Ans. d. Impaired cognition (Ref. Kaplan 10th/1191-1197; Niraj Ahuja 7/ep163-165)According to DSM-V, intellectual disability should he ruled out prior to a diagnosis of pervasive developmental defects."The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD) is characterized by delays in the development of multiple basic functions including socialization and communication. "Pervasive Developmental DisordersThe diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD) are characterized by delays in the development of multiple basic functions including socialization and communication.Pervasive Developmental Disorders arePervasive developmental disorder not otherwise specified (PDD-NOS), (includes atypical autism): Most commonAutismAsperger syndromeRett syndromeChildhood disintegrative disorder (CDD).The first three of these disorders are commonly called the autism spectrum disorders.Onset of PDD occurs during infancy, but the condition is usually not identified until the child is around three years old.Parents may begin to question the health of their child when developmental milestones are not met including age appropriate motor movement & speech production.DSMV: Diagnostic Criteria Autism Spectrum Disorder 299.00 (F84.0)Persistent deficits in social communication and social interaction across multiple contexts, as manifested by:Deficits in social-emotional reciprocityDeficits in nonverbal communicative behaviors used for social interactionDeficits in developing, maintaining, and understanding relationships.Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following:Stereotyped or repetitive motor movements, use of objects, or speechInsistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal-nonverbal behaviorHighly restricted, fixated interests that are abnormal in intensity or focusHyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environmentSymptoms must be present in the early developmental periodSymptoms cause clinically significant impairment in social, occupational, or other important areas of current functioningThese disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.Intellectual disability & autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability', social communication should be below that expected for general developmental level.Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals, who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.Autistic Disorder (Kartner's Autism)It is characterized by qualitative impairment in reciprocal social interaction, delayed and aberrant communication skills & a restricted repertoire of activities and interestsQ.By definition, the onset is before the age of 3 yearsQ.More common in boysQDevelopmental milestones are normalQ.Temporal lobe is believed to be critical area.Clinical FeaturesAutism (marked impairment in reciprocal social and interpersonal interaction)Marked impairment in language and non-verbal communicationAbnormal behavioral characteristicsMental retardation* Absent social smile* Lack of eye-to-eye- contact* Lack of awareness of others existence or feelings; treats people as furniture* Lack of attachment to parents and absence of separation anxiety.* No or abnormal social play; prefers solitary games.* Marked impairment in making friends* Lack of imitative behavior* Absence of fear in presence of danger* Lack of verbal or facial response to sounds or voices; might be thought as deaf initially.* In infancy, absence of communicative sounds like babbling.* Absent or delayed speech* Abnormal speech patterns and content. Presence of echolalia, perseveration, poor articulation and pronominal reversal is common.* Remote memory is usually good.* Abstract thinking is impaired.* Mannerisms* Stereotyped behaviour such as head-banging, bodyspinning, lining-up objects, rocking, clapping, twirling, etc.* Ritualistic & compulsive behaviour.* Resistance to even the slightest change in the environment.* Attachment may develop to inanimate objects.* Hyperkinesis is commonly associated.* Only about 25% of all children with autism have an IQ >70.* >50% of these children have moderate to profound mental retardation.* There appears to be a correlation between severity of mental retardation, absence of speech & epilepsy- in autism. Treatment of AutismBehaviour TheoryPsychotherapyPharmacotherapy* Development of a regular routine with as few changes as possible.* Structured classroom training, aiming at learning new material & maintenance of acquired learning.* Positive reinforcements to teach self- care skills.* Speech therapy and/or sign language teaching.* Behavioral techniques to encourage interpersonal interactions.* Parental counseling &* supportive psychotherapy can be very useful in allaying parental anxiety and guilt, and helping their active involvement in therapy.* However, overstimulation of child should be avoided during treatment.* Halo peridot decreases dopamine levels in brain, decreases hyperactivity & behavioral symptoms.* Risperidone, for treatment of autism in children aged 5 and above.* Anticonvulsants are used for the treatment of generalized or other seizures