Infant Toddler Development Training
Module 6, Lesson 5
Pervasive Developmental Disorders
A National Dissemination Center for Children with Disabilities (NICHCY) briefing paper outlines five categories of pervasive developmental disorders (PDD) that are defined in the DSM-IV. These include:
- Rett's syndrome
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)
Intervention for these disorders targets strengths and deficit areas. Intervention is most effective when provided in the child's environment and focused on daily routines and activities. The ITDS works with the parent or other caregiver to assist them in identifying strategies and increasing skills that support the child's development.
Autism and Other Pervasive Developmental Disorders
Autism and other pervasive developmental disorders are lifelong neurological disabilities that affect a person's ability to communicate, understand language, play and socially interact with others. The first signs of developmental delays are often noted before the age of three.
The key characteristics, sometimes referred to as core deficits of autism, are those the child demonstrates. They include:
- a disturbance in social interactions,
- a disturbance in communication (language skills), and
- rigid or repetitive or stereotypic behavior or thinking.
These characteristics must be present before the age of five years even if the condition is not diagnosed until a later age. Parents are usually the first to notice unusual behaviors in their child. In some cases, the parents report that their baby seemed "different" from birth. When compared to a typically developing child, a young child with autism is often less responsive to people and does not engage in many of the typical nonverbal social behaviors. Autism is classified as a developmental disability because it interferes with the typical rates and patterns of childhood development. There are diagnoses closely related to autism such as pervasive development disorder not otherwise specified (PDDNOS), Asperger's syndrome, and Rett's syndrome that are included in the category of Pervasive Developmental Disorders (PDD).
The following sections will provide a discussion of the three core deficits often recognized for the child with autism or other pervasive developmental disorders. Sometimes pervasive developmental disorders are referred to as autism spectrum disorders, but they will be referred to as pervasive developmental disorders (PDD) in this lesson.
This core deficit in reciprocal social interactions is one of the hallmark features of autism or other pervasive developmental disorders. Some of these social differences include a lack of showing, pointing or following objects, a lack of spontaneous seeking to share enjoyment with their caregiver, being non-responsive to their name, and poor to non-existent eye-contact. Children with pervasive developmental disorders such as autism may resist attention or passively accept hugs and cuddling. They may not seek comfort from others. The young child with autism often prefers to be left alone or to gaze at favorite objects for extended periods of time. To parents, it may seem as if their child is not bonding with them. Parents may feel crushed by this.
Children with a pervasive developmental disorder such as autism do not understand social cues, such as tone of voice or facial expressions and have difficulty interpreting what others are thinking or feeling. They may initially appear to develop typically and then begin to withdraw or become indifferent to social interactions at age two or three.
Verbal and nonverbal communication is another core area of concern for children with a pervasive developmental disorder such as autism. Specifically, children with autism usually demonstrate a delay in, or total lack of, spoken language, and may refer to themselves by their name instead of "I" or "me." If they possess language, they usually demonstrate an inability to initiate or sustain even a simple conversation. They may engage in stereotypical or repetitive use of language such as immediate or delayed echolalia or use words in an idiosyncratic manner.
Some children demonstrate unusual prosody such as speaking in a stiff, nasal, jerky or sing-song tone of voice. Their range of favorite topics is often very restricted, with little regard for the interests of the other person. While it can be hard to understand what children with autism are saying, their body language is also difficult to understand. Facial expressions, movements, and gestures rarely match what the child with autism is saying. Without meaningful gestures or language, children with autism are at a loss to let others know what they need. As a result, they may simply scream or grab what they want.
Restricted and repetitive behaviors or interests are the third, and final, core deficit area for children with autism. Many children with autism engage in repetitive movements or posturing such as rocking or twirling, hand or finger-flapping and toe-walking. Some may also engage in self-abusive behaviors such as biting or head-banging.
Young children with autism may demonstrate an inability to play with a variety of toys or will use the toys in non-functional or unconventional ways, such as lining up objects or spinning the wheels on a car rather than rolling it along the floor. Children with autism also have difficulty with the concept of fantasy or make-believe play and they are unable to play interactively with other children. Finally, children with autism often demonstrate an inflexible adherence to specific, nonfunctional routines and rituals and will become extremely upset if these routines or rituals are not strictly followed.
In addition to the core deficit areas described above, many children with autism have a reduced sensitivity to pain, but are hyper sensitive to sensations such as sound, touch, or other sensory stimulation. These different sensitivities may contribute to behavioral symptoms such as a resistance to cuddling or hugging. A child with autism may fall and break an arm, yet never cry. Another may bash his head against a wall and not wince, but a light touch may make the child scream with alarm.
Each of the symptoms within the three core deficit areas, as well as the sensory issues, range on a continuum from mild to severe and will present differently in each child. However, all children with autism will display communication, social, and behavioral deficits to some degree.
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