Pervasive Developmental Disorders Subjects Research Articles

Concordance of DSM-5 and DSM-IV-TR classifications for autism spectrum disorder.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in May 2013. Autism spectrum disorder (ASD) has been structured for the three subtypes of pervasive developmental disorder (PDD), but the number of impairment in social and communication dimension is not stated. The subjects were 68 children who visited the Department of Psychology and Development at Nagoya City University Hospital for the first time between the ages of 6 and 15 years old. We retrospectively re-examined the subjects using DSM-IV-TR criteria and DSM-5 criteria with two rules (two of three and one of three on the social and communication dimension) and examined the concordance rate. Forty subjects were diagnosed with PDD, and 28 were not. The mean PDD subject age was 9.4 years, and mean IQ was 84.0 on the Wechsler Intelligence Scale for Children III or 62.7 on the Tanaka-Binet test. Twenty-seven (68%) of the PDD subjects were classified with ASD using DSM-5 criteria when the two of three rule was applied, while 32 (80%) were classified with ASD when the one of three rule was applied. All subjects without PDD were not diagnosed with ASD on DSM-5 criteria. DSM-5 criteria may exclude high functioning and older subjects from ASD because they tend to be atypical. The diagnostic procedure for DSM-5 criteria is ambiguous, especially in high functioning subjects and those diagnosed at an older age.

Switching to aripiprazole in subjects with Pervasive Developmental Disorders showing tolerability issues with risperidone

Subjects with Pervasive Developmental Disorders (PDD) often exhibit behavioral symptoms such as aggressiveness and irritability, which are targets of psychopharmacologic intervention. This retrospective study was designed to examine children and adolescents with PDD experiencing tolerability issues with risperidone treatment, and thereby assess the efficacy and tolerability of switching to aripiprazole. This naturalistic study included 23 subjects with PDD (16 males, 7 females, age range 9-24 years, mean age 15.1±3.9 years) diagnosed according to DSM-IV criteria and followed up for 14.9±8.4 weeks after switching to aripiprazole from risperidone. Outcome measures were the Clinical Global Impression-Severity (CGI-S) and CGI Improvement (CGI-I) scales. The mean CGI-S scores of pre-aripiprazole treatment and post-aripiprazole treatment were, respectively 4.7±1.4 and 4.6±1.3. Mean maintenance dosages of risperidone and aripiprazole were, respectively, 0.7±0.5mg/day and 2.8±1.3mg/day. The mean CGI-I score, which shows the difference induced by switching from risperidone to aripiprazole, was 3.4±0.8 for the whole sample, suggesting that the efficacy of risperidone for treating behavioral problems of PDD was maintained by aripiprazole. Some improvement of safety/tolerability issues such as increased appetite, somnolence, hyperprolactinemia, and amenorrhea occurred after switching to aripiprazole. Results show that switching to aripiprazole might be generally well tolerated and might constitute an alternative treatment for subjects with PDD who experience tolerability issues with risperidone treatment. Additional long-term controlled studies of PDD subjects should be undertaken to evaluate the efficacy and safety of switching to aripiprazole from other antipsychotics.

The specific impairment of fearful expression recognition and its atypical development in pervasive developmental disorder

Several studies have examined facial expression recognition in pervasive developmental disorder (PDD), including autism and Asperger's disorder, but the results have been inconsistent. We investigated the relationship between facial expression recognition and age, face recognition, and symptom severity. Subjects were 28 individuals with mild PDD subtypes and 28 age- and gender-matched controls. Among six emotions, fearful expression recognition was specifically impaired in PDD subjects. Age had positive effects on fearful expression recognition directly and indirectly via the development of face recognition in controls, but not in PDD subjects. Furthermore, fearful expression recognition was related to the severity of PDD symptoms. We conclude that individuals with PDD show an atypical development of facial expression recognition. Moreover, impaired fearful expression recognition is closely related to social dysfunction.

Social needs in daily life in adults with Pervasive Developmental Disorders

Although social deficits remain a persistent component of the behavioural phenotype of Pervasive Developmental Disorders (PDD) in adulthood, it remains unclear whether these represent diminished social needs, as is seen in social anhedonia, or rather thwarted social needs, as is seen in social anxiety. This study used the Experience Sampling Method (ESM) – a structured diary technique – to examine social interaction in daily life of 8 adults with PDD, compared to 14 healthy controls. Multilevel linear regression analyses showed that PDD subjects a) did not spend more time alone, b) had no increased preference to be alone when in company, and c) spent more time with familiar people, compared to control subjects. Patients experienced more negative affect and anxiety when in the company of less familiar people compared to when they are alone, whereas no difference in affect could be found between being alone or being with familiar people. All these lines of evidence suggest that PDD subjects do have a desire to interact. However, this may be thwarted as is seen in social anxiety. Therapeutic interventions should aim at decreasing negative affect and anxiety in social interactions possibly by improving social skills to fulfil the existing social needs in adults with PDD.

Smaller insula and inferior frontal volumes in young adults with pervasive developmental disorders

Enlarged head circumference and increased brain weight have been reported in infants with pervasive developmental disorders (PDD), and volumetric studies suggest that children with PDD have abnormally enlarged brain volumes. However, little is known about brain volume abnormalities in young adults with PDD. We explored gray matter (GM) volume in young adults with PDD. T1-weighted volumetric images were acquired with a 3-T magnetic resonance scanner from 32 males with high-functioning PDD (23.8±4.2 years; Full Scale Intelligence Quotient [FSIQ]=101.6±15.6) and 40 age-matched normal male control subjects (22.5±4.3 years; FSIQ=109.7±7.9). Regional GM volumes were compared between the two groups using voxel-based morphometry (VBM) with the Diffeomorphic Anatomical Registration using Exponentiated Lie algebra (DARTEL). Compared with the control group, the high-functioning PDD group showed significantly less GM in the right insula, the right inferior frontal gyrus, and the right inferior parietal lobule. A conservative threshold confirmed considerably smaller volumes in the right insula and inferior frontal gyrus. In these areas, negative correlations were found between Autism Spectrum Quotient scores and GM volume, although no significant correlations were found between each subject's FSIQ and GM volume. No regions showed greater GM volumes in the high-functioning PDD group. The insular cortex, which works as a relay area for multiple neurocognitive systems, may be one of the key regions underlying the complex clinical features of PDD. These smaller GM volumes in high-functioning PDD subjects may reflect the clinical features of PDD itself, rather than FSIQ.

Rapid Quantitative Assessment of Autistic Social Impairment by Classroom Teachers

Teachers routinely observe children in the naturalistic social contexts of their classrooms and provide extremely important input in the evaluation of numerous psychiatric syndromes. Their precision in ascertaining and quantifying autistic symptomatology has not previously been established. In this study, we compared teachers' ratings of autistic symptomatology with those derived from parents, expert clinicians, and trained raters. A total of 577 subjects (ages 4-18 years) with (n = 406) and without (n = 171) pervasive developmental disorders (PDDs) were assessed by one parent and one current teacher using the Social Responsiveness Scale, a quantitative measure of autistic traits. PDD subjects were assessed by expert clinicians, the Autism Diagnostic Interview-Revised, and/or the Autism Diagnostic Observation Schedule. All of the assessments were conducted during the period 1996-2006. Teacher Social Responsiveness Scale reports exhibited strong correlations with parent reports (0.72); use of quantitative ratings from both informants resulted in extremely high sensitivity and specificity for clinical and research diagnoses of PDDs (area under receiver operating characteristics curve = .95). Rapid quantitative assessments by teachers and parents constitute a cost-effective method for measuring and tracking the severity of autistic symptomatology in both educational and clinical settings.

Abnormal spatial frequency processing in high-functioning children with pervasive developmental disorder (PDD)

Objective Basic abnormalities in visual information processing could be associated with the local visual bias often found in subjects with PDD. Therefore, the present study investigated the existence of deficits in spatial frequency processing at an early sensory level in children with PDD. Methods Visual evoked potentials (VEPs) and VEP dipole sources elicited by high and low spatial frequency gratings were analyzed in high-functioning children with PDD and matched controls. Results Around 80 ms (N80-latency) children with PDD did not show the same robust differences between high and low spatial frequencies in VEP amplitude and VEP brain sources as controls, because of atypical processing of high frequencies. Analyses at the P1-latency (130 ms) revealed that, although similar inferior–medial brain sources were activated for the processing of both spatial frequencies in the PDD and control group, source strength in response to both frequencies was weaker in the PDD compared to control group. Moreover, additional superior–lateral brain sources were activated during the processing of both frequencies in the PDD group. Conclusions Decreased specialized processing of high and low spatial frequencies might be a robust characteristic of PDD. Early in processing abnormalities in high spatial frequency processing seem to occur in PDD. At a later phase in processing there seems to be both atypical high and low spatial frequency processing. Considering that the processing of specific spatial frequencies plays an important role in the processing of global and local aspects of hierarchical stimuli and faces and of emotions, present data suggest that peculiarities in PDD subjects with respect to these stimuli might be related to an abnormality in more fundamental visual processes. Significance A basic abnormality in visual frequency processing is established in children with PDD.

Decreased prefrontal activation during letter fluency task in adults with pervasive developmental disorders: A near-infrared spectroscopy study

Functional neuroimaging studies have suggested that dysfunction of prefrontal cortex (PFC) is present in persons with pervasive developmental disorders (PDD). Recently, the development of near-infrared spectroscopy (NIRS) has enabled noninvasive bedside measurement of regional cerebral blood volume. Although NIRS enables the noninvasive clarification of brain functions in many psychiatric disorders, it has not yet been used to examine subjects with PDD. The aim of our study was to conduct an NIRS cognitive activation study to verify PFC dysfunction in PDD. The subjects were 10 adults with PDD and 10 age- and gender-matched healthy subjects. Hemoglobin concentration changes were measured with a 24-channel NIRS machine during the letter fluency task. While the number of words generated during the letter fluency task did not differ significantly between groups, the analysis of covariance including IQ as a confounding covariate showed that the PDD group was associated with bilateral reduction in oxy-hemoglobin concentration change as compared with the control group. The statistical results did not change when only IQ-matched high-functioning subjects ( N = 7) were included. Moreover, reduced oxy-hemoglobin concentration change for the right PFC was significantly correlated with verbal communication deficits within the PDD group. The present findings are consistent with proposed prefrontal dysfunction in PDD subjects identified by other neuroimaging modalities. The present results may be also potentially useful for applying NIRS to clinical settings of child psychiatry.

Processing capacity in children and adolescents with pervasive developmental disorders.

This study sought to investigate whether the abnormally small P3 amplitudes observed in pervasive developmental disorder (PDD) are related to differences in processing capacity. PDD children and adolescents and their control groups participated in the study. Visual probe stimuli were presented during an auditory task with two levels of difficulty. Event-related potentials (ERP) were measured from 62 electrodes during task performance. All groups showed amplitude increases to auditory stimuli with increasing task load. Controls showed expected smaller P3 amplitudes to visual probes, whereas PDD subjects did not. The results suggest that autistic subjects show abnormal capacity allocation. Some of these abnormalities may dissolve over time, while others remain into adolescence.

Mania in Children With Pervasive Developmental Disorder Revisited

Although a small literature of case reports suggests that mania co-occurs with pervasive developmental disorder (PDD), little is known about this overlap. The authors systematically investigated the overlap between mania and PDD in a consecutive sample of referred youths, examining its prevalence and correlates. It was hypothesized that children with PDD plus manic features have both disorders. Subjects were consecutively referred children meeting diagnostic criteria on structured interview for PDD without mania (n = 52), the comorbid condition PDD + mania (n = 14), and mania without PDD (n = 114). All subjects were evaluated using a comprehensive diagnostic battery that included assessment of psychopathology (structured diagnostic interview and Child Behavior Checklist), cognition, and functioning. Of the 727 referred children, 52 met criteria for PDD, 114 met criteria for mania, and 14 met criteria for both. The 14 children with both PDD + mania represented 21% of the PDD subjects and 11% of all manic subjects. Clinical characteristics of PDD were similar in PDD subjects with and without mania, and manic features were similar in manic children with and without PDD. Children with PDD and mania may suffer from two disorders. Comorbid mania among patients with PDD may be more common than previously thought. Identification of the comorbid condition may have important therapeutic and scientific implications.

Lack of Cognitive Impairment in First-Degree Relatives of Children with Pervasive Developmental Disorders

The objective of this study was to test the hypothesis that mild cognitive impairments aggregate in the unaffected first-degree relatives of probands with autism or pervasive developmental disorders (PDD). The unaffected siblings and parents of 52 PDD probands and 33 Down syndrome and low birth weight controls were administered a battery of psychometric tests. The tests included measures previously found to be depressed in siblings of autistic children as well as cognitive deficits seen in PDD subjects of normal IQ. In addition, the Vineland Adaptive Behavior Scales were administered to siblings to measure the social-communication impairments found in PDD. Neither the siblings nor parents of the PDD probands demonstrated lower cognitive or adaptive behavior scores compared with controls. Developmental histories did not reveal greater rates of social, cognitive, or language delays, nor was there evidence to suggest that relatives of subgroups of PDD probands were different from each other. These findings indicate that, apart from relatives with PDD, cognitive and social impairments do not aggregate in the families of PDD probands.

Assessing the relationship between affective responsivity and social interaction in children with pervasive developmental disorder

An investigation of children with pervasive developmental disorder (PDD) was conducted using a new instrument, the Kiddie-Infant Descriptive Instrument for Emotional States (KIDIES). The KIDIES rates several affective and behavioral dimensions based on facial, vocal, gestural, and postural cues. The study's goals were to determine whether the KIDIES could detect individual differences in responsivity among the PDD subjects; to ascertain the KIDIES' sensitivity in identifying group differences between PDD subjects and control children with other developmental disorders. Children were videotaped during episodes with three partners: the mother, a familiar female teacher, an unfamiliar male doctor. Episodes were scored using the KIDIES. PDD subjects were most severely impaired during the Mother episode in comparison to the controls. Equally as striking was the within-episode heterogeneity among PDD subjects. During the Teacher episode, PDD subjects were twice as variable in interpersonal response as the controls.

The Use of Intonation to Communicate in Pervasive Developmental Disorders

The objective of this paper was to employ a functional linguistic approach to explore pragmatic failure in the spontaneous speech of subjects with pervasive developmental disorders (PDD). Patterns of intonation use were compared among subjects with Asperger's syndrome (AS), high-functioning autism (HFA), and psychiatric out-patient controls (OPC) with a variety of non-specific social problems. Written transcripts and audio-recordings were used to measure rates of various intonation types relative to the amount of speech produced. The major finding of the study was that the HFA subjects less often tend to employ useful patterns of intonation for communication than the AS or OPC groups. This suggests that HFA either send random intonation signals to hearers or else demonstrate systematic misuse of the linguistic system. AS subjects differed little from the controls. The implications of these results for understanding the communicative failure of PDD subjects is discussed.