Clinical Reference Systems: Pediatric Advisor 10.0
Autism and Pervasive Developmental Disorder
What is autism?
Children that have difficulty with social skills, language,
and behavior are said to have a pervasive developmental
disorder (PDD). Most children with problems in development
have only one or two areas of disability. Children with
PDD, however, have problems in many areas, such as social
interaction, communication, and imagination. Thus, the term
"pervasive" was chosen to describe this disorder.
Autistic disorder, or autism, is a type of PDD. Specific
criteria must be met for a child to be diagnosed with
autistic disorder. Even though all children with autism
meet all the criteria, they may have different behaviors and
abilities because of their age and how severe their symptoms
Children who have problems in areas of development like
those listed above, but who do not have autistic disorder
are diagnosed with PDD-NOS (Not Otherwise Specified).
What are the symptoms?
Children with autistic disorder may appear normal for the
first few months of life. Your child may then become more
and more unresponsive to you or other stimuli. Your child
may begin having a number of symptoms in the following
- Social skills
- Resists being cuddled; may scream to be put down when
- Remains withdrawn from parents and others and fails
to form relationships.
- Avoids eye-to-eye contact.
- Prefers to play alone.
- Is indifferent to the feelings of others and to
- Use of language and imagination
- Speaks later than other children of the same age.
- Cannot understand or copy speech or gestures.
- Rate, pitch, tone, or rhythm of speech is abnormal.
- Unable to start a conversation or keep one going.
- Unable to engage in fantasy or imaginative play such
as role playing and storytelling.
- Responds inappropriately to sounds.
- Acquired speech is immature and unimaginative. He or
she makes up words and echoes what someone says.
- Behavior, activities, and interests
- Develops habit behavior and compulsive routines.
- Greatly resists even the slightest change; becomes
enraged if his or her obsessive routine is altered or
activities are disrupted.
- Obsessed with one topic or idea; may become attached
to unusual objects.
- Walks on tiptoe and/or flicks or twiddles fingers for
- Bangs head, rocks, or stares.
- Has sudden screaming spells.
- Injures himself on purpose.
- Has trouble learning manual tasks.
No child with autism will have all of the above symptoms
nor is this a list of all the symptoms.
What is the cause?
Many years ago, doctors believed that an abnormal
relationship between the infant and his or her parents
caused autism. Doctors know now that parents are not
responsible for this condition.
Autism is a type of brain dysfunction. The nature of the
dysfunction and what part of the brain is affected are not
known. Many scientists are trying to discover the cause.
Autistic disorder has been found in children with brain
abnormalities such as congenital rubella syndrome,
neurofibromatosis, and tuberous sclerosis. Autism can also
be present with genetic syndromes such as fragile X syndrome
and phenylketonuria (PKU).
Your child's doctor will probably perform lab tests to
rule out these and other medical problems associated with
PDD's. However, most children with autism are found to have
normal health and no medical reason for the symptoms.
What is the treatment?
The treatment of autistic children focuses on educational
and behavioral therapies. Even very young children can
benefit from language therapy and behavior modification
programs designed for children with social and communication
problems. Special teachers and classrooms can help older
children improve their academic level and behavior.
Medical treatment centers around medication. Sometimes
mood- or behavior-altering drugs can control behaviors that
may cause self-injury or greatly interfere with school or
social ability. These medicines must be prescribed by a
doctor experienced with their use in children with autism.
No medication has been found, however, that will eliminate
the symptoms of autism.
Parents of children with autistic disorder or PDD-NOS
often become aware of new or alternative treatments through
friends or the media. Your doctor can help you decide if
these treatments could help or harm your child.
What can we expect in the future?
The great variety in type and number of symptoms in autistic
children makes this a difficult question to answer. Most
experts agree that the more socially distant a child is the
less likely he or she will be able to live independently as
an adult. This is not to say, however, that a child who is
socially removed at age 2 will display the same degree of
social handicap 20 years later.
Another factor used to predict whether the child will be
self-sufficient as an adult is intelligence. Most autistic
children score in the retarded range on IQ tests. However,
when these same children are given tests that measure
visual-spatial and memory skills, many score much higher.
These skills may help an autistic child be self-sufficient
as an adult.
Temperament is also important in predicting whether a child
will live independently as an adult. Autistic people who
are calm and submissive will be more able to adapt to new
rules and situations than those who are not.
In summary, it is impossible to make precise, long-range
predictions for individual autistic children. It is likely
that all children who display the full autistic disorder
will need special education. Some of these children will be
mainstreamed to some degree, especially in the higher
grades. Successful independent living as an adult mostly
depends on how well they develop their social skills and
what degree of mental retardation is present.
Where can my family get help and support?
When parents hear that their child has autistic disorder or
PDD-NOS, they may feel fear, anger, guilt, and other
difficult emotions. Many families find that having
professional guidance with these feelings helps them to cope
with this traumatic news.
Children with autistic disorder or PDD-NOS create great
stress on the entire family. When families were asked which
areas of their lives were most altered by their autistic
child, they listed, in order of significance, recreation and
finances. Troubled marital relationships were also made
worse by this additional stress. In addition, an autistic
child creates stress for his or her siblings.
Therefore, parents will want to consult local support groups
composed of families who have children with similar
difficulties. These groups can help by sharing their common
concerns and solutions to problems. Parents can locate
these services through their doctor, schools, therapy
programs, and local and national support organizations.
For More Information:
Write or call:
Autism Society of America
8601 Georgia Avenue, Suite 503
Silver Spring, Maryland 20910
Autism: Book List