Download Pervasive Developmental Disorders

Pervasive Developmental Disorders
A case study
Andy
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Age 6
Degenerative hearing loss diagnosed at age 2.
Bilateral hearing aid use began at time of identification.
Cochlear implant surgery June of 1999 at age 4.
Use is consistent.
Student is committed to use.
Speech and listening skills not improving.
Relies on sign language for meaningful communication.
Entered Special Needs Preschool at age 3 and has been
receiving services since.
Concerns
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Andy has always engaged in self stimulating behaviors.
When he entered preschool, he was orally and tactically defensive.
Not able to adjust to unexpected deviations in routine.
Tends to obsess over objects being in line, rituals.
Repeats himself.
Learns rote material with little repetition, but cannot generalize.
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Easily distracted; not able to divide attention.
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These behaviors are obstacles to Andy’s instruction. I wanted
to gain an understanding to be better able to serve him and
to address issues as needed.
Andy is currently receiving services for his hearing
loss. Because an official diagnosis would not provide
additional services, it is not being pursued.
However, to provide effective services , an
understanding of PPD is essential.
Of particular concern was his self-stimulating
behavior. He is currently mainstreamed in a first
grade class. This behavior is noticeable to the other
students and becomes the target of their teasing.
Behavior: Crossing arms for self-stimulation when excited.
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BASELINE
INTERVENTION
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30' interval
Intervention: Began with touching arms and telling him to put his
arms down. The cue was lessoned to a meaningful look at his arms.
Pervasive developmental disorder (PPD)
is a broad term used to describe a set of
symptoms that occur along a continuum
of severity. This continuum is often
referred to as Autism Spectrum Disorders
(ASD).
The DSM-IV criteria consists of a set number of characteristics
from three categories:
A. (1) qualitative impairment in social interaction,
(2) qualitative impairments in communication,
(3) restricted, repetitive, and stereotyped patterns of
behavior, interests, and activities,
and,
B. Delays or abnormal functioning in at least one of the
following areas, with onset prior to age 3 years: (1) social
interaction, (2) language as used in social communication, or
(3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Rett's
disorder or childhood disintegrative disorder.
Characteristics associated with PPD are:
1. Withdrawn behaviors
2. Unsocial behaviors
3. Problems using language to communicate
4. Repetitive patterns of behavior
5. Problems with imaginative play
6. Unable to deviate from schedule
7. Self-stimulating behavior
Some common disorders on this
continuum are:
1. Asperger’s Syndrome
2. Pervasive Developmental Disorder
3. Rett’s Syndrome
4. Childhood Disintegrative Disorder
5. Autism
NICHD reports that 1in 500 people have some form
of autism.
Asperger’s Syndrome
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Unsocial behaviors
Repetitive patterns of behavior
Problems with imaginative play
Good language skills
Normal or near normal IQ
Pervasive Developmental
Disorder
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Signs of developmental problems, but without the
significant autism symptoms.
Characteristics vary widely, but tend to be of a
lesser degree than autism.
Sometimes referred to as Pervasive Developmental
Disorder-not otherwise specified, or PDD-NOS.
Rett’s Syndrome
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Has only been seen in girls.
Development is normal until 618 months, then language and
motor abilities are lost.
The development of the
nervous system is not
controlled leading to the loss
of acquired skills.
Normal milestones are stunted.
Rate of progression is specific.
Current Research
NIH’s collaborative Program of Excellence in Autism has also
identified a genetic origin for Rett’s Syndrome.
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Girls have two X chromosomes, therefore some genes are repeated.
Randomly one gene will shut down and the remaining one will control
the process.
The disorder is the result of the mutation on the gene that makes methyl
cytosine binging protein 2 (MECP2).
The abnormality interferes with the biochemical regulator (MECP2) of the
gene’s expression.
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The defect prohibits a gene system from being shut down
allowing too much of a “good” protein to be produced.
During infancy a balance system is in place to decrease the
interference of that protein.
At the age of 2, the balance system no longer functions
allowing the effects of the overproduction to surface.
It is believed that the syndrome is limited to girls because
males have only one MECP2 producing gene. Therefore,
if it is mutant, they have no “back up” copy and die before
birth.
Autism
1. Withdrawn behaviors
2. Unsocial behaviors
3. Problems using language to communicate
4. Repetitive patterns of behavior
5. Problems with imaginative play
6. Seizures (30%)
7. Most often seen in boys
8. Hypersensitivity to stimulation (visual, auditory,
tactile), especially to being touched and loud noises
9. Little or no eye contact
10. Digestive disorders are common
11) Lack of eye contact
12)Inappropriate affect
13)Echolalia
14)Non-responsive to verbal cues
15)Inappropriate attachment to objects
16)Severe emotional outbursts without apparent cause
In Fall of 2001, NIH’s collaborative Program of
Excellence in Autism identified a suspected
chromosome for autism.
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150 sibling pairs found strong evidence to indicate
chromosomes 2 and 7 are involved with autism.
Another possible location, although the
correlation is not as strong, is chromosomes 16
and 17.
Chromosome 7 is known to be linked to language
disorders.
Not exactly sure what is wrong on the gene to
cause the disorder.
In the Fall of 2002, NIH’s Collaborative Program of
Excellence in Autism (10 multidisciplinary
programs) identified a gene, HOXA1, that may
predispose a person to autism.
Childhood Disintegrative
Disorder
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Normal development to age 2 then rapidly lose
acquired skills (language, self-help).
Usually presents between 36-48 months, but can
happen up to age 10.
Child loses interest in the environment.
Very rare.
Interventions
PDD is usually treated with either:
behavioral therapy,
pharmacological therapy,
or a combination of both.
Behavioral Therapy
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One-on-one speech
Communication therapy
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Picture Exchange Communication System (PECS)
Modeling to teach social, self-help skills,
communication and learning
This approach is generally effective, depending
heavily on the intensity of the therapy and the
severity of the child.
Pharmacological Therapy
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Usually used for seizures, self-injurious behaviors,
digestive difficulties
Secretin Therapy
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A hormone involved in intestinal processes
A double blind study where each participant received
both treatment and saline, using a form of secretin
derived from pigs, found no difference between it and
placebo. (Journal of the American Academy of Child and Adolescent Psychiatry, Nov 2001)
A list of scientifically unreplicated therapies can be
found at http://www.autism-biomed.org/unproven.htm
PDD and deafness
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Hearing loss (HL) is difficult to detect in children with
PDD. One of the hallmarks of PDD is non-responsiveness
to auditory cues. This makes it difficult to know if the
child is not hearing or just not responding.
Oral communication is problematic without HL.
Visual communication requires attending and eye contact.
Typically people with PDD avoid both of these.
Tactile defensiveness and over sensitivity to stimuli may
prevent hearing aid fitting and use. Risk of damage and
injury are increased in the presence of self-stimulating or
injurious behaviors.
Resources
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National Institute of Child Health and Human Development
www.hichd.nih.gov
General Information
www.geocities.com/Heartland/Fields/6979
Autism Biomedical Information Network
(Includes complete DSM-IV criterion)
www.autism-biomed.org
Autism society of AL
www.autism-alabama.org
Asperger’s Disorder DSM-IV
http://web.syr.edu/~rjkopp/data/as_diag_list.html
Personal Accounts and links
http://web.syr.edu/~rjkopp/autism.html
Resources, cont.
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Autism/PDD Resources Network
http://www.autism-pdd.net/
Governer’s Council for Developmental Disabilities for GA
http://www.ga-ddcouncil.org/pubs.htm
Autism Society of America’s Greater GA Chapter
www.asaga.com
GA Tools for Life
www.gatfl.org
Parent to Parent of GA
parenttoparentofga.org
GA State Resources at NICHCY
www.nichcy.org/stateshe/ga.htm
Hands on Atlanta-Autism Society of America
http://www.handsonatlanta.org/calendar/where.asp?orgid=266