Pervasive Developmental Disorder Treatment & Management

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

Approach Considerations

Thorough medical evaluation is warranted before psychiatric hospitalization is considered.

Inpatient care is warranted to manage acute medical issues or for a workup of subclinical medical disorders.

Patients often present with medical problems that manifest as changes in behavior.

Psychiatric hospitalization is indicated whenever the safety of the patient cannot be maintained.

Go to Autism and Asperger Syndrome for complete information on these topics.

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Consultations

Consult a child psychiatrist and/or a developmental/behavioral pediatrician to evaluate and treat comorbid diagnoses such as depression, ADHD, or OCD and to lead a multidisciplinary team for case management, which may include family psychoeducational therapy, psychopharmacologic treatment, speech therapy, occupational therapy, physical therapy, and behavioral therapy.

Consult a psychologist and/or an education specialist to assess baseline functions for intellectual capacity and learning disabilities and to design cognitive behavioral strategies for facilitating education and for modifying difficult behaviors. (This area is rapidly growing, with increasing evidence suggesting that specific types of therapy for early intervention can enhance generalization of social skills.)

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Additional Patient Management Considerations

Outpatient management requires a multidisciplinary approach.

Comorbid medical problems, including seizures and constipation, are frequent.

Certain behaviors may require medication prescribed by a child and adolescent psychiatrist or behavioral-developmental pediatrician.

A speech pathologist's expertise is essential to develop a communication plan. The use of augmentative and communication devices is essential for the nonverbal child.[28]

A special education professional may be needed to design a specific curriculum for each child with pervasive developmental disorder (PDD).

Occupational and physical therapists may be indicated for motor deficits and sensory processing deficits.

A social worker not only helps find financial, educational, and emotional resources but also provides important psychosocial support for the family.

Psychologists often develop behavioral plans and ongoing therapy to improve social relationships.

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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.

References

  1. APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994.

  2. Rogers SJ, Wehner DE, Hagerman R. The behavioral phenotype in fragile X: symptoms of autism in very young children with fragile X syndrome, idiopathic autism, and other developmental disorders. J Dev Behav Pediatr. Dec 2001;22(6):409-17. [Medline].

  3. Moeschler JB. Medical genetics diagnostic evaluation of the child with global developmental delay or intellectual disability. Curr Opin Neurol. Apr 2008;21(2):117-22. [Medline].

  4. Schroer RJ, Phelan MC, Michaelis RC, Crawford EC, Skinner SA, Cuccaro M, et al. Autism and maternally derived aberrations of chromosome 15q. Am J Med Genet. Apr 1 1998;76(4):327-36. [Medline].

  5. Chiu S, Wegelin JA, Blank J, Jenkins M, Day J, Hessl D, et al. Early acceleration of head circumference in children with fragile x syndrome and autism. J Dev Behav Pediatr. Feb 2007;28(1):31-5. [Medline].

  6. Rogers SJ. Developmental regression in autism spectrum disorders. Ment Retard Dev Disabil Res Rev. 2004;10(2):139-43. [Medline].

  7. Brune CW, Kim SJ, Salt J, Leventhal BL, Lord C, Cook EH Jr. 5-HTTLPR Genotype-Specific Phenotype in Children and Adolescents With Autism. Am J Psychiatry. Dec 2006;163(12):2148-56. [Medline].

  8. Gregg JP, Lit L, Baron CA, Hertz-Picciotto I, Walker W, Davis RA, et al. Gene expression changes in children with autism. Genomics. Jan 2008;91(1):22-9. [Medline].

  9. Redcay E, Courchesne E. When is the brain enlarged in autism? A meta-analysis of all brain size reports. Biol Psychiatry. Jul 1 2005;58(1):1-9. [Medline].

  10. Waldman M, Nicholson S, Adilov N, Williams J. Autism prevalence and precipitation rates in California, Oregon, and Washington counties. Arch Pediatr Adolesc Med. Nov 2008;162(11):1026-34. [Medline].

  11. Heaton P, Hudry K, Ludlow A, Hill E. Superior discrimination of speech pitch and its relationship to verbal ability in autism spectrum disorders. Cogn Neuropsychol. Sep 2008;25(6):771-82. [Medline].

  12. Grandin T. Thinking In Pictures: and Other Reports from My Life with Autism. Vintage. 1996.

  13. Hagerman RJ, Berry-Kravis E, Kaufmann WE, Ono MY, Tartaglia N, Lachiewicz A, et al. Advances in the treatment of fragile X syndrome. Pediatrics. Jan 2009;123(1):378-90. [Medline]. [Full Text].

  14. Erlandson A, Hagberg B. MECP2 abnormality phenotypes: clinicopathologic area with broad variability. J Child Neurol. Sep 2005;20(9):727-32. [Medline].

  15. Kriaucionis S, Paterson A, Curtis J, Guy J, Macleod N, Bird A. Gene expression analysis exposes mitochondrial abnormalities in a mouse model of Rett syndrome. Mol Cell Biol. Jul 2006;26(13):5033-42. [Medline]. [Full Text].

  16. Fombonne E. Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord. Aug 2003;33(4):365-82. [Medline]. [Full Text].

  17. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators; Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders--autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveill Summ. Feb 9 2007;56(1):12-28. [Medline].

  18. Shattuck PT, Durkin M, Maenner M, Newschaffer C, Mandell DS, Wiggins L, et al. Timing of identification among children with an autism spectrum disorder: findings from a population-based surveillance study. J Am Acad Child Adolesc Psychiatry. May 2009;48(5):474-83. [Medline].

  19. Luyster R, Richler J, Risi S, Hsu WL, Dawson G, Bernier R, et al. Early regression in social communication in autism spectrum disorders: a CPEA Study. Dev Neuropsychol. 2005;27(3):311-36. [Medline].

  20. Chandler S, Charman T, Baird G, Simonoff E, Loucas T, Meldrum D, et al. Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. Oct 2007;46(10):1324-32. [Medline].

  21. Robins DL, Fein D, Barton ML, Green JA. The Modified Checklist for Autism in Toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. J Autism Dev Disord. Apr 2001;31(2):131-44. [Medline].

  22. Wong V, Hui LH, Lee WC, Leung LS, Ho PK, Lau WL, et al. A modified screening tool for autism (Checklist for Autism in Toddlers [CHAT-23]) for Chinese children. Pediatrics. Aug 2004;114(2):e166-76. [Medline].

  23. Sicherer SH. Clinical aspects of gastrointestinal food allergy in childhood. Pediatrics. Jun 2003;111(6 Pt 3):1609-16. [Medline].

  24. Cunningham M, Cox EO. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics. Feb 2003;111(2):436-40. [Medline].

  25. Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, et al. Practice parameter: evaluation of the child with global developmental delay: report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. Neurology. Feb 11 2003;60(3):367-80. [Medline].

  26. Newmeyer A, Cecil KM, Schapiro M, Clark JF, Degrauw TJ. Incidence of brain creatine transporter deficiency in males with developmental delay referred for brain magnetic resonance imaging. J Dev Behav Pediatr. Aug 2005;26(4):276-82. [Medline].

  27. Bryson SE, Rogers SJ, Fombonne E. Autism spectrum disorders: early detection, intervention, education, and psychopharmacological management. Can J Psychiatry. Sep 2003;48(8):506-16. [Medline].

  28. Wilkinson KM, Hennig S. The state of research and practice in augmentative and alternative communication for children with developmental/intellectual disabilities. Ment Retard Dev Disabil Res Rev. 2007;13(1):58-69. [Medline].

  29. McDougle CJ, Scahill L, Aman MG, McCracken JT, Tierney E, Davies M, et al. Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Am J Psychiatry. Jun 2005;162(6):1142-8. [Medline].

  30. Owen R, Sikich L, Marcus RN, Corey-Lisle P, Manos G, McQuade RD, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics. Dec 2009;124(6):1533-40. [Medline].

  31. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. Feb 2004;27(2):596-601. [Medline].

  32. King BH, Bostic JQ. An update on pharmacologic treatments for autism spectrum disorders. Child Adolesc Psychiatr Clin N Am. Jan 2006;15(1):161-75. [Medline].

  33. King BH, Wright DM, Handen BL, Sikich L, Zimmerman AW, McMahon W, et al. Double-blind, placebo-controlled study of amantadine hydrochloride in the treatment of children with autistic disorder. J Am Acad Child Adolesc Psychiatry. Jun 2001;40(6):658-65. [Medline].

  34. Berry-Kravis E, Hessl D, Coffey S, Hervey C, Schneider A, Yuhas J, et al. A pilot open label, single dose trial of fenobam in adults with fragile X syndrome. J Med Genet. Apr 2009;46(4):266-71. [Medline]. [Full Text].

  35. Andersen IM, Kaczmarska J, McGrew SG, Malow BA. Melatonin for insomnia in children with autism spectrum disorders. J Child Neurol. May 2008;23(5):482-5. [Medline].

  36. Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. Aug 27 2008;300(8):915-23. [Medline]. [Full Text].

  37. Myers SM, Johnson CP. Management of children with autism spectrum disorders. Pediatrics. Nov 2007;120(5):1162-82. [Medline].

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