Mutliple complex developmental disorder and pdd nos

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3. PDD-NOS

1) Definition of PDD-NOS

PDD-NOS is an exclusionary diagnostic category, and does not have specified rules for its application. Someone may be classified as having PDD-NOS if met criteria in the social domain plus one of the two other domains (communication or behavior). Besides, it is possible to consider the condition if the person has fewer than six symptoms in total (the minimum required for autism diagnoses), or age of onset later than 36 months.

If the agreement among clinicians is high for autism diagnoses, the same is not true for PDD-NOS.20 Although the epidemiological studies have suggested that PDD-NOS is twice as more common as AD, this category continues to be understudied. Today, different categories have been proposed, some based on descriptive phenomenological approach, some based on other theoretical perspectives, such as neuropsychology.

2) Proposed sub-categories

a) The proposed clinic descriptive categories

i) Multiple and complex developmental disorder

Along with classical autism, related clinical pictures of developmental disorders have been described under various names starting in the 40's of the last century.21 Even before the seminal Camberwell study it was clear that not all children and adolescents were aloof in their social contacts. Clinical descriptions were given of individuals who were mainly passive and avoidant in their social engagement. These individuals have been described under nosological labels such as Asperger's syndrome or schizoid disturbances of childhood referring to rigid loners. On the other hand, cases were described of children presenting social difficulties emerging from one-sided overinvolvement. These developmental conditions received labels as borderline cases in childhood,22-23 symbiotic psychosis24 and schizotypal children.25 These conditions (characterized by impaired social sensitivity reminiscent of autism spectrum disorder, in conjunction with severe problems in the regulation of affects especially anxiety and anger and cognitive deficits in regulating imagination and thoughts) emerged as an independent group in the cluster analysis26 on a large series of well-documented cases examined at the developmental unit of Yale Child Study Center by Gesell and Provence over more than twenty years. Finding this distinct group brought Cohen et al. to propose Multiplex Developmental Disorders as a distinct category within DSM-IV alongside Autistic Disorder and Asperger's syndrome.27 The proposal was not successful in the sense that Multiplex (later Multiple Complex Developmental Disorder - McDD) did hot reach the threshold for inclusion in DSM-IV. Yet over the past twenty years many studies have provided support for the face and external validity28-31 of this category that is well recognized in clinical practice.32 The cognitive distortions named in the definition may, at closer look, reflect communicative deficits more than psychotic features in young children.33

The clinical characteristics of McDD include:

- Impaired social sensitivity

They are one-sided and clinging in their contacts both with adults and children;
They are exclusive in their relationships and will have it only their way;
These individuals have difficulties in social empathy tuning into others needs.
- Impaired regulation of affects

Anger shifts rapidly into rage;
Anxiety turns easily into panic.
- Cognitive distortions: thinking disorder

These individuals are easily confused;
They get carried away by their vivid grandiose fantasies;
They may confuse fantasy and reality;
They tend to have idiosyncratic logics.