Autism Spectrum

Disorders or Pervasive
Developmental Disorder

Dr. Fauzi Ismail

Child & Adolescent Psychiatrist
Hospital Selayang
 Types of PDD (ICD-10)
Childhood autism
autistic ds, infantile autism, infantile psychoses,
Kanner’s syndrome
Atypical autism
Rett’s syndrome
Childhood disintegrative ds
Overactive ds associated with MR
Asperger’s syndrome
PDD- not otherwise specified
 Diagnosis: 3 main areas of
impairment in PDD or ASD
Delay and abnormal quality in:
reciprocal social interaction
language and communication
imaginative thinking - restricted,
repetitive activities and interests
&
early onset: before age 3

***
Prediagnosis
Infant-good baby
6-8/12 – no regards mother
2/3 – trait –f/u diagnosis change
 Social impairment
Qualitative impairment in reciprocal
social relationships
non-verbal cues: poor eye contact, facial
expressions, body postures, gestures
failure to develop peer relationship
fail to share enjoyment or seek comfort
when hurt (lack of pointing, requesting)
difficulties with understanding social
cues
lack of social empathy (difficulty to
recognise others’ emotions)
 Language &
communication
Delay in receptive and expressive
language
stereotyped or repetitive use of language
idiosyncratic use of words
unable to initiate or sustain a
conversation (those with speech)
echolalia, pronoun reversal, invented
reduced gestures or poorly co-ordinated
(abnormal pointing)
lack of social imitative or pretend play
 Repetitive stereotyped
activities and interests
Rigid and inflexible thought processes
resistance to change, insist on same
routines, ritualistic behaviours (lengthy
mealtime ritual)
repetitive activities and interests
(complex or simple)- hand flapping,
twirling objects, fascinated with unusual
parts of objects, same segment TV show)
persistent preoccupation with parts of
objects
 Other features: not
required for diagnosis
Unusual responses to sensory stimuli eg
certain sounds, fascination by certain
visual stimuli, dislike gentle touch, but
enjoys firm pressure
poor motor co-ordination
over or underactivity
food fads
erratic sleeping patterns
abnormalities of mood- excitement/
misery
 Age of Onset
Delay or abnormal functioning in at
least one area must be before age 3
years
 Prevalence
Childhood autism:
3-4 per 10,000 population
20 per 10,000 (broader definition)

Asperger Syndrome
36 per 10,000

Male preponderance
Differential diagnoses of
childhood autism
Deafness
Developmental language disorder
Mental retardation with autistic features
Mental retardation without autistic
features
Intense early deprivation
Pervasive developmental disorders:
Asperger Syndrome, Rett’s syndrome,
Degenerative disorder, atypical
autism, PDD-not otherwise specified
 Treatment plan
 Establish goals for educational purposes
 Establish target symptoms for
intervention
 Co-morbid conditions
 Monitoring
 Multiple domains of functioning
 Medication
 ? Diet modification
No gandum
Milk
Vanilla
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@
Attention Deficit Hyperactive Disorder
(ADHD)

Dr. Fauzi Ismail

Department of Psychiatry
Hyperkinetic children
“Hyperactive”
 parents
 all manner of behaviour
 e.g. frequent night awakenings, talking loudly,
naughtiness, exuberance
 depends on attitudes and tolerance of
parents
 MUST always pay attention to the stage of
development
 when deciding normality and abnormality
 Hyperactive Children

“Hyperactive”
 psychiatrists
 more restrictive definition
 restlessness
 inattentiveness
 impulsiveness
 Hyperactive Children

Overactive :
 increase in amount and tempo of purposeful
activity
 increase in number of purposeless minor
movements irrelevant to tasks
 e.g. wriggle and squirm in seat
fidget with objects
restless
 unable to suppress activity when stillness is
required
 e.g. in classroom or at meal table
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Core
symptoms
Hyperactivity
 More active than children their age
Inattentive
 Short attention span
Impulsive
 Poor impulse control
Pervasive
 Symptoms occur across all situations
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Hyperactivity
Fidgets with hands or feet
Squirms in seat
Runs about or climbs excessively
Difficulty playing or engaging in leisure
activities quietly
Talks excessively
Always “ on the go ”
Described as if “ driven by a motor ”
Inattentivene Little “ Rascals ”

ss
Fails to give attention to details
Makes careless mistake
Do not follow through instructions
Fails to complete schoolwork, chores or
duties
Reluctance to engage in tasks requiring
sustain mental efforts
Difficulty organizing tasks & activities
Easily distracted
Often forgetful for their age
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Impulsive
Blurts out answers before question
completed
Difficulty awaiting their turn
Interrupts or intrudes on others
Makes poor judgement
Accident prone
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Do you fit these criteria…

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Epidemiology
Prevalent in 1-3% of children
Male : Female
 3:1
Hyperactivity dates back to pre-school
years
Referral delayed until primary school
 Present with inattentiveness, learning
difficulties & disruptiveness
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Etiology

Unknown
Unlikely to be a single etiological factor
Most likely an interplay
 psychosocial & biological factors
Differential Little “ Rascals ”

diagnosis

Normality
 Consider parents expectations & level of
tolerance
Situational hyperactivity
 Symptoms occur only in certain situations
Mental retardation
 Poor attention and activity control
Specific learning disability
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Management
Requires a multi-disciplinary approach

 Pharmacological treatment - etarline

 Psychological intervention
 Educational support
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Prognosis
Hyperactivity wanes in adolescence
30% have residual symptoms in adulthood
 Restless & inattentive
30% have no symptoms with good
functioning
 Choose job which allow freedom of movement
30% continuous display of symptom
 Develop other psychopathologies
 E.g. substance abuse & anti-social personality