Core deficits of PDDs.

-Social Interaction

-Communication

-restricted, repetitive behavior, interest

-Impaired nonverbal behaviors (eye contact, imitation)

-Failure to develop age-appropriate peer relationships

-Lack of spontaneous sharing of enjoyment/interests (pointing out objects of interest)

-Lack of social and emotional reciprocity (profound lack of interest in social engagement; unresponsiveseness)

-Quality of parent-infant attachment??

Qualitiave impairment in communication

1. Delayed or lack of spoken language

     -50% have little or no speech

2. When speech is adequate, impairment in initiating or sustaining conversation

     -more of a monologue; inappropriate shifts

 prosody; pronoun rerversal; neologisms

3. Sterotyped, reptitve or idiosyncratic language

     -immediate or delayed echolalia; abnormal

4. Lack of varied, age-appropriate spontaneous make believe or social imitative play

Restricted, repetitve, stereotyped behavior

1. Abnormal preoccupation with stereotyped or restricted interests.

2. Inflexible adherence to nonfunctional routines or rituals.

3. Sterotyped and reptitve motot mannerisms

     -rocking, whirling, hand or finger flapping

4. Persistent preoccupation with parts of objects

     -Not observed before age 3

Autistic Disorder: Case example

Jenny

1. Age 7, attended day school for children with severe developmental disabilites.

2. Unresponsive to other, never made eye contact.

3. Rocked and made noises repitively

4. No speech

5. Unresponsive and resisted being held as a baby.

1. Increase in prevalence; 12/10,000; 1 in 150; 1 million in US

2. High comorbidity with Mental Retardation (70%)

3. Deficits in adaptive function

4. Sex ration: B>G, 3.5:1

1. Two patterns of symptom onset

     -Symptom onset in first year

     -Regression or loss of skills during first 3 years

2. Lifespan disorder

     -Specific symptom presentation changes with development

     -82%: improved social/communication skills

     -55%: improved repetitive behavior

1. Poor for academic achievement and independent living

     -only about 1/3 achieve independent living

2. Two most useful predictors:

     -IQ>70 

     -Development of communicative speech by 5

3. High functioning individuals with AD

     -Temple Grandin

Qualitative deficits in social interaction and restrictive interests, but no delay in language, cognitive development, or other adaptive behavior.

1. Lonely, solative, friendless, socially "odd"

2. Obsessive, restricted interests

3. Viewed as milder forms of autism, has not been shown to be quailitatiely different from high-functioning levels of AD

Robert

1. No problems/concerns with early development

2. Peer interaction problems starting in preschool

3. Age 10, severe isolatin and visuo-motor probs.

4. High Verbal IQ and slightly above average performance IQ

5. Failed to respond to facial expressions and avoided eye contact

6. Fixated with astrology.

1. At least 50% of children with AD fail simple first-order false belief tasks.

     -theory of mind

     -Sally-Anne Test

2. Deficit in understanding mental states of others'

     -mind-reading deficits in autism are fundamental

1. Children with autistic disorder perform much better of false photograph tasks than false belief tasks.

2. Similar to false belief taks except it does not require the child to take the perspective of another person.

An alternative theory to the 'mind-blindess' theory of autism.

1. Explains difficulty seen in ToM tasks as a deficit in executive function.

2. Autistic children display pervasive deficits in executive functioning, especially working memory and inhibition control

3. Concept of central coherence

A weak drive for central coherence is thought to underlie autism.

Central Coherence: The strong tendency of humans to interpret stiumli in a relatively global way that takes the broader context into account

This means that autistics are thought to process info in bits and pieces rather than looking at the big picture.

1. Savants have spectacular levels of ability in specific areas of functioning

     -memory, math, drawing, music

2. Savant abilites can occur in individuals with IQs in the retarded range

     -Video, Jessie Park, painter

1. Twin Studies

     -MZ twins have 60% chance of having AD, even greater chance of being in spectrum

2. Broader autism Phenotype

     -Family members show impairments in social, communicative and repetitive behaviors that are in subclinical range of spectrum; more common in biological relative

3. Molecular genetic linkage: chromosomes 2, 7, & 15.

1. Abnormalites in brain development

     -atypical growth spurt; cellular abnormalities in many parts of brain

2. Abnormalities in function

     -underactivity in frontal lobes

3. Vaccines??

     -No evidence to suggest this causes AD

Autism: Intervention/Education

Behavioral and educational approaches are key to helping each child reach his/her fullest potential.

1. Intenseive assessment of behavioral deficits and excesses

2. Shape and selectively reinforce communication skills and adaptive behavior through intensive one-on-one intervention carried out on a daily basis

     -reduce frequency of self-injurious, aggressive, or disruptive behavior.

3. EARLY intensive intervention has potential for wide-spread and long term effects

4. Parent training important for achieving generalized postive gains.

5. Placement: least restrictive environment.

A servere and disabling neurological developmental disorder that predominantly affects females

1. Result of a specific gene mutation

2. Apaxia (inability to execute desired movement) common

CDD describes children who prior to age 10 evidence a significant loss of previously acquired skills.

1. Very rare and affect mostly boys

This describes childrenw who display the social, communication, and behavioral impairments associated with PDD but do not meet criteria for other PDDs.

1. Might be called atypical autism

2. Most frequently diagnosed disorder on the autism spectrum

Delusions

Hallucinations

Disorganized speech

Disorganized or catatonic behavior

"Flat" affect

Diminished goal-directed activities

1. Rare in Children

     -1% in adults and much lower for children

2. Most sx children have lower than average IQ; but not comorbid with MR

3. Deficits in social functioning; usually earlist sign.

4. Males; diagnosed at earlier age. May be at an elevated risk.

1. Insidious onset in childhood

     -Nonpsychotic symptoms appear first.

2. Adolescent onset

     -Some have acute onset, others are chronic

3. 1/4 recover, 1/4 improve, 1/2 chronic course

4. Early age of onset associated with poor outcome

Mary

1. 10 years old, long history of withdrawn behavior

2. Academic difficulties/social isolation continue

3. Depression, devil speaking to her, paranoid

4. Disorganized, talked of killing herself.

1. Gentic; strongly implicated

     -MZ twins 45-50%

     -children of sx parents have elevated risk for SX and many other disorders

2. Neurobiological

     -Possible, but not consisten

     -Abnormalities in F/T limbic system

     -Abnormal functioning of dopamine receptors

1. Pregnancy/birth complications

     -May play a role, especially anoxia

2. Family Climate

     -Communication Deviance (CD) & Expressed Emotion (EE)

     -in adult, adverse family climate increases relapse ("vulnerability-stress" model)

1. Limited research shows that tranquillizers/anti-psychotic drugs can improve pos. symptoms in kids

2. Motor side effects a concern

     -Tardive dyskinesia

3. Atypical antipsychotic meds act on both positive and negative symptoms (Clozapine), but can have severe risks.

Schizophrenia: Psychosocial Treatment

1. Family psychoeducational

     -reduce blame, discord, strain

     -increase understanding, support

2. Behavioral

     -increase social and self-help skills

3. COMBINATION of meds+psychosocial more effective then either alone

Schizophrenia: Psychosocial Treatment

1. Family psychoeducational

     -reduce blame, discord, strain

     -increase understanding, support

2. Behavioral

     -increase social and self-help skills

3. COMBINATION of meds+psychosocial more effective then either alone