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THE NATURE OF PERVASIVE DEVELOPMENTAL DISORDER
Sam Goldstein, Ph.D.
Pervasive Developmental
Disorders have become a topic of significant interest for researchers, medical
and mental health professionals, as well as the general public. Under the term
"Autism," the last six months have witnessed lead articles in Time,
Newsweek, and the New York Times, as well as multiple radio and television
stories on this subject. While we know that by far, the majority of children
with Pervasive Developmental Disorder experience significant impairments in
general intellect and overall development, the media has been most interested
in the small group of perhaps fifteen to twenty percent of children with
Pervasive Developmental Disorders falling within the normal or better
intellectual range. Because of this, I have found that many parents coming into
the clinic now believe that individuals with Autism, by nature, possess above
average intellect. In this month's article, I will provide a brief overview of
Pervasive Developmental Disorder and reinforce the hypothesis that the true
nature of this condition lies in the impairment in developing appropriate and
gratifying social relations.
The Pervasive
Developmental Disorders comprise a group of conditions with a basic underlying
theme of impairment in interaction with others. Autism is a type of Pervasive
Developmental Disorder. Asperger's and Pervasive Developmental Disorder - Not
Otherwise Specified, though considered "non-autistic PDD's" are
significantly more alike than dissimilar. Children with these conditions fail
to develop effective pragmatic or social language. They appear more interested
in objects than people. They may have odd interests or atypical patterns of
behaviour. In the group of children I am following with this condition, a
significant percentage meet criteria for the Inattentive Type of ADHD. In fact,
I've just completed a research study demonstrating that children with PDD and
ADHD experience significantly more impairment than those with PDD alone.
Although the diagnostic protocol continues to indicate that when PDD is diagnosed,
ADHD should not be diagnosed, the significantly greater impairment these
children demonstrate suggests that when both conditions are present, they
should be diagnosed and treated. The risk of mood and anxiety disorders, as
well as learning disability, may also be greater in this population. The
diagnosis of Asperger versus Autism is provided when children demonstrate
normal early language development. In contrast, children with Autism are
usually language delayed, and thus, at two to three years of age, are clearly
different from other children in their inability to speak. The diagnosis of
PDD-NOS is provided when children demonstrate symptoms of Autism or Asperger
and impairment is present, but those symptoms do not cross the threshold for a
full syndrome diagnosis. There are a number of other conditions also included
under the PDD umbrella. These include Rett Syndrome, a condition that usually
affects girls, and Childhood Disintegrative Disorder. Both conditions are
marked by onset at a young age and a significant deceleration in cognitive,
emotional, and in some cases, physical development.
In the past two years, I have seen an increasing number of
children referred with suspected Autism. Some, in fact, meet diagnostic
criteria for a PDD. However, it's my experience that an equal number do not.
Some simply have other developmental impairments. Some have language or
learning disorders. Some simply have an atypical pattern of behaviour, but one
does not fit within the PDD diagnostic protocol nor appear to cause significant
impairment. I am specific in the diagnostic process. That is, I do not provide
these children with a diagnosis, because they do not fit nor cross the
developmental threshold necessary. However, I am sensitive in my willingness to
help. I explain to parents that I am willing to help them with the problems
they encounter raising their children, even if I don't provide a diagnosis.
We are in the process of attempting to understand what forces,
experiences, or factors insulate and protect children with PDD's, making them
more resilient and ultimately successful as they transition into adult life.
Normal intelligence, the ability to develop friendships, and a lack of
aggressive behaviour in the face of stress, all appear to be protective factors.
It has been my experience that helping this group of children between the ages
of nine and fourteen years develop genuine, reciprocal social relations,
experience school success, and develop "an island of competence" are
very positive protective factors. While many of the children I am following
with a PDD take a psychiatric medication, there are no specific medications
developed for these conditions. There are no extensively researched, proven
psychotherapy or educational models, particularly for teens with these
conditions. It is a matter of time, patience, and taking, as my colleague, Dr.
Robert Brooks, points out, a "helicopter view" recognizing that
change takes time and the ultimate goal is to help this group of children
transition successfully into adult life.
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