Asperger’s Syndrome and Pervasive Developmental Disorder

Introduction

According to the Autism Society websiteIn December 2009, the Centers for Disease

Control and Prevention issued their ADDM autism prevalence report. The report concluded that the prevalence of autism had risen to 1 in every 110 births in the United States and almost 1 in 70 boys. The issuance of this report caused a media uproar, but the news was not a surprise to the Autism Society or to the 1.5 million Americans living with the effects of autism spectrum disorder.

CostsCurrently, the Autism Society estimates that

the lifetime cost of caring for a child with autism ranges from $3.5 million to $5 million, and that the United States is facing almost $90 billion annually in costs for autism (this figure includes research, insurance costs and non-covered expenses, Medicaid waivers for autism, educational spending, housing, transportation, employment, in addition to related therapeutic services and caregiver costs).

The diagnostic category of pervasive developmental disorders (PDD) refers to a group of disorders characterized by delays in the development of socialization and communication skills. Parents may note symptoms as early as infancy, although the typical age of onset is before 3 years of age. Symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns. Autism (a developmental brain disorder characterized by impaired social interaction and communication skills, and a limited range of activities and interests) is the most characteristic and best studied PDD.

The DSM-IV-TR defines

Zero to Three Casebook Addition According to the 0-3 casebook there is a pdd listed for those 24 months and

younger called Multi-System developmental disorder. A child with MSDD does not totally lack the ability to develop a social/emotional relationship with a primary caregiver but will have impairment in developing this relationship. The child may:

1) avoid contact with caregivers, but will give slight cues that show attachment. These children have difficulty forming, maintaining, and/or developing

communication, including preverbal gestures. For many toddlers with MSDD, language does not serve a communicative intent. They may memorize parts of songs

or dialogue but they do not use speech to communicate.2)A child with MSDD may have major difficulty processing visual, auditory, tactile, proprioceptive (spatial awareness of one’s body), and vestibular sensations. Most have poor motor planning—they lack the ability to sequence their movements to

create a desired outcome—and may appear very clumsy when learning a new skill.3) Infants and toddlers diagnosed with MSDD also show impairments in processing sensations. For example, they may be extremely sensitive to touch (startling or even having a tantrum when touched lightly), or they may show great pleasure in heavy pressure (being sat on or wedging themselves in small spaces behind furniture).

4)Get an interactive brain map which provides information on brain development of young children.

Medical issues and Major SymptomsPeople who have Aspergers say its like being locked in a shell with little ability to communicate with the outside world. Its hard to stay involved with your world.

http://www.youtube.com/watch?v=OV_CcmLlaw4&feature=related

Types of PDD Autistic Disorder central feature is the markedly abnormal or impaired development in

social interaction and communication and a restricted repertoire of activity and interest. Asperger's disorder-Severe or sustained impairment in social interaction and the

significant development of restrictive patterns of behavior, interest and activity. The difference is that there was no clinically significant delays in Language or cognitive development. No delays in the development of age-appropriate self-help skills, adaptive behavior and curiosity about the environment.

Rett's Syndrome is the development of multiple specific deficits following a period of normal functioning after birth. A loss of previously acquired purposeful hand skills before the development of a characteristic resembling hand wringing or hand washing. The interest in the social environment diminishes in the first several years after the onset of the disorder. Significant impairment in expressive and receptive language development with severe psychomotor retardation.

Childhood Disintegrative Disorder is a marked regression in multiple areas of functioning following two years of apparently normal behavior development. A clinically significant loss in at least two areas ; expressive or receptive language; social skills or adaptive behavior; bowel or bladder control; or play and motor skills. They also display characteristics of Autistic disorder.

PDD- NOS is used when the criteria has not been met in the descriptors above because of a typical symptomatology.

What impediments are there during childhood

Difficulty with understanding verbal and non-

verbal social interactions

Sometimes children have odd behaviors which

aren’t readily accepted by peers

These children have a low frustration

tolerance and may strike others

Motor skills may not be like their

peers –lack interest in play

Could to be both a bully and a victim.

To Improve Social SkillCurrently, some school uses the Step 2 Social skills training program for children with different levels of social skill attainment[i.e.Asperger's Syndrome].One common theme is accessing peer interactions to model the things learned in training when using this Step 2 program.Children without these impediments could benefit from increasing their skills in handling interactions with others.A recurrent theme in research is to increase social and conflict resolution skills as a mechanism to decrease bullying behavior and change the learning environment. In one instance a psychologist developed a way for nuero-typical kids helped those with Aspergers learn to interact with peers and develop a freindships with others. Thereby decreases the level of bullying by others.

Communication 2) verbal and nonverbal communication By age 3, most children have passed predictable milestones on the path to

learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is “no.”

Some children diagnosed with ASD remain mute throughout their lives. Some infants who later show signs of ASD coo and babble during the first few months of life, but they soon stop. Others may be delayed, developing language as late as age 5 to 9. Some children may learn to use communication systems such as pictures or sign language.

Those who do speak often use language in unusual ways. They seem unable to combine words into meaningful sentences. Some speak only single words, while others repeat the same phrase over and over softly. Some ASD children parrot what they hear, a condition called echolalia. Although many children with no ASD go through a stage where they repeat what they hear, it normally passes by the time they are 3.

Repetitive Behavior 3) They will often have unusual responses to sensory experiences, such as

certain sounds or the way objects look. Each of these symptoms can range from mild to severe. Although children with ASD usually appear physically normal and have good muscle control, odd repetitive motions may set them off from other children. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or walking on their toes. Some suddenly freeze in position.

As children, they might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of the toys, the child may be tremendously upset. ASD children need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, going to school at a certain time and by the same route—can be extremely disturbing. Perhaps order and sameness lend some stability in a world of confusion.

Repetitive behavior sometimes takes the form of a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Often there is great interest in numbers, symbols, or science topics.

Treatment Options

There is no known cure for PDD. Medications are used to address specific behavioral problems;

therapy for children with PDD should be specialized according to need. Some children

with PDD benefit from specialized classrooms in which the class size is small and instruction is

given on a one-to-one basis. Others function well in standard special education classes or regular

classes with additional support.

Some children need therapy for depression symptomsUse medication to assist with depression

symptoms.Seek therapy where CBT can be used to

restructure thought patterns. Learn to see how thoughts impact experiences. Provide direction as to how to deal with the depression and changes that could improve symptoms and dealing with change.

Some of the treatment programs

Applied Behavior Analysis (ABA) ABA is a broad set of principles and guidelines that is often used as a framework for treating

autism.  ABA is a one-on-one, intensive, structured teaching program based on the ideas of behavior modification and involving reinforced practice of different skills. You may also hear it called Discrete Trial Therapy (or DTT).  Other terms associated with ABA are: functional communication training, incidental teaching, script/script fading, self-management, shaping, behavior chaining, errorless learning, functional assessment, reinforcement systems and activity schedules. Each word in the name “Applied Behavior Analysis” is important:

“Applied” means that you are trying cause positive change in socially significant behaviors. “Behavior” changes over time are observed and measured.  “Analysis” refers to the way the evidence is collected and evaluated to show how an intervention

caused a behavior change. Lovaas Therapy The Lovaas Model of Applied Behavior Analysis is a specific ABA treatment method developed by

Ivar Lovaas. For more information, visit his website. Developmental, Individual-Difference, Relationship-Based (DIR) Therapy : DIR—also called Floor

time or the Greenspan Method—is based more on relationships than behavior modification.  The Interdisciplinary Council on Developmental and Learning Disorders (founded by Stanley Greenspan) has information about the DIR/Floor time model.  You can also visit The Floortime Foundation to learn more.

Augmentative and Alternative Communication (AAC)-This augmentative communication glossary will help you learn the terms.  AAC can use strategies like the Picture Exchange Communication System (PECS) and sign language.  

Unconventional therapiesAuditory Integration therapy After 35+ years of clinical practice and study, Dr. Berard determined that, in many

cases, distortions in hearing or auditory processing contribute to behavioral or learning disorders. In the large majority of Dr. Berard's cases, AIT significantly reduced some or many of the handicaps associated with autism spectrum disorders, central auditory processing disorders (CAPD),

speech and language disorders, sensory issues including auditory, tactile or other sensory sensitivities (hyper or hypo), dyslexia, pervasive developmental disorder (PDD), attention deficit disorder with or without hyperactivity, anxiety, and depression.

Berard Auditory Integration Training was designed to normalize hearing and the ways in which the brain processes auditory information. For example, an individual tests as hypersensitive to the frequencies of 1,000 and 8,000 Hertz while perception of all other frequencies falls within the normal range. The individual becomes over stimulated, disoriented or agitated in the presence of sounds at 1,000 and 8,000 Hertz. Therefore, Berard AIT works to normalize the hearing response across all frequencies within the normal hearing range.

In another example, an individual's hearing is asymmetrical (significantly different between the two ears). When the right and left ears perceive sounds in an extremely different way, problems with sound discrimination can occur. Again, Berard AIT works to normalize the hearing of both ears.

Unconventional Therapies Cont. Sensory integration therapy best if referred to Occupational

therapy the child must be able to successfully meet the challenges that are presented through

playful activities (Just Right Challenge); the child adapts her behavior with new and useful strategies in response to the challenges

presented (Adaptive Response); the child will want to participate because the activities are fun (Active Engagement); and the child's preferences are used to initiate therapeutic experiences within the session

(Child Directed). Suggestions for activities: swinging in a hammock (movement through space); dancing to music (sound); playing in boxes filled with beans (touch); crawling through tunnels (touch and movement through space); hitting swinging balls (eye-hand coordination); spinning on a chair (balance and vision); and balancing on a beam (balance   Pasted from <http://autism.healingthresholds.com/therapy/sensory-integration

Observations or questions used to identify traits 1. Poor eye contact, or staring from unusual angle 2. Ignores when called, pervasive ignoring, not turning head to voice   3. Excessive fear of noises (vacuum cleaner); covers ears frequently 4. In his/her own world (aloof)  5. Lack of curiosity about the environment 6. Facial expressions don't fit situations   7. Inappropriate crying or laughing 8. Temper tantrums, overreacting when not getting his/her way   9. Ignores pain (bumps head accidentally without reacting)  10. Doesn't like to be touched or held (body, head) 11. Hates crowds, difficulties in restaurants and supermarkets   12. Inappropriately anxious, scared   13. Inappropriate emotional response (not reaching to be picked up)   14. Abnormal joy expression when seeing parents  15. Lack of ability to imitate  

Questions or Observations to identify SOCIAL INTERACTION DIFFICULTIES 1. Loss of acquired speech 2. Produces unusual noises or infantile squeals 3. Voice louder than required  4. Frequent gibberish or jargon  5. Difficulty understanding basic things ("just can't get it")  6. Pulls parents around when wants something  7. Difficulty expressing needs or desires, using gestures  8. No spontaneous initiation of speech and communication 9. Repeats heard words, parts of words or TV commercials 10. Repetitive language (same word or phrase over and over) 11. Can't sustain conversation  12. Monotonous speech, wrong pausing  13. Speaks same to kids, adults, objects (can't differentiated 14. Uses language inappropriately (wrong words or phrases 

ABNORMAL SYMBOLIC OR IMAGINARY PLAY / use as questions or observations

1. Hand or finer flapping; self stimulation 2. Head banging  3. Self mutilation, inflicting pain or injury  4. Toe walking, clumsy body posture  5. Arranging toys in rows 6. Smelling, banging, licking or other inappropriate use of toys 7. Interest in toy parts, such as car wheels  8. Obsessed with objects or topics (trains, weather, numbers, dates) 9. Spinning objects, self, or fascination with spinning objects 10. Restricted interest, (watching the same video over and over 11. Difficulty stopping repetitive "boring" activity or conversation 12. Attachment to unusual objects, (sticks, stones, strings, or hair) 13. Stubborn about rituals and routines; resists to change  14. Restricted taste by consistency, shape or form (refuses solids) 15. Savant ability, restricted skill superior to age group (reads early, memorizes books)  

Individuals who have Aspergers and Employment Employment should take advantage of the individual's strengths and abilities.

Temple Grandin, Ph.D., suggests, "jobs should have a well-defined goal or endpoint," and that your "boss must recognize your social limitations." In A Parent's Guide to Asperger Syndrome and High-Functioning Autism, the authors describe three employment possibilities: competitive, supported, and secure or sheltered.

Competitive employment is the most independent, with no support offered in the work environment. Individuals with Asperger’s Syndrome may be successful in careers that require focus on details but have limited social interaction with colleagues such as computer sciences, research or library sciences. In supported employment, a system of supports allows individuals to have paid employment in the community, sometimes as part of a mobile crew, other times individually in a job developed for the person. In secure or sheltered employment, an individual is guaranteed a job in a facility-based setting. Individuals in secure settings generally also receive work skills and behavior training, while sheltered employment may not provide training that would allow for more independence. There is a 70% unemployment rate for individuals 20 yrs old or older.

Concerns with vocational concernsOne way to engage the client in therapy is to provide structure.

Individuals with Asperger‟s struggle with planning, organizing, and prioritizing; external structure can compensate for these weaknesses (Anderson & Morris, 2006). Be clear about details concerning where to wait, where to sit, the beginning and ending time of the session, etc. Set an agenda for each session, including appropriate topics of discussion (Ramsay et al., 2005). Be aware that the typical therapy hour may not be appropriate for this population. Clients may need shorter sessions because they are mentally exhausted due to the combined stressors of social interaction and CBT therapy. Conversely, clients may need longer sessions if they need extra time to process information or are particularly difficult to redirect from their restricted and repetitive interests (Anderson & Morris, 2006). In order to develop workable treatment goals that are relevant

Vocational IssuesInterview transcripts revealed four major themes identified by people with Asperger’s concerning why they have difficulty becoming successfully employed. The four themes are: 1) mastering the job application process, 2) adapting to new job routines, 3) communication, and 4) navigating social interactions with employers and coworkers. The job coach should be able to help the client break down larger tasks into smaller, more manageable parts, and to help the client develop strategies to prioritize which tasks should be completed first, act as a social “translator” between the client , must be able to explicitly decode coworkers and supervisors‟ body language, voice tone, and facial expressions for the individual with Asperger‟s .http://youtu.be/XP3zE1P2-a0- is a video about teaching vocational skills

Researchers can be foundThe NINDS conducts and supports research on

developmental disabilities, including PDD. Much of this research focuses on understanding the neurological basis of PDD and on developing techniques to diagnose, treat, prevent, and ultimately cure this and similar disorders.

NIH Patient Recruitment for Pervasive Developmental Disorders Clinical Trials

At NIH Clinical CenterThere is an Autism research Institute

Websites info@horizonsdrc.com Horizons Developmental Remediation Center. Horizons

Developmental Remediation Center has a reputation locally, nationally, and abroad for providing exceptional quality assessment and treatment to children, adolescents, and adults with autism, Asperger’s Syndrome, PDD-NOS, ADHD, and other neurodevelopmental disorders. Through the use of a comprehensive developmental and family-based approach, we develop individualized treatment plans to meet the needs of your child and family.

www.grasp.org- This organization was started by a man who was diagnosed after his son was diagnosed. He has a lot of pertinent information

.Parenting Aspergers,Information Online LLC,PO Box 789,Portsmouth,PO19DY,UK.Phone:0845 519 3412For the quickest response use our support desk http://parentingaspergers.zendesk.com/anonymous_requests/new

www.fraser.org Provides information and services for individuals with PDD and Autism Spectrum Disorders.

Resources National Dissemination Center for Children with Disabilities U.S. Dept. of Education, Office of Special Education Programs 1825 Connecticut Avenue NW, Suite 700 Washington, DC   20009 nichcy@aed.org http://www.nichcy.org Tel: 800-695-0285 202-884-8200 Fax: 202-884-8441        National Institute of Mental Health (NIMH) National Institutes of Health, DHHS 6001 Executive Blvd. Rm. 8184, MSC 9663 Bethesda, MD   20892-9663 nimhinfo@nih.gov http://www.nimh.nih.gov Tel: 301-443-4513/866-415-8051 301-443-8431 (TTY) Fax: 301-443-4279         National Institute on Deafness and Other Communication Disorders Information Clearinghouse 1 Communication Avenue Bethesda, MD   20892-3456 nidcdinfo@nidcd.nih.gov http://www.nidcd.nih.gov Tel: 800-241-1044 800-241-1055 (TTD/TTY)        National Institute of Child Health and Human Information

Resource Center P.O. Box 3006 Rockville, MD   20847 NICHDInformationResourceCenter@mail.nih.gov Tel: 800-370-2943 888-320-6942 (TTY) Fax: 301-984-1473             

Resources Cont. National Organization for Rare Disorders (NORD) P.O. Box 1968 (55 Kenosia Avenue) Danbury, CT   06813-1968 orphan@rarediseases.org http://www.rarediseases.org Tel: 203-744-0100 Voice Mail 800-999-NORD (6673) Fax: 203-798-2291        American Speech-Language-Hearing

Association (ASHA) 2200 Research Boulevard Rockville, MD   20850 actioncenter@asha.org https://asha.org Tel: 800-638-8255 Fax: 301-571-0457

Resources Cont. MAAP Services for Autism, Asperger Syndrome, and PDD P.O. Box 524 Crown Point, IN   46307 info@maapservices.org http://www.maapservices.org Tel: 219-662-1311 Fax: 219-662-0638        Autism Network International (ANI) P.O. Box 35448 Syracuse, NY   13235-5448 jisincla@syr.edu http://www.ani.ac         Autism Research Institute (ARI) 4182 Adams Avenue San Diego, CA   92116 director@autism.com http://www.autismresearchinstitute.com Tel: 866-366-3361 Fax: 619-563-6840        Autism National Committee (AUTCOM) P.O. Box 429 Forest Knolls, CA   94933 http://www.autcom.org

ReferencesDSM-IV-TR

ReferencesZero- Three Casebook(1997) Lieberman, Wieder,

Fenichelwww.zerotothree.org/baby-brain-map.htmlwww.childrain.org The PDD Assessment Scale/

Screening Questionnaire www.autism.com/ari - ATEC form screening toolMinnesota Association for Children’s Mental

Health • MACMH 800-528-4511 • 651-644-7333 • www.macmh.org

National Institute of /neurological disorders and Stroke  http://www.ninds.nih.gov/http://www.autism-society.org/