Childhood Disorders 641
in the mouth, and fi nally for using it with food. Parents of children with autism are
encouraged to use this method at home.
Targeting Social Factors: Communication
Treatment for autism and Asperger’s disorder that addresses social factors often
focuses, in one way or another, on facilitating communication and interpersonal in-
teractions. For example, when an individual with autism has severe communication
diffi culties, treatment may include the use of PECS, the picture system for facilitat-
ing communication mentioned in the section on mental retardation. For people with
high-functioning autism or Asperger’s, treatment may focus on training appropri-
ate social behaviors through social skills groups or through individual instruction
and modeling—observing others engaging in appropriate social behavior and then
role-playing such behaviors (Bock, 2007). For instance, when Richie enters elemen-
tary school, he might attend a social skills group for selected kindergarteners and
fi rst-graders; the psychologist who leads such groups explicitly teaches the children
appropriate social behavior—such as making eye contact and asking and answer-
ing questions—and has the children practice with each other. Parents are asked to
continue social skills training at home by modeling desired social behaviors and
reinforcing their children for improved behavior (Kransny et al., 2003).
In addition, various training programs have been developed to help people withAsperger’s or autism who do not also have mental retardation; such programs help
them perceive and interpret social cues—facial expressions and body language—more
accurately. In fact, there is a pilot project that uses a computer game to provide such
training (Golan & Baron-Cohen, 2006). Another tool to develop the ability to read
social cues is social stories, which are stories in which the important social cues and
responses are made explicit (Konstantareas, 2006). Although intriguing, research
on the outcomes of various training programs and their tools is in its infancy. The
extent to which a change in one factor affects another factor is unknown for the au-
tism spectrum disorders. Thus, we do not include a discussion of treatment-related
feedback loops among the three types of factors.
Other Pervasive Developmental Disorders
DSM-IV-TR includes two other disorders in the subcategory of pervasive develop-
mental disorders: childhood disintegrative disorder and Rett’s disorder. Both disor-
ders are extremely rare, and are caused by neurological factors.
Childhood Disintegrative Disorder
In contrast to autism, which involves defi cits in communication and interest in oth-
ers since birth, childhood disintegrative disorder is characterized by normal devel-
opment until at least 2 years old, followed by a profound loss of communication
skills, normal types of play, and bowel control. The loss of normal functioning may
occur as early as 2 years old or as late as 10 years old. DSM-IV-TR requires a loss of
skills in at least two of fi ve areas: language, social skills, bowel or bladder control,
play, and motor skills. Normal functioning is often lost in all fi ve areas (American
Psychiatric Association, 2000). Thus, a clinician can distinguish childhood disinte-
grative disorder from autism by the age of the child when the symptoms began and
by the course of the symptoms: Symptoms of childhood disintegrative disorder usu-
ally do not improve over time (Ozonoff, Rogers, & Hendren, 2003), whereas symp-
toms of autism can improve with interventions. Childhood disintegrative disorder is
a rare neurological disorder that is caused by factors that appear to be unrelated to
those of autism.
Rett’s Disorder
Similar to childhood disintegrative disorder, Rett’s disorder—which affl icts only
females—involves a loss of skills already mastered. Specifi cally, Rett’s disorder is
characterized by normal prenatal development and normal functioning after birth
through at least 5 months of age (up to about 2 years), after which the growth of
Childhood disintegrative disorder
A pervasive developmental disorder
characterized by normal development until at
least 2 years old, followed by a profound loss
of communication skills, normal types of play,
and bowel control.Rett’s disorder
A pervasive developmental disorder that
affects only females and is characterized by
normal prenatal development and functioning
after birth through at least 5 months of age,
after which the growth of the child’s head
slows and she loses the ability to control
normal muscle movements, interest in other
people, and previously developed skills.P SN