3/21/2012. Pervasive Development Disorders PDD. Pervasive Development Disorders PDD

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1 Moshe Heller LAc. Pervasive Development Disorders PDD The term "pervasive development disorders" (PDDs) refers to a group of conditions that involve delays in the development of many basic skills, most notably the ability to socialize with others, to communicate and to use imagination. Children with these conditions often are confused in their thinking and generally have problems understanding the world around them Pervasive Development Disorders PDD Because these conditions typically are identified in children around 3 years of age -- a critical period in a child's development -- they are called development disorders. Although the condition begins far earlier than 3 years of age, parents often do not notice a problem until the child is a toddler who is not walking, talking or developing as well as other children of the same age. 1

2 There are five types of PDDs: Autism Asperger's syndrome Childhood disintegrative disorder Rett's syndrome Pervasive development disorder not otherwise specified (PDDNOS) Autism Children with autism have problems with social interaction, pretend play and communication. They also have a limited range of activities and interests. Many (nearly 75%) of children with autism also have some degree of mental retardation. To Diagnose Autistic disorder requires impairments in all three domains: communication, social interaction and repetitiveness Asperger's syndrome Like children with autism, children with Asperger's syndrome have difficulty with social interaction and communication, and have a narrow range of interests. However, children with Asperger's have average or above average intelligence, and develop normally in the areas of language and cognition (the mental processes related to thinking and learning). Children with Asperger's often also have difficulty concentrating and may have poor coordination. Asperger s disorder is distinguished by the lack of communication impairments and better-preserved intellectual functioning. 2

3 Pervasive development disorder not otherwise specified (PDD NOS) This category is used to refer to children who have significant problems with communication and play, and some difficulty interacting with others, but are too social to be considered autistic PDD NOS is diagnosed in cases when diagnostic criteria for autistic or Asperger s disorders are not met. Rett's syndrome Children with this very rare disorder have the symptoms associated with a PDD and also suffer problems with physical development. They generally suffer the loss of many motor, or movement, skills -- such as walking and use of their hands -- and develop poor coordination. This condition has been linked to a defect on the X chromosome, so it almost always affects girls Childhood disintegrative disorder Children with this rare condition begin their development normally in all areas, physical and mental. At some point, usually between 2 and 10 years of age, a child with this illness loses many of the skills he or she has developed. In addition to the loss of social and language skills, a child with disintegrative disorder may lose control of other functions, including bowel and bladder control. 3

4 Autism Diagnosis (DSM IV) Impaired social interaction (at least two): Markedly deficient regulation of social interaction through multiple nonverbal behaviors, such as eye contact, facial expression, body posture, and gestures Lack of peer relationships that are appropriate to developmental level Absence of seeking to share achievements, interests, or pleasure with others Absence of social or emotional reciprocity Autism Diagnosis (DSM IV) Impaired communication (at least one): Delayed or absent development of spoken language, for which the patient doesn't try to compensate with gestures In patients who can speak, notable deficiency in ability to begin or sustain a conversation Language that is repetitive, stereotyped, or idiosyncratic Appropriate to developmental stage, absence of social imitative play or spontaneous, makebelieve play Autism Diagnosis (DSM IV) Activities, behaviors, and interests that are repetitive, restricted, and stereotyped (at least one): Abnormal (in focus or intensity) preoccupation with interests that are restricted and stereotyped (such as spinning things) Rigid performance of routines or rituals that don't appear to have a function Repetitive, stereotyped motor mannerisms (such as hand flapping) Persistent absorption with parts of objects 4

5 Autism Diagnosis (DSM IV) Before age three, the patient shows delayed or abnormal functioning in one or more of these areas: Social interaction Language used in social communication Imaginative or symbolic play These symptoms are not better explained by Childhood Disintegrative Disorder or Rett's Disorder. Asperger's Diagnosis (DSM IV) At least two demonstrations of impaired social interaction: Markedly deficient regulation of social interaction through multiple non-verbal behaviors, such as eye contact, facial expression, body posture, and gestures. Lack of peer relationships that are appropriate to developmental level Absence of seeking to share achievements, interests, or pleasure with others Absence of social or emotional reciprocity Asperger's Diagnosis (DSM IV) At least one demonstration of activities, behavior, and interests that are repetitive, restricted, and stereotyped: Abnormal (in focus or intensity) preoccupation with interests that are restricted and stereotyped (such as spinning things) Rigid performance of routines or rituals that don't appear to have a function Repetitive, stereotyped motor mannerisms (such as hand flapping) Persistent absorption with parts of objects 5

6 Asperger's Diagnosis (DSM IV) The symptoms cause clinically important impairment in social, occupational, or personal functioning. There is no clinically important general language delay (the child can speak words by age two, phrases by age three). There is no clinically important delay in developing cognition, age-appropriate self-help skills, adaptive behavior (except social interaction), and normal curiosity about the environment. The patient doesn't fulfill criteria for Schizophrenia or for another specific pervasive developmental disorder. PDD NOS(DSM IV) Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS) for severe, per-vasive developmental disturbances that do not meet criteria for one of the specific disorders described above or for Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. DSM-IV particularly mentions atypical autism, which is a label used for disturbances that don't meet criteria for Autistic Disorder because of late age of onset, too few symptoms, or atypical symptoms. Rett's Disorder(DSM IV) All of the following suggest normal early development: Prenatal and perinatal development Psychomotor development, at least until age 5 months Head circumference at birth 6

7 Rett's Disorder(DSM IV) After this apparently normal beginning, all of these occur: Head growth slows abnormally between 5 and 48 months. Between 5 and 30 months, the child loses already acquired purposeful hand movements and develops stereotyped hand movements, such as hand washing or hand wringing. Early in the course, the child loses interest in the social environment. (However, social interaction often develops later.) Gait or movements of trunk are poorly coordinated. Severe psychomotor retardation and impairment of expressive and receptive language. Childhood Disintegrative Disorder (DSM IV) At least until age two, the child develops normally, as shown by age-appropriate adaptive behavior, play, social relationships, and both nonverbal and verbal communication. Childhood Disintegrative Disorder (DSM IV) Before age 10, the child experiences clinically important loss of previously learned skills in the following areas (two or more required): Language (expressive or receptive) Adaptive behavior or social skills Bladder or bowel control Play Motor skills 7

8 Childhood Disintegrative Disorder (DSM IV) The child functions abnormally in two or more of the following ways: Social interaction is characterized by impaired nonverbal behaviors, peer relationships, or emotional or social reciprocity. Communication is characterized by delayed or absent spoken language, inability to converse, language use that is repetitive or stereotyped, or absence of varied makebelieve play. Activities, behavior, and interests are repetitive, restricted, and ste-reotyped; this includes motor mannerisms and stereotypies. These symptoms are not better explained by Schizophrenia or by another specific pervasive developmental disorder. Diagnosis (Western) Autistic disorder, Asperger s disorder and PDD NOS are referred to as autism spectrum disorders (ASD). The current gold standard for diagnosing ASD is based on clinical history and patient observation performed by trained clinicians with the use of structured diagnostic tools such as the Autism Diagnostic Interview revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). Treatment (Western Alternative) Gluten Free / Casein-Free diet Allergies 8

9 Chinese Medicine In trying to understand Autism Spectrum Disorder (ASD) in Chinese medical terms it is Important to look at : 1. Physiology of the organs involved 2. Possible etiological factors 3. Common symptoms Physiology of the organs involved Heart the heart controls all mental activities of the mind and is responsible for insight and cognition, A healthy Heart and mind will positively influence our ability to relate to other people Giovanni Maciocia, Foundations of Chinese Medicine. The heart is also in charge of appropriate behavior and understanding of social cues Spleen The Spleen houses the intellect (Yi) Giovanni Maciocia, Foundations of Chinese Medicine. The Yi is responsible for applied thinking, studying and generating ideas. It is interesting to see that Autistic Children often suffer from digestive disorders. Physiology of the organs involved Kidneys - The Kidneys store essence control growth and development Developmental issues always involve Kidneys. The Kidney are also in charge of the production of marrow that fills up the brain. Liver The Liver Houses the Hun. The Hun provides for a sense of direction as well as a way to sense other peoples emotions. The Hun and the Shen work together in the interactions with other people. 9

10 Pathological factors contributing to Autism Phlegm Phlegm can be both the etiological factor as well as the pathological factor. Patterns will vary From Phlegm Damp to Phlegm misting the mind to Phlem wind or fire Pathological factors contributing to Autism Heat - Heat can cause hyperactivity and violent behavior particularly when combined with phlegm Pathogenic factors may influence the mind especially when they become lingering, or the infestation of parasites Etiology Immunizations Although there is still a debate weather immunizations can be associated with Autism, from a Chinese medical perspective it is important to take into consideration that they may be contributing to toxicity Antibiotics In certain cases (when used inappropriately) can be the cause of Lingering Pathogenic Influences (LPF) and their cold nature can contribute to the formation of Phlegm 10

11 Etiology Parasites parasitic infections (worms, fungal and viral) are more common then we think and they have a strong influence on both physiological and psychological functions (Gu Syndrome) Digestive disorders Children with Autism almost always present with digestive disturbances. It is interesting to note that although in main stream western medicine this link is controversial in western alternative therapies it is very much the hallmark. In Chinese medicine diet is extremely important in the treatment of autism Etiology Constitutional predisposition The development of this disorder at young age as well as the fact that it is a developmental disorder point to the involvement of Jing. Thus in order to address autism the Kidney Jing must be addressed Common Symptoms Other than the symptoms mentioned above there are other common symptoms such as: Sleep disturbances Digestive symptoms Irregular appetite Hypersensitivity to touch, smell and sound 11

12 Treatment Modalities Shoni Shin Cutaneous Electro Stimulation Acupuncture Tiger warmer Magnets Herbs Nutrition Shoni Shin Bachi Bari (Plectrum), Heragata Arrow, Choto, Hoki, Choki, Kakibari Rake, Solid Copper Yoneyama and Matsuba (Pineapple) Cutaneous electro stimulation 12

13 Cutaneous electro stimulation Acupuncture With children up to 2 years of age we use non retention technique. Between 2 to 6 years we try to leave the needle for a few of minutes, 7-12 retain 4-10 minutes and between 10 and 20 minutes I Use Serin reds (40G) 1 inch needles but I have commonly seen the use of thicker gauges. Common Points Used Si Shen Zhen (Four Spirits Needles): A.k.a. Si Shen Cong (M-HN-1), the four points located 1.5 inches in front, behind, and to the left and right of Bai Hui (GV 20) Ding Shen Zhen (Stabilizing the Spirit Needles): 5 inches above each of Yin Tang (M-HN-3) and Yang Bai (GB 14) Nie San Zhen (Temporal Three Needles): 2 inches perpendicularly above the apex of the ear and 1 inch in front and back of that on the same level; three points in total 13

14 Common Points Used Nie Shan San Zhen (Temporal Above Three Needles): 3 inches perpendicularly above the apex of the ear and 1 inch in front and back of that on the same level; three points in total Nao San Zhen (Brain Three Needles): Nao Hu (GV 17), both Nao Kong (GB 19) Zhi San Zhen (Intelligence Three Needles): Shen Ting (GV 24), both Ben Shen (GB 13) Xing Shen Zhen (Arousing the Spirit Needles): Ren Zhong (GV 26), Shao Shang (LU 11), Yin Bai (Sp 1) Tiger warmer Magnets Qi flows in the con-nective tissue energetic pathways from the bionorth (-) pole to the biosouth (+) pole The designation of bionorth (-) and biosouth (+) is based on the earth's geographic North and South Poles. The bionorth (-) side of the magnet will point to the geographic South Pole (the Antarctic) and will attract the north-seeking needle of a compass. The biosouth (+) side of the magnet will be repelled by the north-seeking needle of a compass and will point to the geographic North Pole (the Arctic). It should be noted that this is opposite to the definition used by the National Bureau of Standards (NBS). 14

15 Magnets Simple tonification of one acupoint: place the biosouth pole of the magnet facing downward on the skin, with the bionorth pole of the magnet facing outward. This would direct Universal Qi to flow into the child and therefore tonifies. Simple sedation of one acupoint: place the bionorth pole of the magnet on the skin, with the biosouth pole facing outward. This directs Qi flow away from the body and is therefore dispersing or sedating. Gu Syndrome Black alcamy Infestation of a pathogenic influence Gu pathogens represent a type of toxin (gu du). This makes reference to their virulent epidemic quality, but also to the only recently corroborated fact that the metabolic byproducts of parasitic organisms have a toxic affect on the body. Cause a variety of symptoms Gu Syndrome the authoritative 6th century encyclopedia Beiji Qianjin Yaofang (Thousand Ducat Formulas) explains, "Some of them will cause bloody stools, while others initiate the desire to lay in a dark room; others may bring about bouts of irregular emotions, such as depression that alternates with periods of sudden happiness; others again cause the extremities to feel heavy and ache all over; and then there are myriads of other symptoms " 15

16 Disperse Gu toxins (with diaphoretic herbs) (san du) Zi Su Ye (Follum Perillae Frutescentis), Bo He (Herba Men-thae), Bai Zhi (Radix Angelicae), Lian Qlao (Fructus Forsythiae Suspensae), Gao Ben (Rhizoma et Radix Ligustici Sinensis), Sheng Ma (Rhizoma Cimicifugae) Ju Hua (Flos Chrysantherrit Morifolli). Kill parasites (sha Chong) and expel demons (qu gui) Da Suan (Bulbul Alli Sativi), Yu jin (Tuber Curcumae), Shen (Radix Sophorae Flavescentis), Huai Hua (Flos Sophorae Japonicae Immaturus), She Chuang Zi (Fructus Cnidii Monnieri), Jin Yin Hua (Flos Lonicerae Japonicae), Qing Hao (Herba Arteinislae Apiaceae), Shi Chang Pu (Rhizome Acori Graminei), Ding Xiang (Flos Caryophylli), He Zi (Fructus Terminaliae Chebulae) Bing Lang (Semen Arecae Catechu), Calm the spirit (by nourishing the qi and yin of the Lung and Heart) (an Shen) Huang Jing (Rhizome Polygonati), Bai He (Bulbus Lilii), Bei Sha Shen (Radix Glehniae Littoralis), Xuan Shen (Radix Scrophulariae Ningpoensis), Sheng Di Huang (Radix Rehmanniae Glutinosae), Xi Yang Shen (Radix Panacis Quinque-folli), Fu Shen (Poriae Cocos, Sclerotium) 16

17 Tonify qi and blood (pungent/detoxifying substances) (bu qixue) Dang Gui (Radix Angelicae Sinensis), Bai Shao (Radix Pae-oniae Lactiflorae), He Shou Wu (Radix Polygoni Multiflori), Gan Cao (Radix Glycyrrhizae Uralensis), Huang Qi (Radix Astragals) Wu Jia Pi (Cortex Acanthopanacis Radicis). Move qi and blood (with anti parasitic herbs) (xingqi poju) Chuan Xiong (Radix Ligustici Wallichii), Chai Hu (Radix Bupleuri), E Zhu (Rhizoma Curcumae Zedoariae), San Leng (Rhizoma Sparganii), Chen Pi (Pericarpium Citri Reticulatae), Mu Xiang (Radix Saussureae seu Vladimirae), Ze Lan (Herba Lycopi Lucidi) San Qi (Radix Notogin-seng). Basic Autism Formulas Deficiency pattern Shi Chang Pu (RhizomaAcori Graminei) Yuan Zhi (Radix Polygalae Tenuifoliae) Tian Zhu Huang (Concretio Silicea Bambusae) Qian Shi (Semen Euryales Ferox) Long Chi (Dens Draconis) Bai Zhu (RhizomaAtractylodis Macrocephalae) Tian Nan Xing (RhizomaArisaematis) Bei Xie (Rhizoma Dioscoreae) Bai Zi Ren (Semen Biotae Orientalis) Xi Yang Shen (Radix Panacis Quinquefolii) Chuan Xiong (Radix Ligustici Wallichii) Excess pattern Shi Chang Pu (RhizomaAcori Graminei) Yuan Zhi (Radix Polygalae Tenuifoliae) Tian Zhu Huang (Concretio Silicea Bambusae) Qian Shi (Semen Euryales Ferox) Long Chi (Dens Draconis) Huang Lian (Rhizoma Coptidis) Rou Gui (Cortex Cinnamomi Cassias) Suan Zao Ren (Semen Ziziphi Spinosae) Hu Po (Succinum) Dan Zhu Ye (Herba Lopthatheri Gracili) Yu Jin (Tuber Curcumae) 17

18 Autism Treatment Main Points Ht9,, Ht8,, Ht7,, Ht3 UB15 15,, UB44 44,, Du16 16,, GB20 20,, Du20 20,, Du26 Eight extra channels, Windows to the Sky For Sp type use: Sp3, Sp10 St36 Liver Qi Constraint use: Liv2, Liv14 UB18 Kidney Vacuity Kid3 UB23 Phlegm Ht 5, St 40 Gui Pi Tang, Shen Ling Bai Zhui Tang Chai Hu Jia Long Gu Mu Li Tang Gui Zi Gan Cao Long Gu Mu Li Tang Ban Xia Bai Zhu Tian Ma Tang A 3 year old with PDDNOS S/S Developmental delays with speech Hyperactive Frequent ear infection and fluid accumulation behind the eardrum Urine reflux 18

19 B 7 year old ASD, ADD,SID S/S Developmental delays in speech, gross and fine motor skills, social interaction; Inability to follow directions; Inability to remain focused and behave appropriately in a classroom setting. Repetitive self-stimulative behaviors. Narrow Range of Interests, Very narrow range of diet Eye contact is very difficult. Sensory Input can be too much, or not enough. Low muscle tone. Echolalia 19