Pervasive developmental disorder

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Pervasive developmental disorder
Specialty Psychiatry, pediatrics

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) (from 1980 to 2013), and the International Classification of Diseases (ICD) (until 2022).

Contents

The pervasive developmental disorders included autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), childhood disintegrative disorder (CDD), overactive disorder associated with mental retardation and stereotyped movements, and Rett syndrome. [1] The first four of these disorders are commonly called the autism spectrum disorders; the last disorder is much rarer, and is sometimes placed in the autism spectrum and sometimes not. [2] [3]

There is a division among doctors on the use of the term PDD. [4] Many use the term PDD as a short way of saying PDD-NOS. [4] Others diagnose the general category label of PDD because they are hesitant to diagnose very young children with a specific type of PDD, such as autism. [4] Both approaches contribute to confusion about the term, because the term PDD is intended by its coiners and major bodies to refer to a category of disorders and not be used as a diagnostic label. [4]

The terminology PDD and ASD is often used interchangeably and varies depending on location.[ citation needed ]

The onset of pervasive developmental disorders occurs during infancy, but the condition is usually not identified until the child is around three years old. Parents may begin to question the health of their child when developmental milestones are not met, including age appropriate motor movement and speech production. [5]

The fifth edition of the DSM removed PDD as a category of diagnoses, and largely replaced it with ASD and a measure of the relative severity of the condition. [6] The eleventh edition of the ICD also removed the category.

Signs and symptoms

Symptoms of PDD may include behavioral and communication problems such as:

Degrees

Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information—loud noises, lights—are common. [7]

Diagnosis

Diagnosis is usually made during early childhood. Individuals who received diagnoses based on the DSM-IV maintain their diagnosis under the autism spectrum disorders. However, an editorial published in the October 2012 issue of American Journal of Psychiatry notes that, while some doctors argue that there is insufficient evidence to support the diagnostic distinction between ASD and PDD, multiple literature reviews found that studies showing significant differences between the two disorders significantly outnumbered those that found no difference. [9]

The World Health Organization’s International Classification of Diseases, 10th edition (ICD-10) categorized PDD into five distinct subtypes, each with their own diagnostic criteria. [1] The five subtypes, childhood autism, atypical autism, Rett syndrome, Asperger’s Syndrome and childhood disintegrative disorder, are characterized by abnormalities in social interactions and communication. [1]

The disorders were primarily diagnosed based on behavioral features, although the presence of any other medical conditions is important, it is not taken into account when making a diagnosis.[ medical citation needed ]

Before the release of the DSM-5, some clinicians used PDD-NOS as a "temporary" diagnosis for children under the age of five when, for whatever reason, they are reluctant to diagnose autism. There are several justifications for this. Very young children have limited social interaction and communication skills to begin with, so it can be difficult to correctly diagnose milder cases of autism in toddlers. The unspoken assumption is that by the age of five, unusual behaviors will either resolve or develop into diagnosable autism. However, some parents view the PDD label as no more than a euphemism for autism spectrum disorders, while the PDD label makes it more difficult to receive aid for early childhood intervention.[ medical citation needed ]

Classification

The pervasive developmental disorders were: [4]

The first three of these disorders are commonly called the autism spectrum disorders; the last two disorders are much rarer, and are sometimes placed in the autism spectrum and sometimes not. [2] [3]

In May 2013, the Diagnostic and Statistical Manual–5th Edition (DSM-5) was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger Syndrome, Rett Syndrome, and CDD, has been removed and replaced with the general term of Autism Spectrum Disorders (ASDs). The American Psychiatric Association has concluded that using the general diagnosis of ASD supports more accurate diagnoses. The grouping of these disorders into ASD also reflects that autism is characterized by common symptoms and should therefore bear a single diagnostic term. In order to distinguish between the different disorders, the DSM-5 employs severity levels. The severity levels take into account required support, restricted interests and repetitive behaviors, and deficits in social communication. [11]

PDD and PDD-NOS

There is a division among doctors on the use of the term PDD. [4] Many use the term PDD as a short way of saying PDD-NOS. [4] Others use the general category because the term PDD actually refers to a category of disorders and is not a diagnostic label. [4]

PDD is not itself a diagnosis, while PDD-NOS is a diagnosis. To further complicate the issue, PDD-NOS can also be referred to as "atypical personality development", "atypical PDD", or "atypical autism".[ citation needed ]

Treatment

Medications are used to address certain behavioral problems; therapy for children with PDD should be specialized according to the child's specific needs. [7]

Some children with PDD benefit from specialized classrooms in which the class size is small and instruction is given on a one-to-one basis. Others function well in standard special education classes or regular classes with support. Early intervention, including appropriate and specialized educational programs and support services, play a critical role in improving the outcome of individuals with PDD. [7]

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Neurodevelopmental diagnosis now categorized under Autism Spectrum Disorder

Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior, interests, and activities. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses that were merged into ASD due to relatively unimpaired spoken language and intelligence.

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders. In broader definitions ADHD is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays—or severe and sudden reversals—in language, social engagement, bowel and bladder, play and motor skills. Researchers have not been successful in finding a cause for the disorder. CDD has some similarities to autism and is sometimes considered a low-functioning form of it. In May 2013, CDD, along with other sub-types of PDD, was fused into a single diagnostic term called "autism spectrum disorder" under the new DSM-5 manual.

<span class="mw-page-title-main">Conditions comorbid to autism spectrum disorders</span> Medical conditions more common in autistic people

Autism spectrum disorders (ASD) are neurodevelopmental disorders that begin in early childhood, persist throughout adulthood, and affect three crucial areas of development: communication, social interaction and restricted patterns of behavior. There are many conditions comorbid to autism spectrum disorders such as attention-deficit hyperactivity disorder and epilepsy.

High-functioning autism (HFA) was historically an autism classification where a person exhibits no intellectual disability, but may experience difficulty in communication, emotion recognition, expression, and social interaction.

Nonverbal learning disability (NVLD) is a proposed category of neurodevelopmental disorder characterized by core deficits in visual-spatial processing and a significant discrepancy between verbal and nonverbal intelligence. A review of papers found that proposed diagnostic criteria were inconsistent. Proposed additional diagnostic criteria include intact verbal intelligence, and deficits in the following: visuoconstruction abilities, speech prosody, fine motor coordination, mathematical reasoning, visuospatial memory and social skills. NVLD is not recognised by the DSM-5 and is not clinically distinct from learning disorder.

The following outline is provided as an overview of and topical guide to autism:

The epidemiology of autism is the study of the incidence and distribution of autism spectrum disorders (ASD). A 2022 systematic review of global prevalence of autism spectrum disorders found a median prevalence of 1% in children in studies published from 2012 to 2021, with a trend of increasing prevalence over time. However, the study's 1% figure may reflect an underestimate of prevalence in low- and middle-income countries.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

Asperger syndrome (AS) was formerly a separate diagnosis under autism spectrum disorder. Under the DSM-5 and ICD-11, patients formerly diagnosable with Asperger syndrome are diagnosable with Autism Spectrum Disorder. The term is considered offensive by some autistic individuals. It was named after Hans Asperger (1906–80), who was an Austrian psychiatrist and pediatrician. An English psychiatrist, Lorna Wing, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.

Pathological demand avoidance (PDA) or extreme demand avoidance (EDA) is a proposed disorder, and sub-type of autism spectrum disorder, defined by characteristics such as a demand avoidance—which is a greater-than-typical refusal to comply with requests or expectations—and extreme efforts to avoid social demands. Any expectation, even routine activities or highly desired activities, such as getting ready to leave home to visit a playground, can trigger avoidant behavior. If the demand cannot be avoided, a panic attack or a meltdown may ensue. Depending on an individual's trigger, the intensity of their reactions may differ. Looking at a PDA profile can help determine explanations for the demand avoidance, whether it is internalized or externalized.

<span class="mw-page-title-main">Classic autism</span> Neurodevelopmental condition

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Ryan's Law is a South Carolina law which requires insurance companies to cover treatments for autism. The law states that insurance companies must provide up to $50,000, annually, on behavioral therapy, up to the age of 16. The law provides coverage for various treatments, including Applied Behavior Analysis, which was previously denied as "experimental". Ryan's Law also prohibits insurers from refusing other medical care to children because of their autism. The law does not apply to people who are self-insured.

<span class="mw-page-title-main">Autism spectrum</span> Neurodevelopmental disorder

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulties with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The history of autism spans over a century; autism has been subject to varying treatments, being pathologized or being viewed as a beneficial part of human neurodiversity. The understanding of autism has been shaped by cultural, scientific, and societal factors, and its perception and treatment change over time as scientific understanding of autism develops.

Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by significant difficulties in the social use of verbal and nonverbal communication. Individuals with SPCD struggle to effectively engage in social interactions, interpret social cues, and use language appropriately in social contexts. This disorder can have a profound impact on an individual's ability to establish and maintain relationships, navigate social situations, and participate in academic and professional settings. Although SPCD shares similarities with other communication disorders, such as autism spectrum disorder (ASD), it is recognized as a distinct diagnostic category with its own set of diagnostic criteria and features.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

References

  1. 1 2 3 World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. World Health Organization. ISBN   92-4-154422-8. OCLC   28294867.
  2. 1 2 Lord C, Cook EH, Leventhal BL, Amaral DG (2000). "Autism spectrum disorders". Neuron. 28 (2): 355–63. doi: 10.1016/S0896-6273(00)00115-X . PMID   11144346. S2CID   7100507.
  3. 1 2 Johnson CP, Myers SM, Council on Children with Disabilities (2007). "Identification and evaluation of children with autism spectrum disorders". Pediatrics. 120 (5): 1183–215. doi: 10.1542/peds.2007-2361 . PMID   17967920.
  4. 1 2 3 4 5 6 7 8 National Dissemination Center for Children with Disabilities (NICHCY) (October 2003) Disability Info: Pervasive Developmental Disorders (FS20). Archived 2008-03-09 at the Wayback Machine Fact Sheet 20 (FS20)
  5. ↑ Autism Health Center. "Pervasive Developmental Disorders (PDDs)". WebMD. Retrieved 2013-06-29.
  6. ↑ Posar, Annio; Resca, Federica; Visconti, Paola (2015). "Autism according to diagnostic and statistical manual of mental disorders 5(th) edition: The need for further improvements". Journal of Pediatric Neurosciences. 10 (2): 146–148. doi: 10.4103/1817-1745.159195 . ISSN   1817-1745. PMC   4489060 . PMID   26167220.
  7. 1 2 3 4 5 6 7 8 PD-icon.svg This article incorporates public domain material from NINDS Pervasive Developmental Disorders Information Page. National Institutes of Health.
  8. 1 2 Baird, G.; Douglas, H. R.; director, a.; Murphy, M. S. (2011-10-21). "Recognising and diagnosing autism in children and young people: summary of NICE guidance". BMJ. 343 (oct21 1): d6360. doi:10.1136/bmj.d6360. ISSN   0959-8138. PMID   22021468. S2CID   31196910.
  9. ↑ American Psychiatric Publishing. "Autism Spectrum Disorder" (PDF). American Psychiatric Association. Retrieved 4 July 2013.
  10. ↑ Jon Baio, EdS, National Center on Birth Defects and Developmental Disabilities, CDC (2012). "Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008".
  11. ↑ Autism Research Institute. "DSM-V: What Changes May Mean" . Retrieved 29 June 2013.
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