and language therapists work with children who
have communication disorders to improve their
communication skills and to teach parents to con-
tinue speech therapy activities at home (Johnson &
Beitchman, 2000).◗ PERVASIVEDEVELOPMENTAL
DISORDERS
Pervasive developmental disordersare charac-
terized by pervasive and usually severe impairment
of reciprocal social interaction skills, communication
deviance, and restricted stereotypical behavioral
patterns (Volkmar & Klin, 2000). This category of
disorders also is called autism spectrum disorders
and includes autistic disorder (classic autism), Rett’s
disorder, childhood disintegrative disorder, and
Asperger’s disorder. Approximately 75% of children
with pervasive developmental disorders have men-
tal retardation (APA, 2000).AUTISTIC DISORDER
Autistic disorder,the best known of the pervasive
developmental disorders, is more prevalent in boys
than in girls and is identified no later than 3 years of
age. Children with autism display little eye contact
with and make few facial expressions toward others;
they do not use gestures to communicate. They do
not relate to peers or parents. They lack spontaneous
enjoyment, have apparently no moods or emotional
affect, and cannot engage in play or make-believe with
toys. There is little intelligible speech. These children
engage in stereotyped motor behaviors such as hand-
flapping, body-twisting, or head-banging.
Eighty percent of cases of autism are early-onset
with developmental delays starting in infancy. The
other 20% of children with autism have seemingly
normal growth and development until 2 or 3 years of
age when developmental regression or loss of abili-
ties begin. They stop talking and relating to parents
and peers and begin to demonstrate the behaviors de-
scribed above (National Institute of Child and Human
Development [NICHD], 2002).
Autism was once thought to be rare and was es-
timated to occur in 4 to 5 children per 1000 in the
1960s. Current estimates suggest that 1 in 1000 to 1
in 500 U.S. children from 1 to 15 years of age have
autism (NICHD, 2002). Figures on the prevalence of
autism in adults are unreliable.
Autism does have a genetic link; many children
with autism have a relative with autism or autistic
traits. Controversy continues about whether or not
measles, mumps and rubella (MMR) vaccinations
contribute to the development of late-onset autism.
The National Institute of Child Health and Human
Development states there is no relationship and the
MMR vaccine is safe. Congressional hearings in 2002
continued to review testimony from those who be-
lieve a link exists.
Autism tends to improve, in some cases substan-
tially, as children start to acquire and to use language
to communicate with others. If behavior deteriorates
in adolescence, it may reflect the effects of hormonal
changes or the difficulty meeting increasingly com-
plex social demands. Autistic traits persist into adult-
hood, and most people with autism remain depen-
dent to some degree on others. Manifestations vary
from little speech and poor daily living skills through-
out life to adequate social skills that allow relatively
independent functioning. Social skills rarely improve
enough to permit marriage and child rearing. Adults
with autism may be viewed as merely odd or reclu-
sive or they may be given a diagnosis of obsessive-
compulsive disorder, schizoid personality disorder,
or mental retardation.
Until the mid-1970s, children with autism usu-
ally were treated in segregated, specialty outpatient,
or school programs. Those with more severe behav-
iors were referred to residential programs. Since then,
most residential programs have been closed; children
with autism are being “mainstreamed” into local
school programs whenever possible (Kimball, 2002).
Short-term inpatient treatment is used when behav-
iors such as head-banging or tantrums are out of
control. When the crisis is over, community agencies
support the child and family.
The goals of treatment of children with autism
are to reduce behavioral symptoms and to promote
learning and development particularly the acquisi-
tion of language skills (Volkmar & Klin, 2000). Com-
prehensive and individualized treatment including
special education and language therapy is associated
with more favorable outcomes. Pharmacologic treat-
ment with antipsychotics such as haloperidol (Hal-
dol) or risperidone (Risperdal) may be effective for
specific target symptoms such as temper tantrums,
aggressiveness, self-injury, hyperactivity, and stereo-
typed behaviors (Tanguay, 2000). Other medications
such as naltrexone (ReVia), clomipramine (Anafranil),
clonidine (Catapres), and stimulants to diminish self-
injury and hyperactive and obsessive behaviors have
had varied but unremarkable results (Volkmar &
Klin, 2000).RETT’S DISORDER
Rett’s disorderis a pervasive developmental disorder
characterized by the development of multiple deficits
after a period of normal functioning. It occurs exclu-
sively in girls, is rare, and persists throughout life.484 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS