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PubMed1999

Exploring the boundaries of pervasive developmental disorder not otherwise specified: analyses of data from the DSM-IV Autistic Disorder Field Trial.

This study aimed to explore the boundaries between PDD and related disorders and to develop classificatory algorithms for what is currently called Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS). Data collected by means of a standard coding system for the DSM-IV field trial for autistic disorder were used. Information on diagnostic criteria for autistic disorder as listed in ICD-10 and DSM-IV was compared between subjects functioning at least in the mildly retarded range and clinically classified as autistic disorder (n = 205), PDDNOS (n = 80) and other non-PDD disorders (n = 174). Only a limited number of items from the ICD-10 and DSM-IV systems for autistic disorder significantly discriminated the PDDNOS group from other disorders. A scoring rule based on a short set of 7 ICD-10/DSM-IV criteria with a cutoff of 3 items and 1 social interaction item set as mandatory had the best balance between high sensitivity and high specificity in discriminating PDDNOS from non-PDD disorders. These rules yielded a somewhat better prediction than most effective rules based on the full set of 12 criteria for autistic disorder with a cutoff of 4 items and 1 social item as mandatory. Generally accepted and well-validated criteria to identify individuals with PDDNOS should facilitate both research and clinical services.

Adolescent↗
PubMedDate not supplied

Sensory integrative-based occupational therapy and functional outcomes in young children with pervasive developmental disorders: a single-subject study.

OBJECTIVE: This single-subject study explored the effects of sensory integrative-based occupational therapy provided in an outpatient clinic on the functional behaviors of two young children with pervasive developmental disorder (PDD) at home. METHOD: The participants were two 3-year-old boys with PDD. Before the study, the participants had not received a consistent program of sensory integrative-based occupational therapy. Before the baseline phase, three target behaviors were identified for each child, using an adapted version of Cook's revised Functional Behavior Assessment for Children with Sensory Integrative Dysfunction. These target behaviors were operationalized and used as repeated measures taken in the home during both the 2-week baseline and treatment phases. The treatment phase was 11 weeks for Participant 1 and 7 weeks for Participant 2. RESULTS: Both participants displayed significant improvements in the areas of social interaction, approach to new activities, response to holding or hugging, and response to movement. Decreases were noted in the frequency and duration of disruptive behaviors (e.g., high activity levels, aggressive behaviors), with an increase in functional behaviors, such as spontaneous speech, purposeful play, and attention to activities and conversation. Concurrent interventions that were not part of this study (e.g., initiation of speech therapy, preschool, vitamins) may have confounded these results. CONCLUSIONS: These findings support the application of sensory integrative-based occupational therapy as a part of the services provided to some children with PDD. Further research is needed to replicate these findings and to isolate the effects of sensory integrative-based occupational therapy because both participants were receiving other interventions at the time of this study.

Activities of Daily Living↗
PubMed2003

Pervasive developmental disorders among children and adolescents attending psychiatric day treatment.

OBJECTIVE: This study sought to determine the prevalence of pervasive developmental disorders (PDD) among children admitted to a state hospital day treatment service and to characterize the psychiatric disturbance of patients with PDD. METHODS: A total of 146 consecutively admitted patients were evaluated for PDD. Patients who had PDD were compared with a sample of age- and sex-matched patients in day treatment who did not have PDD. Psychiatric symptoms, family history, and developmental and educational histories were examined. RESULTS: Of the 146 patients, 20 (14 percent) met criteria for PDD. An additional five patients who had PDD were included, yielding a final sample of 25. Only two of an array of psychiatric symptoms were more prevalent among patients with PDD: engaging in unusual fantasy and talking to themselves, animals, or inanimate objects. Significantly more patients with PDD had a history of speech delay, language abnormalities, and inexplicable or lengthy episodes of crying or screaming. The groups did not differ significantly in IQ or global functioning. Seven patients with PDD (28 percent) met criteria for childhood-onset schizophrenia, and 19 (76 percent) had symptoms of a tic disorder. CONCLUSIONS: The study found that PDD is not rare and that children with PDD represent a significant subgroup of children with serious emotional disturbance referred for psychiatric treatment. The findings support the view that PDD may be easily missed because it may be mild and associated with psychiatric disturbances that are present among other severely ill youngsters.

Adolescent↗
PubMed2004

A prevalence estimate of pervasive developmental disorder among immigrants to Israel and Israeli natives- a file review study.

BACKGROUND: The prevalence rates of pervasive developmental disorder (PDD) have risen in the West over the last 10 years. There is argument over the etiology of this change in rates. Social and cultural processes including migration have been hypothesized. Israel, as a country of ongoing immigration with a national registry of children diagnosed with PDD, offers an opportunity to compare rates of PDD among immigrants from developing countries and native Israelis. METHOD: A Social Security national registry of 1004 children diagnosed with PDD was reviewed and rates were calculated using data extracted from the Israel National Bureau of Statistics. Of all Jewish children that were born in the years 1983-1997 and who are currently living in Israel, we defined four groups: (1). native Israelis of non-Ethiopian extraction (N = 1198, 300), (2). native Israelis of Ethiopian extraction (N = 15600), (3). immigrants of non-Ethiopian extraction (N = 110300) and (4). children born in Ethiopia (N = 11800). A further breakdown of groups 1 and 3 by well-characterized ethnic or geographical origins was not possible. RESULTS: The rate of PDD was significantly elevated in native Israelis as compared to all immigrant children. Among immigrants, the rate of PDD in Ethiopian-born children was lower than that of those born in other countries. The rate of PDD in immigrant Ethiopian children was much lower than in native Israeli children of Ethiopian extraction. CONCLUSIONS: Birth in Israel, an industrialized country, is a marker for an environmental risk factor for PDD. This may indicate that gestation, birth or infancy in industrialized countries exposes children to environmental insults that increase the risk for contracting PDD.

Adolescent↗
PubMed1997

Mania in children with pervasive developmental disorder revisited.

OBJECTIVE: Although a small literature of case reports suggests that mania co-occurs with pervasive developmental disorder (PDD), little is known about this overlap. The authors systematically investigated the overlap between mania and PDD in a consecutive sample of referred youths, examining its prevalence and correlates. It was hypothesized that children with PDD plus manic features have both disorders. METHOD: Subjects were consecutively referred children meeting diagnostic criteria on structured interview for PDD without mania (n = 52), the comorbid condition PDD + mania (n = 14), and mania without PDD (n = 114). All subjects were evaluated using a comprehensive diagnostic battery that included assessment of psychopathology (structured diagnostic interview and Child Behavior Checklist), cognition, and functioning. RESULTS: Of the 727 referred children, 52 met criteria for PDD, 114 met criteria for mania, and 14 met criteria for both. The 14 children with both PDD + mania represented 21% of the PDD subjects and 11% of all manic subjects. Clinical characteristics of PDD were similar in PDD subjects with and without mania, and manic features were similar in manic children with and without PDD. CONCLUSIONS: Children with PDD and mania may suffer from two disorders. Comorbid mania among patients with PDD may be more common than previously thought. Identification of the comorbid condition may have important therapeutic and scientific implications.

Bipolar Disorder↗
PubMed2000

Pervasive developmental disorders: a 10-year review.

OBJECTIVE: To summarize recent advances about the nature, diagnosis, and treatment of pervasive developmental disorders. METHOD: Review of Medline databases, books, and book chapters published between July 1989 and November 1999. RESULTS: Clinical and genetic studies support expansion of the concept of autism to include a broader spectrum of social communication handicaps. The prevalence of autism is approximately 1 per 2,000; the prevalence of autism and Asperger's disorder together is 1 per 1,000. The Checklist for Autism in Toddlers is a useful screening instrument for 18-month-old children; the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule are instruments of choice for research. Although twin and family studies clearly support genetic factors as important in autism, linkage analysis studies indicate that many genes may be involved. There is no one treatment of choice. Social-pragmatic approaches, augmented by individualized strategies and social coaching, may be best for teaching social communication skills. Pharmacological interventions have a limited role in improving social communication, but selective serotonin reuptake inhibitors and atypical neuroleptic medications may help ameliorate aggression, hyperactivity, and other secondary problems. CONCLUSIONS: Private and government agencies must continue to support basic and applied research.

Autistic Disorder↗
PubMed2004

[Surgical management of developmental disorder of the hip in older children by double osteotomy of the pelvis].

Our results of surgery of developmental disorder of the hip (DDH) in older children and adolescents by using the combination of Selter's innominate osteotomy and osteotomy of the superior pubis ramus were presented in this paper, enclosing the period from 1993 to 1995. The study included 11 hips, i.e. 9 patients, aged 8 to 23 years, mean age 13 years at the time of surgery. The mean follow-up period was 8 years. Combined osteotomy was very efficient, what was verified by X-ray findings, confirming the Wieberg's and acetabular angles, as well as by clinical range of hip motion and gait. In comparison to other similar osteotomies, this method is simpler, less traumatic and carries lower risk.

Adolescent↗
PubMed2001

Advancing advanced mind-reading tests: empathic accuracy in adults with a pervasive developmental disorder.

Research using advanced but static mind-reading tests with high-functioning adults with a pervasive developmental disorder (PDD) provided evidence for subtle social cognitive deficits. In the present study, adults with PDD were unimpaired on such tasks, relative to individually matched normal controls. Significant differences between the two groups were, however, found on a more naturalistic empathic accuracy task developed for this study. Participants viewed two videotaped interactions that both depicted a male and female stranger having an initial conversation and were asked to infer the unexpressed thoughts and feelings of the four targets. Subjects with PDD performed significantly worse on the second video. These findings suggest that the mind-reading deficit of a subgroup of able adults with PDD may only be apparent when a sufficiently complex naturalistic assessment method is being used.

Adolescent↗
PubMed2003

[Pervasive developmental disorder: a model of early intervention centered on the family].

Early intervention with children suffering from a pervasive developmental disorder is widely recognized. However, models of services which integrate the many components are lacking. It is indeed important to support not only the child but also his family, to identify the needs at an early stage and to assess and diagnose very early on in order to respond rapidly. This article proposes a model of services divided in five phases: 1) early identification; 2) individualized family service plan; 3) preliminary assessment of the child; 4) detailed diagnostic evaluation and 5) intervention. The last two phases are concurrent while the five phases are elaborated as well as integrated within a dynamic model.

English Abstract↗
PubMed2004

A retrospective assessment of topiramate in children and adolescents with pervasive developmental disorders.

An open-label retrospective study was conducted to assess the effectiveness and tolerability of topiramate in children and adolescents with pervasive developmental disorders (PDD). Topiramate is a novel antiepileptic drug approved as an adjunctive treatment for seizure disorders. A retrospective chart review was conducted in an outpatient clinic specialized in treating individuals with developmental disabilities, to identify all children and adolescents with PDD who received topiramate. Patients were included if concomitant medications remained unchanged. Treatment response was assessed using the Global Improvement item of the Clinical Global Impressions scale (CGI-GI), based on a review of medical records and the Conners Parent Scale (CPS), as completed by parents. Fifteen patients were identified (12 male, 3 female; age = 14.7 +/- 3.3 years), including 11 patients with autistic disorder, 2 patients with Asperger's disorder, and 2 patients with PDD not otherwise specified (PDD, NOS). Eight patients (4 patients with autistic disorder, 2 patients with Asperger's disorder, and 2 patients with PDD, NOS) were judged to be responders, as defined by a score of 1 or 2 on the CGI-GI. Treatment duration was 25 +/- 16 weeks, and the mean dose was 235 +/- 88 mg. Differences between baseline and the end-of-trial period were observed in the following CPS subscales: conduct, hyperactivity, and inattention. No differences were noted in the psychosomatic, learning, and anxiety subscales. Three patients discontinued topiramate because of side effects, with 2 patients experiencing cognitive difficulties and 1 patient a skin rash. Topiramate may be beneficial for treating secondary symptoms of PDD, and prospective openlabel studies and double-blind, placebo-controlled studies to assess its efficacy and safety are needed.

Adolescent↗
PubMed1995

Empirically derived subtypes of pervasive developmental disorders: a cluster analytic study.

A cluster analytic study was conducted to empirically derive behaviorally homogeneous subtypes of pervasive developmental disorders (PDD). Subjects were clustered based on a broad range of behavioral symptoms which characterize autism. Behavioral variables were measured using several of the standardized psychometric instruments most commonly employed in assessing autistic individuals. The cluster solution indicated the presence of four distinct groups. Validity checks generally confirmed significant between-group differences on independent measures of social, language, and stereotyped behaviors. In addition, the four-group cluster solution was compared to previously developed typological systems of PDD (i.e., subcategories based on IQ early onset, styles of social interaction, and DSM-III-R diagnosis). Results generally supported both the behavioral homogeneity of the four subgroups and also several important between-group differences. The potential utility of using cluster analyses to explore subtypes of PDD is discussed.

Adolescent↗
PubMed2006

Sibling risk of pervasive developmental disorder estimated by means of an epidemiologic survey in Nagoya, Japan.

Broad-spectrum autism, referred to as pervasive developmental disorder (PDD), may be associated with genetic factors. We examined 241 siblings in 269 Japanese families with affected children. The sibling incidence of PDD was 10.0% whereas the prevalence of PDD in the general population in the same geographic region was 2.1%. Both of these rates are higher than those reported previously, probably because of the expanded clinical criteria applied. The prevalence in males of the general population was 3.3% and that in females was 0.82%. The sibling incidences were 7.7 and 20.0% for families in which the probands were male and female, respectively. Because the reversed sex ratios correspond to the general rule for a multifactorial threshold model, we suggest that most PDD cases result from the cumulative effects of multiple factors (mostly genetic). The sibling incidences were 0 and 10.9% for families in which the proband had low and normal birth-weight, respectively, suggesting the risk is lower in families with low-birth-weight probands.

Birth Order↗
PubMed2003

Face recognition in children with a pervasive developmental disorder not otherwise specified.

This study investigates the accuracy and speed of face recognition in children with a Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS; DSM-IV, American Psychiatric Association [APA], 1994). The study includes a clinical group of 26 nonretarded 7- to 10-year-old children with PDDNOS and a control group of 65 normally developing children of the same age. Two computerized reaction time tasks were administered: a face recognition task and a control task designed to measure the recognition of abstract visuospatial patterns. The latter were either easy or difficult to distinguish from a set of alternative patterns. The normally developing children recognized the faces much faster than the hardly distinguishable abstract patterns. The children in the PDDNOS group needed an amount of time to recognize the faces that almost equalled the time they needed to recognize the abstract patterns that were difficult to distinguish. The results suggest that, when processing faces, children with PDDNOS use a strategy that is more attention-demanding and, hence, less automatic or "Gestalt-like" than the one used by the control children. The results are discussed in the light of a theory that explains the development of coherent mental representations.

Attention↗
PubMed2004

A naturalistic retrospective analysis of psychostimulants in pervasive developmental disorders.

OBJECTIVE: We set out to examine the effectiveness and tolerability of psychostimulants in children and adolescents with pervasive developmental disorders (PDDs). METHODS: Medical records of all patients with PDDs treated with a stimulant were retrospectively reviewed. Demographics, stimulant type, drug dosage, trial duration, and adverse effects were recorded. Global improvement, focused on symptoms of hyperactivity and inattention, was measured by the Clinical Global Impressions-Improvement scale, with positive response defined by a rating of much improved or very much improved. RESULTS: Of 195 patients (174 males, 21 females; mean age +/- SD = 7.26 +/- 3.45 years, range 2-19 years), 61 had more than one trial, resulting in a total of 274 separate stimulant trials. It was discovered that 24.6%, 23.2%, and 11.1% of patients with a history of one, two, or three stimulant trials, respectively, responded to their first stimulant trial. Among first trial nonresponders, 6 (14.0%) of 43 patients responded to a second trial. Of those who did not respond to their first or second stimulant trial, 2 (14.3%) of 14 patients responded to a third trial. Patients with Asperger's disorder, in contrast to those with autistic disorder or PDD not otherwise specified, were significantly more likely to respond to a stimulant trial (p < 0.01). Use of concomitant medication (p < 0.007) positively affected response, whereas no association was found between stimulant type and IQ and response. Adverse effects, including agitation, dysphoria, and irritability, often occurred (154 [57.5%] of 268 trials, with 6 missing values). CONCLUSIONS: Overall, stimulants appeared ineffective and poorly tolerated for the majority of patients with PDDs. Response may differ with PDD subtype. Controlled studies are needed to further evaluate these preliminary findings in a systematic manner.

Adolescent↗
PubMed1988

Markers for improvement in children with pervasive developmental disorders.

In a series of prevalence and follow-up studies on North Dakota's 59 children with pervasive developmental disorders, the patient characteristics of hyperlexia, Tourette disorder (TD), and the absence of seizures were found to be associated with improved outcome or higher IQ. We entered these and 17 other characteristics into a regression model using forward, step-wise inclusion to identify the smallest set of predictor variables which were significantly associated with the dependent variables of IQ, and receptive and expressive language. Of the 20 predictor variables used in the regression analysis, the same four variables met inclusion criteria for each of the dependent variables. These predictor variables were: hyperlexia, a known aetiology, TD and age. The relevance of these findings is discussed.

Child Development Disorders, Pervasive↗
PubMed2005

Clinical variables at age 2 predictive of mental retardation at age 5 in children with pervasive developmental disorder.

This study attempted to find clinical variables evaluated at age 2 that would predict mental retardation (MR, IQ/cognition-adaptation developmental quotient [C-A DQ]<70) at age 5 in 57 children with pervasive developmental disorder (PDD). About two-thirds of subjects had MR at both initial and outcome evaluations. The C-A DQ at initial evaluation was significantly lower in mentally retarded PDD (MRPDD) than in high-functioning (IQ >or= 70) PDD (HFPDD). MRPDD changed less than HFPDD in IQ/C-A DQ between ages 2 and 5. The C-A DQ at age 2 was a potent predictor for MR at age 5 and the total score and three item scores of Childhood Autism Rating Scale-Tokyo Version evaluated at age 2 were also useful in predicting MR at age 5.

Autistic Disorder↗
PubMedDate not supplied

Axenfeld-Rieger syndrome. A spectrum of developmental disorders.

The clinical and histopathologic features of Axenfeld's anomaly and Rieger's anomaly and syndrome are reviewed, and recent findings regarding the pathogenesis of this spectrum of developmental disorders are discussed. Based on these observations, it has been suggested that a developmental arrest, in the third trimester of gestation, of tissues derived from the neural crest cells accounts for the ocular and most of the nonocular abnormalities in this group of disorders. Since previous collective terms, such as mesodermal dysgenesis and anterior chamber cleavage syndrome, are not consistent with these new observations, the alternative name, Axenfeld-Rieger syndrome, has been proposed. The differential diagnosis of the syndrome includes two additional spectra of disorders: the iridocorneal endothelial syndrome and the posterior polymorphous dystrophies. The most serious ocular problem in Axenfeld-Rieger syndrome is the associated glaucoma, which occurs in a high percentage of patients and is typically difficult to control. Recent observations regarding the mechanism of the glaucoma, as reviewed in this paper, provide guidance in the management of this aspect of Axenfeld-Rieger syndrome.

Abnormalities, Multiple↗