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Direct health care costs for children with pervasive developmental disorders: 1996-2002.

We compared direct costs of treatment of Pervasive Developmental Disorder (PDD), asthma, and diabetes in children aged 3-17 years. A retrospective, claims-based study was conducted using the California Medicaid (Medi-Cal) database (1996-2002). Seven hundred and thirty-one children with PDD were identified and matched for sex with an equal number of randomly selected children with asthma and diabetes. Mean total health care costs for PDD were two- to threefold higher than for asthma and diabetes post-diagnosis ($4,815 vs. $1,469 vs. $2,404, respectively, P < 0.0001). Children with PDD incur significantly greater health care costs when compared with children with other chronic pediatric diseases.

Adolescent↗

Efficacy of porcine secretin in children with autism and pervasive developmental disorder.

Secretin, a gastrointestinal (GI) hormone, was reported in a preliminary study to improve language and behavior in children with autism/pervasive developmental disorder (PDD) and chronic diarrhea. To determine the efficacy of secretin, we completed a double-blind, placebo-controlled, crossover (3 weeks) study in children with autism/PDD and various GI conditions using a single dose of intravenous porcine secretin. Children with chronic, active diarrhea showed a reduction in aberrant behaviors when treated with the secretin but not when treated with the placebo. Children with no GI problems are unaffected by either secretin or placebo. The improvement seen with secretin in children with autism/PDD and chronic diarrhea suggests that there may be a subtype of children with autism/PDD who respond to secretin.

Autistic Disorder↗

Pervasive developmental disorder, not otherwise specified: primary care perspectives.

Pervasive developmental disorder, not otherwise specified (PDD, NOS), a developmental-neurologic spectrum disorder, occurs in 10 to 12 of every 10,000 children. PDD, NOS is characterized by a spectrum of significant problems that may vary substantially in range and expression. These may include visual/spatial, kinesthetic, verbal/linguistic, and musical/rhythmic problems. Social skill deficits are also common, as are restricted, repetitive patterns of behavior, interests, and activities. Symptoms of PDD, NOS are often expressed differently among children with the disorder and can be mistakenly attributed to other problems such as attention deficits, oppositional behavior, or stress reactions. Clinicians may encounter children in their practice who exhibit symptoms of PDD, NOS and must be familiar with this disorder so that appropriate diagnosis and treatment can be provided. Families also need ongoing, anticipatory guidance to help them cope with the behavioral aspects of the disorder.

Child Behavior↗

Childhood disintegrative disorder. Re-examination of the current concept.

Childhood disintegrative disorder (CDD), which is classified as a sub-type of pervasive developmental disorder (PDD), has been recognised for many years. Research data on CDD, however, is sparse and it primarily describes the clinical parameters. In this research report clinical data on 12 cases of CDD and 21 cases of typical autism, seen during a specified period, are compared and critically evaluated in reference to the diagnostic criteria in ICD-10 for these disorders. While the findings support the clinical validity of CDD, these also highlight the limitations of the current criteria (ICD-10) particularly the age of onset in CDD and the conceptual confusion in labelling it as a 'PDD'. Need for more research in the areas of the biology, course and outcome of CDD is emphasised.

Adolescent↗

The effect of selection criteria on outcome studies of children with pervasive developmental disorders (PDD).

The objective of this paper is to see whether regression to the mean biases the differences on outcome observed between children with Asperger syndrome and autism. Children with pervasive developmental disorders (PDD) and normal nonverbal IQ were divided into those with Asperger syndrome and autism. It was hypothesized that IQ in the autistic children would fall at the 2-year outcome assessments since the autistic group represented a subgroup selected on the basis of extreme scores on a single measure. In fact, the Asperger syndrome group experienced a significant drop in nonverbal IQ contrary to expectation. Serial measurements of nonverbal IQ at inception indicated that this drop was probably a function of high initial nonverbal IQ scores that fall over time due to increasing complexity of problem-solving tests. The results are discussed in relation to outcome studies of high functioning children with PDD.

Autistic Disorder↗

A comparison of behavioral and emotional functioning in children and adolescents with Autistic Disorder and PDD-NOS.

Behavioral symptomatology was compared in 26 children and adolescents with Autistic Disorder ("autism") and 25 children and adolescents with Pervasive Developmental Disorder, Not Otherwise Specified ("PDD-NOS"). Relative to individuals with PDD-NOS, those with autism had more symptoms of depression, social withdrawal, atypical behavior, and immature social skills--and fewer family problems. These differences remained even when group differences in intellectual ability were statistically controlled. No group differences emerged in somatization, anxiety, or hyperactivity. Findings suggest that although both groups demonstrate considerable evidence of behavioral and emotional problems, those with autism are at particularly high risk for comorbid behavioral and emotional disabilities.

Adaptation, Psychological↗

Autism and epilepsy: cause, consequence, comorbidity, or coincidence?

Autism is associated with epilepsy in early childhood, with evidence suggesting that individuals with both autism and more severe cognitive impairment are at higher risk. However, the incidence of an abnormal electroencephalogram and/or epilepsy in the full range of pervasive developmental disorders (PDDs) is not well defined. This naturalistic study addresses the incidence of epilepsy and electroencephalographic abnormalities in children with PDDs. The clinical history and electroencephalograms of 56 children diagnosed with PDD-not otherwise specified, autism, or Asperger syndrome were retrospectively reviewed. Forty percent of children with autism were diagnosed with epilepsy. Abnormal electroencephalograms and epilepsy occurred at significantly higher rates in children in the more impaired range of the autism spectrum (P<0.05). These findings suggest that the use of neurological investigative techniques such as electroencephalography should be a consequence of careful clinical evaluation and should be considered routinely during evaluation of more impaired individuals.

Adolescent↗

The yield of the medical evaluation of children with pervasive developmental disorders.

Little information is available regarding the yield of the medical evaluation of children diagnosed with pervasive developmental disorder-not otherwise specified (PDD-NOS) compared to children diagnosed with autistic disorder. Medical records were reviewed for 182 patients less than 18 years of age with either PDD-NOS or autistic disorder evaluated between 1994 and 1998 at Mayo Clinic. A condition likely to be etiologically relevant was identified in 6/117 (5.1%) patients diagnosed with PDD-NOS and 2/65 (3.1%) patients diagnosed with autistic disorder. Genetic disorders, both chromosomal and single-gene, were the most commonly identified conditions. Seizure disorders, electroencephalogram abnormalities, and anomalies on brain imaging were common in both groups. The likelihood of uncovering an etiologically relevant condition in children diagnosed with either PDD-NOS or autistic disorder may be equivalent. The scope of the etiological search in an individual patient with an autistic spectrum disorder should not be limited by the specific diagnostic category.

Adolescent↗

Social gaze, social avoidance, and repetitive behavior in fragile X males: a controlled study.

Preference for social gaze as well as the percentage occurrence of social gaze, nonverbal social avoidance, and nonverbal repetitive behaviors were examined in autistic and nonautistic prepubertal males with the fragile X syndrome (fra[X]) during social interaction with a parent or stranger. Comparison groups were nonhandicapped, Down syndrome, atypical pervasive developmental disorder, and autistic males. The subjects with fra(X) and the nonhandicapped and Down syndrome control subjects discriminated parent from stranger as evidenced by their avoidance behavior. The overall percentage of avoidance was higher, however, for both parent and stranger, among the males with fra(X). Autistic and atypical groups without fra(X) failed to discriminate parent from stranger in their avoidance behavior. Possible explanations for these group differences in terms of language level or degree of language demand were ruled out. Implications for research concerning the relations among fra(X), autism, and mental retardation were discussed.

Autistic Disorder↗

Communication profiles of individuals with Down's syndrome, Angelman syndrome and pervasive developmental disorder.

The communication profiles of individuals with Down's syndrome (DS), Angelman syndrome (AS) and pervasive developmental disorder (PDD) were investigated and contrasted. Seventy-seven individuals participated in the study. A within-group analysis revealed that those with DS performed better on tacting or labelling and echoing than on manding or requesting. No other effects were found, apart from an absence of echoing in those with AS, a result that is hardly surprising. A between-groups analysis revealed no differences between the aetiological groups in terms of their use of mands or requests and tacts. Individuals with DS and PDD did not differ in their scores on echoic functioning. The implications of these findings for the study of behavioural phenotypes and for communication intervention are discussed.

Adolescent↗

[Sixty years of autism].

The concept of autism has been broadened the last few years from 'early infantile autism' to 'an autistic spectrum'. Autism and related contact disorders are grouped together under 'pervasive developmental disorders' or 'autistic spectrum disorders'. The autistic disorder, Asperger's syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), Rett's disorder and the childhood disintegrative disorder all belong to this group. People with an autistic spectrum disorder have severe difficulties in the integration of perceived stimuli into a meaningful entity. More than two-thirds of the people with the autistic disorder (classical autism) are also mentally retarded. Although autism can still only be diagnosed at the behavioural level, there is considerable consensus regarding an underlying organic aetiology. Autism is clearly a multifactorial condition. Autism cannot be cured, but adequate intervention can significantly improve the quality of life of people with this disorder. Diagnosis and intervention are highly interrelated. In the intervention, a distinction is made between family-oriented and child-oriented strategies. Augmentative communication plays a key role in the treatment. People with autism need a lot of structure, clarity and predictability, also when they have become adults.

Adolescent↗

[Classification systems for the clinical approach to pervasive developmental disorders].

This paper compares four systems for the classification of pervasive developmental disorders: DSM-III-R, ICD-10, the French classification of mental disorders in children and adolescents and Manzano and Palacio-Espasa's operational classification. Five children were examined according to a protocol which included clinical and instrumental examination, the BSE scale, a development scale and a psychodynamic observation recorded by video camera. A detailed discussion of the diagnosis of one of the cases is reported as an example, while a synthetic description is given of the other four. The comparison highlights the characteristics of the four systems considered. The differing theoretical premises which inspire them mean that it is important to use all four in the clinical investigation of each case: DSM-III-R and ICD-10 can be used for the initial screening, whilst the other two can be used to classify more specifically all the forms of infantile psychosis.

Autistic Disorder↗

Social behaviour in pervasive developmental disorders: effects of informant, group and "theory-of-mind".

Theory of mind skills and a range of social behaviour in everyday life were assessed in a sample of 21 children with pervasive developmental disorders and 22 normally-developing preschoolers. Parents, teachers and therapists were interviewed using the Vineland Adaptive Behaviour Scales and a new supplementary scale, the "Echelle d'Adaptation Sociale pour Enfants" (EASE). Teachers and therapists were able to differentiate subtle forms of social problems in everyday life between subgroups of children diagnosed later to have either autism (n = 13) or PDDNOS (n = 8), according to DSM-III-R (1) criteria. This study offers a (small) cross-cultural replication of recent work suggesting that differences in the mentalising skills of children with autism are reflected in the everyday social behaviour of this group. A significant effect of informant was found for the PDD group, and this effect was particularly pronounced when children with autism were considered separately. The implications of informant differences are discussed.

Activities of Daily Living↗

The broad autism phenotype: findings from an epidemiological survey.

This study aimed to determine if relatives of children with autism and less severe pervasive developmental disorders (PDDs) have higher rates of various components of the broad autistic phenotype. Psychiatric and medical disorders were investigated. Parents of children with PDDs were selected from an epidemiological survey and compared with parents of control children with non-autistic developmental problems. Rates of abnormalities and disorders were compared in relatives of 79 cases and 61 controls. Medical and autoimmune disorders in both groups were endorsed by few relatives. Specific developmental disorders were commoner in parents of controls. Depression and anxiety were significantly more prevalent in mothers of children with PDDs. Significantly more PDD children had at least one first-degree relative with anxiety and one second-degree relative with OCD. PDDs were commoner in first-degree relatives. The implications of the findings for the definition of the broad phenotype of autism are discussed.

Adult↗

Autism and pervasive developmental disorders.

The quantity and quality of research into autism and related conditions have increased dramatically in recent years. Consequently we selectively review key accomplishments and highlight directions for future research. More consistent approaches to diagnosis and more rigorous assessment methods have significantly advanced research, although the boundaries of the 'broader phenotype' remain to be defined and the validity of Asperger's disorder as a discrete syndrome remains controversial. Recent epidemiological studies have shown that Autism Spectrum Disorders are common, but there continues to be debate about the causes of the increase in the frequency with which autism is diagnosed. Psychological research has helped to develop new developmental models for the disorder and there have also been significant advances in the molecular genetics of autism and understanding of the underlying neurobiological processes. Areas important for future research include the study of autism as it first develops, i.e., in infants and very young children, and of specific processes (psychological and neurobiological) which underlie the disorder. Significant challenges lie ahead in evaluating the growing number of treatments for autism and in integrating the results of research into treatment and educational settings.

Autistic Disorder↗

Diagnostic rules for children with PDD-NOS and multiple complex developmental disorder.

This study was designed to examine the classification performance of diagnostic rules for pervasive developmental disorder not otherwise specified (PDD-NOS) and multiple complex developmental disorder (McDD), with clinical diagnosis as the gold standard. McDD is an heuristic concept of a developmental disorder characterised by social impairments, affective dysregulation, and thought disturbance. Detailed information on the symptoms, reliably extracted from the charts of 103 children with PDD-NOS and McDD, 32 with autistic disorder, and 96 with non-PDD disorders, was used to determine the presence of the DSM-IV criteria of autistic disorder and the criteria of McDD. A scoring rule for PDD-NOS based on a short set of seven DSM-IV criteria with a cut-off point of three items and one social interaction item set as mandatory had the best balance between high sensitivity and high specificity. The most effective and simple rule based on McDD criteria had a cut-off of three items, out of six items of anxieties and thought disturbance.

Child↗

Study of the onset of autism through home movies.

The authors describe the natural history and the beginning of pervasive developmental disorders (PDD) by the observation of home movies. The sample is composed of 26 children aged 18 months to 5 or 6 years at the first consultation. The methodology used in the observation of home movies includes: (1) application of the ERC-A-III scale for recognizing the precocious symptoms of autism; (2) analysis of the coming out and coming off of social, emotional and cognitive competences. The authors, starting from the analysis of these data, describe three kinds of onset and courses of PDD: progressive, regressive and fluctuating. The authors present some conclusive considerations on the different age of PDD onset in home movies, in anamnestic reconstruction and in recall for diagnosis.

Autistic Disorder↗

Parents and collateral relatives of children with pervasive developmental disorders: a family history study.

The objective of this study was to see whether, using the family history method, the risk for pervasive developmental disorder (PDD), cognitive impairments, and other psychiatric symptoms is greater in the parents and collateral relatives of probands with PDD compared to a control group. A semistructured family history interview was carried out with the parents of 52 probands with PDD and 33 parents of controls. Rates of cognitive impairments and psychiatric problems were not found more frequently in parents or relatives of PDD probands compared to relatives of controls, but four cases of PDD were reported among the extended families of the PDD probands. The relatives with PDD were related to the probands through the maternal line, possibly suggesting some form of maternal influence on inheritance or reduced penetrance in females with the PDD genotype.

Adolescent↗