Disorders usually first diagnosed in infancy, childhood, or adolescence Mental Retardation Learning Disorders Motor Skills Disorder Communication Disorders.

Disorders usually first diagnosed in infancy, childhood, or adolescence

• Mental Retardation• Learning Disorders• Motor Skills Disorder• Communication Disorders• Pervasive Developmental Disorders• Attention-Deficit/Hyperactivity & Disruptive Behavior

Disorders• Feeding and Eating Disorders of Infancy/Early Childhood• Tic Disorders• Elimination Disorders• Others (Separation Anxiety, Selective Mutism, etc.)

Pervasive Developmental Disorders

• Severe/pervasive impairment in:– Reciprocal social interaction skills– Communication skills

• Or Stereotyped behavior, interests, activities• Often associated with Mental Retardation• Often also have other medical conditions

(chromosomal abnormalities, seizures, abnormal CNS structure, primitive reflexes, delayed hand dominance, etc.)

Pervasive Developmental Disorders

• Autistic Disorder (onset < age 3)– Impairments in social interaction & language– Repetitive/stereotyped behaviors, interests

• Asperger’s Disorder– Impairments in social interaction– Repetitive behavior, interests– No early language delays

• Rett’s Disorder– Normal early development but deterioration in motor, social, language functioning as well as

slowed head growth between 5-48 months• Motor: hand-wringing/washing, incoordination (gait), psychomotor slowing• Social: interest in others may increase in adolescence and adulthood• Severe receptive and expressive language deficits persist

– Typically associated with severe or profound mental retardation– Rare, and reported only in females

• Childhood Disintegrative Disorder– Loss of previously acquired skills after age 2 but before age 10 (language, social, play,

motor skills; bowel/bladder control)– Typically associated with severe mental retardation– Very rare

Autistic Disorders

• First identified in 1943

• By definition, symptoms appear before 3

• Prevalence rates are increasing

• At least one in 600 may have autism

• Majority are male (4-5 more boys than girls)

Autism• Central feature: lack of responsiveness, including

extreme aloofness and lack of interest in people– Lack of eye contact, reciprocal interaction– Failure to develop peer relationships– Solitary playing (can be oblivious of others)

• Language/communication problems – May be lack of language or problems starting/maintaining– Echolalia, exact echoing of phrases– Tone, pitch, rate, rhythm, inflexion may be flat or inappropriate– Language comprehension delayed (and arrested)

• No or inimal appreciation of humor, irony, figurative langauge

• Limited imaginative play, repetitive/rigid behavior– Become very distressed when routine is broken

Autism• May become strongly attached to

– Particular objects (e.g., buttons, piece of string) – Specific interests (names, dates)

• Unusual motor movements– “Self-stimulatory” behaviors: jumping, arm flapping– Self-injurious behaviors: head-banging– Nonsensical gesturing– Other stereotyped movments: rocking, swaying, clapping

• At times seem overstimulated and/or understimulated by their environments

• Range of related behavioral symptoms: hyperactivity, poor attention span, impulsivity, aggressiveness, temper tantrums

Asperger’s Disorder

• Similar social deficits, impairments in expressiveness, idiosyncratic interests, and restricted and repetitive behaviors as Autism

• Relatively well-developed language and other cognitive abilities

• Not usually associated with Mental Retardation• More prevalent than autism

– Approximately 1 in 250 individuals– Again, majority are male

Case ExampleAsperger’s Disorder

• 23 year-old student at a technical college studying computer networks

• Diagnosed with Autism (high functioning) at age 10 by neurologist

• Served as student with Specific Learning Disabilities grades 2-11

• Repeated 6th grade

Developmental History

• No pregnancy/birth complications• Developmental milestones met• Normal early language development• Generalized tonic-clonic seizures

diagnosed at age 6 (none for 2 years)• Seizures aggravated by excitement,

photosensitivity, MSG, sensitivity to noise

Developmental History

• Mom: “he has always been different”• Impaired social interactions/no close friends• Bullied in school because of unusual behaviors• Stereotyped interests• Stereotyped patterns• By age 9, speech “sounded like he was reading

a book”• Self-injurious and aggressive behaviors (head-

butted walls, hit other kids)

Self-reported Problems

• “Receiving information”• “Lot of words” he does not know• Hard to pay attention• Slow at thinking, “like a personal computer over

packed with information”• Basic, concrete tasks easier; those requiring

abstraction more difficult• Better communicating through writing because

“no backspace key in conversation”• Periods of low mood, loss of interest in things,

trouble concentrating, thoughts of death

Behavioral Observations

• Flat affect (smiled and laughed occasionally)

• Initiated conversation but in long, tangential (but fluent) monologues

• Situationally inappropriate comments and questions

• Monotonous/pedantic speech pattern (like lecturing)

• Many questions clarifying test instructions

Asperger’s Criteria

Impaired social interaction skills (>2 of the following):

– Nonverbal behaviors (eye contact, facial expression, body posture, gestures)

– Development of peer relationships– Spontaneous seeking to share with others– Social or emotional reciprocity

Asperger’s Criteria

Restricted repetitive and stereotyped patterns of behavior, interests, activities (> 1 of the following):

– Preoccupation with interests that is abnormal in intensity or focus

– Inflexible routines, rituals– Stereotyped and repetitive motor mannerisms

(e.g., hand flapping, twisting, body movements)– Preoccupation with parts of objects

Asperger’s Criteria continued

• Clinically significant impairment in social, occupation, other functioning

• No general delay in early language development

• No delay in cognitive development, self-help skills, adaptive behavior, curiosity about the environment

• Not another Pervasive Developmental Disorder or Schizophrenia

Test Results

• Average overall abilities• Deficits:

– Understanding figurative, non literal, abstract language

– Understanding complex syntax– Vocabulary– Processing Speed– Motor Functioning– Academic Fluency– Reading Comprehension– Math calculation and reasoning

Test Results

• Strengths– Visual-Spatial Abilities– Nonverbal Reasoning (solving logic puzzles) – Verbal Analogies(?)

Test Results

• Other Areas Assessed– Working Memory– Learning– Word Retrieval– Reading Decoding– Spelling– Mechanics of Writing

Test Results

• Asperger Syndrome Diagnostic Scale Quotient = 105 (“likely”)

• BASC-2 - Mother– Attention Problems– Social Skills– Leadership– Atypical Thoughts– Withdrawal

Test Results

• BASC-2 – Father– Anxiety– Depression– Leadership– Withdrawal– Activities of Daily Living

Some Accommodations

• Note taking help (note-taker and/or digital/tape recorder)

• Written instructions

• Use of digital camera to capture class assignments

• Reduced course load

• Priority registration

Other Recommendations

• Continue with Vocational Rehabilitation• Therapy for social skills, daily living skills,

easing need for routines• Speech/language therapy for vocabulary

building, understanding figurative language, prosody/tone regulation

• Online or hybrid courses when available• Vocabulary building tools (flashcards,

word-a-day calendars/e-mails)

Some possible areas forteams to explore

• Biological factors• Psychological and sociocultural contributors• Treatment approaches• Community resources for caregivers• Comparison of Autism, Asperger’s, Rett’s,

Disintegrative Disorder on any combo of above• Social development in Asperger’s compared to

other Pervasive Developmental Disorders• Other famous individuals with Pervasive

Developmental Disorder