Pervasive Developmental Disorders
Description
This is a group of uncommon psychiatric disorders with the common denominators of deficient social skills, impaired development of verbal and nonverbal communication, and an inability to participate in activities requiring imagination. The child may be slow in developing intellect, language and speech, and motor activity, including posture. The degree and form of these deficiencies vary widely among afflicted children. The most well-known pervasive developmental disorder is autism. Several forms of pervasive developmental disorders have been identified: Autistic disorder, Rett's Disorder, Childhood Disintegrative Disorder, and Asperger's Disorder. Rett's disorder involves autistic behavior, dementia, ataxia, severely impaired expressive and receptive language development with severe psychomotor retardation, and loss of previously acquired purposeful hand use between ages 30 months and 5 years, with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing). Autism is rare, occurring in only 10 to 15 children per 100,000. In addition to lack of development of cognitive and language skills, children with this disorder have significant problems in social interaction. They seem detached and unable to become involved emotionally with those around them. From infancy these children may not be responsive to cuddling or eye contact with their mothers. They prefer to play by themselves and often develop rituals and repetitive behaviors, including rocking and head-banging. Their play also tends to be repetitive, and they may spend hours lining up objects or being preoccupied in making patterns with toys. Creative play with dolls or stuffed animals is limited, as is play that requires interaction with others, such as pat-a-cake or peek-a-boo. Childhood integrative disorder involves qualitative impairment in social interaction; qualitative impairments in communication; and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms. Asperger's disorder involves encompassing preoccupation with one or more stereotyped patterns of interest that is abnormal either in intensity or focus; apparent inflexible adherence to specific, non-functional routines or rituals; stereotyped and repetitive motor mannerisms; and persistent preoccupation with parts or objects. This disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
Treatment
There is no known cure for autism. Treatment focuses on attempting to foster normal development, improved communication skills, and reducing abnormal behavior. While the majority of autistic individuals are severely handicapped and unable to care for themselves, an estimated 5 to 17 percent of autistic individuals work and function, to some extent, in the community. Most individuals need supervision and care throughout life. To address the problems of language, parents of autistic children are sometimes advised to set aside short periods of 30 minutes or so each day exclusively for conversation and play with their child. Because another feature of autism is the child's isolation, treatment must also focus on developing personal interaction. With a therapist's help, parents should plan activities that engage their child in social interaction, intruding on his or her totally solitary play.
Questions
Does the child have a developmental disability? What is the exact diagnosis? Has this been confirmed by appropriate testing? Is this a neurological problem? What treatment or counseling do you recommend? Would you recommend a specialist in childhood developmental disabilities? Would behavior therapy help? How do you recommend the parents communicate with the child? How can the child's abilities in social interaction be helped?
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