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Pediatricians And Spectrum Development Disorders An Overview

Aug 17, 2007
If one goes only by statistics, it would seem that childhood development disorders are experiencing an epidemic. However, these disorders have been with us always, they just weren't known and diagnosed before. We do not know how many children who had the developmental disorders we know today were actually diagnosed as simply retarded or perhaps schizophrenic. The development disorders have a somewhat edgy reputation - not all of the are accepted by the pediatrics community at large, and there is a very good chance that some things we're diagnosing now are actually several smaller disorders, symptoms of a different problem, or even not disorders at all but regular fluctuations in personality. One thing is clear: you won't go very far in a pediatrics career without encountering one.

Autism: Now recognized as a spectrum disorder; it seems no two autistic patients have the same set of symptoms, but all of them share common symptoms. The markers of autism are lack of social interaction, poor or no verbal communication skills, and repetitive or preoccupied motions and behavior. Prior to 1990 it was estimated to affect 5 in 10,000 births, but it is now estimated to be as much as 1 in 1000.

The puzzling thing is, people today are being diagnosed as autistic when they can speak and socially interact freely, and show no impairments to functioning. These may actually be cases of misdiagnosis, either just odd personal behavior or a less disabling disorder such as Asperger's or ADD. One has only to look at a typical child with severe autism, sitting and behaving as the classic "piece of furniture", alone in their own world, and then consider the adult diagnosed with autism but who holds down a job, has a degree, and is the mother of two. Clearly, these two people do not have the same thing, and it would be ridiculous to treat them as if they did.

Unlike several other pervasive development disorders, there is no disputing that autism is a real, and highly handicapping syndrome. Severe cases of autism function at a mentally retarded capacity, need medications to temper some of their behavior, and will need some form of nursing care all their lives.

Asperger's syndrome: The lesser cousin of autism. A big debate is going on with Asperger's right now, where some say that Asperger's is actually high-functioning non-severe autism and others saying Asperger's isn't a disease at all, but a normal variation of brain functioning. Not a disability, but a difference. It has also been speculated that Asperger's may be an explanation of many of the people society calls "geeks": Socially clumsy, not very emotional, but with highly skilled mental capacity, and technically adept at a narrow field. You almost never meet the Asperger's patient who is without a well-paying profession such as scientist or engineer.

An interesting (but "out-there") theory being tossed around by evolutionists is that Asperger's may be evolution's way of adapting the human mind to the increased pervasiveness of technology in our society. Asperger's patients may be poor with human interaction, but they are great with computers. Is it really so unexpected that if we create computers and put them everywhere, nature will give us adapted humans who specialize in interacting with computers? It has also been proposed that the human race may eventually separate into two branches, much like Neanderthals and Cro-Magnons once did, with the race this time splitting off into the technically able and unable. While intriguing, this theory has been refuted in many circles.

Unlike autism, Asperger's is so far not usually medicated and while the patient must make efforts to adapt to society and will have difficulty with social interactions, they have an easier time living in our world.

Attention Deficit Disorder
The most controversial of the development disorders, merely mentioning ADD in a crowd of pediatricians is enough to touch off a debate.

The symptoms as given for ADD are impulsiveness, forgetfulness, a chronic inability to concentrate or focus on one particular thing at a time, and being easily distracted. Many people can be described with these words at one time or another, but the word "disorder" is used when this behavior is chronic and characteristic of an individual, so much so that it impairs their ability to interact with other people or focus on the task at hand.

The problem with ADD is that there is widespread abuse of this diagnosis. Teachers use it as a label to subdue unruly pupils, parents who are too busy to see after their children's development claim that their children have it, and doctors find it easier to write off a case as ADD when there may be something else entirely wrong. The symptoms are so open to interpretation and situations where these would be the normal human reaction (i.e. 'boredom') that it is difficult to pin down who has this disorder and who doesn't. Overmedication is rampant.

Like Asperger's, some ADD cases have been eventually tagged as normal personality characteristics. Even amongst those who have a full-blown case of ADD, there is little stopping them from having a happy and productive life and medication can be used to treat symptoms.

An alternative explanation
The Myers-Briggs personality test identifies characteristics of personalities which have a spooky resemblance to both ADD and Asperger's symptoms. To refresh, the Myers-Briggs measures four axises of personality variation:

(E)xtraversion - (I)ntroversion,
(S)ensing - i(N)tuition,
(T)hinking - (F)eeling,
(J)udging - (P)erceiving.

ADD fits in well with ESFP, while Asperger's fits with INTJ. An ADD person can be described as extroverted (very talkative and sociable), sensing (focused on the moment, hence distracted), feeling (emotional), and perceiving (spontaneous and flexible). An Asperger's person can be described as introverted (withdrawn and unsociable), intuitive (focused on the past or future, hence concentrating), thinking (intellectual), and judging (organized and neat).

It is interesting to note that many Asperger's and ADD patients mention these personality characteristics themselves! It may turn out that what we have is a misunderstood pair of diseases which are actually normal personalities, a pair of misunderstood personality which are actually diseases, or diseases and personalities which blend into each other.

Just some food for thought for those following the pediatrics career! It's just a web article, after all; learn from your books and college.
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