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Pervasive Developmental Disorder and Reactive Conduct Problems
By
Deane G. Baldwin, MD |
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Pervasive Developmental Disorder (P.D.D.) is a complex developmental disorder that includes children with symptoms associated with poor to severely impaired social skills, repetitive and often compulsive, ritualistic behavior (stereotypies) and to varying degrees of severity, a communication disorder. The hallmark disorder in this group is Autistic Disorder. Other conditions included with Autistic Disorder are Asperger's Disorder, Pervasive Developmental Disorder, not otherwise specified, Rett's Syndrome and Childhood Disintegrative Disorder.
P.D.D. is not generally considered to be associated with aggression. However, many children with P.D.D. come to mental health care professionals because of aggressive behavior. Their targets are usually caregivers/teachers or playmates/classmates who are engaged with them in activities where there are close encounters.
These children are often thought to have Attention Deficit Hyperactivity Disorder, Impulsive Hyperactive Type, Oppositional Defiant Disorder or a Conduct Disorder where in reality they have a subtle form of P.D.D. It is important to make a diagnostic distinction because treatment for P.D.D. behavior is often quite different from the treatment used for other disorders.
Aggression in children with P.D.D. can, theoretically, be explained by another disorder often associated with P.D.D. The disorder is called Sensory Integrative Disorder. Children with this disorder misperceive a variety of sensations associated with every day activities. Examples are: rejection of a food because of the texture, fear or negative reaction toward a harmless noise, rejection of an article of clothing because of its "feel". Paramount to this discussion is the child who perceives ordinary and usual physical contact with another person as threatening. Here, the child with P.D.D. often reacts by withdrawal but some of the children react by countering the "intruder" with combative behavior. Still others may become abusive to themselves, often biting or striking themselves. Because of the repetitive nature of some behaviors of children with P.D.D., the aggression could perhaps become habitual.
Aggression in children with P.D.D. should be viewed and treated in a different manner. For this reason an aggressive child should be evaluated by keeping P.D.D. in mind as a possible explanation for his/her aggression. Treatment involves pinpointing actions that precipitate the combative behavior and avoiding them. Therapy for Sensory Integrative Disorders may be beneficial. Medication, while it does not treat the core symptoms of P.D.D., may also help. This is especially true in higher functioning children with the disorder.
For more information regarding P.D.D. and other behavioral disorders please refer to the www.abledev.com web site. ABLE Development Group? 2000
Author's Bio
Dr. Deane G. Baldwin, M.D., FAAP, is a Board Certified Pediatrician in private practice for 39 years. Specializing in developmental disorders and school health.
http://www.abledev.com
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