Neuroscience For Kids

El TGD, consiste como su nombre indica en un trastorno en el desarrollo del tubo neural en el feto y sobre todo en un dficit en la poda neuronal que se da desde los dos aos hasta la adultez.
An no se conoce la causa exacta, pero se sabe que existe claramente una base neurobiolgica: est afectado el funcionamiento del sistema neurolgico y el del cerebro

La embriologa nos dice que el tubo neural se desarrolla a partir del ectodermo (igual que la piel y el sistema inmunolgico, de ah la comorbilidad en estos sistemas). Y que las neuronas cuando crecen en un feto lo hacen primero de forma inmadura, siendo pequeas y con conexiones a corta distancia muy densas. Y lo hacen primero en el sistema lmbico y en el cerebelo, densamente poblado en lo neuronal, pero de clulas inmaduras y de axon pequeo. As el nio cuando nace es muy emocional pero no puede pensar, es con el tiempo que hay una poda de estas conexiones a corta distancia para lograr el establecimiento de otras a larga distancia hacia la corteza cerebral. Por eso en la infancia se es ms emocional e impulsivo, porque el sistema nervioso central es an inmaduro. Cuando una persona con TGD muere, tambin se le hacen autopsias y en el estudio de su encfalo se ha visto un sistema lmbico inmaduro con neuronas pequeas, y tambin pocas clulas de Purkinje en el cerebelo, porque esta poda neuronal por defecto gentico no se hizo con la amplitud necesaria (y en eso hay grados que indica que es un espectro desde la normalidad hasta sndromes graves de autismo) Y en las personas con TGD, y dficit en algunas conexiones, tienes que utilizar otras reas del cerebro para la misma funcin. Pero siempre lo har de forma ms lenta o con otra cualidad, diferente a los normales. Por eso no es una enfermedad, sino una forma de ser que se ve rara y por eso provoca rechazo, pero que puede ser ms exhaustiva o ms inteligente, pero siempre fuera de la onda social y con mayor lentitud. Ya que adems el cerebelo en una regin inmaduro y el hemisferio derecho (holstico) no pueda hacer su labor de integracin de muchos estmulos a la vez y por eso estas personas prefieran la soledad para poder trabajar secuencialmente con su hemisferio izquierdo, analtico, funcionando en perfecto estado y sin interferencias. Growing knowledge
Later in the 1960's research into the way the brain functioned and the how the process of brain development can go wrong pre- and post-natal started to show that autism was indeed a spectrum of conditions and that they are disorders of development.

So what causes autism?

Once researchers had dismissed emotional causes for autism (although this is still a belief held in some countries) it became apparent that there must be a biological origin to the disorder. There were a number of powerful indicators for a biological cause: 1. 2. 3. 4. 5. Autism is often accompanied by other neurological symptoms; Autism is often associated with other learning difficulties; Autism is often accompanied by epilepsy; Mothers of autistic people often report difficulties in pregnancy and labour; Other conditions such as viral infections, metabolic conditions and genetic abnormality are closely related to autistic spectrum disorders.

The evidence
At present, various techniques are used to obtain pictures of the brain including CAT (Computer Axial Tomography) scans and MRI (Magnetic Resonance Imaging) scans. Several studies have revealed abnormalities in different regions of the brain. The following areas have been highlighted for special attention: 1. 2. 3. Abnormalities in the frontal lobes areas in the brain responsible for planning and control. Abnormalities in the limbic system the part of the brain responsible for emotional regulation. Abnormalities in the brain stem and fourth ventricle or in the cerebellum which governs motor coordination.

What all this research shows is that in many cases brain anomalies are associated with people with autism. Brain research has also shown that between 30 and 50% of children with autism have abnormally high levels of serotonin in the blood, a chemical responsible for transmitting signals in nerve cells.

Medical conditions that may cause autism

The following lists the medical conditions that have been identified in some children with autism:

Genetic conditions; Viral infections; Metabolic conditions; and Congenital anomaly syndromes.

4.4.1 Genetic conditions

Studies of identical twins (sharing identical genetic material) and non-identical twins (sharing half their brothers or sisters genes) have shown an increased prevalence of autism in identical rather than non-identical twins. This shows a clear genetic link. However, even with identical twins there are recorded cases of just one sibling with autism. There are also some rare genetic conditions that sometimes give rise to autism.

This study has shown that autism can affect memory, sensory perception and movement because it prevents different parts of the brain working together to achieve complex tasks. All autistic children had the ability to speak, read and write. However while these performed as well as, and sometimes even better than, the other children in basic tests, they all had trouble with complex tasks.

Read more: Multiple Parts of the Brain Affected by Autism http://www.medindia.net/news/view_news_main.asp?x=13396#ixzz1PLB5DaZG

Autism
A Case Study

Fred's parents were concerned. Fred was two and a half years old, but had not begun to talk. He didn't babble like other children his age. Fred did not make eye contact, but his vision seemed fine. He loved watching his own hands. He could sit for hours watching his hands move back and forth. Fred was diagnosed with autism, a neurological disorder that disrupts normal development. Some children with autism can attend school with children their own age; others need special care.
The Symptoms

Autism is classified as a pervasive developmental disorder. The "pervasive" part of the name implies that the disorder is serious, or that it affects many areas of development. Symptoms vary greatly from person to person. People with autism may appear to daydream constantly or be unaware of people around them. Most children with autism prefer to play by themselves, and treat other people like furniture. The major symptoms of autism include:

Communication Problems: Many people with PDD are uncommunicative - they will not speak, gesture, or make facial expressions. When they do speak, the speech may be in a sing-song pattern or monotone (no variation in pitch, like playing a single note on an instrument). Other people with PDD may talk at length with no regard to what another person says or does. Repetitive Motions: Most people with PDD enjoy repetitive motions, such as spinning objects, running water, or sniffing objects. A sense of routine is very important, and it can be extremely upsetting to them when part of their routine is changed. This could be something as trivial as changing the route to the grocery store or moving an item within the house. Problems with Social Interactions: People with PDD have trouble interpreting other people's facial expressions. Most of the time they will not make eye contact with others and have trouble making friends. Some people with autism are hypersensitive to sound and may get very upset when they hear sirens or dogs barking. Others are fascinated by faint noises such as the ticking of a watch. To some, bright lights are distressing, while others will stare at bright lights for hours. Many people with autism can not stand light touch: scratchy clothing could be unbearable. Others seem immune to pain and may hurt themselves. Mood swings are common.

The Cause of Autism is Unknown

It was once thought that poor parenting caused autism. This is definitely not true. Although the cause of autism is unclear, it is known that genetics do play a role. The disorder is seen often in identical twins: different studies have shown that if one identical twin has autism then there is a 63-98% chance that the other twin will have it. For non-identical twins (also called fraternal or dizygotic twins), the chance is between 0-10% that both twins will develop autism. The chance that siblings will be affected by autism is about 3%. Chance that both people will develop autism:

63-98% Identical Twins

0-10% Fraternal Twins

3% Siblings

Autism appears to be associated with other chromosomal abnormalities, such as Fragile X syndrome or brain abnormalities such as congenital rubella syndrome. A large number of people with these disorders are also diagnosed with autism. Furthermore, complicated births, such as difficult pregnancies, labor, or delivery may to contribute to the disorder.
Diagnosis

Autism is a behaviorally defined syndrome. There is no simple test for it. Usually parents notice that their child is not developing in the same way as other children the same age. A physician can perform a psychiatric exam, ruling out other disorders such as schizophrenia, selective mutism (when the child chooses not to speak but can speak if he wanted to), or mental retardation, to name a few. Other tests examine language skills. When all test results are examined, a physician can make a diagnosis.
Treatment

Although symptoms in children may lessen with age, autism is a lifelong disorder. Some people with autism will remain in institutionalized care and approximately 50% will remain without the ability to

speak. Structured programs that do not allow the child to "tune out" have proved successful at helping many children gain language and some social skills. Many times children with autism will have other disorders, such as epilepsy (seizures), hyperactivity, and attention problems. Epilepsy, in particular, appears to get worse as autistic children get older. Drugs that inhibit the reuptake of the neurotransmitter called serotonin have some success in treating patients with autism. These drugs, such as Fluoxetine, slow the reuptake of serotonin by the neuron that releases it. Therefore, serotonin stays in the synapse for a longer time.

Normal Synapse

With Fluoxetine

A Look at the Brain of a Person with Autism

Brain imaging techniques, such as magnetic resonance imaging (MRI), have been used to examine the brains of people with autism. However, results have been inconsistent. Abnormal brain areas in people with autism include the:

Cerebellum - reduced size in parts of the cerebellum. Hippocampus and Amygdala - smaller volume. Also, neurons in these areas are smaller and more tightly packed (higher cell density). Lobes of the Cerebrum - larger size than normal. Ventricles - increased size. Caudate nucleus - reduced volume.

Quick Facts About Autism

Autism occurs in approximately 1 out of every 110 children in the U.S. (Reference: CDC, 2009)

Autism is the third most common developmental disorder in the U.S., affecting at least 500,000 people. Autism is seen more often in boys; four or five boys will have autism compared to one girl. But girls with autism are often more severely affected than boys and score lower on intelligence tests. Leo Kanner first described autism as the "inability to relate themselves in the ordinary way to people and situations from the beginning of life" in the 1943 paper "Autistic Disturbances of Affective Contact." Autism usually is seen within the first three years of life. Some people with autism are gifted in certain areas such as math or music. Autism has also been called "early infantile autism," "childhood autism," "Kanner's autism," and "pervasive developmental disorder."

References and further reading:

1. American Psychiatric Association: Diagnostic Manual of Mental Disorders (DSM-IV), 4th Edition, Washington, D.C., American Psychiatric Association, 1994. 2. Griffiths, D. 5-Minute Clinical Consult, Baltimore: Williams and Wilkins, Inc., 1999. 3. Kaplan, H.I. and Sadock, B.J., Comprehensive Textbook of Psychiatry, 6th Edition, Baltimore: Williams and Wilkins, 1995. 4. Kates, W.R. et al., Neuroanatomical and neurocognitive differences in a pair of monozygous twins discordant for strictly defined autism, Ann. Neurol., 43:782-791, 1998. 5. Rapin, I. Autism in search of a home in the brain. Neurology, 52:902-904, 1999. 6. Rowland, L.P., Merritt's Textbook of Neurology, 9th Edition, Malvern: Williams and Wilkins, 1995. 7. Autism Information from the National Institute of Child Health and Human Development 8. Autism Resources
Copyright 1996-2010, Eric H. Chudler, University of Washington

Pervasive Developmental Disorders (PDD)

The central nervous system is the core of our existence. It controls our personality thoughts, memory, intelligence, speech and understanding, emotions; senses vision, hearing, taste, smell, touch; basic body functions breathing, heart beat, blood pressure; and how we function in our environment movement, balance, and coordination. Learning about the normal workings of brain will help you understand why people with PDD share certain characteristics and you may imagine why this happens. In this case we are going to analyse the characteristics of PDD and how it affects the learning process of the person with this illness. Problems may occur when a child's developmental level is quite low and it is easily observable in children who are toddlers and young preschool-age children. Many of the behaviours that are considered crucial for diagnosis are still very variable in typically developing young children in this age range. Some children may receive a diagnosis of PDD as a toddler because they did not have any

communicative behaviour; later they may qualify for a diagnosis of autism as their communication develops and it becomes more evident that a qualitative difference exists in that area. For parents and educators, the important thing to focus on is what can be

done to help the child develop skills in the areas of concern.

What are the Pervasive Developmental Disorders? The Pervasive Developmental Disorders or Autism Spectrum Disorders (ASD) are a group of developmental disabilities, which according to recent estimates, affect as many as 1-2 out of every 500 people. PDD is a disability that affects verbal and nonverbal communications, social interactions, and play activities. PDD children often appear relatively normal until the age of 18-24 months when parents notice delays in language, play or social interaction. PDD is a spectrum disorder, meaning there is a wide variation in symptoms from mild to severe. PDD is an "umbrella" diagnosis that includes Autism, Aspergers Syndrome, Rett's Syndrome, Childhood Disintegrative Disorder, and PDD Not Otherwise Specified (PDD-NOS).They affect up to 4-5 times as many boys as girls, occur in all cultures, and are present among all socioeconomic classes. They usually become noticeable between the ages of 1 and 3 years, and affect the way in which social behavior, communication (verbal and nonverbal communication), and attention/interests develop. There is a wide spectrum of impairment associated with the Pervasive Developmental Disorders, which can range from mild to severe. The PDDs do not describe a delay in development, but rather a difference or deviation in development in these three areas. Causes of PDD There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in autistic versus non-autistic children. Researchers are investigating a number of theories, including the link between heredity, genetics and medical problems. In many families, there appears to be a pattern of autism or related disabilities, further supporting a genetic basis to the disorder. While no one gene has been identified as causing autism, researchers are searching for irregular segments of genetic code that autistic children may have inherited. It also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single "trigger" that causes autism to develop.

When assessing the skills of a child with a PDD, it is important to evaluate the skills that they show on an everyday basis in situations that are meaningful and familiar to them. Evaluation should not only focus on identifying a childs intellectual level, but should aim to identify the childs learning characteristics so that meaningful goals can be planned to help the child develop to his or her potential. What causes Pervasive Developmental Disorders? Pervasive Developmental Disorders are neurologically-based, medical disorders that in a percentage of cases, there may be a genetic cause. Although scientists are making strides in identifying their cause(s), right now, there does not appear to be one specific cause for all cases. A physician or psychologist may diagnose one of these conditions using a medical model (following the criteria set forth in the Diagnostic and Statistical Manual-Fourth Edition, DSM-IV). Alternatively, an education team may assign an educational eligibility (autism), based on a child's special needs for educational modifications. At the present time, there is no medical test that indicates an autism spectrum disorder; however, routine medical screenings (metabolic, genetic, and Fragile X) are recommended to rule out the presence of another identifiable condition. In either case, the diagnosis of a PDD is based on behavioral observations and clinical experience. People with an intellectual impairment continue to develop skills and abilities as they grow, although they typically progress more slowly than their peer group. Intellectual Impairment is identified by comparing a person's intellectual performance on standardized tests with others in his/her age group, and by looking at how well that individual can function in adaptive skills (self-care, safety knowledge, independent living skills). Characteristics of PDD Communication: Their language development is delayed. They use words without understanding their meaning. They communicate with gestures instead of words. They may "lead," taking you by the hand to what they want Many, but not all, make poor eye contact. They often have few facial expressions. They may echo your words. Some have an amazing memory (repeating TV commercials exactly, or memorize all the world's capitals). They may read Time magazine perfectly at 3 years of age but not understand what they are reading. They may reverse their pronouns. They often refer to themselves as "he" or "she" instead of l."

Social Interaction: They spend time alone rather than with others, show little interest in making friends and are less responsive to social cues such as smiles. Sensory Impairment: They have unusual reactions to physical sensations such as being overly sensitive or unresponsive to touch, pain, sight, hearing, smell, or taste. They may smell everything or refuse foods because of texture. They may stare at moving lights or fan. They may self stim behavior. These PDD children have repetitive motor mannerisms (e.g., rocking, clapping or hand flapping). Play: They lack spontaneous make-believe play. They do not imitate others actions, or initiate pretend games. They may stick on one activity (like stacking. lining up cars, rolling marbles, or watching water drip). They may have a favorite toy (like a thread or a stick) that they will carry everywhere. Behaviors: They may be hyperactive or very passive, throw frequent tantrums for no apparent reason, or perseverate (get stuck) at a single item, idea, or person. They lack common sense and have abnormal intense interests. They become obsessed with a routine and may have extreme temper tantrums if something is changed. They may be aggressive or violent towards others. They may hurt themselves by biting or head banging. Types of PDD Autism, sometimes called Kanner's Autism, is fairly rare. These children do not communicate at all and will spend hours rocking or playing with string or books. PDDNOS is a child who exhibits fewer symptoms than "classic Autism. " Rett's Syndrome occurs in girls who have normal head size at birth and normal development. Then between 5 and 48 months their head growth slows and they develop stereotypic hand movements (e.g., hand-wringing or hand washing). They become socially withdrawn. They have poor coordinated gait or trunk movements. They develop severely impaired expressive and receptive Language. Many have difficult to control seizures. Asperger's Syndrome (AS) have normal language development during the first few years. But they have impaired social and non-verbal behaviors such as eye-to-eye gaze,

facial expression, body postures, and gestures. Children with AS tend to be "in their own world" and preoccupied with their own agenda. They take things literally (they look for dogs when you say "it's raining cats and dogs"). AS children have -an excellent rote memory and musical ability. They become intensely interested and perseverate on a subject. For example, an AS child may have a favorite TV program, and one day it is on at a different time. Not only are they upset by the change, but they talk about the incident for weeks afterward. They may obsess on encyclopedias or memorize all the 60's rock groups. Their social skills are very poor. They lack self-awareness-they simply do not perceive themselves as "in the world." They may be insulted by other kids, and they are not hurt because they do not understand that they have been insulted. They think of themselves as perfect. They see everything as black or white, pointing out flaws or mistakes in others. They are not able to interpret their own feelings. They do not know what feelings are. They cannot understand that other people have feelings. Other features include clumsiness lack of a sense of humor, and a high anxiety level. AS children appear to be "oddballs," but they are not stupid; in fact they are almost always very intelligent. But they are stuck in a "fog"

The child need not show all of these characteristics.

I. Qualitative impairment in reciprocal social interactions: This refers to a developmental difference in the individual's interest and competence in achieving reciprocal interactions. It does not mean that the individual is not affectionate, or cannot make contact with other people, or is simply behind schedule in the development of social skills. What is different is the quality of interaction and interest. Behaviors suggesting this area may be affected include: difficulty understanding/perceiving the emotions of others difficulty sustaining interactions initiated by others poor, fleeting or abnormal eye contact lack of comfort-seeking when distressed difficulty making peer friendships appropriate to developmental level lack of social or emotional reciprocity lack of effort to share interests or enjoyment with others (may not show, point out or bring objects to share with others)

in preschool children, lack of turn-taking play with peers (although the child may enjoy active and rough-and-tumble play) difficulty understanding social cues(clave) difficulty understanding and expressing his/her own emotions seeking touch and affection on own terms, but shunning(to deliberately avoid someone or something) affection when offered by others (not on own terms) preference for solitary play instead of group or paired play absence of symbolic play behaviour, very literal and concrete in comprehension (e.g., would not use a block as a telephone) frequent or sustained giggling, laughing or crying without visible cause may appear deaf at times, yet hear sounds from a distance at other times (ignore voice when name is called, yet run to window when ice cream truck is two blocks away)

II. Qualitative impairment in verbal and non-verbal communication and imaginative activities: Again, this does not refer to a delay in development, but rather a difference in the way verbal and nonverbal communication proceeds. Behaviours suggesting this area may be affected include: normal development of early babbling and first words which are later lost between the ages of 1 and 3 years, while other development appears to proceed on course difficulty developing verbal communication pulling adults to items of interest rather than pointing or gesturing lack of use of gestures, demonstration, mime to compensate for lack of verbal expression repeating phrases verbatim frequently (echolalia) repeating phrases (often from TV) out of context after a period of time has passed (delayed echolalia) using words out of communicative context (walks around saying "hi daddy" when daddy is at work, and nobody is present) answering question by parroting question back to you poor timing and content variation in topic difficulty taking turns in maintaining a conversation difficulty with abstract concepts (learns nouns better than verbs or adjectives) difficulty understanding the "theme" of a story inventing own words for objects and rigidly uses them (neologism)

talking mainly about one restricted topic, or using one word repeatedly (perseveration) acting as if adults can read his/her mind question-like or sing-song cadence to their speech difficulties in imitation

III. Restricted repetitive and stereotyped patterns of behaviour, interests, and activities: engaging in repetitive non-functional body movements (for example, spinning or whirling around, flapping arms or hands, rocking, walking on tiptoes, looking at fingers (stereotypies) difficulty with changes or transitions under- or over-sensitivity to sensory stimuli (sounds, lights, textures, odours) restricted food preferences, sometimes related to food texture may explore environment in unusual ways (smelling objects, mouthing excessively, scratching, licking) develop attachments to objects that are not typical for children (must sleep with twigs(a small very thin stem of wood that grows from a branch on a tree)) may carry around objects without ever playing with them, and become upset when they are taken away becomes fascinated with parts of objects (wheels, lines, writing) may spin objects that are round in shape may focus on ordering and reordering or categorizing toys instead of playing with them (lining up cars, amassing red blocks) plays with materials in the same sequence across a period of time where variation would be expected (has Ernie follow same route to hospital every time he plays with car mat) develops routines that are difficult to break may get upset over trivial changes in environment (moving a lamp) not interested in a wide variety of toys and materials peculiar insistence in selected items, sequences, or routines (will only drink milk out of a certain cup) does not ask for help, but figures out how to get what he/she wants

OTHER CONCERNS:

eating inedible objects undersensitive to pain attention span fleeting(lasting for only a short time) for most activities, yet can spend long periods of time focused on one activity of his/her own interest (can watch videos for hours, but can't sit for 30 seconds for other tasks)

high overall activity level may need less sleep than typical children of the same age absence of fear or appreciation of dangerous situations self-injurious behaviour that does not appear to be directed at achieving any result (head banging, eye poking, biting) uneven intellectual ability (skills show a great deal of variability) peculiar fascination with one specific medium (country music, TV station, Wheel of Fortune, preview guide), etc. more interested in credits and commercials than TV shows unusual fear reactions

STRENGTHS: good memory, especially for visually presented information enjoys completing tasks with a set end point may have precocious interest in letters and numbers cuddly and affectionate with parents, usually on own terms mechanical aptitude (can program the VCR at age 2) higher skills/talents in art, music, math, balance enjoy vestibular stimulation (tosses, being turned upside down, etc) stamina physical or mental strength that lets you continue doing something for a long time without getting tired: good non-verbal problem solving abilities (can get what they want)

What should I do about my child's Autism/PDD-NOS? The most successful approach to dealing with the symptoms of Autism involves systematic and intensive educational programming. You may want to pursue a second opinion regarding diagnosis; however, the most prudent approach is to assume that the diagnosis is correct and proceed to develop plans to deal with the language and social difficulties of the child through educational programming (including speech therapy, therapeutic play groups, etc.) while you are also looking for a second opinion. If the original diagnosis was incorrect, no

valuable time will be lost. The Emory Autism Center is available at (404) 727-8350 to provide you with information, referrals, evaluations, and recommendations for your child. Those with PDD respond well to a highly structured specialized education and behavior modification program, tailored to the individual. This includes language therapy, social skills development, daily living skills, sensory impairment therapy, (OT: Occupational Therapy) and a behavior modification program. Methods like Lovaas (Applied Behavioral Analysis - ABA) have been shown to work well. Medications are helpful for treating symptoms but they are not a cure. SRI's like Prozac, Atypical Tranquilizers like Risperdal, and TCA's like Parnelor may help hyperactivity and obsessions. Stimulants like Ritalin help attention. AED's like Tegretol may help aggression. Trazazdone or naltraxone help self injurous behavior. Stay calm! Be sure to take time off for yourself. Let relatives and friends help. Attend support groups. If you are "burned out" you will not help your child. It is very important to get and keep eye contact with the child. You may have to hold their head to do this. Speak clearly and be concrete. Keep it short. Use time-out to discipline the child. Be consistent. A regular routine is very helpful. Don't take misbehaviour personally.

Transtorno Generalizado del Desarrollo especifically mind problems Definicin y Sntomas Para el CIE-10, los TGD (cdigo F84) se definen como un "grupo de trastornos caracterizados por alteraciones cualitativas de las interacciones sociales recprocas y modalidades de comunicacin, as como por un repertorio de intereses y de actividades restringido, estereotipado y repetitivo. Estas anomalas cualitativas constituyen una caracterstica pervasiva del funcionamiento del sujeto, en todas las situaciones". Los trastornos generalizados del desarrollo (TGD) tienen en comn una asociacin de sntomas conocida con el nombre de trada de Wing, del nombre de la investigadora inglesa que prob mediante un estudio clnico y estadstico que esta asociacin de tres categoras de sntomas apareca ms a menudo de la simple casualidad porque se trataba, en efecto, de un sndrome (conjunto de sntomas que actan en conjunto). Son: 1. trastornos de la comunicacin verbal y no verbal 2. trastornos de las relaciones sociales 3. centros de inters restringidos y/o conductas repetitivas

La severidad de los sntomas vara de una persona a otra (de ah la subdivisin actual en 5 categoras). Es variable en el transcurso de la vida, con una relativa tendencia espontnea a la mejora incluso en ausencia de una responsabilidad educativa especfica, pero esta evolucin espontnea favorable sigue en general siendo muy modesta salvo en las formas menos severas, y excluyendo el sndrome de Rett, cuya evolucin neurolgica es particular. Por tanto, es posible que varias personas que presenten dificultades de intensidad muy variables reciban el diagnstico de TGD. De ah la nocin de "espectro autista" para designar la extensin de los trastornos caractersticos de los TGD. La clasificacin DSM-IV permite utilizar el diagnstico de "trastorno generalizado del desarrollo no especificado" (TGD-NE) para dar cuenta de situaciones en que los trastornos no estn presentes ms que en dos de las tres categoras de sntomas, o hasta en una sola de los tres. As, los trastornos de comunicacin pueden ir del mutismo total con incompresin del lenguaje hablado y escrito y ausencia de mmicas congruentes al humor, a dificultades de comunicacin que se engloban esencialmente en la comunicacin verbal (en particular en el aspecto de la comprensin de los mensajes implcitos) y no verbal (comunicacin gestual, expresiones del rostro) y en la adaptacin al interlocutor. En estos casos, el vocabulario puede ser incluso preciso, hasta pedante, y el tono de voz o la entonacin pueden parecer extraos, pero no son criterios obligatorios. Los trastornos de la socializacin pueden ir desde la ausencia de bsqueda de contactos sociales (incluso para satisfacer necesidades fisiolgicas como el hambre), hasta situaciones en las que la persona intenta tener amigos pero no sabe cmo hacerlo, o bien es presa fcil de la picarda de los dems debido a una gran ingenuidad (muy superior a la que se podran esperar en una persona de la misma edad y CI similar). Finalmente, los centros de inters restringidos y las conductas repetitivas pueden variar tambin, desde situaciones en las que la persona no se va a ocupar ms que de conductas repetitivas y no funcionales (actividad de recuento, estereotipias gestuales, tics, muecas, deambulacin, etc.) hasta perseverancias, dificultades en abordar otros asuntos de conversacin aparte de los centros de inters de la persona, o compulsiones, obsesiones que pueden evocar a primera vista un trastorno obsesivo-compulsivo. En las formas menos severas de TGD sucede que la persona afectada se d cuenta del carcter fuera de lo comn de sus centros de inters, y desarrolla estrategias para disimularlos, o disminuir el impacto sobre su vida social. No es excepcional encontrar a varias personas afectadas de trastornos generalizados del desarrollo a diferentes grados en una misma familia.

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication. Parents may note symptoms of PDD as early as infancy and typically onset is prior to three years of age. PDD itself does not affect life expectancy. The term was introduced by the APA in 1980. Classification The pervasive developmental disorders are:[2]

Pervasive developmental disorder not otherwise specified (PDD-NOS), which includes atypical autism (or is also called atypical autism), and is the most common; Autism, the best-known; Asperger syndrome; Rett syndrome; and Childhood disintegrative disorder (CDD). The first three of these disorders are commonly called the autism spectrum disorders; the last two disorders are much rarer, and are sometimes placed in the autism spectrum and sometimes not.[3][4]

I have read this and i think is good to have this things in mind when delivering our speech PDD and PDD-NOS
There is a division among doctors on the use of the term PDD.[2] Many use the term PDD as a short way of saying PDD-NOS.[2] Others use the general category label of PDD because they are hesitant to diagnose very young children with a specific type of PDD, such as autism.[2] Both approaches contribute to confusion about the term, because the term PDD actually refers to a category of disorders and is not a diagnostic label.[2] PDD is not itself a diagnosis, while PDD-NOS is a diagnosis. To further complicate the issue, PDD-NOS can also be referred to as "atypical personality development", "atypical PDD", or "atypical Autism". Because of the "NOS", which means "not otherwise specified", it is hard to describe what PDDNOS is, other than its being an autism spectrum disorder (ASD). Some people diagnosed with PDD-NOS are close to having Asperger syndrome, but do not quite fit. Others have near full fledged autism, but without some of its symptoms. The psychology field is considering creating several subclasses within PDD-NOS.

Symptoms
Symptoms of PDD may include communication problems such as: Difficulty using and understanding language Difficulty relating to people, objects, and events; for example, lack of eye contact, pointing behavior, and lack of facial responses Unusual play with toys and other objects Difficulty with changes in routine or familiar surroundings Repetitive body movements or behavior patterns, such as hand flapping, hair twirling, foot tapping, or more complex movements

Unable to cuddle or be comforted

Degrees
Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident as well. Unusual responses to sensory information loud noises, lights are also common.

Diagnosis
Diagnosis is usually done during early childhood. Some clinicians use PDD-NOS as a "temporary" diagnosis for children under the age of 5, when for whatever reason there is a reluctance to diagnose autism. There are several justifications for this: very young children have limited social interaction and communication skills to begin with, therefore it can be tricky to diagnose milder cases of autism in toddlerhood. The unspoken assumption is that by the age of 5, unusual behaviors will either resolve or develop into diagnosable autism. However, some parents view the PDD label as no more than a euphemism for autism spectrum disorders, problematic because this label makes it more difficult to receive aid for Early Childhood Intervention.

Cure and care

There is no known cure for PDD. Medications are used to address certain behavioral problems; therapy for children with PDD should be specialized according to the child's specific needs. Some children with PDD benefit from specialized classrooms in which the class size is small and instruction is given on a one-to-one basis. Others function well in standard special education classes or regular classes with support. Early intervention, including appropriate and specialized educational programs and support services play a critical role in improving the outcome of individuals with PDD.