Autism Spectrum / Pervasive Developmental Disorders (PDD):

Answers for Parents and Teachers

PDD is characterized by three distinct features. Children with Autism experience communication difficulties; social-emotional impairments; and restricted, repetitive, and stereotyped patterns of behavior. Verbal and nonverbal communication are affected. Some children talk later than same-age peers and refer to themselves by name instead of "I" or "me." Others may never learn to talk. Some children have trouble participating in conversation, sharing emotions, and understanding feelings. They may talk about a narrow range of preferred topics, with little awareness of others' interests. Some children have trouble playing with peers and prefer to be alone. Unusual patterns of behavior concerning objects and routines may be observed. Stereotyped behaviors include playing with toys or objects in repetitive and/or unusual ways, having specific and inflexible ways of arranging items, repeating words or actions, and obsessively following routines or schedules. Some children flap their hands/arms, engage in repetitive movements (rocking or twirling), develop unusual sensory interests, have difficulty processing sensory input, or engage in self-injurious behavior (head-banging).

Autism occurs across all racial, ethnic, and social groups. The best estimate of the prevalence of Autism in the United States is between 3 to 6 children per 1,000 (1 in 150). While the prevalence of Autism is clearly rising, the reasons why are less certain. Some of the increase is likely related to greater awareness in the primary care system. Since the greatest increase in new cases involve those with milder symptoms, it is likely that the threshold for a formal diagnosis has shifted as well.

There are three subgroups of children who are considered at higher-than-normal risk for Autism. Males are 4 times more likely to be affected than females. Among families that have 1 child with Autism, the likelihood of a second diagnosis among siblings is 5%, a much higher figure than in the general population. About 5% of individuals with Autism have co-occurring neurodevelopmental disorders. Some of these disorders include:

• Epilepsy or Seizure Disorder
• Tuberous Sclerosis
• Fragile X Syndrome
• Intellectual Disability

Causes of Autism (PDD)

Parents and caregivers are usually the first to notice signs of Autism. Some behavioral symptoms are observable by 18 months of age. As early as infancy, a baby with Autism may be unresponsive to caregivers or focus intently on one item for long periods of time. Other symptoms include failure to respond to one's name, avoidance of eye contact, joint attention problems, and underdeveloped pretend play and imitation. Children with Autism have difficulty interpreting what others are thinking or feeling because they do not detect social cues (tone of voice, facial expressions) in the intuitive manner that most children do. Children with Autism do not spend as much time watching people's faces for feedback about behavior. This may look like a lack of empathy. Children with Autism may engage in repetitive movements or self-injurious behavior. Research indicates that a subgroup of children experience a regression in skills. They may stop using already developed language, play, or social skills. Your child's healthcare provider may refer your child for evaluation if you report any of the following behaviors:

• Epilepsy or Seizure Disorder
• Child does not babble or coo by 12 months of age
• Child does not point by 12 months of age
• Child does not say single words on his/her own by 16 months of age
• Child does not say two-word phrases on his/her own by 24 months of age
• Child does not respond to their name
• Child demonstrates poor eye contact
• Child does not smile or show social responsiveness
• Child lines up toys or objects excessively
• Child experiences a loss of language or social skills at any age

• Impaired ability to make friends
• Absence or impairment of imaginative and social play
• Restricted patterns of interest that are abnormal in intensity and focus
• Preoccupation with certain objects or subjects
• Child has odd movement patterns
• Child has unusual reactions to the way things smell, taste, look, feel, or sound

What to do if you think your child may have a Pervasive Developmental Delay / Autism?

Speak to your child's healthcare provider if you have concerns about your child's development. Your healthcare provider will note concerns, ask questions, and determine a plan of action. Healthcare providers will ask questions related to normal development to measure your child's progress. They may ask you to complete a questionnaire about your child to get specific information about symptoms. Your child's healthcare provider may recommend that your child undergo a comprehensive developmental evaluation.

Treatment of Autism

While there is no universal cure for Autism, some children make so much progress that their symptoms are significantly less obvious, and less impairing, as they get older. Early diagnosis and early intervention often leads to the greatest functional gains. Colorado sponsors early intervention programs for children from birth to age 3 and children with an Autism diagnosis typically qualify for these services. Early intervention programs may include behavioral training, early developmental education, communication therapy, occupational and physical therapy, and structured social play. The sooner a child begins to receive therapy, the more opportunity for learning. No matter when an individual is diagnosed with Autism, it is never too late to benefit from treatment. This applies to children of all ages and ability levels. Some of the evidenced-based treatments for children diagnosed with Autism are listed below:

• Applied Behavior Analysis (ABA) involves using systematic instructional methods to change behavior in measurable ways, with the intent of increasing acceptable behaviors, decreasing problematic behaviors, and teaching new skills.

• Behavior therapy involves parents working with behavior specialists to identify underlying causes of behavior, skills that the child needs to learn to replace the problem behavior, strategies to assist the child in developing skills, and ways to respond when problem behaviors occur. This process begins with a Functional Behavior Assessment (FBA).

• Speech/Language therapy helps individuals with Autism improve their ability to communicate and interact with others effectively. Therapists may teach nonverbal modes of communication and focus on social/pragmatic communication goals as well. This can also help children improve spoken fluency (rate and rhythm of speech).

• Occupational therapy helps children with Autism access the right accommodations at home and school. This may include finding a specially designed computer, mouse or keyboard to ease communication. Therapists also design exercises to help children better tolerate sensory input, develop motor control, and improve posture and balance.

There is no medication that can cure Autism or the associated symptoms. In many cases; however, medication can effectively treat symptoms associated with Autism. Medications used to treat Autism may include:

• Selective Serotonin Re-Uptake Inhibitors (SSRIs). These are a group of antidepressants that treat symptoms such as obsessive-compulsive behaviors and anxiety. SSRI’s may reduce the frequency and intensity of repetitive behaviors; decrease irritability, tantrums, and aggressive behavior; and improve eye contact.

• Tricyclics are a type of antidepressant also used to treat depression and obsessive-compulsive behaviors. Although these drugs tend to cause more side effects than SSRIs, they are also more effective for certain individuals.

• Psychoactive or anti-Psychotic medication is the most widely studied treatment for Autism. This class of medication decreases severe stereotyped behaviors and aggression for some children.

• Stimulants may be used to increase focus and decrease hyperactivity in individuals with Autism.

NeuroDevelopment Center of Colorado in Fort Collins helps hundreds of children each year from across Colorado and surrounding states. It would be our privilege to help your child also. Find out why parents, teachers and pediatricians rely on NeuroDevelopment Center of Colorado. Call 970.282.4428 for an appointment with one of our doctors.