Autistic disorder, the best known of the
pervasive developmental disorders, is more prevalent in boys than in girls,
and it is identified usually by 18 months and no later than
Eighty percent of cases of autism are early onset, with developmental delays starting in infancy. The other 20% of children with autism have seemingly normal growth and development until 2 or 3 years of age, when devel-opmental regression or loss of abilities begins. They stop talking and relating to parents and peers and begin to demonstrate the behaviors described earlier ( Volkmar et al., 2005).
Autism was once thought to be rare and was estimated to occur in 4 to 5 children per 10,000 in the 1960s. Current estimates suggest that 1 in 1,000 to 1 in 500 U.S. children from 1 to 15 years of age have autism (National Institute of Child Health and Human Development, 2006). Figures on the prevalence of autism in adults are unreliable.
Autism does have a genetic link; many children with autism have a relative with autism or autistic traits. Controversy continues about whether measles, mumps, and rubella (MMR) vaccinations contribute to the devel-opment of late-onset autism. The National Institute of Child Health and Human Development, Centers for Disease control (CDC), and the Academy of Pediatrics have all conducted research studies for several years and have concluded that there is no relationship between vaccines and autism and that the MMR vaccine is safe. However, litigation and class action suits are still in progress. The first decision from a panel of grand mas-ters was issued in February, 2009, regarding three test cases. The masters ruled that sufficient evidence had not been presented to prove vaccines had caused autism. National groups called for more investigation and research to find the cause(s) of autism (Cable News Network [CNN], 2009).
Autism tends to improve, in some cases substantially, as children start to acquire and use language to communi-cate with others. If behavior deteriorates in adolescence, it may reflect the effects of hormonal changes or the dif-ficulty meeting increasingly complex social demands. Autistic traits persist into adulthood, and most people with autism remain dependent to some degree on others. Manifestations vary from little speech and poor daily liv-ing skills throughout life to adequate social skills that allow relatively independent functioning. Social skills rarely improve enough to permit marriage and child rear-ing. Adults with autism may be viewed as merely odd or reclusive, or they may be given a diagnosis of obsessive– compulsive disorder, schizoid personality disorder, or mental retardation.
Until the mid-1970s, children with autism usually were treated in segregated, specialty outpatient, or school pro-grams. Those with more severe behaviors were referred to residential programs. Since then, most residential pro-grams have been closed; children with autism are being “mainstreamed” into local school programs whenever pos-sible. Short-term inpatient treatment is used when behav-iors such as head banging or tantrums are out of control. When the crisis is over, community agencies support the child and family.
The goals of treatment of children with autism are to reduce behavioral symptoms (e.g., stereotyped motor behav-iors) and to promote learning and development, particularly the acquisition of language skills. Comprehensive and indi-vidualized treatment, including special education and lan-guage therapy, is associated with more favorable outcomes (Myers & Johnson, 2007). Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol) or risperidone (Risperdal), may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyper-activity, and stereotyped behaviors. Other medications, such as naltrexone (ReVia), clomipramine (Anafranil), clonidine (Catapres), and stimulants to diminish self-injury and hyper-active and obsessive behaviors, have had varied but unre-markable results (Volkmar et al., 2005).
Rett’s disorder is a pervasive developmental disorder char-acterized by the development of multiple deficits after a period of normal functioning. It occurs exclusively in girls, is rare, and persists throughout life. Rett’s disorder devel-ops between birth and 5 months of age. The child loses motor skills and begins showing stereotyped movements instead. She loses interest in the social environment, and severe impairment of expressive and receptive language becomes evident as she grows older. Treatment is similar to that of autism.
Childhood disintegrative disorder is characterized by marked regression in multiple areas of functioning after at least 2 years of apparently normal growth and development (APA, 2000). Typical age at onset is between 3 and 4 years. Children with childhood disintegrative disorder have the same social and communication deficits and behavioral patterns seen with autistic disorder. This rare disorder occurs slightly more often in boys than in girls.
Asperger’s disorder is a pervasive developmental disorder characterized by the same impairments of social interac-tion and restricted stereotyped behaviors seen in autistic disorder, but there are no language or cognitive delays. This rare disorder occurs more often in boys than in girls, and the effects are generally lifelong.