This is an informative chapter about pervasive developmental disorders (Autistic Disorder, Asberger's Disorder, Childhood, Disintegrative Disorder, Rett's Disorder). None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.

Pervasive Developmental Disorders

All aspects of development are disrupted in pervasive developmental disorders.

Autistic Disorder

The word autism means; self-centered, withdrawn from reality.

Divided into early infantile autism and childhood autism.

The autistic disorder involves extreme problems with social interaction, a greatly reduced ability to communicate, restricted, repetitive, and stereotyped behavior, a very limited range of interests and activities. They live in their own little world.

Autistic Disorder Symptoms

Three symptoms,
At least one before the age of 3.

1. Impairments in social interactions.
2. Impairments in communication.
3. Restricted, repetitive, and stereotyped behavior.

• The absence of language is an important factor in determining the prognosis.
• If the child does not have language skills by the age of 5, there is a 75% probability that this child will never make an adequate social adjustment.
• The symptoms appear very early: At birth
• Comorbidity with mental retardation: At least %80 show mild mental retardation (IQ:35-50).
• Some has less severe symptoms: High-functioning individuals with autism.
• Some may show extraordinary abilities in one particular area like music (Savant Syndrome).

Autistic Disorder: Epidemiology

• Relatively rare: 2-5 in 10 000 children.
• 4 times more prevalent in boys than in girls.
• A greater awareness and a greater willingness to use the diagnosis.
• A serious, chronic disorder.
• No relation to social class.

Autistic Disorder: Explanations

It is an unsolved mysteries of abnormal psychology.

• First identified 60 years ago.
• There are many erroneous explanations.

Psychodynamic Explanations;

• The role of parent's personalities and their style's of child-rearing.
• Parents were: cold, formal, humorless, detached, highly rational, objective
• Parents: “mechanical”: No interpersonal warmth and nurturing.
  As a result, the child turned inward for comfort and stimulation.

Learning Theories;

• Autistic behaviors are thought by parents who reward the wrong behaviors.
• Behaviors such as head banging, uncooperativeness, tantrums and mutism are followed by rewards such as attention, food, and toys (to distract the child), but, these don't reduce the abnormal behavior, instead increase and strengthen them.
• If autistic symptoms were learned, they could be extinguished and normal behaviors could be learned. However, no reversal autism.

Physiological Explanations;

Due to brain development not completely understood.
In new approach: Specific problems linked to specific symptoms.

• Dominance of the right temporal lobe increased the size of the amygdala and the basal ganglia. Process faces as objects.

• Dominance of the right temporal lobe over the left temporal lobe is related to language-communication symptoms (left temporal lobe plays a role in language).

• Increased size of the amygdala is related to temper and head banging (amygdala plays a role in rage and aggression).

• Increased size of the basal ganglia is related to abnormal motor behaviors and compulsion(basal ganglia plays a role in motor behavior).

• Process faces as objects: when they look at a face the area of the brain that usually processes objects becomes active rather than the area that processes faces.(uninterested in people and respond them as objects)

What causes these brain development problems?

Genetics problems during prenatal development.

*Increased rate in siblings.
"Normal" siblings suffer from cognitive impairments (delayed speech development and reduced verbal abilities)
Delayed speech in 25% of the siblings

*Identical-nonidentical twins.
%36 of identical twin pairs suffer whereas none of the non-identical twins did both suffer.

*Fragile x syndrome
Can lead to mental retardation similar to autism.
In boys (XY)
In girls (XX)

Genetic factors are important but they don't account for all cases.

*Drugs and illness in the early prenatal period (some soft physical anomalies).
*Bleeding, infections, poisoning, physical trauma especially in the first trimester.
*Rare diseases affecting brain development.

• Different factors influence different parts of the brain. This explains why individuals with autism show different patterns of symptoms.
• Different causes or timing of causes can lead to differences in symptom patterns and severity.

Autistic Disorder: Treatments

Behavior Therapy:

Behavior modification procedures: Rewarding for appropriate behaviors punishment for inappropriate or self-destructive behaviors.
Good results but; the treatment effects did not last and did not generalize to other situations (when the treatment was stopped the old inappropriate behaviors turned).

Drug Therapy:

Numerous drugs, but does not reduce core symptoms.

Asberger's Disorder

Similar to autism, except for impairments in communication and mental retardation.
*Impairments in social interaction.
*Restricted, repetitive, and stereotyped behaviors.
*General clumsiness.

Limit their intense interest in selected topics “little professors”.

Childhood Disintegrative Disorder

Normal development for at least 2 years. However, between the age of 2-10 a rapid disintegration.

A dramatic decline in;
*The growth of the head.
*Language abilities.
*Social skills.
*Bladder and bowel control.
*Motor skills.

Rett's Disorder

Symptoms same as childhood disintegrative disorder but the decline in functioning begins by 5 months.

It occurs almost exclusively in girls.

Case Work

Echo and Puzzles:

Richard, age 3.5, a firstborn child, was referred at the request of his parents because of his uneven development and abnormal behavior.

Delivery had been difficult, and he had needed oxygen at birth.

His physical appearance, motor development, and self-help skills were all age appropriate, but his parents had been uneasy about him from the first few months of life because of his lack of response to social contact and the usual baby games.

Richard appeared to be self-sufficient and aloof from others. He did not greet his mother in the mornings, or his father when he returned from work, though, if left with a babysitter, he tended to scream much of the time.

He had no interest in other children and ignored his younger brother. His babbling had no conversational intonation. At age 3, he could understand simple practical instructions.

His speech consisted of echoing some words and phrases he had heard in the past, with the original speaker's accent and intonation; he could use one or two such phrases to indicate his simple needs. For example, if he said, "Do you want a drink?" he meant he was thirsty. He did not communicate with a facial expression or use gesture or mime, except for pulling someone along and placing his or her hand on an object he wanted.

He was fascinated by bright lights, spinning objects and would stare at them while laughing, flapping his hands, and dancing on tiptoe. He also displayed the same movements while listening to music, which he had liked from infancy. He was intensely attached to a miniature car, which he held in his hand, day and night, but he never played imaginatively with this or any other toy.

He could assemble jigsaw puzzles rapidly (with one hand because of the car held in the other), whether the picture side was exposed or hidden. From age 2, he had collected kitchen utensils and arranged them in repetitive patterns all over the floors of the house.

These pursuits, together with occasional periods of aimless running around, constituted his whole repertoire of spontaneous activities.

The major management problem was Richard's intense resistance to any attempt to change or extend his interests.

Removing his toy car, disturbing his puzzles or patterns, even retrieving, for example, an egg whisk or a spoon for its legitimate use in cooking, or trying to make him look at a picture book precipitated temper tantrums that could last an hour or more, with screaming, kicking, and the biting of himself or others.

These tantrums could be cut short by restoring the status quo. Otherwise, playing his favorite music or a long car ride was sometimes effective.

His parents had wondered if Richard might be deaf, but his love of music, his accurate echoing, and his sensitivity to some very soft sounds, such as those made by unwrapping a chocolate in the next room, convinced them that this was not the cause of his abnormal behavior.

Psychological testing gave him a mental age of 3 years in non-language-dependent skills (fitting and assembly tasks), but only 18 months in language comprehension.

Richard demonstrates marked impairment in reciprocal social interaction and in verbal and nonverbal communication and a markedly restricted repertoire of activities, all beginning in the first few months of life.

He doesn`t seem interested in other children and never wants to play "baby games" with his parents.

His speech is limited and peculiar (echoing words, and phrases of others), and his play is abnormal in that he never engages in imaginative play.

His interests are markedly restricted and stereotyped (doing puzzles and making patterns with kitchen utensils), and has stereotyped motor mannerisms(flapping of his hands).

These behaviors, beginning prior to age 3, are the characteristic signs of the Pervasive Developmental Disorder, Autistic Disorder.

Table of Contents

1.Introduction and Historical Issues
Normality and Abnormality in Clinical Psychopathology
2.Diagnostic Systems and Techniques
Interviews, Observations and Tests
3.Anxiety Disorders I
Symptoms of Anxiety, Phobic Disorders, Generalized Anxiety Disorders, Panic Disorder
4.Anxiety Disorders II
Obsessive-Compulsive Disorders, Post-Traumatic and Acute Stress Disorders.
5.Mood Disorders I
Major Depressive Disorder and Dysthymia.
6.Mood Disorders II
Bipolar Disorder and Cyclothymic Disorder.
7.Schizophrenia I
Symptoms and Issues.
8.Schizophrenia II
Explanations and Treatments.
9.Disruptive Behavior Disorders-I
Attention Deficit/Hyperactivity Disorder.
10.Disruptive Behavior Disorders-II
Conduct Disorder and Oppositional Defiant Disorder.
11.Pervasive Development Disorders
Autistic Disorder, Asberger`s and other Developmental Disorders.
12.Elimination Disorders and Tic Disorder.
13.Mental Retardation.
14.Cognitive Disorders
Amnesia Disorders, Dementia Disorders, Delirium Disorders.
15.Suicide.
16.Substance-related disorders.
17.Sexual Dysfunctions.