Pervasive Development Disorder

Pervasive Development Disorder (PDD) is the collective term that is now being used for a group of developmental disorders of brain function with a broad range of behavioral consequences and severity. PDD manifests in infancy as impaired attachment but is more often identified in toddlers, mostly boys from 18 - 30 months of age when their parents or physician note an absence or delay of speech development and a lack of normal interest in other children or adults or a regression of early speech and sociability. These infants and children also do not know how to play. They manipulate or line up toys without apparent awareness of what the toys represent. They do not engage in pretend play. For example they do not play with the telephone which is a common natural occurrence in the development of virtually all children. They have several behavioral disturbances including shyness, fearfulness, anxiety or mood lability. They may have temper tantrums if someone tries to make them switch activities or if a ritual behavior is interrupted. They seem to have a decreased need for sleep and frequent awakenings during the night are not uncommon. It is not infrequent to find that these children are hypotonic, clumsy and often walk on their toes. They may have several motor stereotypic behaviors including hand flapping, spinning, running in circles, biting, head banging, and gouging. Classic autism is the best known subtype of this disorder and involves severe qualitative deficits in social interaction, language communication and play and is associated with stereotypic and perseverative behavior. Other conditions that fall under this category of Pervasive Development communication disorders include Asperger's syndrome, Heeler's syndrome and Rett's disorder. PDD specifically, is a disorder in children with Autistic behavior who do not fulfill the criteria for any of the other disorders in the spectrum. The outcome of the disorder may vary from little speech and poor daily living skills throughout life to the achievement of college degrees and independent functioning. The causes of PDD are largely unknown. Is it hereditary? There is a risk of recurrence of between 3 - 8 % in families with one affected child. Other secondary causes that may be associated with PDD (10 - 30 % of cases) include perinatal difficulties, phenylketonuria, viral encephalitis etc. The correct diagnosis depends on an accurate developmental history and evaluation of the current functioning of the child. The use of the DSM-IV criteria substantially increases diagnostic reliability. The most important intervention in PDD is early and intensive remedial education that addresses both behavioral and communication disorders. These effective approaches use a highly structured environment with intensive individual instruction and a high teacher to student ratio. Occupational and physical therapy should address specific deficits. The parents require on going counseling and support and they must understand that they are not responsible for the child' condition.

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