Pervasive developmental disorders
Meaning
Group of disorders characterized by abnormalities in
communication and social interaction and by restricted repetitive activities
and interests.
Epidemiology
• Prevalence- 60-70/10000 population around the
world(Fombonne E . 2009)
• Autism 62/10000 population
• Male:Female-5:1 ratio
Types
v Childhood
autism
v Rett’s
disorder
v Asperger’s
syndrome
v Childhood
disintegrative disorder
v other
PDD
Childhood autism
Meaning
Autistic disorder is characterized by
symptoms from each of the following three categories: qualitative impairment in
social interaction, impairment in communication, and restricted repetitive and
stereotyped patterns of behavior or interests.
Etiology
• Genetic
v Sibilings
v Monozygotic twins-36%
v Fragile X chromosome
• Biological
v Mental retardation
v Seizure disorder
v Congenital rubella
v Phenyl ketonuria
• Immunological
v Maternal antibodies directed to fetus
• Prenatal
v Respiratory distress
v Neonatal anemia
v Post term delivery
• Neuro anatomical
v Increased brain volume
v Temporal lobe damage
• Biochemical
v Elevated plasma serotonin
• Parental factors
v Parental rejection
v Family break up
v Family stress
v Insufficient stimulation
v Lack of warmth and affectionate behaviour
v Fixation in pre symbiotic phase
• Theory of mind
v Mind blind- Children with autism lack ability to put
themselves in the place of another person.
Clinical features
• Behavioural characteristics
v Autistic aloofness- Unresponsiveness to affection
v Gaze avoidance
v Poor eye contact
v Anxious on disruptions of regular routine
v No separation anxiety when left alone with strangers
v Inappropriate social play
v Limited or no friends
v Lack of empathy and feelings to others
v Anger or fear without reason
v No fear of danger
• Communication and language
v Poor language development
v Lack babbling in infantile period
v Produce noises like clicks and nonsense syllabels
v Difficulty in articulation of speech
v Echolalia
v Absence of imaginative play
v Abnormality in production of speech.
• Activities
v Rigid, repetitive and monotonous play
v Restricted, repertoire of activities
v Pre occupation with parts of objects
v Fear or panic when there is change in environment
v Response to stimuli
v Reluctance to change
v Over or under responsive to stimuli
v Altered response to pain
v Enjoy vestibular stimulation
• Instability of
mood and affect
v Sudden mood changes
• Other behavioural symptoms
v Hyperkinesis
v Self injurious behaviour
v Poor attention span
v Idiot Savant syndrome
Treatment
Pharmacological
v CNS stimulants
v Antipsychotics
v Anti epileptics
v SSRIs
Psychological
Management
v Contingency management
v Special schooling
v Supportive Counselling
Nursing management
• Assessment
• Interventions
v Nursing interventions
v Work on one to one basis
v Diversion of attention to reduce anxiety
v Ensure warmth and care
v Familiar toys
v Positive reinforcements
v Identify and fulfill the needs
v Encourage expression verbally
v Teach self care needs
v Language training
v Teach by naming own body parts
v Involve family in care.
COMMENTS