What is the definition of pervasive developmental disorder-not otherwise specified and how was it considered different then autism spectrum disorder? What are the symptoms of pervasive developmental disorder-not otherwise specified? How prevalent is it? What is the age of onset? What causes it? What are the physical features? What are the treatments for pervasive developmental disorder-not otherwise specified? What does pervasive developmental disorder-not otherwise specified look like in the DSM-IV and what does it look like now in the DSM-V? Why where these changes made?
Definition of PDD-NOS
PDD-NOS is Pervasive Developmental Disorder-Not Otherwise Specified. PDD-NOS and ASD are sometimes used interchangeably. Sometimes PDD-NOS is referred to as “subthreshhold autism” this can mean one of two things: One, the child does not have all of the characteristics. Two, they have mild symptoms (Autism Speaks Inc.). When saying my son had PDD-NOS it was often stated “oh so he has a mild form of autism” or “he is high functioning then”. I would try to explain that although those statements can be true, they are not always true with the diagnoses of PDD-NOS. When we went in he was hardly talking and was not very social with very little short eye contact, so he was not mild in those areas, but he did not have repetitive behaviors, so he was missing one of the three areas of diagnoses of classic autism.
Symptoms, Prevalence and Age of Onset of PDD-NOS
“PDD-NOS is characterized by delays in development of socialization and communication skills. Parents may notice associated behaviors as early as infancy. These may include delays in using and understanding language, difficulty relating to people, unusual play with toys and other objects, difficulty with changes in routine or surroundings and repetitive body movements or behavior patterns” (Autism Speaks Inc.). “Some children with an ASD show hints of future problems within the first few months of life. In others, symptoms might not show up until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had. A person with an ASD might: not respond to their name by 12 months, not point at objects to show interest (point at an airplane flying over) by 14 months, not play "pretend" games (pretend to "feed" a doll) by 18 months, avoid eye contact and want to be alone, have trouble understanding other people's feelings or talking about their own feelings, have delayed speech and language skills, repeat words or phrases over and over (echolalia), give unrelated answers to questions, get upset by minor changes, have obsessive interests, flap their hands, rock their body, or spin in circles, have unusual reactions to the way things sound, smell, taste, look, or feel” (Centers for Disease Control and Prevention, 2013). “Children with these conditions [PDDs] often are confused in their thinking and generally have problems understanding the world around them” (WebMD, LLC).
These conditions are identified in children around the age of 3. This is why they are called developmental disorders because 3 and younger is when the most development occurs in a child. “The condition actually starts far earlier than age 3, but parents often do not notice a problem until the child is a toddler who is still not walking, talking, or developing in the ways other children of the same age are.” “The five types of PDD are: autism, aspergers syndrome, childhood disintegrative disorder, rett’s syndrome, and not otherwise specified” (WebMD, LLC).
The prevalence is 1 in 88 children in the US. In South Korea, using a different diagnoses process, it is 1 in 38. The process that South Korea uses picks up the 2/3 of the children who could be missed using the US diagnoses process (Autism Speaks Inc., 2014).
Cause of PDD-NOS
“Investigators have already identified more than a dozen gene patterns associated with autism” (Wallis, 2009). Although all the causes are not known, there are many likely causes. There are many different factors that make children have a higher chance of having ASD: environmental, biologic, and genetic factors can all play a role. Scientists agree that genes are at the top of the list. “Children who have a sibling or parent with ASD are at a higher risk of having ASD. ASDs tend to occur more often in people who have certain genetic or chromosomal conditions”. 10% of children with ASDs also have Down syndrome, fragile X syndrome, Tuberous Sclerosis or other genetic and chromosomal disorders. The prescription drugs valproic acid and thalidomide have been linked with ASD when taken during pregnancy. Parenting practices do not cause ASDs. “The critical period for developing ASDs occurs before birth.” “However, concerns about vaccines and infections have led researchers to consider risk factors before and after birth. A small percentage of children who are born prematurely or with low birthweight are at greater risk for having ASDs.” (Centers for Disease Control and Prevention, 2013).
Physical Features
“The face and brain develop in coordination, with each influencing the other, beginning in the embryo and continuing through adolescence. Now, University of Missouri researchers have found distinct differences between the facial characteristics of children with autism compared to those of typically developing children. This knowledge could help researchers understand the origins of autism. Aldridge and colleagues found the following distinct differences between facial characteristics of children with autism and those of typically developing children: Children with autism have a broader upper face, including wider eyes. Children with autism have a shorter middle region of the face, including the cheeks and nose. Children with autism have a broader or wider mouth and philtrum -- the divot below the nose, above the top lip. She says these are subtle differences that will enable researchers to further study people with autism spectrum disorders” (Missouri-Columbia., 2011)
Treatment
The main treatment is behavioral therepy, but some children may need medications ot stabilze mood or behaviors (Encyclopædia Britannica, Inc.). Applied behavioral analysis (ABA) is used to bring about positive, long lasting changes in behavior through learning principles. “ Positive reinforcement is one such principle. When a behavior is followed by some sort of reward, the behavior is more likely to be repeated. Through decades of research,” many techniques have been developed “for increasing useful behaviors and reducing those that may cause harm or interfere with learning.” (Autism Speaks Inc., 2014)“Curriculum development is an individualized process that varies with each child (and his/her family).” “As Lord and Bishop (2010) point out, ‘One of the cardinal requirements of ABA involves collecting data on the progress of the individual and then changing the treatment plan if progress is not occurring.’” (Borden, 2011). “There is currently no cure for ASDs. However, research shows that early intervention treatment services can greatly improve a child’s development.” “Services can include therapy to help the child talk, walk, and interact with others.” (Centers for Disease Control and Prevention, 2013). “ Additionally, the National Research Council offered the following recommendations for Educating Children with Autism (NRC, 2001): Begin treatment early — as soon as a diagnosis of ASD is considered, actively engage the child with ASD in intensive instructional programming, year-round, for at least 25 hours/week, plan teaching opportunities for brief periods of time (15–20 minutes with young children) either one- to-one with an adult or in a small group (depending on individualized need), maintain a low student/teacher ratio (no more than two children with ASD per adult in a classroom), include a family component in programming and provide parent training, evaluate treatment interventions and assess the child’s progress on an ongoing basis to insure that his/her individualized needs are being met” (Borden, 2011).
What are the differences in DSM-IV and DSM-V and why was the change made?
“(DSM-IV), which was adopted formally in 1994, includes 5 subtypes of Pervasive Developmental Disorder (Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder — not otherwise specified). DSM V only lists ASD” (Borden, 2011). One of the reasons that they are making the change is if someone is recommended to get testing for autism they may dismiss it because they talk and have friends and don’t realize there are milder forms of autism. It also “replace[s] the old “you have it or you don’t” model of mental illness with the more modern view” that there are many degrees of severity. The other source of confusion that is addressed with this change is “’A child can look like they have P.D.D.-N.O.S., then Asperger’s, then back to autism,’ Dr. Lord said. The inconsistent use of these labels has been a problem for researchers recruiting subjects for studies of autism spectrum disorder” (Wallis, 2009). I completely understand the confusion of the changing diagnoses subgroups. At my son’s therapy there are two other children that are really similar to him and they have a lot of the same behavior and speech level. One of them is diagnosed with classic autism the other aspergers while my son is diagnosed with PDD-NOS with the note that it could be changed in the future when more testing is done. Dr. Lord, of Michigan, said the genetic markers [for autism] “don’t seem to map at all into what people currently call Asperger’s or P.D.D.” Nor have many of these genes been linked to distinct sets of symptoms. Until research can identify reliable biological markers for autism subtypes, Dr. Lord and other experts say, it is better to have no subtypes than the wrong ones” (Wallis, 2009).
Bibliography
Autism Speaks Inc. (2014). Applied Behavior Analysis (ABA). Retrieved Febuary 10, 2014, from Autism Speaks: http://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba
Autism Speaks Inc. (n.d.). PDD-NOS. Retrieved Febuary 10, 2014, from Autism Speaks: http://www.autismspeaks.org/what-autism/pdd-nos
Autism Speaks Inc. (2014). Prevalence Faq. Retrieved Febuary 10, 2014, from Autism Speaks: http://www.autismspeaks.org/what-autism/prevalence/prevalence-faq
Borden, M. C. (2011). Treating individuals who have autism: DSM-V, ABA, and beyond. The Brown University Child and Adolescent Behavior Letter , 27 (8), 1, 4-6.
Centers for Disease Control and Prevention. (2013, December 20). Facts About ASDs. Retrieved Febuary 10, 2014, from Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/autism/facts.html
Encyclopædia Britannica, Inc. (n.d.). pervasive developmental disorder not otherwise specified (PDD-NOS). Retrieved Febuary 10, 2014, from Encyclopædia Britannica, Inc.: http://www.britannica.com/EBchecked/topic/1527231/pervasive-developmental-disorder-not-otherwise-specified-PDD-NOS
Missouri-Columbia., U. o. (2011, October 21). Autistic facial characteristics identified. Retrieved Febuary 10, 2014, from Science Daily: http://www.sciencedaily.com/releases/2011/10/111020105914.htm
Wallis, C. (2009, November 2). A Powerful Identity, a Vanishing Diagnosis. New York Times , 1-5.
WebMD, LLC. (n.d.). Pervasive Developmental Disorders (PDDs). Retrieved Febuary 10, 2014, from WebMD: http://www.webmd.com/brain/autism/development-disorder
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