What is PDD Autism

PDD or pervasive developmental disorder is a behavioral disorder of speech, communication, social interaction, and repetitive type compulsive behavior. Autism is a form of PDD. There are five types of PDD's. The most commonly encountered are PDD NOS (pervasive developmental disorder not otherwise specified), childhood autism, and Asperger's syndrome. All these "different" conditions have common diagnostic and physiologic features but differ slightly by the specific diagnostic criteria.

How is PDD or autism diagnosed?

The diagnosis of PDD is clinical, meaning "what you see is what you've got." One needs to meet specific diagnostic criteria for the different conditions, but the general requirements are that one must have symptoms that belong to the three main areas of impairments:

There are five types of PDD's.

Childhood autism

Asperger's syndrome

Childhood disintegrative disorder

Rett's disease

PDD NOS or pervasive developmental disorder not otherwise specified

This section will give general guidelines, providing a superficial understanding of the differences between these above-mentioned disorders. A better, more specific understanding of these disorders is given by the specific DSM IV criteria for each disorder.

A. Childhood autism

Always presents before 36 months of age, these children may have some speech developmental and social interactive regression, usually around 18 months of age. The diagnosis of childhood autism must meet the specific DSM IV criteria and will therefore present with poor eye contact, pervasive ignoring, language delay, and other features. Per definition, these children will have a severe impairment in speech, communication, or social interaction. Many of them will be completely non-verbal and "in their own world."

B. Asperger's syndrome

These are kids with a form of autism that affects language less, yet there are difficulties with appropriate speech and communicative development. Mostly, however, these children have social interaction difficulties and impairments related to a restricted, repetitive, stereotype behavior. These kids may have very high IQ's, may do very well academically, have a superior memory for "unimportant" details, such as the birth dates of all baseball players, some historical or geographical trivia, yet they lack the skills to care for themselves and live independently. These individuals may talk repetitively about a certain topic without understanding that it may be boring to others. The "amount" of memory of these individuals is incredible and one may expect different degrees of impairments with Asperger's syndrome. This may involve more or less memory and more or less social communicative impairment with regards to being able to live independently. As long as a child or individual seems "different" or "odd" and has a thought process that doesn't fit the way everyone else thinks, yet shows some of the required autistic characteristics, Asperger's syndrome should be considered. Many people with this condition remain undiagnosed because of their ability to compensate with their memory or excellent aademic abilities, yet they are considered by others to be "socially inept," "weird," "nerds," "bizarre," "eccentric," etc.

A typical example of a child with Asperger's syndrome would be that of a child who has some odd behaviors, poor eye contact, "sluggish" social interaction abilities, and an extreme interest in a central topic such as a washing machine. The child likes to sit and watch the washing machine door rotate, knows everything about it including its operative and professional manual and may spend hours perseverating about it. Such a child when he has a play date, may try to involve his "friend" in his most exciting interest (the washing machine) without realizing how boring it is to others and that will be the end of the play dates forever. This pattern may present itself in different degrees and circumstances, but the prinicipal is the same: the lack of the ability to understand how other people perceive what you do, say, or express with body language and facial expressions.

C. Childhood disintegrative disorder

These are kids who develop normally for the first 3 years of life. Later they seem to regress and develop some autistic features associated with a severe functional impairment. These children must be thoroughly evaluated for the possibility of the development of seizures, affecting the speech areas of the brain, or Landau Kleffner syndrome (acquired epileptiform aphrasia), where seizure activity "robs" the brain from previously acquired speech.

D. Rett's disease

This affects only girls. These are girls who develop normally until 6 months of age and regress. Their regression is associated with microcephaly (small head). The head size seems to stop growing from 6 months and on, from the time of the observed regression. Recently a specific chromosomal marker (MEC-P-2) has been associated with this disorder and is now commercially available in some laboratories.

E. PDD NOS

PDD NOS will present similarly to the kids who have autism (some people argue that these conditions should be combined as one), but will have a lesser degree of a severe impairment. These kids are more likely to be verbal and have some degree of verbal or non-verbal effective communication, yet they must have the autistic features (as per the DSM IV criteria) and a severe impairment in social interaction, communication, or repetitive stereotype behavior. This term is reserved for children with a severe impairment who do not fully qualify for any other autistic diagnosis, due to age of onset or combination of autistic features.

The DSM IV criteria for the autistic disorders

The full diagnostic criteria for the pervasive developmental disorders are outlined below. As mentioned above, the diagnostic criteria for the autistic (PDD) disorders are defined by the DSM IV criteria.

Childhood autism

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 other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

lack of ocial 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

Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of 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.

Omega-3s

Previous trials have shown that omega-3s can improve memory, mood, concentration and behaviour.

Researchers in the UK will supplement 38 pupils, aged 10 to 16, with the oils for six months and closely follow their behaviour.

The children have problems like attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), autism, dyslexia, Asperger's syndrome and pervasive development disorder.

Some of them have already been prescribed drugs like Ritalin, used to treat ADD and ADHD, but which also has side effects like decreased appetite and insomnia. The new study will also examine whether fish oil supplements can help reduce the side effects of this medication.

The findings will be analysed by Dr Madeline Portwood, a senior educational psychologist working for Durham county council.

How does a typical child with autism present?

Most kids with PDD's simply present with a language delay. Some never acquire language, but most will have a slight regression, losing the ability to say a few words that they've already learned. This may occur at around 18 months of age. Most parents will report no difficulties prior to this period, but some may observe a "different interactive," eye contact or socialization impairment, lack of pleasure with regard to being touched, or other unusual behavior from as early as 1 to 3 months of age, in extreme situations.

Typically, kids with PDD's will not get diagnosed initially. The statistics indicate that only about 10% of kids with autistic disorders get diagnosed following the initial complaint of the parents that "something is wrong" with their child.

At the onset of symptoms, when the child regresses, several difficulties appear. There is loss of eye contact, the child drifts into his own world, may sit quietly for prolonged periods of time, and develops pervasive ignoring of other people. This means that he may be called several times, even very loudly, and ignore the calling as if he is deaf, yet when he hears even the slightest sound of something he likes, such as song from a favorite video, he runs to it immediately. Some of the kids develop hand flapping, toe walking, and severe temper tantrums, especially when required to change from a favorite activity to some other activity. Arranging toys in rows, spinning themselves or objects, or showing fascination in spinning objects, straight lines, or trains is a common behvior.

What are the causes of autism?

The causes for autism are most likely genetic. In most kids who present with a mild form of autism, such as in PDD NOS, despite a very extensive workup that may include blood test, urine tests, imaging studies, and other tests, everything comes back normal. The general consensus is that autism and PDD NOS are genetic disorders that can't be identified in current genetic testing. This may never become specifically identified in the future because "autism" is a general term of a behavioral pattern that may be caused by several different genetic abnormalities. This means that different genes or different combinations of defective genes may result in the same presentation of PDD NOS or autism.

Identified causes for autism include several chromosomal abnormalities involving different "genetic sites." Fragile-x syndrome involves the x chromosome, Angelman's syndrome involves chromosome 15, and many other chromosomal abnormalities may present with "autism." Other disorders such as Touberouse sclerosis, a disorder causing skin and brain abnormalities and frequent severe epileptic seizures (chromosome 9 and 16) may present with "autism" also. Some "metabolic disorders" such as PKU (phenylketonuria), where a substance (phenylalanine) accumulates in the brain, and other disorders of metabolism may present with autism.

Another important condition that may cause "autism" is a form of a seizure disorder or Laundau Kleffner syndrome. This disorder, also known as acquired epileptiform aphasia, is a disorder in which seizures develop from the area responsible for speech (in the left hemisphere), "robbing" the child from acquiring language and is associated with an autistic regression.

Behavioral modification

Behavioral modification program for a child with PDD:

This behavioral modification program is based on training the child to behave in a more appropriate and socially accepted manner. This should consist of an immediate correction of any aberrant behavior, utilizing a special holding technique to overcome temper tantrums. Many of the most difficult behaviors, if dealt with early, may become controlled, or if neglected, may lead to a wild, impulsive, uncontrollable behavior that may require institutionalization. In many families of children with PDD, instead of the children being taught normal, socially accepted behavior, the entire family learns abnormal behaviors from the kids in the process of trying to accommodate them to prevent the temper tantrums. This is why controlling the tantrums is so important. Accommodating these kids by giving in to the abnormal behaviors only delays the tantrums and makes the abnormal behaviors the accepted standard for those children with PDD.

A structured daily routine is important. The child will perform best under familiar conditions, including location and activities. Later, as the situation improves, the rigid routine may be gradually modified, as tolerated.

Temper tantrum control: Controlling temper tantrums is of extreme importance.

The holding technique, as demonstrated during the office visit, requires a firm hold of the child, with the back to the parent's chest; the child's legs should be held between the parent's legs. During the holding time, the parent mus try to communicate with the child, calm him/her, yet not give in to the behavior that led to the tantrum. This procedure is not a form of punishment. It is devised to protect the child and others from the erratic behaviors. It must be done gently, not to hurt the child, yet firmly to get a clear unequivocal message through. It definitely is not meant to be "fun" time and a firm approach is required. Communication must be short, clear, and firm, expressing the parent's appropriate emotional reaction to the behaviors that led to the tantrum. The reaction (firmness of communication) must be proportionate to the severity of the behavior. This will also teach a child whose ability to understand emotional responses are impaired, how one must react under different circumstances. The main objective of the holding and the behavioral modification program is to correct inappropriate behaviors, thus trying to normalize the child's routines and behavior, including all social interactions as much as possible.

There are three priorities, when it comes to "insisting" with a child over behavioral issues.

First priority: Temper tantrums and inappropriate behavior that if left unchanged may potentially become life threatening, such as hitting, throwing objects, jumping out of high places or windows, running into the street, or refusing to eat, must be attended to immediately, without compromise.

Second priority: "Sitting skills." Behavior, that if left alone, will make it impossible for the child to sit in class and, therefore, impossible to attend school with his/her peers, regardless of his abilities or "baseline IQ." This consists of teaching sitting skills. This may be accomplished while sitting for dinner with the rest of the family, sitting in a restaurant or at any family or social gathering that require sitting skills.

Third priority: Dealing with the "repetitive ritualistic habits. Unusual "bizarre" behaviors, that may result in social isolation or difficulties, if left unchanged. Such are inappropriate play habits, pervasive repetition of activities, self-stimulatory behavior, hand flapping, persevering into strict interests or production of unusual sounds. This may be done with a simple firm "stop!" command, and by directing the attention to more appropriate behaviors.

Dietary changes can help to control Autism

by Edward F. Group III, D.C., Ph.D, N.D.,CCN

Because the autistic person may be sensitive to foods, there will have to be changes in diet to help accommodate this condition. Many autistic people are allergic to proteins like gluten (found in wheat, barley, oats and other foods) and casein (found in human and cow's milk). Many parents of autistic children who have removed these foods from the diet have, in many cases, observed positive changes in health and behavior. Research strongly suggests that many autistic individuals may be sensitive to dairy products and certain fruits, such as strawberries and citrus fruits, which can affect the immune system. These food products may increase or magnify various problems such as headaches, bedwetting, "spaced-out" appearance, stuttering, whining, crying, aggression and depression. Increasing the amount of vitamins, such as vitamin C, may reduce allergy symptoms. Many people suffering from autism need to change things within their life to help reduce the effects of autism.

Other changes that help include eating a high fiber diet and eliminating alcohol, caffeine, canned and packaged foods, carbonated beveages, chocolate, all junk food, refined and processed foods, wheat, salt, sugar, sweets, saturated fats, soft drinks and white flour products. Autistic individuals may want to have a hair analysis performed to check for heavy metal poisoning.