaas-Young Autism Project
TEACCH
Programs should:
Be intensive, start early, be carefully controlled/systematic, promote generalization, involve parents, be flexible
Educational opportunities