The Generalized developmental disorders (PDT) are a set of alterations that result in a delay and / or deviation from normal developmental patterns and that most significantly affect social and communicative areas (National Institute of Neurological Disorders and Stroke, 2015).
This set of disorders will produce alterations in social interactions and relations, alterations in both verbal and non-verbal language Verbal, in addition to the presence of restrictive or repetitive behavior patterns (García-Ron, 2012).
The American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), within the denomination Disorders Generalized Developmental Disorder (PDD) includes different types of clinical entities, including:
- Autistic disorder .
- Rett Disorder .
- Childhood Disintegrative Disorder .
- Asperger's Disorder .
- Generalized disorder of non-specific development (García-Ron, 2012).
In the literature on generalized developmental disorders it is common to find allusion to these with the generic name of disorder autistic. However, each of these items is a clearly defined entity with its own diagnostic criteria.
Despite this, the current edition of the diagnostic manual, published in 2013 (DSM-V), has proposed a change in the diagnostic criteria for Generalized developmental disorders.
Thus states that all patients with a clearly defined diagnosis according to the DSM-IV of autistic disorder, Asperger's disease or Development, the diagnosis of Autism Spectrum Disorder (DSM-V, 2013) will be applied.
The rationale for combining individual diagnoses of PDT in a single category of Autism Spectrum Disorder (ASD) has been questioned. Different researchers refer to autism not as a unit condition, but rather to"autisms"in the plural, due to the great and heterogeneous nature of this Pathology (Federation Autism Andalucia, 2016).
Definition and types of generalized developmental disorders
According to the DSM-IV, the TGD is not a specific diagnosis, but a general term under which different specific diagnoses are defined: Autistic Disorder, Rett Disorder, Childhood Disintegrator Disorder, Asperger's Disorder and Generalized Developmental Disorder no. Specified (Autism Society, 2016).
Usually, these are disorders that occur in early childhood, especially before age three. Some of the symptoms that Parents and caregivers may observe may include:
- Difficulties in using and understanding language.
- Difficulty marked to interact with people, Objects and / or events.
- Atypical games.
- Resistance to changes in routines and / or family environment.
- Repetitive body and movement patterns (National Institute of Neurological Disorders and Stroke, 2015).
From the classification shown in the DSM-IV, five types of disorders are identified (GPC for the management of patients with spectrum disorders Autistic and primary care, 2009):
- Autistic Disorder : It is characterized by an alteration of the skills related to social interaction, communication Verbal and non verbal , Restriction of interests and stereotyped and repetitive behaviors; Unusual response to stimuli and / or presence of disorders development.
- Asperger's Disorder Asperger's Syndrome : It is characterized by the presence of a marked inability to establish Social relations adjusted to their age and level of development, along with mental and behavioral rigidity.
- Rett Syndrome or Rett Syndrome : Only occurs in girls and is characterized by a marked regression of the behaviors Motor vehicles before the age of 4 years. It is usually associated with a severe intellectual disability.
- Childhood Disintegrative Disorder or Heller's Syndrome : It is characterized by a loss of skills acquired after a Normal development. It usually occurs between two and 10 years. Almost all the skills developed in the different areas usually disappear and usually Associated with severe intellectual disability and seizures.
- Generalized developmental disorder unspecified : This diagnostic category tries to group all the cases in which it does not An exact match occurs with each of the above definitions, or the symptoms are incompletely or inappropriately presented.
Prevalence of generalized developmental disorders
In general, the data that are derived from the different epidemiological studies are variable and heterogeneous, largely because of the different Instruments to be used to establish the diagnoses as to the differences in the samples studied (AEPNYA, 2008).
Despite these, generalized developmental disorders (PDD) are the most common developmental alterations in the early stages of childhood (Garcia-Primo, 2014).
Until recently, different studies estimated a prevalence of 6-7 cases of pervasive developmental disorder per 1,000 population (García-Primo, 2014) In addition, among the different diagnostic categories, autism is the most frequent condition, establishing in 1% (Garcia-Primo, 2014).
On the other hand, it is more frequent that this type of pathologies present in children than in girls, with a ratio of approximately 3: 1 (García-Ron, 2012).
These types of alterations usually occur before the individual reaches the age of three years. Normally, as early as the first year of life, Develop developmental delays or anomalies that may be an alarm signal for their caregivers (AEPNYA, 2008).
Many parents report that"something is not right"about 18 months and they usually go to the doctor when they reach 24 months of age (AEPNYA, 2008).
Only 10% of the cases receive an early diagnosis, the rest are not established until approximately two or three years (AEPNYA, 2008).
Symptoms and clinical features
In general, generalized developmental disorders (PDD) are defined in relation to a series of alterations based on the triad of Wing disorders:
- Alterations in the communication.
- Alterations of the social interaction.
- Alterations of the Flexibility and imagination (GPC for the management of patients with autism spectrum disorders and primary care, 2009).
Depending on the specific clinical course of each individual, these alterations will be presented in lesser or greater degree of severity, age or form of appearance GPC for the management of patients with autism spectrum disorders and primary care, 2009).
On the other hand, Spanish Association of Child and Adolescent Psychiatry (2008) does not provide an accurate description of each of the alterations Which can be presented in different areas:
1. Alterations in social interaction : Severe difficulties appear in the social field, characterized by absence of contact Interpersonal, tendency to introversion and isolation or indifference to people (AEPNYA, 2008).
2. Alterations in communication : In the different generalized disorders of the development and concretely, in autism appear a series of Language disorders Including: a) difficulty or inability to understand verbal and non-verbal language; B) difficulty or Inability to produce an understandable verbal and non-verbal language; C) specific anomalies (ecolalias, metaphorical language, neologisms) (AEPNYA, 2008).
3. Impaired flexibility and imagination : Different restrictions will appear in the area of interests. It is very frequent To observe repetitive, rigid and restrictive behaviors, which lead the individual to submit restricted interests to few activities and objects. It is also frequent to observe manual stereotypes, object alignment or ritualistic compulsive phenomena. Atypical responses may appear Sensory stimuli, concern about lights or noise (AEPNYA, 2008).
Four. Other relevant symptoms : Motor incoordination, Hyperactivity , Self-injurious behaviors, decrease of pain threshold, swing, Fluttering, laughter and crying out of context or Affective lability (AEPNYA, 2008).
Causes
There is no clear consensus about the nature of generalized developmental disorders. Experimental studies show a clear Heterogeneity because it is a diagnostic category encompassing a wide variety of clinical disorders that may have different bases (AEPNYA, 2008).
Generally, these disorders are justified by the presence of cerebral, functional and / or structural anomalies, which need not be common (GPC For the management of patients with autism spectrum disorders and primary care, 2009).
Among the etiological factors related to these disorders have been identified genetic factors; Neurochemical alterations; The alterations Of immune functions; And environmental factors.
Genetic factors
The genetic etiology is not completely established. It is thought that they may be involved both Monogenic and multigenic anomalies (García-Ron, 2012). In the case of autism, results on complete genome Hypothesis that the person must inherit at least 15 to 20 genes, which interact synergistically to express the complete phenotype of the autism.
The rate of recurrence in siblings of people with autism is 2.2%, which can reach up to 8% when all ASDs are included, which Means about 50-75 times the risk of the general population (GPC for the management of patients with autism spectrum disorders and primary care, 2009).
Neurochemical factors
Different neurochemical correlates have been identified ( Serotonin , Oxytocin , Dopamine , Noradrenaline Y Acetylcholine ) That may affect CNS maturation formation at different stages of development (CPG for the management of patients with disorders Of autism spectrum and primary care, 2009).
Immune Factors
It has been identified that the presence of IgG antibodies against fetal brain proteins in the Maternal plasma during gestation, coupled with a marked genetic lability, can lead to a global regression of neurodevelopment (GPC for the management of
Patients with autism spectrum disorders and primary care, 2009).
Environmental factors
Among these factors, a number of conditions have been identified that can give rise to Specifically the phenotype characteristic of ASDs. Among these factors, obstetric complications, vaccinations, opiates, Exogenous brain, exposure to mercury, toxic diseases, among others. However, the actual incidence of these has not yet been detailed in scientific research.
Diagnosis
The mean age at diagnosis was between 3 and 4 years of age. However, parents report that they have been noticing Abnormal signs or symptoms from approximately 18 months and that is at 2 years of age when they begin to seek specialist advice (García-Ron, 2012).
Traditionally, the detection of autism has been characterized by the identification of the warning signs; Have been addressed in a minimal way, therefore, it has been the parents who are mobilized before the presentation of these alterations.
The American Academy of Pediatrics (AAP) recommends that early detection mechanisms be established at both the professional and public administration.
It is recommended that family doctors perform different TGD screenings on routine visits at least twice before two years for To detect possible signs of alarm (García-Primo, 2014).
Once behavioral abnormalities are detected early, the establishment of a definitive diagnosis is usually difficult due to the Heterogeneity that symptoms and signs can manifest in each individual.
At present, the diagnostic criteria to be used are stimulated in the latest version of the Diagnostic and Statistical Manual of Mental disorders (DSM-V).
In this category within the Autism Spectrum Disorder category 299.00 (F8A.0), we collect each of the criteria that patients must complete Or partially as stipulated. Each of the diagnostic criteria refers to both communicative, social, and behavioral areas.
Treatment
At present, there is no single treatment for generalized developmental disorders. Some drugs are usually used to treat problems Specific at the behavioral level (National Institute of Neurological disorders and Stroke, 2015).
On the other hand, therapeutic and neuropsychological interventions are performed according to the specific needs of individuals (National Institute of Neurological Disorders and Stroke, 2015).
Communicative and social alterations will cause a significant delay in the acquisition of school and social learning. Thus, the Early intervention at the educational level, has demonstrated a fundamental role for improving functional performance.
CONCLUSIONS
Currently the early detection of this type of alterations in the early stages in the child population remains a challenge. Not all Health administrations include protocols for detection of alarm symptoms and follow-up of at-risk children.
Research has shown that early detection of pathologies related to child development is essential for the approach Therapeutic and therefore efficient to achieve an efficient functioning of the individual improving their quality of life.
References
- Autism Andalucia (2016). Obtained from Andalusian Federation of Parents with Children with Autistic Spectrum Disorders: autismoandalucia.org.
- AEPNYA. (2008). Generalized developmental disorders.
- Autism Society (2016). Retrieved from autism-society.org/.
- García-Primo, P., Santos Borbujo, J., Martín Cilleros, M., Martínez Velarte, M., Lleras Muñoz, S., Posada de la Paz, M., & Canal Bedia, R. (2014).
Program for the early detection of generalized developmental disorders in health areas of Salamanca and Zamora. An Pediatr, 80 (5), 285-292. - García-Ron, G., Carratalá, F., Andreo-Lillo, P., Maestre-Ricote, J., & Moya, M. (2012). Early clinical indicators of generalized disorders development. An Pediatr, 77 (3), 171-175.
- Ministry of Health and Social Policy. (2009). Guide to Clinical Practice for the Management of Patients with Autism Spectrum Disorders in Primary Care.
- NIh (2015). Pervasive Developmental Disorders. Obtained from National Institute of Neurological Disorders and Stroke.