Tag Archives: autism

11

Asperger’s Syndrome vs Narcissistic Personality Disorder

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Eh?

As we know it, Asperger’s Syndrome (AS) is considered a higher functioning autism spectrum disorder, meaning a person with AS can live more independently, can talk, study, and have a job but still does not function socially well as neurotypicals because of their difficulty in comprehending the social world. This implies that AS people do not know how to interact with people, from approaching acquaintances to keeping friends and lovers and understanding another person’s emotional states (empathy). But AS people do really want to interact with people, they just don’t know how. When approaching people they just blurt out things or tell about themselves right away, which looks like they are rude or self-absorbed, making them look like a person with Narcissistic Personality Disorder.

Image courtesy of sodahead.com. Self-absoption of the AS individual could look like Narcissistic Personality Disorder.

Narcissistic Personality Disorder?

To make things clear, let’s define first the following:

Personality

Personality refers to individual differences in characteristic patterns of thinking, feeling and behaving.[1] It has to do with individual differences among people in behaviour patterns, cognition and emotion.[2]  Personality can be classified according to introversion-extraversion (quiet vs outgoing), body humours (not jokes, but bodily fluids that can affect personality: sanguine (bubbly), melancholic (gloomy), choleric (grumpy), and phlegmatic (sluggish)), and so on.  So when you refer a friend’s personality, you can say that my friend’s got a bubbly personality for example.

Now, psychologists say that personality influences life experiences and vise versa. A certain personality can take life either lightly or seriously. Also, in order for one person to navigate life well, he or she develops coping mechanisms, the expending conscious effort to solve personal and interpersonal problems, and seeking to master, minimize or tolerate stress or conflict.[3][4][5][6][7] Examples of coping mechanisms include denial (not admitting one’s fault), sublimation (substituting an activity for a feeling, ie, watching porn instead of raping), displacement (aggression toward non enemy), etc. If coping mechanisms are too much or too little, or his personality is said to be very difficult, then psychologists call this a personality disorder.

What is a personality disorder?

Personality disorders are mental health conditions that affect how people manage their feelings and how they relate to other people.[8] Those who struggle with a personality disorder have great difficulty dealing with other people. They tend to be inflexible, rigid, and unable to respond to the changes and demands of life. Although they feel that their behavior patterns are “normal” or “right,” people with personality disorders tend to have a narrow view of the world and find it difficult to participate in social activities.[9]

There are 10 personality disorders and are categorized into 3 clusters according to common features. They are developed by the American Psychiatric Association and are listed below[10]:

Cluster A (odd disorders) – often associated with schizophrenia, often described as having a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. However, people diagnosed with an odd-eccentric personality disorder tend to have a greater grasp on reality than those diagnosed with schizophrenia. In general, patients suffering from the disorder can be paranoid, have difficulty being understood by others as they have an odd or eccentric manner of speaking and a lack of close relationships.[10]

Cluster B (dramatic, emotional or erratic disorders) – self-explanatory, dramatic, too emotional, drama queen or king, or maybe dictator or criminal like personality, also promiscuous people

Cluster C (anxious or fearful disorders) –  people with these types of personality disorders are the nervous types, aka, comparable to Hades’s sidekick Panic in the Disney version of Hercules.

(C) Disney. Panic from Disney’s version of Hercules is an archetype of Cluster C Personality Disorders.

Now, back to the Asperger’s vs Narcissistic Personality Disorder. They say narcissistic personality disorder is a personality disorder where a person is grandiose, full of himself, and has no empathy with others. You can speculate that this is actually similar to Asperger’s Syndrome. But it’s actually not. They can look quite alike, but still different. Let’s explore more about narcissistic personality disorder.

Narcissistic personality disorder (NPD) is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.[11]

A narcissistic personality disorder causes problems in many areas of life, such as relationships, work, school or financial affairs. You may be generally unhappy and disappointed when you’re not given the special favors or admiration you believe you deserve. Others may not enjoy being around you, and you may find your relationships unfulfilling.[11]

A person with NPD or narc for short, is generally a self-absorbed person. His or her motto is this: “Me, myself, and I”. And his or her life is always about me, me, me, and nobody else. Way similar to Asperger’s? It can be, but wait…

The Mayo Clinic states that a person with NPD may come across as conceited, boastful or pretentious.[12] Also a narc often monopolizes conversations, belittles or looks down on people perceived as inferior, feel a sense of entitlement — and when he or she doesn’t receive special treatment, he or she may become impatient or angry.[12] A narc may look very proud on the outside, but is actually a very big baby that is hypersensitive to criticism (ie when someone criticizes him even how constructive, he or she will explode and get very mad at that person).

Narcs have secret feelings of insecurity, shame, vulnerability and humiliation. To feel better, he or she may react with rage or contempt and try to belittle the other person to make himself or herself appear superior. Or he or she may feel depressed and moody because he or she fall short of perfection.[12]

Why is the name of the disorder Narcissistic?

NPD is based on the Greek mythological character Narcissus, a very handsome young man who fell in love with his own image on a lake, thus the disorder is named after him.

To summarize, the DSM has the following symptoms confirmatory of narcissistic personality disorder

DSM-5 criteria for narcissistic personality disorder include these features[12]:

  • Having an exaggerated sense of self-importance
  • Expecting to be recognized as superior even without achievements that warrant it
  • Exaggerating your achievements and talents
  • Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
  • Believing that you are superior and can only be understood by or associate with equally special people
  • Requiring constant admiration
  • Having a sense of entitlement
  • Expecting special favors and unquestioning compliance with your expectations
  • Taking advantage of others to get what you want
  • Having an inability or unwillingness to recognize the needs and feelings of others
  • Being envious of others and believing others envy you
  • Behaving in an arrogant or haughty manner

Image courtesy of PsychCentral. Narcissistic personality disorder.

Maybe some of the symptoms of NPD like self-absorption and no empathy are similar to Asperger’s, but not arrogance or entitlement… Narcs are openly boastful while Aspies (people with AS) are totally clueless and gullible.

Typical narcs and Aspies are opposite poles –  but they still look similar to the unaware person. Both a narc and an Aspie appear rude and self-centered but with opposite reasons.

Why?

People with narcissism appear rude in order to gain recognition and special attention from other people or objects. They feel they are entitled, omnipotent, or perfect that they crave attention, which is called “narcissistic supply.” Narcs are obsessed with the “me, me, me” mantra that they are so full of love to themselves that they leave nothing for other people. Aspies, on the other hand, appear clueless on how the social world operates. It’s like they don’t have the operation manual for socialization that’s why they are also about me, me, me, but actually, they long to connect socially. That’s why they look similar: self-absorbed, no empathy, difficulty in the social arena as well as emotional arena. Also, both AS and NPD can cause severe burnout to any close relationship, be it a romantic partner, parent, child, relative, friend, or employer as they both have struggles in their interaction with other people. Actually, NPD and Asperger’s Syndrome are frequently misdiagnosed (and interchanged).

The reason for this confusion is understandable since some of the symptoms found in people with AS and HFA (high function autism) are also found in those with NPD.[13]

Their similarities are listed below[13]:

  • apparent lack empathy
  • difficulty understanding others’ feelings
  • eccentric personality
  • harsh interpersonal communication
  • inability to view the world from the perspective of others
  • lack of demonstrated non-verbal cues and inability to pick-up on the non-verbal cues of others
  • lack of interest in others
  • lack of psychological awareness
  • narrow range of interests and activities
  • obvious self-focus in interpersonal exchanges
  • preoccupation with their own agenda
  • problems in sustaining satisfying relationships
  • self-centeredness
  • similar eye-to-eye gaze, body stance, and facial expressions
  • tendency to react to social problems/stress with depression
  • underdeveloped conversational skills

Confusing, right? But AS and NPD are totally opposite poles. Here are the differences between AS and NPD[13]:

  1. The Aspergerian (i.e., person with Asperger’s) wants a good and happy life – not just for himself, but for everyone. He would rather “fit-in” with his peer-group (or simply be left alone) rather than be the “boss” or the “leader” – even if he is the brightest student in the class. The Narcissist (i.e., person with NPD), however, wants a good and happy life only for himself (or the individuals he includes in his inner circle). He wants to be in control and doesn’t care who he has to hurt to get control. He will do anything he can to be in charge of the people around them (without being noticed as a “control freak”).

  2. The Aspergerian typically pays little attention to the body language of others – and would have great difficulty reading it even if he tried. The Narcissist pays close attention to others’ body language – looking for signs that they may be weak or vulnerable – and then seizes the opportunity to exploit them for his own gains.

  3. The Aspergerian typically does not have any hidden agenda toward others. But, the Narcissist lives and breathes hidden agenda, as any good con man would.

  4. The Aspergerian simply wants to be treated with normal consideration and respect, but he often receives much less respect than he deserves due to his social skills deficits, quirkiness, and lack of desire to appear “cool” in the eyes of others. On the contrary, the Narcissist typically receives way more respect than he deserves since he is great at presenting himself as the smartest, coolest person on the block. He discards and devalues others in order to make himself look better.

  5. The individual with Asperger’s often appears selfish, uncaring and insensitive due to the fact that he tends to live in his “own little world,” often minding his own business to a fault. The individual with NPD often appears selfish, uncaring and insensitive BECAUSE HE IS.

  6. The Aspergerian is unlikely to obey the hidden rules of conversation (e.g., unable to read or exhibit non-verbal language, may ramble on about a special interest even when the listener has stopped paying attention, may not allow others to speak in turn, interrupts the speaker on a whim, etc.). On the other hand, the Narcissist pays very close attention to the rules of conversation and is highly verbal, using language as a manipulative tool to get his ego fed.

  7. The Aspergerian wants marriage, children, friends and social acceptance, but is fairly clueless about how to go about procuring these things. As a result, he may develop a fear of rejection – and even choose a solitary lifestyle. Conversely, the Narcissist has the ability to switch between social responsiveness and social disengagement. He is not interested in relationships with certain people, because he views them as unworthy or inferior. However, if he can take advantage of someone for his own gains, he will easily and immediately regain his social skills and charm.

  8. Asperger’s individuals don’t exploit Narcissists. However, Narcissists do exploit people with Asperger’s. In fact, the Aspergerian is often the Narcissist favorite target!

  9. The Aspergerian experiences developmental delays, whereas the Narcissist experiences personality flaws.

  10. The Aspergerian is rather naïve and innocent, while the Narcissist is rather cunning and guilty.

Still, AS and NPD can still be misdiagnosed because of their seemingly similar symptoms. Oftentimes, narcs may act innocent to the outside world to boost their inflated self-image and become so mean at home, making immediate family members rather confused. Plus, narcs are considered very good con artists and are expert liars, which Aspies don’t do; instead, Aspies are tactless and too brutally honest, making them also rude too.

But let me tell you that the current DSM description of NPD is only one type of NPD. In fact, psychologists and psychiatrists as well as other experts believe there are many types of narcissistic personality disorder.

The types of narcissists are as follows[14]:

Cerebral Narcissists

Like the word cerebral implies, a cerebral narcissists has a profound belief that they have a superior intellect, that their intelligence far exceeds that of ordinary folk. They have a vast array of knowledge on just about any topic. They tell stories (real or made up) exemplifying their colossal brilliance. They are quick to point out the failings of others, often showing a great amount of disdain for those of lesser intelligence. Their Narcissistic Supply is generated through their intellect. Their audience admires their wit, stories and superior intelligence.

My comment: This type of narcissism is often common among the highly intelligent, including gifted populations, prodigies, and may also be common to people on the autism spectrum. It’s possible that autism and narcissism can co-exist.

Somatic Narcissists

Somatic Narcissists are consumed with their physical beauty and prowess.  You will often find somatics working hard at the gym, or on their appearance in some fashion or another. Somatics derive their Narcissistic supply from the reactions of others to their appearance, or sexual conquests.  You will often find a long list of sexual partners in their repertoire.

My comment: This is your typical narcissist. Always assumes he or she is the fairest of them all, common among celebrities. And she or he isn’t just enough of selfies. This is the real-life Narcissus!

Image courtesy of everydayfeminism.com. Your typical narcissist is more than just someone obsessed with selfies.

Overt Narcissist

When I think of an overt Narcissist I think of the character played by Julia Robert’s husband in Sleeping with the Enemy. This is the type of Narcissism that most people think of when they think of a Narcissist.

The overt Narcissist must always be in control. They are always right. They don’t hide their expectations that everything must always be all about them and done their way. They have massive egos and they aren’t afraid to show it. This type can verbally or physically slice you to ribbons and feel not an ounce of remorse or guilt.  They can be seen as over confident, but it becomes a pathology when the behaviors are way over the top. They are extroverts – their personalities like their sense of entitlement is large, loud, obvious and oppressive.

My comment: This is your still typical narcissist. Unfortunately I am classified as this combined with cerebral type (disclaimer: that’s just my self diagnosis). These are your usual tyrant politician like Hitler, Hussein, Bonaparte, etc…

Covert Narcissist

A Covert Narcissist is a Narcissist who, to the outside world, appears to be kind, altruistic and full of integrity, but they save their rage, extreme selfishness and cruelty for their nearest and dearest. They could be your religious leaders, teachers, counselors, politicians, anyone in a position with some authority or power. Covert Narcissists are very good at pretending. They pretend in order to get what they want, be it power, success, money, fame. They are the proverbial wolf in sheep’s clothing.

My comment: Hmm… a very dangerous type… common among clergymen, Filipino politicians (disclaimer: I’m a Filipina (female Filipino) who’s disgusted with Filipino politicians), even romantic partners and friends.

The Parasitic Narcissist

Parasitic Narcissist is a narcissist who exhibits all of the traits of Narcissism as outlined in the DSM-IV, however this type wants to be taken care of. They lead a parasitic lifestyle, feeding off of their host, and anyone that provides them the opportunity.

They don’t want responsibility. They look for strong, intelligent,  successful partners that can run the show, while they don’t contribute and have an, ‘it’s all about me’ party.

Errmm… very self explanatory, reality stars fit into this and business tycoons as well and elites too

The Boomerang Narcissist

Like the name implies the Boomerang Narcissist is one who is constantly popping in and out of your life. They offer very little in the way of believable excuses, but their co-dependent partners keep taking them back. They usually have several other partners they are involved with and bounce from one to the other when it suits them or something is expected of them. These types usually have a harem they can choose from, whom they feed bits and pieces of attention and affection to – just enough to keep them emotionally invested in them.

Okay. There are really self-absorbed and very selfish people. This can’t be the AS person. Right?

Wrong.

Huh???

A narcissist can have ASD and a person with ASD can have narcissism. In these cases, it is very hard to diagnose these as they are seemingly similar. This is particularly true when it comes to the covert and cerebral types, which is quite complicated as they are both similar in terms of self-absorption, low self-esteem, difficulty in socialization and and so on (for the articles of each autism spectrum disorders, click these following links: autism, Asperger’s Syndrome, pervasive developmental disorder-not otherwise specified)

Can’t still believe?

The only sure way to test whether a person can be a narc or an autistic is through formal psychiatric and or neurodevelopmental assessment. Usually, to be diagnosed on the spectrum, he or she must have a neurodevelopmental delay or damage and have global developmental delays. Narcissists, on the other hand, mustn’t have any other developmental disabilities or delays, but psychiatric problems like coming from a dysfunctional family or being either overindulged, abused, or neglected as a child to have the diagnosis of NPD.

Image courtesy of cartoonstock.com. Self-absorption is the hallmark sign of both ASD and NPD.

Nevertheless, both disorders can have a very huge impact on both the person who possesses it and to the family and society itself. It is therefore very important to differentiate these two disorders and give appropriate therapies to lessen the impact of these disorders and so as to help  them reach their true potential.

P.S.

There is a study that NPD can be considered a lighter version of ASD. Click this link here: https://www.psychologytoday.com/blog/resolution-not-conflict/201406/do-you-think-narcissism-autistic-spectrum-disorder

Accordingly, there is a study that the brains of narcissists are also deficient. They have very thin areas (or sometimes damaged) of the brain concerning with empathy and mirroring (brain activity which mimics other people’s movements and emotions). This could be very good as more light will be shed in human neurodiversity. This way we will be more able to understand people’s behavior in general that are really part of the human brain wiring and not just as is.

Do you suspect yourself to be a narcissist which you thought was Asperger’s or high emotional sensitivity? Click this article: http://blogs.scientificamerican.com/beautiful-minds/23-signs-youe28099re-secretly-a-narcissist-masquerading-as-a-sensitive-introvert/

Hmm… This is the non DSM type of narcissism. Much more common and can be misdiagnosed as an autism spectrum or is a highly sensitive person (HSP). Have a try. This doesn’t automatically make you a psychopath.

References:

  1. http://www.apa.org/topics/personality/
  2. https://en.wikipedia.org/wiki/Personality
  3. https://en.wikipedia.org/wiki/Coping_(psychology)
  4. Weiten, W. & Lloyd, M.A. (2008) Psychology Applied to Modern Life (9th ed.). Wadsworth Cengage Learning. ISBN 0-495-55339-5.
  5. Snyder, C.R. (ed.) (1999) Coping: The Psychology of What Works. New York: Oxford University Press.ISBN 0-19-511934-7.
  6. Cummings, E. Mark; Greene, Anita L.; Karraker, Katherine H., eds. (1991). Life-span Developmental Psychology: Perspectives on Stress and Coping. p. 92.
  7. R. S. Lazarus & S. Folkman, Stress, Appraisal, and Coping (1984) p.141.
  8. http://www.nhs.uk/conditions/personality-disorder/Pages/Definition.aspx
  9. http://www.mentalhealthamerica.net/conditions/personality-disorder
  10. https://en.wikipedia.org/wiki/Personality_disorder
  11. http://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/basics/definition/con-20025568
  12. http://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/basics/symptoms/con-20025568
  13. http://www.myaspergerschild.com/2015/05/is-it-aspergers-or-narcissism-or-both.html
  14. http://esteemology.com/the-different-faces-of-narcissism-types-and-sub-types/

Useful links:

Misdiagnosing Asperger’s as Narcissistic Personality Disorder: http://samvak.tripod.com/journal72.html

Self-admitting narcissist Sam Vaknin tells that Asperger people are usually misdiagnosed as NPDs. He does believe that narcs are actually extroverted and very good at socializing that he cannot include AS as a type of NPD.

Another differences between NPD and AS: http://www.mindretrofit.com/2013/02/24/aspergers-narcissism-not-the-same-i/

The autism and narcissism spectrum: http://luckyottershaven.com/2014/10/05/the-spectrums-of-autism-and-narcissism/

Very nice article about autism and narcissistic personality disorder spectrum types, written by a person with borderline personality disorder, a victim of a narcissist, and self-confessed covert narcissist too who initially thought that she has Asperger’s but actually covert narcissism.

Famous people with NPD: http://luckyottershaven.com/2014/11/21/famous-people-who-have-npd/

By the same author who has covert narcissism. You’ll be actually surprised that NPD is a very common disorder especially in the entertainment industry. No wonder there are no stable relationships, marriages, and families there. Also common in the business, politics, and religious organizations.

Narcs can have Asperger’s too: http://luckyottershaven.com/2015/04/11/narcissists-with-aspergers/

And this is a bad combination, though.

The typical narcissist vs the vulnerable narcissist: http://www.bpdcentral.com/blog/?Is-Your-Narcissist-the-Vulnerable-or-Grandiose-Type-22

This is a descriptive report on the two kinds of narcissism.

The covert narcissist: http://www1.appstate.edu/~hillrw/Narcissism/shycovertnarcissist.html

The actual description of a covert narcissist, which is usually mistaken as Asperger’s (or maybe similar or can be direct relatives or so…). I’m very guilty of this though, as I have this (self-diagnosis with the help of my mom)

Final word: to be sure whether your loved one, friend, colleague, or yourself have either ASD or NPD, I advise you to please consult a psychiatrist/psychologist/neuropsychiatrist to have a proper assessment. But for penniless like me, Google is the answer, and prayers too (for believers)

Narcissistic perfectionism: http://npatraits.homestead.com/nptype.html

This is under the NPA personality theory (NPA means narcissism, perfectionism, and aggression personalities) where such personality types are genetic in origin and have common subtypes per ethnicity. Narcissistic perfectionism are autistic-cerebral narcissistic in nature and are fairly common to peoples of the northern latitudes with rigid, rule-like perfectionism such as East Asians and Northern Europeans… (and my family’s very much related to this personality type, now I know why we are such narcissists)

4

Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

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You may know someone who’s like this: looks really normal, but when speaking, sometimes, she doesn’t fully understand language, sometimes, she talks like a child or professor or philosopher. She has complete limbs but seem not to do tasks well. At far she stands good, but when near her, she has poor gait. She rather be alone than socialize, seems so shy. She is maybe very beautiful, but cannot groom herself, and has no experience in romance. You may suspect she has autism, but hey, she talks. Maybe she has ADHD, but not really. She has dyspraxia, but not clumsy enough. What does she have? These symptoms are part of the “atypical autism,” better known as pervasive developmental disorder-not otherwise specified (PDD-NOS).

What is PDD-NOS?

PDD-NOS is a sub-type of autism spectrum disorder (ASD) marked with autism symptoms but not fully to be diagnosed with typical autism. Generally, PDD-NOS is under the umbrella ASD or pervasive developmental disorders (PDD) where it is a group of conditions that involve delays in the development of many basic skills. Most notable among them are the ability to socialize with others, to communicate, and to use imagination (triad of impairments). Children with these conditions often are confused in their thinking and generally have problems understanding the world around them.[1]

PDD-NOS is a ‘subthreshold’ condition in which some – but not all – features of autism or another explicitly identified Pervasive Developmental Disorder are identified.[2] It is also referred to as “atypical personality development,” “atypical PDD,” or “atypical autism.”[2]

Like all forms of autism, PDD-NOS can occur in conjunction with a wide spectrum of intellectual ability. Its defining features are significant challenges in social and language development.[3]

Image courtesy of Dr. Joshi’s Center for Autism. PDD-NOS is under the ASDs which is under the broader PDDs.

PDD-NOS is removed from the current DSM-5 and is replaced by the general autism spectrum disorder by severity. But in ICD-10, PDD-NOS is still accepted

What causes PDD-NOS?

Like in other ASDs, PDD-NOS has no definitive cause, but PDD-NOS can run in families. The underlying basis of PDD is neurological and most probably genetic. They affect more boys than girls and are usually evident by age three years, although in the case of PDD-NOS the signs may not be noticed until slightly later.[4]

What are the symptoms of PDD-NOS?

PDD-NOS symptoms are the following[5]:

  • Do not respond to their name by 12 months of age.
  • Do not point at objects to show interest (point at an airplane flying over) by 14 months.
  • Do not play “pretend” games (pretend to “feed” a doll) by 18 months.
  • Avoid eye contact and want to be alone.
  • Have trouble understanding other people’s feelings or talking about their own feelings.
  • Have delayed speech and language skills.
  • Repeat words or phrases over and over (echolalia).
  • Give unrelated answers to questions.
  • Get upset by minor changes.
  • Have obsessive interests.
  • Flap their hands, rock their body, or spin in circles.
  • Have unusual reactions to the way things sound, smell, taste, look, or feel.

Generally, PDD-NOS symptoms are[6]:

  • Communication difficulties (e.g., using and understanding language)
  • Difficulty with social behavior
  • Difficulty with changes in routines or environments
  • Uneven skill development (strengths in some areas and delays in others)
  • Unusual play with toys and other objects
  • Repetitive body movements or behavior patterns

Studies suggest that persons with PDD-NOS belong to one of three very different subgroups[6][7]:

  • A high-functioning group (around 25 percent) whose symptoms largely overlap with that of Asperger syndrome, but who differ in terms of having a lag in language development and/or mild cognitive impairment.[7] (The criteria for Asperger syndrome excludes a speech delay or a cognitive impairment.[8])
  • A group (around 25 percent) whose symptoms more closely resemble those of autistic disorder, but do not fully meet all its diagnostic signs and symptoms.[7]
  • The biggest group (around 50 percent) consists of those who meet all the diagnostic criteria for autistic disorder, but whose stereotypical and repetitive behaviors are noticeably mild.[7]

How is PDD-NOS diagnosed?

To diagnose PDD-NOS, a child must have a certain number of characteristics relating to social and communication skills, and also show some repetitive behaviour. When a child has only some of these characteristics, the child might be diagnosed with pervasive developmental disorder – not otherwise specified (PDD–NOS).[9]

PDD-NOS is typically diagnosed by psychologists and Pediatric Neurologists. No singular specific test can be administered to determine whether or not a youngster is on the spectrum. Diagnosis is made through observations, questionnaires, and tests. A mother or father will usually initiate the quest into the diagnosis with questions for their youngster’s doctor about their youngster’s development after noticing abnormalities. From there, doctors will ask questions to gauge the youngster’s development in comparison to age-appropriate milestones. One test that measures this is the Modified Checklist of Autism in Toddlers (MCHAT). This is a list of questions whose answers will determine whether or not the youngster should be referred to a specialist such as a Developmental pediatrician, a neurologist, a psychiatrist, or a psychologist.[10]

Although PDD-NOS is milder than the typical autism (autistic disorder), much difficulty in navigating the world is apparent when compared to a neurotypical (NT). The sad part is, PDD-NOS is harder to diagnose than autistic disorder because people with PDD-NOS can talk and usually have average to high intelligence (though can also exist in low intelligence), can be assimilated into school and/or work, and can live independently. The problem with PDD-NOS is that the child or adult with PDD-NOS is “labeled” as Different. Clearly. “Weird.”[11] They are also prone to be loners as well because of their inappropriate social behavior.

Image courtesy of asiam.ie. People with PDD-NOS are usually described as loners.

To better understand PDD-NOS symptoms, let’s quote from My Asperger’s Child about PDD-NOS[10]:

Because PDD-NOS is a spectrum disorder, not every youngster shows the same signs. The two main characteristics of the disorder are difficulties with social interaction skills and communication. Signs are often visible in babies, but a diagnosis is usually not made until around age 4. Even though PDD-NOS is considered milder than typical autism, this is not always true. While some characteristics may be milder, others may be more severe.

Once a youngster with PDD-NOS enters school, he will often be very eager to interact with classmates, but may act socially different than peers and be unable to make genuine connections. As they age, the closest connection they make is typically with their mom and dad. Kids with PDD-NOS have difficulty reading facial expressions and relating to feelings of others. They do not know how to respond when someone is laughing or crying. Literal thinking is also characteristic of PDD-NOS. They are unable to understand figurative speech and sarcasm.

Inhibited communication skills are a sign of PDD-NOS that begins immediately after birth. As an infant, they will not babble, and as they age, they do not speak when age appropriate. Once verbal communication begins, their vocabulary is often limited. Some characteristics of language-based patterns are: repetitive or rigid language, narrow interests, uneven language development, and poor nonverbal communication. A very common characteristic of PDD-NOS is severe difficulty grasping the difference between pronouns, particularly between “you” and “me” when conversing. Difficulty with this would look something like this:

Parent: “Do you want to color this or do you want me to?”

Child: “Me.”

This “me” response would be because, since the mother or father spoke the word “me”, the youngster thinks that “me” still applies to the parent. The youngster with autism cannot grasp – without intervention – that the pronoun assignment of “me” refers to the speaker, and not to whomever spoke it first.

The former DSM-IV diagnostic criteria of PDD-NOS go like this[12]:

I. Qualitative impairment in reciprocal social interactions:
This refers to a developmental difference in the individual’s interest and competence in achieving reciprocal interactions.  It does not mean that the individual is not affectionate, or cannot make contact with other people, or is simply behind schedule in the development of social skills. What is different is the quality of interaction and interest.

Behaviors suggesting this area may be affected include:

  • difficulty understanding/perceiving the emotions of others 
  • difficulty sustaining interactions initiated by others
  • poor, fleeting or abnormal eye contact
  • lack of comfort-seeking when distressed
  • difficulty making peer friendships appropriate to developmental level
  • lack of social or emotional reciprocity
  • lack of effort to share interests or enjoyment with others (may not show, point out or bring objects to share with others)
  • in preschool children, lack of turn-taking play with peers (although the child may enjoy active and rough-and-tumble play)
  • difficulty understanding social cues
  • difficulty understanding and expressing his/her own emotions
  • seeking touch and affection on own terms, but shunning affection when offered by others (not on own terms)
  • preference for solitary play instead of group or paired play
  • absence of symbolic play behavior, very literal and concrete in comprehension (e.g., would not use a block as a telephone)
  • frequent or sustained giggling, laughing or crying without visible cause
  • may appear deaf at times, yet hear sounds from a distance at other times (ignore voice when name is called, yet run to window when ice cream truck is two blocks away)


II. Qualitative impairment in verbal and non-verbal communication and imaginative activities:
Again, this does not refer to a delay in development, but rather a difference in the way verbal and nonverbal communication proceeds.  Behaviors suggesting this area may be affected include:

  • normal development of early babbling and first words which are later lost between the ages of 1 and 3 years, while other development appears to proceed on course
  • difficulty developing verbal communication
  • pulling adults to items of interest rather than pointing or gesturing
  • lack of use of gestures, demonstration, mime to compensate for lack of verbal expression
  • repeating phrases verbatim frequently (echolalia)
  • repeating phrases (often from TV) out of context after a period of time has passed (delayed echolalia)
  • using words out of communicative context (walks around saying “hi daddy” when daddy is at work, and nobody is present)
  • answering question by parroting question back to you
  • poor timing and content variation in topic
  • difficulty taking turns in maintaining a conversation
  • difficulty with abstract concepts (learns nouns better than verbs or adjectives)
  • difficulty understanding the “theme” of a story
  • inventing own words for objects and rigidly uses them (neologism)
  • talking mainly about one restricted topic, or using one word repeatedly (perseveration)
  • acting as if adults can read his/her mind
  • question-like or sing-song cadence to their speech
  • difficulties in imitation


III. Restricted repetitive and stereotyped patterns of behavior, interests, and activities:

  • engaging in repetitive non-functional body movements (for example, spinning or whirling
  • around, flapping arms or hands, rocking, walking on tiptoes, looking at fingers (stereotypies)
  • difficulty with changes or transitions
  • under- or over-sensitivity to sensory stimuli (sounds, lights, textures, odors)
  • restricted food preferences, sometimes related to food texture
  • may explore environment in unusual ways (smelling objects, mouthing excessively, scratching, licking)
  • develop attachments to objects that are not typical for children (must sleep with twigs) 
  • may carry around objects without ever playing with them, and become upset when they are taken away 
  • becomes fascinated with parts of objects (wheels, lines, writing)
  • may spin objects that are round in shape
  • may focus on ordering and reordering or categorizing toys instead of playing with them (lining up cars, amassing red blocks)
  • plays with materials in the same sequence across a period of time where variation would be expected (has Ernie follow same route to hospital every time he plays with car mat)
  • develops routines that are difficult to break
  • may get upset over trivial changes in environment (moving a lamp)
  • not interested in a wide variety of toys and materials
  • peculiar insistence in selected items, sequences, or routines (will only drink milk out of a certain cup)
  • does not ask for help, but figures out how to get what he/she wants


OTHER CONCERNS:

  • eating inedible objects
  • undersensitive to pain
  • attention span fleeting for most activities, yet can spend long periods of time focused on one activity of his/her own interest (can watch videos for hours, but can’t sit for 30 seconds for other tasks)
  • high overall activity level
  • may need less sleep than typical children of the same age
  • absence of fear or appreciation of dangerous situations
  • self-injurious behavior that does not appear to be directed at achieving any result (head banging, eye poking, biting)
  • uneven intellectual ability (skills show a great deal of variability)
  • peculiar fascination with one specific medium (country music, TV station, Wheel of Fortune, preview guide), etc.
  • more interested in credits and commercials than TV shows
  • unusual fear reactions


STRENGTHS:

  • good memory, especially for visually presented information
  • enjoys completing tasks with a set end point
  • may have precocious interest in letters and numbers
  • cuddly and affectionate with parents, usually on own terms
  • mechanical aptitude (can program the VCR at age 2)
  • higher skills/talents in art, music, math, balance
  • enjoy vestibular stimulation (tosses, being turned upside down, etc)
  • stamina
  • good non-verbal problem solving abilities (can get what they want)

What happens if PDD-NOS is not diagnosed?

PDD-NOS is more than just a combination of language disorders, motor disorders, and social difficulties. This is an autism spectrum disorder with atypical or uneven development: can talk but cannot comprehend language, can move limbs but cannot play sports or dance, can make acquaintances but cannot form close friends and romantic relationships, can go to school and learn but cannot work and be employed long-term, and this makes one of the most difficult neurodiverse conditions to be identified, making people with PDD-NOS very prone to social isolation, unemployment, homelessness, depression, anxiety, OCDs, various mental disorders, and suicide. That’s why the earlier the identification and intervention for PDD-NOS, the better the outcome.

How is PDD-NOS managed?

PDD-NOS has no cure. To achieve the best possible progress children identified with PDD–NOS need focused support and intervention early on. And, the intervention programme must be tailored to suit the child’s specific needs.[13]

Interventions include[13]:

  • Special Education – this is the concept of tailoring or adapting day to day education to specifically meet a child’s unique learning needs. This may include modified curriculum and modified reporting systems. It is obligatory in most developed countries.
  • Establish an Individualised Educational Plan (IEP) or a Negotiated Educational Plan (NEP) – this is a plan formulated by school staff, specialists and parent input. This plan lays the groundwork for necessary therapies and academic training. IEP’s and NEP’s can be developed as funded or unfunded options.
  • Behavior Modification – the development of positive strategies to support the behaviour of the child to improve their learning and functioning (Applied Behavior Analysis makes use of reinforcements so that the child learns to respond in a particular manner. It rewards positive behaviours and ignores the undesirable ones. The desired outcomes are broken down into attainable, success-based tasks. This teaches the child how to learn so that they can then move on to academic work)
  • Teaching and learning – quite often, these children simply require a little more time to learn and respond. Their learning is always buoyed by additional visual input. Never underestimate the positive impact on learning when a student and teacher (and parents) have the best of relationship.
  • Develop visual aids; schedules, planners and timetables – these children often resist change to their routines. It is important to provide them with a plan so they know what activities are first, next, and last. If they are unable to read, then use picture cues on the schedule. These kids are reliant on advanced notice of imminent changes.
  • Speech Therapy – this specialisedadditional work is often needed to correct specific letter and word pronunciations. When necessary, language skills are addressed to help the child learn how to respond appropriately to certain phrases and questions. This type of therapy is often administered on an individualised basis, by a speech therapist. It is very appropriate for therapy to occur during the course of the school day.
  • Occupational Therapy – offers designs to increase the child’s day to day and classroom functional abilities (sensory integration therapy). Sensory problems often cause children to be overly sensitive to textures, noises, smells and sounds. If the child has problems with fine motor skills that hinder writing and other class tasks, therapy can be used to address these problems as well. Again, it is very appropriate for therapy to occur during the course of the school day.
  • Medication – considered to treat specific secondary symptoms such as anxiety, depression, hyperactivity and highly aggressive or reactive behaviours
  • Social Skills Training – where children are explicitly taught pro-social behaviours; how to interact with their peers in specific situations[13]
  • Complementary Therapies – martial arts, gymnastics and music therapy, assist children flex their muscles, literally and figuratively, as they learn how to function in a group setting away from school[13]

Some of the more common therapies and services include:[6]

Image courtesy of Therapy, Learning & Communication – WA. The earlier the intervention for PDD-NOS, the better the outcome.

Adults with PDD-NOS? What to do?

If an adult suspects he might have PDD-NOS, usually a referral to a psychiatrist is first made. This is usually because he has experienced struggles with the so-called “triad of impairments” – socialization, communication, and language (as opposed to speech) and is already suffering from depression or other mood disorder. Although adult diagnosis of PDD-NOS is difficult at first, still he must describe his symptoms suspected to be identifiable with PDD-NOS (cannot hold a regular job, longtime involuntary celibacy, depression, etc). Once a diagnosis is made, therapies to manage PDD-NOS for children are also applied to adults, as well as support groups are also included in management for PDD-NOS.

Adults with PDD are able to function at varying degrees depending on the severity of the disorder. Many adults with milder forms of PDD are able to work and live on their own or with some help. Still, difficulties communicating and relating to people can cause problems in many areas of life. People with PDD can benefit from skills training, support, and therapy into adulthood.[14]

Regardless, people with PDD-NOS are still people after all. ll they need is acceptance and support for them to live satisfying lives.

Reference:

  1. http://www.webmd.com/brain/autism/development-disorder
  2. http://childstudycenter.yale.edu/autism/information/pddnos.aspx
  3. https://www.autismspeaks.org/what-autism/pdd-nos
  4. http://www.autism.org.uk/About-autism/Related-conditions/Pervasive-developmental-disorder/PDD-NOS-whats-in-a-name.aspx
  5. http://www.brainbalancecenters.com/who-we-can-help/pdd-nos/
  6. https://en.wikipedia.org/wiki/Pervasive_developmental_disorder_not_otherwise_specified
  7. Walker DR, Thompson A, Zwaigenbaum L, Goldberg J, Bryson SE, Mahoney WJ, Strawbridge CP, Szatmari P 2004. Specifying PDD-NOS: a comparison of PDD-NOS, Asperger syndrome, and autism. J Am Acad Child Adolesc Psychiatry. 2004 Feb;43(2):172-80. PMID 14726723 [1] and [2].
  8. American Psychiatric Association (2000).“Diagnostic criteria for 299.80 Asperger’s Disorder (AD)”. Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.).ISBN 0-89042-025-4. Retrieved 2007-06-28.
  9. http://raisingchildren.net.au/articles/pervasive_developmental_disorder.html
  10. http://www.myaspergerschild.com/2011/08/pervasive-developmental-disordernot.html
  11. http://pddworld.blogspot.com/2013/01/a-pdd-nos-diagnosis-sucks.html
  12. http://www.psychiatry.emory.edu/PROGRAMS/autism/pdd.html
  13. http://www.whatsthebuzz.net.au/whats-the-buzz/pervasive-development-disorder-not-otherwise-specified-pdd-nos
  14. http://www.womenshealth.gov/illnesses-disabilities/types-illnesses-disabilities/pervasive-developmental-disorders.html

Further Reading:

  1. http://www.bbbautism.com/diagnostics_psychobabble.htm
  2. http://edition.cnn.com/2013/04/02/health/iyw-growing-up-autistic/
  3. http://www.foxnews.com/health/2013/04/11/lost-in-crowd-growing-up-with-pervasive-developmental-disorder/
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Childhood Disintegrative Disorder

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Every parent are sure proud when they see their baby learn to crawl, turn over, and walk, achieving developmental milestones. But what if a child suddenly regresses and become very delayed in development? This scenario exist, and this is called childhood disintegrative disorder.

What is childhood disintegrative disorder?

Childhood disintegrative disorder (CDD) also known as Heller’s syndrome and disintegrative psychosis, is a rare developmental disorder characterized by  late onset of developmental delays in language, social function, and motor skills.[1] CDD has some similarity to autism, and is sometimes considered a low-functioning form of it.[1][2][3] CDD is similar to dementia – skills already learned and acquired suddenly disappear and regress; the difference is CDD is occurring in toddlerhood, commonly in 3 years of age.

CDD  was originally described by Austrian educator Theodor Heller in 1908, 35 years before Leo Kanner and Hans Asperger described autism.[1] Heller had previously used the name dementia infantilis for the syndrome.[1][4]

Childhood disintegrative disorder is part of a larger category called autism spectrum disorder. However, unlike autism, someone with childhood disintegrative disorder shows severe regression after several years of normal development and a more dramatic loss of skills than a child with autism does. In addition, childhood disintegrative disorder can develop later than autism does.[5]

What causes CDD?

The cause of CDD is still unknown. There is not enough research on this rare disorder to determine a cause.[6]  It has been linked to brain and nervous system problems.[7]

How common is CDD?

More boys than girls appear to be affected. Childhood disintegrative disorder is perhaps 10 times less common than more strictly defined autism and is estimated to occur in between 1-2 children per 100,000.[8]

What are the symptoms of CDD?

CDD has the following characteristics taken from MedlinePlus[7]:

  • Delay or lack of spoken language
  • Impairment in nonverbal behaviors
  • Inability to start or maintain a conversation
  • Lack of play
  • Loss of bowel and bladder control
  • Loss of language or communication skills
  • Loss of motor skills
  • Loss of social skills
  • Problems forming relationships with other children and family members

Additional symptoms may include the onset of difficulty in the transition to waking from sleep. Social interactions become compromised (as manifested by aggressiveness, tantrums, or withdrawal from peers), as does motor function, resulting in poor coordination and possible awkwardness of gait.[9][10]

Image courtesy of Dreamstime. A toddler with childhood disintegrative disorder (CDD) may regress from walking to clumsy gait and needs support like walker.

Image courtesy of DSM-IV/rickpdx.files.wordpress.com. CDD is under the umbrella of autism spectrum disorders (ASD).

How is CDD diagnosed?

CDD is most commonly diagnosed when the parents of the affected child consult the pediatrician about the child’sloss of previously acquired skills. The doctor will first give the child a medical examination to rule out epilepsy or other medical conditions.[11] The child’shead may also be x rayed to rule out head trauma or a brain tumor. Following the medical examinations and tests, the child will be referred to a psychiatrist who specializes in treating children and adolescents. The psychiatrist will then make the differential diagnosis of CDD.[11]

To be diagnosed with CDD, a child must show loss or regression in at least two of the areas listed below. Usually regression occurs in more than two areas. These are[11]:

  • receptive language skills (language understanding)
  • expressive language skills (spoken language)
  • social or self-help skills
  • play with peers
  • motor skills
  • bowel or bladder control, if previously established

CDD must be differentiated from autism and such other specific pervasive developmental disorders as Rett’s disease. It also must be differentiated from schizophrenia . One of the differences between CDD and other PDDs is that to be diagnosed with CDD, a child must develop normally for at least two years before loss of skills occurs, and the loss must occur before age ten. Parents’ reports of the child’s development, records in baby books, medical records kept by the child’s pediatrician, and home movies are often used to document normal development through the first two years of life.[11]

How is CDD managed?

CDD’s management is similar to other autism spectrum disorder (ASD) management[1]:

  • Behavior therapy: The main aim of Applied Behavior Analysis (ABA) is to systematically teach the child to relearn language, self-care and social skills. The treatment programs designed in this respect “use a system of rewards to reinforce desirable behaviors and discourage problem behavior.” ABA programs may be designed by a board-certified specialist in behavior analysis called a “BCBA” (Board Certified Behavior Analyst), but ABA is also widely used by a number of other health care personnel from different fields like psychologists, speech therapists, physical therapists and occupational therapists with differing levels of expertise. Parents, teachers and caregivers are instructed to use these behavior therapy methods at all times.[1]
  • Environmental Therapy: Sensory Enrichment Therapy uses enrichment of the sensory experience to improve symptoms in autism, many of which are common to CDD.[1]
  • Medications: There are no medications available to directly treat CDD. Antipsychotic medications are used to treat severe behavior problems like aggressive stance and repetitive behavior patterns. Anticonvulsant medications are used to control seizures.[1]

What is the prognosis of CDD?

The outlook for this disorder is poor. Most children with the condition have an impairment similar to that of children with severe autism by age 10.[7]

  • Effects on intellectual function, self-sufficiency and adaptive skills are profound, with most cases regressing to severe intellectual disability.[12]
  • Medical co-morbidities such as epilepsy commonly develop.[12]
  • Those with moderate-to-severe mental intellectual disability or with an inability to communicate tend to do worse than those left with a higher IQ and some verbal communication.[12]
  • Outlook is poor. Children will require lifelong support.[12]
  • Risk of seizures increases throughout childhood, peaking at adolescence, and seizure threshold may be lowered by SSRIs and neuroleptics.[12]
  • Life expectancy has previously been reported as normal. However, more recent studies suggest that mortality of people with autistic spectrum disorders is twice that of the general population, mainly due to complications of epilepsy.[12][13]

Because CDD is a rare condition, differential diagnoses are ruled out first before considering CDD as a disorder[12]:

The differential diagnosis incudes any of the other pervasive developmental disorders (autistic spectrum disorder, Rett’s Syndrome, PDD-NOS) or causes of general learning disability. Other specific conditions which need to be ruled out are[12]:

48421855

Image courtesy of thescrewjack.com. On the autism spectrum scale, CDD is considered the most severe form of ASD.

CDD is one of the most devastating developmental disorders. This really require awareness, acceptance, and support from all those involved – parents, family, medical personnel, and the community at large. Even if the child with CDD cannot speak, still show unconditional love for her and surely she will thank you for loving her no matter what.

Reference:

  1. https://en.wikipedia.org/wiki/Childhood_disintegrative_disorder
  2. McPartland J, Volkmar FR (2012). “Autism and related disorders”. Handb Clin Neurol 106: 407–18.doi:10.1016/B978-0-444-52002-9.00023-1.PMID 22608634.
  3. Venkat A, Jauch E, Russell WS, Crist CR, Farrell R (August 2012). “Care of the patient with an autism spectrum disorder by the general physician”. Postgrad Med J 88 (1042): 472–81. doi:10.1136/postgradmedj-2011-130727. PMID 22427366.
  4. Mouridsen SE (June 2003). “Childhood disintegrative disorder”. Brain Dev. 25 (4): 225–8.doi:10.1016/s0387-7604(02)00228-0. PMID 12767450.
  5. http://www.mayoclinic.org/diseases-conditions/childhood-disintegrative-disorder/basics/definition/con-20026858
  6. http://www.mayoclinic.org/diseases-conditions/childhood-disintegrative-disorder/basics/causes/con-20026858
  7. http://www.nlm.nih.gov/medlineplus/ency/article/001535.htm
  8. http://childstudycenter.yale.edu/autism/information/cdd.aspx
  9. http://emedicine.medscape.com/article/916515-overview
  10. Volkmar FR, State M, Klin A. Autism and autism spectrum disorders: diagnostic issues for the coming decade. J Child Psychol Psychiatry. 2009 Jan. 50(1-2):108-15.
  11. http://www.minddisorders.com/Br-Del/Childhood-disintegrative-disorder.html
  12. http://patient.info/doctor/childhood-disintegrative-disorder-hellers-syndrome
  13. Mouridsen SE, Bronnum-Hansen H, Rich B, et al; Mortality and causes of death in autism spectrum disorders: an update. Autism. 2008 Jul;12(4):403-14. doi: 10.1177/1362361308091653