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Medical Advice >> Pediatric Advisor
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Autism and Pervasive Developmental Disorder
What is a pervasive developmental disorder (PDD) and autism?
Children that have difficulty with social skills, language,
and behavior are said to have a pervasive developmental
disorder (PDD). Most children with problems in development
have only one or two areas of disability. Children with
PDD, however, have problems in many areas, such as social
interaction, communication, and imagination. Thus, the term
"pervasive" was chosen to describe this disorder. The name
of this disorder may soon be changed to Autistic Spectrum
Disorder (ASD).
Autistic disorder, or autism, is a type of PDD. Specific
criteria must be met for a child to be diagnosed with
autistic disorder. Even though all children with autism
meet all the criteria, they may have different behaviors and
abilities because of their age and how severe their symptoms
are.
Children who have problems in areas of development like
those listed above, but who do not have autistic disorder
are diagnosed with PDD-NOS (Not Otherwise Specified).
Children with PDD-NOS may be later diagnosed with autistic
disorder if they develop more symptoms.
What are the symptoms?
Children with autistic disorder may appear normal for the
first few months of life. Your child may then become more
and more unresponsive to you or other stimuli. Delay in
language development is the most common reason children who
are later diagnosed with autism are brought to the doctor.
Your child, depending on his or her age, may have a number
of symptoms in the following areas:
- Social skills
- Resists being cuddled; may scream to be put down when
held.
- Remains withdrawn from parents and others and fails
to form relationships.
- Avoids eye-to-eye contact.
- Prefers to play alone.
- Is indifferent to the feelings of others and to
social norms.
- Use of language and imagination
- Speaks later than other children of the same age.
- Cannot understand or copy speech or gestures.
- Rate, pitch, tone, or rhythm of speech is abnormal.
- Unable to start a conversation or keep one going.
- Unable to engage in fantasy or imaginative play such
as role playing and storytelling.
- Responds inappropriately to sounds.
- Acquired speech is immature and unimaginative. He or
she makes up words and echoes what someone says.
- Behavior, activities, and interests
- Develops habit behavior and compulsive routines.
- Greatly resists even the slightest change; becomes
enraged if his or her obsessive routine is altered or
activities are disrupted.
- Hyperactive.
- Obsessed with one topic or idea; may become attached
to unusual objects.
- Walks on tiptoe and/or flicks or twiddles fingers for
long periods.
- Bangs head, rocks, or stares.
- Has sudden screaming spells.
- Injures himself on purpose.
- Has trouble learning manual tasks.
No child with autism will have all of the above symptoms
nor is this a list of all the symptoms.
What is the cause?
Many years ago, doctors believed that an abnormal
relationship between the infant and his or her parents
caused autism. Doctors know now that parents are not
responsible for this condition.
Autism is a type of brain dysfunction. The nature of the
dysfunction and what part of the brain is affected are not
known. Scientists now believe that there are multiple
causes.
Autistic disorder has been found in children with brain
abnormalities such as congenital rubella syndrome,
neurofibromatosis, and tuberous sclerosis. Autism can also
be present with genetic syndromes such as fragile X syndrome
and phenylketonuria (PKU).
Your child's doctor will probably perform lab tests to rule
out these and other medical problems associated with PDD.
As with all children with problems in developing
communication, an evaluation by an audiologist to check your
child's hearing is necessary. However, most children with
autism are found to have normal health and no medical reason
for the symptoms. Because PDD can be inherited, your health
care provider will also want to screen your other children
for symptoms.
What is the treatment?
The treatment of autistic children focuses on educational
and behavioral therapies. Even very young children can
benefit from language therapy and behavior development
programs designed for children with social and communication
problems and their families. Special teachers and
classrooms can help older children improve their academic
level and behavior. Contact your local school district
before your child starts school. Children with autism or
PDD-NOS usually require special class placement or special
classroom changes. A team of professionals will help
evaluate your child and put this plan together. You may
also ask your doctor to review the plan. Ask and find out
all the services that may be available for your child.
Medical treatment centers around medication. Sometimes
mood- or behavior-altering drugs can improve behaviors that
may cause self-injury or greatly interfere with school or
social ability. These medicines must be prescribed by a
doctor experienced with their use in children with autism.
No medication has been found, however, that will eliminate
the symptoms of autism. Don't forget that children with PDD
have the same health care needs as any other child and
benefit from the same health care and disease prevention
activities.
Parents of children with autistic disorder or PDD-NOS often
become aware of new or alternative treatments through
friends or the media. Your doctor can help you decide if
these treatments could help or harm your child.
What can we expect in the future?
The great variety in type and number of symptoms in autistic
children makes this a difficult question to answer. Most
experts agree that the more socially distant a child is, the
less likely he or she will be able to live independently as
an adult. This is not to say, however, that a child who is
socially removed at age 2 will display the same degree of
social disability 20 years later.
Another factor used to predict whether the child will be
self-sufficient as an adult is intelligence. Most autistic
children score in the retarded range on IQ tests. However,
when these same children are given tests that measure
visual-spatial and memory skills, many score much higher.
These skills may help an autistic child be self-sufficient
as an adult.
Temperament is also important in predicting whether a child
will live independently as an adult. People with autism who
are calm and cooperative will be more able to adapt to new
rules and situations than those who are not.
In summary, it is impossible to make precise, long-range
predictions for individual children with autism or PDD-NOS.
It is likely that all children who display the full autistic
disorder will need special education. Some of these
children will be mainstreamed to some degree, especially in
the higher grades. Successful independent living as an
adult mostly depends on how well they develop their social
and communication skills and what degree of mental
retardation is present.
Where can my family get help and support?
When parents hear that their child has an autistic spectrum
disorder or PDD-NOS, they may feel fear, anger, guilt, and
other difficult emotions. Many families find that having
professional guidance with these feelings helps them to cope
with this traumatic news.
Children with autistic disorder or PDD-NOS create great
stress on the entire family. When families were asked which
areas of their lives were most altered by their child with
autism, they listed, in order of significance, recreation
and finances. Troubled marital relationships were also made
worse by this additional stress. In addition, a child with
autism creates stress for his or her siblings.
Therefore, parents will want to explore community and
governmental resources as well as local support groups
composed of families who have children with similar
difficulties. These groups can help by sharing their common
concerns and solutions to problems. Parents can locate
these services through their doctor, schools, therapy
programs, and local and national support organizations.
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