Pervasive Developmental Disorder

An Altered Perspective

Barbara H. Quinn, Anthony Malone

• Publisher: Jessica Kingsley Publishers
• Year: 2000
• Print ISBN: 9781849853590
• eBook ISBN: 9781846422065
• Topic: Psychology
• Subtopic: Autism Spectrum Disorders
• Index: Psychology

Pervasive Developmental Disorder, or PDD, is the umbrella term used to cover the whole family of autistic spectrum disorders - including autism and Asperger Syndrome. Within this group there is a subgroup called NOS - not otherwise specified - which covers the conditions which do not quite meet the diagnostic criteria for autism or Asperger Syndrome. Because PDD covers such a wide spectrum, it presents very differently from child to child.

Written principally for parents, this is a book which explains what it means for your child to be diagnosed with PDD, NOS, autism or Asperger Syndrome, and where you go from there. The authors describe the symptoms of PDD, what a diagnosis means, how a child fits into the diagnostic terminology and the diagnostic procedures involved. They also review associated disorders such as OCD, and discuss the different treatments and therapies available.

The book includes frequently-asked questions, as well as the experiences of other parents. It is accessible, informative and supportive, a practical introduction to PDD.

CHAPTER I

What is Pervasive
Developmental Disorder?

What is typical development?

Before we can have a thorough understanding of what a developmental disorder is, we need to have an understanding of typical, often referred to as ‘normal’, development. Perhaps nothing is more interesting to the human species than the understanding of ourselves and how we grow. Child development has been studied from many viewpoints including the fields of education, medicine, sociology, and psychology. One need only explore the local bookstore to discover the multitude of volumes on the many facets of growth and development. One can conclude, from any perspective taken, that typical development is most simply defined as healthy development, a progressive process that follows along a course of expected outcomes.

The expectations of progress in healthy development are based on information obtained from observations and studies of a large number of children in a given age range. Appropriate developmental progress and stages are determined by establishing the commonalties in age groups. When observing a group of one-year-old children, one is witness to some very inquisitive little human creatures who are very interested in exploring and getting around. Some may be walking independently, while others manage the terrain with the assistance of handy props, such as chairs and coffee tables. The one-year-old curiosity is the stimulating factor that assists in the learning of motor milestones. Furthermore, these little ones may have a few words, or they may not, but be certain that they are able to make their needs known! Whether it is a preference of juice over milk or a desire to go out for a walk, the one-year-old has already established a relatively sophisticated system of communicating with their caregiver. The use of facial expressions, gestures, different crying tones and qualities are all means of communication that are intact in the one-year-old.

It is to be noted that there is a good deal of variation in typical development. Children are not frozen in a moment of time but rather develop over many years, therefore, it is only reasonable that there are variations of the onset of given skills from child to child. One need only look at a nursery school classroom of children to see that ‘Susie’ may be speaking in complete sentences while ‘Johnny’ only has a few words. Additionally, personality and individual strengths and weaknesses play into the acquisition of healthy developmental skills.

How does personality effect development?

Let us not forget that children are people after all, and have many things that set them apart from one another. Individuality, our expression of ourselves, is innate to humanity. Our personalities and temperamental qualities certainly influence how we grow and learn. A naturally gregarious infant may smile at the mother walking by, while a more serious baby studies the mother’s face for a long period of time before rewarding her with a grin. Individual aptitudes also need to be factored into the various presentations of healthy development. Aptitudes, or innate abilities, are those skills that come easily to one child, yet may be difficult for another. Janice could take piano lessons and practice diligently for several years, but she may still never become a concert pianist. Kevin, on the other hand, may study piano for the same amount of time, find it easy, and some day find his fingers gracing the ivories at Carnegie Hall! Kevin has an aptitude for music.

Personality and aptitudes may influence the rate in which some skills are mastered, but these individual qualities do not greatly alter the course of development unless these qualities are extreme. Personality and temperamental qualities all contribute to healthy development as long as the personal characteristics are within the range of ‘normal’. It is not until they are extreme or out of the typical range that they effect learning, socialization, and overall functioning of life skills.

MARY

Mary, a timid child, entered a birthday party and smiled sheepishly at the sight of the balloons and at her girlfriends. She clung to her mother’s leg and hesitated in joining the fun. Once she ‘warmed up’, she quietly joined in the festivities. Though she never became chatty with her friends, she was certainly able to let the hostess know that she wanted chocolate icecream with her cake.

A shy temperament has not altered Mary’s development to the point of severely influencing her understanding of the communication process, or her awareness of what is going on around her. However, being extremely shy, to the point of becoming fearful and being unable to interact at all appropriately, may indeed lead to an altered path of development in the area of speech and language and/or socialization.

ELIZABETH

Elizabeth, an extremely shy child, entered a birthday party and became filled with anxiety and fear. She was unable to release the grasp of her mother’s thigh. She could not look around the room or engage in any interaction with the other party-goers. Eventually, the mother made excuses and left the party. The child felt no disappointment, but rather relief.

Demonstrating this extreme of a temperamental characteristic, in this illustration, shyness may influence the course of that child’s social development. Social skills, like all skills, require practice. Play situations, like birthday parties, are the social classroom of the child. If anxiety prevents such interaction, it is reasonable to think that it will alter the path to how a child learns to socialize.

There are many temperamental qualities which flavor a child’s development. Emotionality, or how a child wears his or her emotions, varies hugely in healthy development. ‘Sally’ may jubilantly embrace her aunt while ‘Cody’ smiles tentatively at her outstretched arms. To further illustrate this, if Sally greeted complete strangers at the Mall the same way she greeted her aunt, or if Cody ran to hide in the closet every time someone came to the door, one might become concerned about how the child’s way of expressing feeling and emotions will impact his or her development. Think of all the personality characteristics of people and the range of presentations; enthusiastic to overly energetic, inquisitive to pensive, cheerful to exuberant, motivated to driven. The list could go on and on. While these characteristics alter the style of a child’s development, or flavor the nature of the child, they do not significantly impact developmental progression, unless they are presented to the extreme.

Can personality differences be a good thing?

The answer to this question is, of course, a resounding ‘Yes!’ Differences among people not only add flavor to life, but fulfil the multiple needs of human beings. We need electricians, painters, doctors, and teachers (to name only a few) and there are unlikely to be many people who could fit all of these roles. We certainly need to embrace the individuality of any child and foster the strengths they present to us.

History reveals to us several people who were felt perhaps to have extreme temperamental qualities, which today, and in some cases in their day as well, caused them to be viewed as significantly different. Included among those were some great thinkers and creators. Picasso was criticized for having such a different perspective of the world, but his unique perspective gave us the gift of his beautiful art. Albert Einstein was also ridiculed for his unusual way of looking at the world and his desire not to follow the status quo. He contributed a tremendous amount of knowledge of our world by having an altered perspective. History recounts the lives of several men and women who failed to fit the mold of expected social norms, or who failed to take the accepted vantage point, and yet they left behind gifts that have extended well beyond their lifetimes.

There seems to be today, a heightened awareness of the need to foster the individual strengths of children. It is becoming more acceptable to embrace the differences in children and even more importantly, to facilitate learning and overall school progress by truly accepting that no two people are educationally, socially or creatively equal!

No parent wants to have a child fall out of the domain of the norm. It’s a rough road to hoe when behaviors and learning styles are so different that a child needs specialized help and attention. Yet we are reminded by Picasso, Einstein, and others, that perhaps coloring outside of the lines, or looking at something from an unusual angle has great value! How did we come to know that the world was not flat?

What is a developmental delay?

As mentioned, healthy development follows along a predictable path. When a child is obtaining developmental skills along the predicted path but more slowly than expected, they are said to be delayed. For the purpose of illustration, let’s look at a car-ride. Our destination is 60 miles away and we can go between 45 mph and 60 mph. That means that our estimated time of arrival is somewhere between 1 and 1½ hours. This represents normal development. In the case of delayed development, the car does not change its course, but arrives 2 to 3 hours after the expected time. Let us apply this concept to child development. If a child moved its total body as an infant, but was a little slow to sit independently, and did not walk until close to 16 months of age, one could say that this child is progressing at a slower pace than his/her peers. This progress is not different. It is just delayed.

What is a developmental disorder?

When we speak of a difference in the pattern or nature of the developmental process, we are speaking of a disorder. Categorizing into groups those behaviors or differences that set some children apart from their peers defines a developmental disorder. A well-known developmental disorder is Attention Deficit Hyperactive Disorder (ADHD). Children with this disorder have in common, the inability to focus their attention appropriately and they have a high degree of physical activity. They have a common group of characteristics that are different from their peers, yet similar to each other. Therefore, ADHD is said to be a developmental disorder.

Children with developmental disorders are not merely slow in obtaining skills. Applying this case to the concept above, children with developmental disabilities are not travelling at a slower pace, they are travelling a different route all together. They may arrive at the same point, but they will need some help and guidance along the way. They either have a different way of acquiring appropriate developmental skills than expected, or they have a lessened capacity of acquiring certain skills.

What is Pervasive Developmental Disorder?

Pervasive Developmental Disorder (PDD) is the diagnostic terminology for a group of individuals who present with an underlying impairment in the communication process and connectedness to the world around them. This impairment in turn pervades over all areas of development. The inability to fully connect, or relate appropriately to ones’ surroundings greatly influences learning and the pathway of development. As mentioned previously, a developmental disorder entails a compilation of characteristics that set the group apart from their peers but are in common with each other. In the case of PDD, the characteristics include impairments in the areas of language and communication, socialization, and use of imaginative play. The disorder is viewed as a spectrum disorder because there is a great deal of variability in the presentation of the disorder along a spectrum of severity. Therefore, the diagnostic terminology of Pervasive Developmental Disorder (PDD) is an umbrella term that encompasses a continuum of impairments in communication, socialization, and play repertoire.

Terms used within this framework are Asperger Syndrome; PDD, not otherwise specified (NOS); and autism. These all represent different degrees of impairment along a continuum. The areas which are effected, although to differing degrees, are shared.

To elaborate on this spectrum concept, let us look specifically at the range of impairment in each area. In the area of language and communication, a child’s abilities may range from one who is able to verbalize well and communicate ideas and thoughts clearly, to one who has no language at all. Impairment in the social realm can range from being slightly distant and described as aloof, to one who has no direct eye contact or response to their surroundings. Play skills can vary greatly from a child who plays with toys as if they are symbolic of real life, to one who plays mechanically with the movable parts of a favored toy.

It is clear to see how differently any two children on this spectrum of disorders may present. One child may use language to request his food preference at a meal, meet your face to seek assistance, and play rowboat on the log outside. Another may use no words, have only fleeting eye contact and spend playtime spinning the wheels of a toy truck. As illustrated, these two children have significantly different degrees of impairment, however, they are on the same spectrum of disorder.

The degrees of impairment in communication, socialization, and play style greatly alter the ultimate course of development. PDD represents a different pathway of development, or a different pattern of thinking and perspective, than that of a typical child. This altered perspective impacts the developmental course. In order for the diagnostic terminology to apply, all three areas must be effected to some degree, across the broad spectrum.

The particular components of PDD will be more fully addressed in later chapters. For the purpose of understanding the diagnostic terminology the important thing to keep in mind is that there is a qualitative difference in the development of the process of communication, socialization, and repertoire of play. By looking at these qualitative differences in the development of these children, we are able to look at the individual child and take their own strengths and weaknesses into account. This allows us to set up the most appropriate intervention and educational plan for each child and optimize that individual child’s potential.

In addition to impairments in communication, socialization, and play style, often children with PDD have other characteristics as well. These include differences of sensory perceptions, physical mannerisms, and unusual strengths. The presentation of these characteristics differs greatly from one child to the next. Altered perception of sensory input may cause a child to see, feel, or hear things differently to that which others might experience. For this reason they may respond unexpectedly to sensory input. They may demonstrate only minor sensory difficulties or they may be intolerant to certain noises, sources of lights, food textures, or the feel of particular clothing fabrics. Sometimes children with PDD are even fussy about the tags in their shirts or having their sleeves rolled up, or down. A child who does not even flinch when his/her name is called 10 times, may head for the window at the sound of an ambulance siren in the far distance. Each child may present with their own nuances, as we all do, and alone they may mean nothing. When put together collecti...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• Foreword
• Acknowledgements
• About the Authors
• Sam Likes Trains
• Introduction
• 1. What is Pervasive Developmental Disorder?
• 2. Social Reciprocity
• 3. Communication
• 4. Impairment in Play Style
• 5. More Characteristics
• 6. The Evaluation Process
• 7. What Can Be Done? Medical Perspective
• 8. What Can Be Done? Educational Perspective
• 9. Additional Options
• 10. Up Close and Personal
• Resources
• References
• Index