42 - 10. Disorders of psychological development

10. Disorders of psychological development

© SPMM Course 10. Disorders of psychological development

In ICD-10 these include specific developmental disorders of speech and language (expressive, receptive language disorders, acquired aphasia with epilepsy), scholastic skills (reading, spelling, arithmetical skills), motor skills and pervasive developmental disorders. In non-pervasive disorders, the domain showing a deficit in development often improves with age. For example, in specific reading disorders of childhood, reading improves significantly though spelling difficulties persist longer. Pervasive developmental disorders include childhood autism, Asperger’s  syndrome,  Rett’s  syndrome,  atypical  autism  and   other childhood disintegrative disorder. Autism is defined by the presence of abnormal and/or impaired development evident before the age of 3 years, with abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour. Unlike children with autism, children with Asperger’s  syndrome have normal language functions before the age of 3. Though language development is affected in autism, the children do not remain mute in most cases. Though not a diagnostic criteria, the presence of persistent gaze avoidance is strongly suggestive of pervasive  developmental  disorder  such  as  autism  /  Asperger’s.   Atypical autism is diagnosed if autistic features are seen but either of the age of onset is not satisfied or a failure to fulfill all three sets of diagnostic criteria is noted. Rett’s  syndrome is  seen  only  in  girls  in  whom  “apparently  normal  or  near-normal early development is followed by partial or complete loss of acquired hand skills and of speech, together with deceleration in head  growth,  usually  with  an  onset  between  7  and  24  months  of  age”  (ICD-10). Children also show handwringing stereotypies, hyperventilation and loss of purposive hand movements. During later ages, trunk ataxia and apraxia, associated with scoliosis along with choreoathetoid movements are seen. Epilepsy is also a common feature. Heller's syndrome or childhood disintegrative disorder is said to resemble dementia that occurs in childhood. Apparently normal development up to 2 years is followed by a loss of previously acquired skills and abnormal social functioning. DSM-5 AND AUTISM Autism Spectrum Disorder is a new description that will now include autism,  Asperger’s, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder (not otherwise specified) in a single category. ASD is characterized by 1) deficits in social communication and social interaction and 2) restricted repetitive behaviors, interests, and activities (RRBs). If no RRBs are seen, then social communication disorder is diagnosed.

© SPMM Course Acquired Aphasia with Epilepsy is also called Landau-Kleffner syndrome. It is a disorder in which the child, despite the previous normal progress in language development, loses both receptive and expressive language skills (starting from age 3 – 7) but retains general intelligence. Epilepsy with paroxysmal abnormalities on the EEG is noted; these almost always originate from the temporal lobes bilaterally.