The Nature of Pervasive Developmental Disorder

Dr. Sam Goldstein

Pervasive Developmental Disorders have become a topic of significant interest for researchers, medical and mental health professionals, as well as the general public. Under the term “Autism,” the last six months have witnessed lead articles in Time, Newsweek, and the New York Times, as well as multiple radio and television stories on this subject. While we know that by far, the majority of children with Pervasive Developmental Disorder experience significant impairments in general intellect and overall development, the media has been most interested in the small group of perhaps fifteen to twenty percent of children with Pervasive Developmental Disorders falling within the normal or better intellectual range. Because of this, I have found that many parents coming into the clinic now believe that individuals with Autism, by nature, possess above average intellect. In this month’s article, I will provide a brief overview of Pervasive Developmental Disorder and reinforce the hypothesis that the true nature of this condition lies in the impairment in developing appropriate and gratifying social relations.

The Pervasive Developmental Disorders comprise a group of conditions with a basic underlying theme of impairment in interaction with others. Autism is a type of Pervasive Developmental Disorder. Asperger’s and Pervasive Developmental Disorder – Not Otherwise Specified, though considered “non-autistic PDD’s” are significantly more alike than dissimilar. Children with these conditions fail to develop effective pragmatic or social language. They appear more interested in objects than people. They may have odd interests or atypical patterns of behavior. In the group of children I am following with this condition, a significant percentage meet criteria for the Inattentive Type of ADHD. In fact, I’ve just completed a research study demonstrating that children with PDD and ADHD experience significantly more impairment than those with PDD alone. Although the diagnostic protocol continues to indicate that when PDD is diagnosed, ADHD should not be diagnosed, the significantly greater impairment these children demonstrate suggests that when both conditions are present, they should be diagnosed and treated. The risk of mood and anxiety disorders, as well as learning disability, may also be greater in this population. The diagnosis of Asperger versus Autism is provided when children demonstrate normal early language development. In contrast, children with Autism are usually language delayed, and thus, at two to three years of age, are clearly different from other children in their inability to speak. The diagnosis of PDD-NOS is provided when children demonstrate symptoms of Autism or Asperger and impairment is present, but those symptoms do not cross the threshold for a full syndrome diagnosis. There are a number of other conditions also included under the PDD umbrella. These include Rett Syndrome, a condition that usually affects girls, and Childhood Disintegrative Disorder. Both conditions are marked by onset at a young age and a significant deceleration in cognitive, emotional, and in some cases, physical development.

In the past two years, I have seen an increasing number of children referred with suspected Autism. Some, in fact, meet diagnostic criteria for a PDD. However, it’s my experience that an equal number do not. Some simply have other developmental impairments. Some have language or learning disorders. Some simply have an atypical pattern of behavior, but one does not fit within the PDD diagnostic protocol nor appear to cause significant impairment. I am specific in the diagnostic process. That is, I do not provide these children with a diagnosis, because they do not fit nor cross the developmental threshold necessary. However, I am sensitive in my willingness to help. I explain to parents that I am willing to help them with the problems they encounter raising their children, even if I don’t provide a diagnosis.

We are in the process of attempting to understand what forces, experiences, or factors insulate and protect children with PDD’s, making them more resilient, and ultimately successful as they transition into adult life. Normal intelligence, the ability to develop friendships, and a lack of aggressive behavior in the face of stress, all appear to be protective factors. It has been my experience that helping this group of children between the ages of nine and fourteen years develop genuine, reciprocal social relations, experience school success, and develop “an island of competence” are very positive protective factors. While many of the children I am following with a PDD take a psychiatric medication, there are no specific medications developed for these conditions. There are no extensively researched, proven psychotherapy or educational models, particularly for teens with these conditions. It is a matter of time, patience, and taking, as my colleague, Dr. Robert Brooks, points out, a “helicopter view” recognizing that change takes time and the ultimate goal is to help this group of children transition successfully into adult life.