A girl with normal milestones spends her time seeing her own hand, do not interact with others, what is the diagnosis?
Ans. is 'b' i.e. Autism Pervasive developmental disorder includes the following conditionAutismRett's disorderAsperger's disorderChildhood disintegrative disorderPervasive disorders not otherwise specifiedPervasive development disorders are characterized by three symptom clusters-Impairment in social reciprocity marked by poor eye contact, lack of interest in other people and failure to interact appropriately with others.Communicative impairment, it is characterized by either no language at all or by deviant speech with errors in tone, prosody, pitch, grammar, or pragmatics.Restricted and repetitive behaviors include using the same words and phrases repeatedly out of context, performing the same action in routine ways or insisting that others do so, or exhibiting other vocal or visual self-stimulatory behaviors. Stereotype movements are seen.Stereotype movements are apparently purposeless movements such as hand flapping, head rolling or body rocking.)Now, the salient feature of each pervasive disorder:Autistic disorderIt gives all the classical features of pervasive developmental disorder.The patient presents with problems in social interaction, communication and repetitive stereotype behaviour.In most of these patients there is subnormal intelligence.ExampleA 3 year old boy shows no interest in or connection to his parents, other adults or children. He does not speak voluntarily and is fascinated with watching rotating objects. He screams fiercely when his environment is altered in any way such as when his mother tries to dress him.Rett's disorderIt is seen exclusively in females.The characteristic feature of these patients is that they begin to lose their acquired skills.Example After 4 months of normal development, an infant begins to lose her acquired skills. By 18 months of age, she shows little social interaction with her parents, other adults or children and she uses strange hand gestures.Asperger's disorderThe important point in differential diagnosis of these patients is that they have normal intelligence. These are the only pervasive development disorders in which the intelligence is unimpaired.These patients often have some exceptional ability.They have little or no developmental language delay and relatively normal cognitive development.In the question the lack of social interaction and communication along with stereotypic behaviour (watching her own hard) suggests Autistic disorder.The patient does not give any symptoms of attention deficit disorder i.e. there are no symptoms indicating lack of concentration and hyperactivity.The patients of ADHD can also present with symptoms similar to pervasive developmental disorder but the main complaint will always be that of attention deficit and hyperactivity.Patients with depression should give other features of depression.
ADHD
Autism
Schizophrenia
Depression
Intellectual disability, communication, autism, and ADHD