Barbar L. Trommer MD Pediatric Neurology . Associate Director, Maimonides Developmental Center . Medical School: Columbia University . Fellowship: Children's Memorial Hospital Northwestern University Medical School Pediatric Neurology
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So most of you know that the DSM IV. The TR just stands for text revision. So the DSM IV identifies five pervasive developmental disorders of which three have come to be known as the Autism Spectrum Disorders and those are Autistic disorder, Asperger's disorder and pervasive developmental disorder not otherwise specified or PDD-NOS or PDD-NOS depending on the terminology that you prefer.And those are the three in red that I will be focusing on today. All Autism Spectrum disorders have three core features. There is an impairment in social skills. There is an impairment in the communicative use of language, verbal and non-verbal and there is the presence of restricted and repetitive behavior that sheer focus on details and an inability to grasp concepts. One of the distinctions that I think can be very confusing at times is that between Autistic disorder and Asperger syndrome and you will notice that since they both have the same initials, Autistic disorder has come to abbreviated as AD and Asperger disorder as. Again to just graphically point out the distinctions in the way we characterize them, both have social impairment, both have restricted and repetitive stereotyped behavior. Verbal communication is impaired in Autistic disorder and not Asperger syndrome although there are many peculiarities if you will of language in Asperger syndrome that we will discuss. Autistic disorder has clear cut delay by age three and therefore it's diagnosed much earlier than Asperger disorder and that is obviously lacking on the other slide of the slide. In the two areas of distinction, communication in Autistic disorder, speech may be completely absent or manifestations might be just impaired conversation Echolalia is highly characteristic do you know what that is? You say, how are you, and the child responds, how are you. Instead of I am fine, and lack of imitative play. Asperger syndrome again, no delay in language and by language here I am really referring to grammar, syntax vocabulary. Children with Asperger syndrome are able to construct appropriate sentences and make themselves understood and communicate and understand. Autistic children will have delays in the spheres of social interaction, language and symbolic play before age three, and Asperger kids will not. Their cognitive development and self-help skills and adaptive behavior are all intact, only their social interactions are delayed. And for PDD-NOS, again the core, social, communicative and stereotypic features are present but somehow they differ from true Autistic disorder and it can be in one of these ways, the onset is later, the onset is a typical or the symptoms are sub-threshold or any and all of those. So that's the sort of that term that's used when you can't comfortably say this is clear cut severe classic Autism but it looks like it's on the spectrum to me. One question.

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