Pervasive Developmental Disorder Not Otherwise Specified Group Research Articles

Evaluation of sleep disturbances, gastrointestinal problems and eating behaviors in Turkish children with autistic disorder and PDD-NOS

PurposeThe purpose of this study is to evaluate the relationship between sleep disturbances, gastrointestinal (GI) problems and eating behaviors in children who are diagnosed with autistic disorder (AD) and pervasive developmental disorder not otherwise specified (PDD-NOS).Design/methodology/approachThis study was conducted with 102 children who were diagnosed with autism spectrum disorder (ASD). Sleeping and GI (abdominal pain, constipation, diarrhea, vomiting, difficulty swallowing) problems in children were obtained by asking their parents using a questionnaire. The feeding assessment survey (FAS), brief autism mealtime behavior inventory (BAMBI) and food consumption frequency were used to obtain information about the children’s eating habits.FindingsThe BAMBI total score, food refusal and features of autism subscale scores of those with AD were higher than those in the PDD-NOS group (p < 0.05). Sleeping, GI and eating problems are seen in those with AD more commonly than in those diagnosed with PDD-NOS.Originality/valueTo the knowledge, this is the first study that compares GI, sleeping and eating problems in children with AD and PDD-NOS. Sleeping, GI and eating problems may be more frequent in children with AD than in those with PDD-NOS. The GI problem rate is higher in children with autism with sleeping problems than without sleeping problems.

Significant Changes in Plasma Alpha-Synuclein and Beta-Synuclein Levels in Male Children with Autism Spectrum Disorder.

Alpha-synuclein (α-synuclein) and beta-synuclein (β-synuclein) are presynaptic proteins playing important roles in neuronal plasticity and synaptic vesicle regulation. To evaluate the association of these two proteins and autism spectrum disorder (ASD), we investigated the plasma α-synuclein and β-synuclein levels in 39 male children with ASD (2 subgroups: 25 autism and 14 pervasive developmental disorder-not otherwise specified (PDD-NOS)) comparing with 29 sex- and age-matched controls by using enzyme-linked immunosorbent assay (ELISA). We first determined the levels of these two proteins in the ASD subgroups and found that there were no significant differences in both plasma α-synuclein and β-synuclein levels in the autism and PDD-NOS groups. Thus, we could combine the 2 subgroups into one ASD group. Interestingly, the mean plasma α-synuclein level was significantly lower (P < 0.001) in the ASD children (10.82 ± 6.46 ng/mL) than in the controls (29.47 ± 18.62 ng/mL), while the mean plasma β-synuclein level in the ASD children (1344.19 ± 160.26 ng/mL) was significantly higher (P < 0.05) than in the controls (1219.16 ± 177.10 ng/mL). This is the first study examining the associations between α-synuclein and β-synuclein and male ASD patients. We found that alterations in the plasma α-synuclein and β-synuclein levels might be implicated in the association between synaptic abnormalities and ASD pathogenesis.

A lack of self-consciousness in Asperger's disorder but not in PDDNOS: Implication for the clinical importance of ASD subtypes

Self-consciousness plays an important role in a person's social life. Assuming that self-consciousness is a key to understanding social impairments in high-functioning autism spectrum disorder (ASD), we examined self-consciousness in individuals with Asperger's disorder, pervasive developmental disorder not otherwise specified (PDDNOS) and their controls using an episodic memory task. The PDDNOS group consisted of individuals in a milder subgroup of PDDNOS, with less autistic features than Asperger's disorder. In the learning phase, one of three types of questions (phonological, semantic, self-referential) was asked about each following target word. The target words were all personality trait adjectives. Next, a recognition test was conducted. The PDDNOS group, like the control, showed the most superior performance in self-referential processing (i.e. the self-reference effect) while the Asperger's group did not; however, both the ASD groups revealed an atypical pattern of relationship between memory performance and IQ. Individuals with PDDNOS, unlike those with Asperger's disorder, may be self-conscious to the same degree as typically developing individuals, but the cognitive process leading them to self-consciousness seems atypical, causing social impairments similar to those seen in individuals with Asperger's disorder who lack self-consciousness.

An examination of the relationship between communication and socialization deficits in children with autism and PDD-NOS

Autism Spectrum Disorders (ASDs) are characterized by pervasive impairments in repetitive behaviors or interests, communication, and socialization. As the onset of these features occurs at a very young age, early detection is of the utmost importance. In an attempt to better clarify the behavioral presentation of communication and socialization deficits to aid in early assessment and intervention, impairments in these areas were examined among infants and toddlers (17–36 months) with Autistic Disorder (AD), Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), and non-ASD related developmental delay. The Baby and Infant Screen for Children with aUtIsm Traits-Part1 (BISCUIT-Part1) and the Battelle Developmental Inventory, 2nd Edition (BDI-2) were utilized to examine communication and socialization levels, respectively, among these groups. All groups significantly differed on level of socialization impairment with the Autism group displaying the greatest impairment and the non-ASD related developmental delay group evincing the least impairment. In regards to communication deficits, the non-ASD related developmentally delayed group differed significantly in comparison to the Autism and PDD-NOS groups; however, no significant differences were found between children with AD and PDD-NOS. While communication and socialization impairments were found to significantly correlate for all participants with the exception of those with PDD-NOS, these correlations were not found to significantly differ from one another across groups. The implications, limitations, and future directions of these results are discussed.

Communication Skills in Children with Cerebral Palsy and Autism Spectrum Disorder

While the literature focusing on communication deficits in children with cerebral palsy (CP) is extensive, few researchers have analyzed this construct in individuals with CP and a comorbid Autism Spectrum Disorder (ASD). Therefore, the purpose of the current study was to examine impairments in communication in infants and toddlers (18 to 35 months of age) who had CP and comorbid autism, CP and comorbid pervasive developmental disorder-not otherwise specified (PDD-NOS), and CP alone. A total of 42 children met inclusion criteria for this study. Those diagnosed with CP and a comorbid ASD were found to possess significantly greater communication impairments as assessed by the Baby and Infant Screen for aUtIsm Traits-Part 1 (BISCUIT-Part 1) than participants who only had a diagnosis of CP. The autism and PDD-NOS groups did not significantly differ from one another on the communication domain of this measure, however. Implications of these results are discussed.

Neutral versus emotional human stimuli processing in children with pervasive developmental disorders not otherwise specified

Pervasive developmental disorder not otherwise specified (PDD-NOS) represents up to two-thirds of autism spectrum disorders; however, it is usually described in terms of the symptoms not shared by autism. The study explores processing of neutral and emotional human stimuli (by auditory, visual and multimodal channels) in children with PDD-NOS ( n = 10) compared to typically developing children ( n = 35). The neutral human stimuli consisted of faces and common first names. The emotional human stimuli consisted of happy, sad, angry, and neutral faces and vocalizations. The results confirmed previous findings and led to others. The PDD-NOS group (a) accurately processed neutral human stimuli; (b) had difficulty processing emotional stimuli in general and more easily identified happy compared to angry or neutral faces and vocalizations; (c) had a strong discrepancy between emotional and neutral human stimuli processing; (d) used the multimodal channel to compensate for unimodal deficits, especially for angry faces; and (e) was strongly heterogeneous.

Comparing Autism, PDD-NOS, and Other Developmental Disabilities on Parent-Reported Behavior Problems: Little Evidence for ASD Subtype Validity

Studies on the distinction between Autistic Disorder (AD) and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) have been inconclusive. This study examined the validity of PDD-NOS by comparing it to AD and other developmental disorders (DD) on parent-reported behavior problems. Fifty-four children with PDD-NOS were individually matched on age and non-verbal IQ to 54 children with AD and 54 children with DD. Groups were compared on select subscales of the Child Behavior Checklist. High rates of psychopathology were observed in both ASD groups. The only difference between PDD-NOS and AD groups was higher scores in the PDD-NOS group on two items measuring Anxiety/Depression. Cognitive functioning may be a more salient variable than subtype when studying psychopathology in individuals with ASDs.

Signes neurologiques mineurs et troubles envahissants du développement

Many studies have focused on specific motor signs in autism and Asperger's syndrome, but few has been published on the complete range of neurological soft signs (NSS) in children with pervasive developmental disorder (PDD). Scarce are the studies evaluating NSS in children suffering from PDD not otherwise specified (PDDNOS). This study compared performance of 11 autistic children (AD) and 10 children with PDDNOS, with controls matched on age, sex and cognitive performance on Krebs et al.'s NSS scale. Because of the duration of the assessments and specific difficulties encountered in managing some items, an adaptation of the scale had to be made during a pilot study with the agreement of the author. To be eligible, patients had to meet the following inclusion criteria: an age range of 6-16 years, a diagnosis of autistic disorder or PDDNOS based on the DSMIV criteria (American Psychiatric Association 1994). The autism diagnostic interview-revised (ADI-R) was used in order to confirm the diagnosis and to evaluate the association of the symptoms to the severity of the NSS. The childhood autism rating scale (CARS) was completed for the patients in order to evaluate symptoms at the time of the NSS examination. Cognitive ability was assessed with Raven's progressive matrices. Were excluded patients with: history of cerebral palsy, congenital anomaly of the central nervous system, epilepsy, known genetic syndrome, tuberous sclerosis, neurofibromatosis, antecedent of severe head trauma, Asperger's syndrome, obvious physical deformities or sensory deficits that would interfere with neurological assessment, deep mental retardation and recent or chronic substance use or abuse. Healthy controls shared the same exclusion criteria, with no personal history of neurological, psychiatric disorder or substance abuse, no family history of psychiatric disorder and normal or retardation in schooling. All study procedures were approved by the local Ethics Committee (Comité d'éthique, Razi Hospital), according to the declaration of Helsinki. There was no difference between patients and controls with respect to sex, age and cognitive function. All children had an IQ higher than 81. Significant differences were found between AD children and control group in the motor integration function and sensory integration function. Different NSS scores were significantly higher in the PDDNOS group than in controls: the total scores, motor coordination, motor integration function, sensory integration and abnormal movements. Lower performance in motor coordination skills was associated with higher ADI-R communication score in the AD group. No relationship was found between NSS and CARS' total sore. This study confirms the impaired neurological functioning in autistic as well as PDDNOS children. The association of motor impairment with autistic symptoms highlights the argument that motor control problems can be part of the autism spectrum disorders. The lack of relationship between NSS and intellectual aptitude in the clinical sample provides new elements for the neurodevelopment model of the autism spectrum.

Motor skill abilities in toddlers with autistic disorder, pervasive developmental disorder-not otherwise specified, and atypical development

Motor skills were assessed in 397 toddlers, and it was demonstrated that atypically developing toddlers exhibited significantly greater motor skill abilities than toddlers with autistic disorder. No significant difference on gross or fine motor skill abilities were found between atypically developing toddlers and toddlers with pervasive developmental disorder-not otherwise specified (PDD-NOS), or between toddlers with autistic disorder and toddlers with PDD-NOS. Gross and fine motor skills were found to be more impaired for toddlers with autistic disorder compared to the atypical development group. Furthermore, differences in gross or fine motor skills between the autistic disorder and the PDD-NOS group approached significance. Approximate effect sizes were also calculated. Implications of the results are also discussed.

Overlap With the Autism Spectrum in Young Children With Williams Syndrome

The sociocommunicative abnormalities of young children with Williams syndrome (WS) with limited language were compared with those of children with clinical diagnoses of autism, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), or nonspectrum developmental disability. Participants were 30 children with WS and individually matched groups of participants with autism (n = 28), PDD-NOS (n = 17), and mixed etiology nonspectrum developmental disabilities (n = 16). The autism, PDD-NOS, and mixed etiology groups were matched individually to the children with WS for age, sex, and developmental level. All participants were administered the Autism Diagnostic Observation Schedule Module 1 and the Mullen Scales of Early Learning. As a group, children with WS with limited language showed fewer sociocommunicative abnormalities than children with autism, about the same level as children with PDD-NOS, and more abnormalities in reciprocity social interaction than participants in the mixed etiology group. Examination of the subgroup of participants with WS matched and compared with children with PDD-NOS indicated that half of the children showed fewer abnormalities than their individual matches with PDD-NOS, whereas half of the children with WS showed more abnormalities than their matches with PDD-NOS. Sociocommunicative difficulties are present for many children with WS and overlap with the autism spectrum. The results of this investigation suggest that these abnormalities are not accounted for by developmental delay alone, and care should be taken to avoid diagnostic overshadowing in young children with WS.

Differentiating Among Children with PDD-NOS, ADHD, and those with a Combined Diagnosis on the Basis of WISC-III Profiles

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and Attention Deficit/Hyperactivity Disorder (ADHD) have partly overlapping symptoms. It can also be debated whether a third diagnostic category exists: children with a combined diagnosis. In this study an attempt was made to distinguish among the three groups on the basis of intelligence (WISC-III) profiles. It was found that the PDD-NOS group had higher verbal and performance IQ's, as well as higher WISC-III index scores than the ADHD group. Subtests Block Design and Mazes discriminated best. It was concluded that based on intelligence scores, only PDD-NOS and ADHD emerged as distinct categories, whereas the combined diagnosis did not. Future research on the distinctiveness of these diagnostic groups, however, should include variables other than IQ.

Altered Chemical Metabolites in the Amygdala-Hippocampus Region Contribute to Autistic Symptoms of Autism Spectrum Disorders

Although several previous studies have been conducted, the neural basis of autism spectrum disorder (ASD) is poorly understood. The objective of the present study was to determine whether individuals with ASD have altered brain chemical metabolites and whether such alterations are related to their autistic symptoms. N-acetylaspartate (NAA)/creatine (Cr) and choline/Cr ratios in the right medial temporal lobe (MTL), medial prefrontal cortex, and cerebellar vermis were measured in 38 individuals with ASD (mean age = 12.9 years), including 12 with autism, 15 with Asperger's Disorder, and 11 with pervasive developmental disorder not otherwise specified (PDD-NOS), and 16 matched healthy control subjects (mean age = 11.5 years) with proton magnetic resonance spectroscopy. Autistic symptoms were assessed by the Childhood Autistic Rating Scale-Tokyo Version. There was a significant group difference for NAA/Cr ratio in the right MTL between the autism, Asperger's Disorder, PDD-NOS, and control groups (p < .001), and the autism group had a significantly lower NAA/Cr ratio compared with the PDD-NOS (p < .001) and control (p < .001) groups. In the ASD group, there was a significant negative correlation between NAA/Cr ratio in the right MTL and their Childhood Autistic Rating Scale-Tokyo Version total scores (r = -.44, p = .01) and subscales of emotional response (r = -.38, p = .02) and listening response (r = -.54, p = .001). The results of the present study suggest that subjects with ASD have abnormalities of neural integrity in the amygdala-hippocampus region that are related to their severity and social impairments.

Executive Functioning in Children with an Autism Spectrum Disorder: Can We Differentiate Within the Spectrum?

The aim of this study was to investigate whether children with high-functioning autism (HFA), Asperger's syndrome (AS), and pervasive developmental disorder not otherwise specified (PDDNOS) can be differentiated from each other and from normal controls on their neurocognitive executive functioning (EF) profile. Children with HFA and AS showed the most EF deficits. The EF profile of the PDDNOS group was more disturbed that the normal control group, but was less disturbed than the profile of the HFA and AS groups. Little difference was found between the three PDD subtypes with respect to EF. This study supports the view that executive dysfunctioning plays an important role in autism. The usefulness of a distinction between different PDD subtypes was not demonstrated.

Specifying PDD-NOS: A Comparison of PDD-NOS, Asperger Syndrome, and Autism

To describe the clinical characteristics of children given a diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) by expert clinicians and to compare these to the clinical characteristics of children given a diagnosis of autism and Asperger syndrome (AS). Two hundred sixteen children with autism, 33 with AS, and 21 with PDD-NOS were compared on measures of level of functioning (communication, daily living and social skills, IQ, and age of acquisition of language) and on various symptoms of autism (impaired communication and reciprocal social interaction and a preference for repetitive and stereotyped activities). In terms of level of functioning measures, the PDD-NOS children had scores that were between those of the children with autism and those of the children with AS. In contrast, the PDD-NOS group had fewer autistic symptoms, especially repetitive stereotyped behaviors, than both the autism and AS groups (chi2 = 11.06, p =.004). Children with PDD-NOS could be placed into one of three subgroups: a high-functioning group (24%) who resembled AS but had transient language delay or mild cognitive impairment; a subgroup resembling autism (24%) but who had late age of onset or too severe cognitive delays or were too young to potentially meet the full diagnostic criteria for autism; and a group (52%) not fulfilling the criteria for autism because of fewer stereotyped and repetitive behaviors. With some revision to current diagnostic criteria, a more homogenous atypical group with significant impairments in social-communication but fewer repetitive behaviors can be differentiated from the more nonspecific PDD-NOS group. This differentiation may lead to better reliability in diagnosis and to further progress in studies of etiology.

Relation of the Childhood Autism Rating Scale-Parent version to diagnosis, stress, and age

This study explored the relation of severity of functional impairment on the Childhood Autism Rating Scale-Parent version (CARS-P) to diagnosis, parenting stress, and child age. Twenty-two mothers of children with autism and 19 mothers of children with pervasive developmental disorder-not otherwise specified (PDD-NOS) completed the CARS-P and the Parenting Stress Index. The autism group received significantly higher (i.e., more severe impairment) CARS-P ratings that did the PDD-NOS group. For the total sample, severity of impairment was a significant predictor of child-related parenting stress. The CARS-P was inconsistently associated with age—significantly positive for the PDD-NOS group but nonsignificantly for the autism group. Implications for the use of the CARS-P in assessment of children and the evaluation of interventions are discussed.

Prenatal, perinatal, and neonatal factors in autism, pervasive developmental disorder-not otherwise specified, and the general population.

To examine various pre-, peri-, and neonatal factors in autistic participants and in pervasive developmental disorder-not otherwise specified (PDD-NOS) participants and to compare the incidence of each factor to that of the normal population. Seventy-four participants (66 males, 8 females) were diagnosed with autism at 2.5 through 4 years of age using the most accurate and up-to-date methods, including the Diagnostic and Statistical Manual of Mental Disorders and the Autism Diagnostic Interview-Revised. At age 5, all participants were reevaluated using the Diagnostic and Statistical Manual of Mental Disorders, the Autism Diagnostic Interview-Revised, the Childhood Autism Rating Scale, and the Autism Diagnostic Observation Schedule-Revised, resulting in 61 autistic and 13 PDD-NOS participants. Twenty-eight pre-, peri-, and neonatal factors were examined in these 2 groups using both medical records and parental interviews. Incidences were compared with those of the US population as reported in the Report of Final Natality Statistics, 1995. This grand scale population group was used to closely approximate comparison to a normal, unbiased population. Results were analyzed using the binomial probability test, with a P value of <.05, constituting a significant difference in incidence. A Bonferroni correction was applied to the data to adjust for the number of factors investigated. Although most of the factors showed comparable incidences between the index and control groups, several factors showed statistically significant differences. Following the Bonferroni correction, the autism group was found to have a significantly higher incidence of uterine bleeding, a lower incidence of maternal vaginal infection, and less maternal use of contraceptives during conception when compared with the general population. Similarly, the PDD-NOS group showed a higher incidence of hyperbilirubinemia when compared with the general population. The results of this study support previous findings suggesting a consistent association of unfavorable events in pregnancy, delivery, and the neonatal phase and the pervasive developmental disorders. However, interpretation of the meaningfulness of these results is difficult, as the specific complications that carried the highest risk of autism and PDD-NOS represented various forms of pathologic processes with no presently apparent unifying feature. Additional studies are needed to corroborate and strengthen these associations, as well as to determine the possibility of an underlying unifying pathological process. This study's analysis of obstetric and neonatal complications in combination with the use of participants diagnosed at an early age provides some interesting concepts to consider. Perhaps future research will confirm certain pre-, peri-, and neonatal associations that could be used to generate a high-risk historical profile with which to use in conjunction with currently employed diagnostic tools. This may, in turn, help to determine the reliability of a diagnosis of autism in younger children, leading to earlier intervention and assistance for an improved outcome in long-term functionality and quality of life.

How unspecified are disorders of children with a pervasive developmental disorder not otherwise specified? A study of social problems in children with PDD-NOS and ADHD.

This study examines possible differences and similarities between social behaviour problems in children with problems classified as pervasive developmental disorder not otherwise specified (PDD-NOS) and a group of children with problems classified as ADHD, as measured by parent questionnaires. The instruments involved were the CBCL (Child Behaviour Checklist), the ABC (Autism Behaviour Checklist) and a new instrument: the CSBQ (Children's Social Behaviour Questionnaire). In comparing the PDD-NOS group and the ADHD group, the results show that, according to parent reports, both groups have severe problems in executing appropriate social behaviour, but the PDD-NOS group can be distinguished from the ADHD group by the nature and the extent of these problems. The PDD-NOS group had significantly more social problems (as measured by the CBCL Social scale), withdrawn problems (as measured by the CBCL Withdrawn scale) and PDD-specific problems (as measured on the ABC Relating scale, the ABC Language scale, the CSBQ total score, the CSBQ Social Interaction scale and CBSQ Communication scale). In addition, although the descriptions of the social problems are global, i.e. on scale level, the results also show that the social problems of PDD-NOS children can be positively formulated and described as at least including severe social interaction problems, withdrawn behaviours and communication problems.

Emotional Role‐Taking Abilities of Children with a Pervasive Developmental Disorder Not Otherwise Specified

Seven to 12-year-old children with a Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) were compared with normal, healthy children of the same age and sex on three different emotional role-taking tasks. In these tasks, children had to use person-specific information to make an inference about another child's emotional reaction and behaviour, Significant differences were found between the PDDNOS group and control group: PDDNOS children performed worse on all three role-taking tasks. However, the differences on one of these tasks could be completely explained by intelligence differences between the two groups. On the other tasks, differences could not or be partially explained by intelligence differences. The results of this study led to the formulation of a more specific hypothesis, namely that PDDNOS children might have problems interpreting social information when affectively charged background information has to be used.