Pervasive Developmental Disorder Clinical Presentation

  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Jun 7, 2011
 

History

When eliciting history from the parents, reviewing pregnancy, peripartum, and infancy behaviors can yield clues to the genetic etiology of pervasive developmental disorder (PDD) behaviors or support the decision to perform brain imaging.

Many parents of children later diagnosed with autism can recall that, as infants, their child had poor eye contact and was unlike older siblings in interpersonal interactions.

Studies using the 1-year birthday party as a developmental milestone show that these children lack interest in the party, do not engage with adults, and/or show inappropriate interest in the gifts or activities.

A significant history of neglect or failure to thrive requires consideration of reactive attachment disorder, which is an important differential diagnosis of PDD. If the child has a clinically significant history of physical or emotional deprivation, a diagnosis of PDD should be deferred until the child has had an opportunity to recover in an enriched environment.

A common misconception is that children with a PDD do not show attachment to parent figures. In fact, many children with PDD have an emotional attachment to parental figures, but the attachment may manifest mostly as separation anxiety or as a seeking of comfort in odd ways. Children whose first language is not English may pose additional challenges in differentiating PDD from selective mutism and language disorders.

A thorough medical review is important, because none of the pervasive developmental disorders (PDDs) has a medical cure. Treatable conditions may cause symptoms of PDD, or they may worsen behaviors associated with these disorders.

Any history of deficiencies in the following areas is an indication for an evaluation for PDD:

  • Language development
  • Social interaction
  • Sensory integration

Language development

Delay suggests autism or PDD not otherwise specified.

Regression is consistent with Rett disorder or childhood disintegrative disorder but may also be an important subtype of autistic disorder.[19]

Normal language development is a diagnostic feature of Asperger disorder.

Poor social interaction

Features include the following:

  • Social isolation
  • Poor eye contact
  • Attachment to unusual objects
  • Overdeveloped, circumscribed interests in odd or specific topics
  • Inability to engage in imaginative play

Sensory integration difficulties

Features include the following:

  • Oral aversion to certain textures or colors
  • Olfactory aversion
  • Tactile aversion to certain fabrics (eg, tags on clothing, position of socks)
  • Auditory aversion to loud noises or types of music

Stereotyped behaviors

Stereotyped behaviors are also an indication for an evaluation for PDD. Such behaviors include hand flapping and self-injurious behavior (eg, head banging). Children with stereotyped behavior may have difficulty making a transition between activities.

Screening for PDD in the pediatric visit

The social communication questionnaire (SCQ) is a short parent report of current and past behavior. It has been validated to be consistent with the Autism Diagnostic Observation Schedule (ADOS) and has excellent sensitivity and specificity for PDDs.[20] The form is filled out by parents of children who are aged 4 years or older and have a mental age of 2 years. It is short enough to be completed in the waiting room.

The Developmental and Behavioral Pediatrics subgroup of the American Academy of Pediatrics recommends using the Modified Checklist for Autism in Toddlers (M-CHAT) Form[21] to screen for symptoms in children aged 16-30 months. The checklist has been translated into Chinese[22] and many other languages, with differing degrees of validation in progress.

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Physical Examination

Physical examination findings in children with pervasive developmental disorder (PDD) are usually normal, but the evaluation should be thorough in order to identify genetic or metabolic disorders.

The most important exception is Rett disorder; almost all patients who present with this disorder have the characteristic findings of hand-wringing, hyperventilation, or both. Unlike children with autism, who tend to have larger head circumference (>90%), children with Rett disorder have smaller head circumference (< 10%). Children with fragile X syndrome have a larger head circumference, while children with both fragile X syndrome and autistic disorder have even larger mean head circumference as a group.[5]

Children with PDD often have constipation, diarrhea, or reflux that they may lack the verbal ability to report. Untreated conditions present as disruptive behavior. A physical examination may be the only method to identify these issues. Food allergies may be the etiology of these gastrointestinal issues. Physical findings of eczema, wheezing, and poor weight gain should heighten the suspicion for food allergies.[23]

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Contributor Information and Disclosures
Author

Sufen Chiu, MD, PhD  Assistant Clinical Professor (Volunteer Faculty), University of California, Davis, School of Medicine; Consulting Staff, Child and Adolescent Psychiatry of Sacramento County; Consulting Staff, Sutter Center for Psychiatry; Consulting Staff, Transcultural Wellness Center

Sufen Chiu, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychiatric Association, California Medical Association, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Randi Jenssen Hagerman, MD, FAAP  Professor of Pediatrics, Medical Director MIND Institute, Endowed Chair in Fragile X Research, Division of Developmental/Behavioral Pediatrics, University of California Davis Medical Center

Randi Jenssen Hagerman, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Human Genetics, Society for Developmental and Behavioral Pediatrics, Society for Pediatric Research, and Western Society for Pediatric Research

Disclosure: Roche Grant/research funds PI on study; Novartis Grant/research funds PI on study; Seaside therapeutics Grant/research funds PI on study; Johnson and Johnson Grant/research funds PI on study; Forest Grant/research funds PI on study; curemark Grant/research funds PI on study

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Young child with fragile X syndrome who does not have obvious dysmorphic features.
 
 
 
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