Generalized developmental disorders definition and types

According to the DSM-IV Mental Disorders (APA, 1994), the set of pathologies categorized within the generalized developmental disorders (TGD) would be characterized by generalized alterations in various areas of the development of the individual, mainly in three Specific dimensions: social interaction, communication and the presence of interest and stereotyped activities.

In this Psychology Line article we explain in detail Generalized development disorders: definition and types.

1. Definition of generalized developmental disorders
2. DSM-V proposal
3. Characteristics of Asperger's Syndrome - Language Deficit Skills Symptoms
4. Symptoms in the social skills of Asperger's syndrome
5. Developed skills: Savant syndrome
6. Hypermnesia
7. Perpetuity calendar
8. Hypercalculia
9. Arts
10. Hyperlexia

Definition of generalized developmental disorders

When comparing TGD definition The introduction of this article with other proposals from sources agreed by professionals regarding the diagnosis of mental disorders, there is a fundamental similarity in the definition, mainly related to what is known as the "Wing Triad" ( verbal and nonverbal communication, social relations disorders and restricted centers of interest and/or repetitive behaviors), which would define the disorders that are included in the category object of study. In this sense, the CIE-10 (WHO, 1993) defines TGD as "a group of disorders characterized by qualitative alterations characteristic of reciprocal social interactions and communication modalities, as well as by a repertoire of interests and restricted, stereotyped and stereotyped activities repetitive". In this definition, certain nuances are introduced if compared to that offered by the DSM-IV, such as the need for the alteration to occur in social interactions of reciprocal nature or the inclusion of the adjective restricted when defining the type of interest and activities carried out by individuals affected by TGD. In short, it seems clear that the set of disorders that are included in the TGD category share alterations in three main areas of development (social interaction, communication and interests and activities), although the definitions present certain differential nuances.

The set of disorders that are included in this category also varies depending on the reference manual to which. The DSM-IV includes in this category diagnoses the following disorders: Autistic disorder, RETT disorder, child disintegrative disorder, asperger disorder and generalized developmental development disorder. However, the CIE-10 includes child autism, atypical autism, Rett syndrome, another disintegrative disorder Generalized development without specification.

The lack of consensus in this regard, as is the case in another type of disorders, is an added difficulty at the time of delimiting the criteria for inclusion of disorders within this category and of making a precise diagnosis by professionals.

These limitations have been shown mainly in certain disorders that are included in this category, and that the DSM, in its fourth edition, already catalogs as autistic spectrum disorders (ASD). Within the TGD dimension, a subgroup of disorders that share common symptoms and to some extent differential in relation to the other TGD, and whose affectation is preferable to characterize within a continuum (mules et al., 2010).

Within the TEA, autistic disorder, Asperger syndrome and generalized development disorder are collected. In relation to the autistic disorder, both the DSM-IV and the CIE-10 propose very similar diagnostic criteria, as with Asperger Syndrome (SA), whose main difference with respect to the first resides in the absence of delay in debut Language (APA, 1994).

Unlike what happens with autistic disorder, SA is not characterized by an anomaly in language development or significant mental retardation (individuals suffering from SA usually have a normal IC), in addition to not having a significant delay in Cognitive development (hail et al., 2006).

Therefore, SA is characterized by a condition of reciprocal social interaction, alterations in verbal and nonverbal communication, difficulty accepting changes, inflexibility of thought and the disposition of fields of reduced and restricted interest (Etchepareborda et al. 2007).

In these types of definitions, only the alterations and deficits that characterize the disorder are usually highlighted, however, in the SA there are a whole series of idiosyncratic characteristics of the pathology that would configure a set of developed skills that are not usually found in the population general. These skills would refer to high memorial, mathematical, scientific and artistic capabilities.

These capacities will be developed later throughout the work, together with those skills in which individuals with SA show alterations, to later analyze the studies that have been carried out for improvement (in the case of deficit skills) or the empowerment (in the case of the skills developed) of their capacities.

DSM-V proposal

The commission that is currently studying the reclassification of the diagnostic criteria of mental disorders (American Psychiatric Association), with the aim of developing the fifth edition of the Diagnostic and Statistical Criteria Manual of Mental Disorders (APA, 2010), has proposed The elimination of SA as its own diagnostic entity, integrating it into what will be called "autistic spectrum disorder" (within this disorder the autistic disorder, the SA, the infant disintegrative disorder, and the generalized disorder of the un specified development, these disappearing as independent disorders in the DSM-V.

The name change tries to emphasize the dimensionality of the disorder in the different areas that are affected and the difficulty in establishing precise limits between the subgroups, thus establishing a continuum in which to be able to distribute the patients according to the symptomatology they present.

The new criteria proposed by the Commission are two, instead of the three that have previously been commented, since it is proposed Social communication. The criteria of restricted and stereotyped patterns of behavior, activities and interests are maintained. In this way, the diagnostic criteria would be more uniform, being as follows:

Autistic spectrum disorder

Clinically significant and persistent difficulties in social communication, which manifests itself in all the following symptoms:

• Marked difficulty in nonverbal and verbal communication used in interaction.
• Absence of social reciprocity.
• Difficulties in developing and maintaining relationships appropriate for the level of development.

Repetitive and restricted patterns of behavior, activities and interests, which manifest in at least two of the following symptoms:

• Motor or verbal stereotyped behaviors, or unusual sensory behaviors.
• Excessive adhesion to ritual behavior patterns.
• Restricted interests.

The symptoms must be present at early childhood (although they may not manifest themselves completely until the demands of the environment exceed their abilities).

The subject must meet the three criteria to be diagnosed with an autistic spectrum disorder.

The justifications that the Commission alleges (APA, 2010) when establishing autistic spectrum disorder as the only disorder by integrating those described above, are varied. Next, the reasons stated by the Commission will be summarized:

• The differentiation between autistic spectrum disorder, typical development and other un-spectrop disorders, is made reliable and valid; While the distinctions between the disorders have proven inconsistent over time, variables between one site or another, often associated with severity, the level of language or intelligence instead of characteristics of the disorder. It has been demonstrated that the differences between disorders are not functional in most cases, both at the clinical and research level. This fact can affect the validity of the studies or the diagnoses carried out by professionals, considering criteria that overlap.
• As autism is defined by a set of behaviors, it is better represented as a single diagnostic category that adapts to the clinical presentation of each person, with the inclusion of clinical specifications (for example, gravity, verbal skills and others) and the associated characteristics (for example, known genetic disorders, epilepsy, intellectual disability and others). A single spectrum disorder is a better reflection of the state of knowledge on pathology and clinical present features presented by the subject that acquire more importance. In this way, excessive generalization can be reduced and therefore studying the individual in a concrete and idiosyncratic way, for the development of specific treatments and interventions for it.
• The three domains are reduced to two, since the deficits in communication and social behavior are inseparable, and can be considered more precisely as a single set of symptoms with environmental and contextual specificities. In this sense, it is much more parsimonious for both the professional and the researcher to detect dysfunctional behaviors in the field of child communication, discarding the need to have to differentiate the deficits in communication and social interactions, when it comes to Two intrinsically connected terms (a communication deficit is detrimental to adequate social interaction, and a poor social interaction is deducted a basic problem in communication).

In relation to the SA, disorder object of study, the commission bases the disappearance of it from the following statements:

• Asperger's label has proven to be popular, acceptable, and has increased the recognition of ASD when it appears combined with good language and intelligence. In addition, the introduction of this diagnostic entity has achieved the planned objective of provoking research on the possible differences between this and other subgroups of general developmental disorders.
• A series of published works have argued that the DSM-IV criteria for Asperger's disorder do not work clinically. There is talk of the inability to establish an exact diagnosis of the moment the language began, in addition to the fact that, as mentioned above, the studies show that the majority of individuals diagnosed with SA could be categorized as autistic, since the majority of them come to fulfill the criteria of autistic disorder (overlap of criteria).
• Partly due to the difficulty of applying the criteria, different research groups often use different criteria, and the quality of information on the first achievements in relation to language is variable [.] Research suggests that the criteria on the early use of language do not delimit a different subgroup with different course, etiology, neuro-cognitive profile and treatment needs. With other words, what has already been commented again. In practice, SA really does not make up a differentiated diagnosis in relation to other ASD, since the clinical characteristics of this are very similar compared to the rest of the disorders included in the category. Studies still show that this disorder present differences with respect to others.
• ¿Already existing research literature allows us to suggest new criteria to diagnose Asperger's disorder, in contrast to autistic disorder / ASD? The current clinical and investigation consensus seems to be that Asperger's disorder is part of the autism spectrum, although with a possible over -utilization of the term it is very likely that other types of people (not ASD) have received this label. In this sense, the results are not conclusive, since some authors defend the idea that the study of language must be stricter, with the aim of analyzing in different studies if there are really differences or simply those people with SA are autistic with A good mastery of language.
• If Asperger's disorder does not appear in the DSM-V as an independent diagnostic category, ¿How will continuity and clarity be maintained for those already diagnosed? The objective of the criteria draft is that all people who have a significant deterioration in social communication and repetitive/restrictive behaviors must be able to have adequate diagnostic criteria. The deterioration/language delay is not a necessary criterion for the diagnosis of ASD, and therefore any person who shows the type of asperger pattern with good language and CI, but with a significant deterioration of social communication and interests and repetitive behaviors /Restrictive, and who has previously been given the diagnosis of SA, should now meet the criteria of ASD, and be described in the various dimensions of the disorder.

As can be seen, the objective of the commission lies in establishing a single disorder, where to include all those individuals who share the nuclear symptoms of tea. This fact provides greater functionality to clinicians and researchers who face the study of this type of pathologies, providing them exact and determined criteria to evaluate, diagnose and treat those individuals who comply with the criteria established by consensus. In this sense, more reliable and valid diagnoses will be made from specific evaluation strategies, which will allow the development of both prevention and much more accurate prevention actions.

Characteristics of Asperger's Syndrome - Language Deficit Skills Symptoms

The acquisition and development of language plays a main role in the TEA. As described above, the element that allows the professional to make a difference between an autistic disorder or a SA is marked by language development (APA, 1994). According to this criterion, one would expect, that neither the acquisition nor the development of language were affected within the disorder object of study, but this fact has created controversy among the researchers (Martín-Boreguero, 2005).

First, an operational definition of what is understood as "absence of language delay" is necessary ". According to the author Martín-Borreguero (2005) a delay in language is evidenced by "the production of unique words before the two years and combination of two or three words in communicative phrases before or at the time of reaching the third year of life ".

The importance of this differential criterion in the diagnosis has not caused an improvement in its evaluation measures, which in most cases are based on the clinical impressions of professionals. Starting from this basis, it seems logical.

However, different studies that have been carried out with individuals suffering from SA and have used standardized measures for language evaluation, have shown significant results, demonstrating that language is one of the areas affected in the syndrome under study ( Martín-Borreguero, 2005). In this sense, the Spanish Asperger Federation (F.TO.AND.), since its inception, it included as an affected part in children who suffered from language. Specifically, it defines its language as "pedantic, formally excessive, inexpressive, with prosodic alterations and strange characteristics of tone, rhythm, modulation, etc"

In addition to recognizing that there is a delay in its acquisition, he affirms that they do it anomalous. Martín-Borreguero (2005), in an exhaustive review of the different works done on the functioning of the language of individuals with SA, develops a linguistic profile that is summarized below:

Based on the three aspects of language (syntax, semantics and pragmatic), it establishes in which areas the deficits appear and in which development is considered normal.

Syntax (Formal relations between words): Despite having found evidence about the existence of a mild initial delay in language development, the majority of individuals affected by SA reach an adequate level of operation in this area (syntax and grammar).

Pragmatics (An individual to evaluate a communicative act globally and understand the influential contextual variables, in addition to their competence when choosing linguistic forms with respect to others to express an intention). This is undoubtedly the most relevant scope in relation to the disorder, since it is directly related to its nuclear symptoms. In the review carried out, it is revealed that although not all aspects of pragmatic language are affected, if they are in their vast majority causing great problems in the social sphere of the child. Based on the Twachtman-Cullen model (1998), he makes a profile of the individual with SA based on the different components of pragmatic language:

• Capacity for expression and communication of intentionality to achieve established goals or objectives. In the individual with SA there is a form of an expression of idiosyncratic intention, mostly of instrumental and mainly aimed at expressing their own needs. In this sense, the expression of social intentionality (eg. Start a conversation), they are acts, if not absent, quite uncommon. In addition, the fact that they have their own way of expressing their intentions entails the misunderstanding by these of the communicative intentions developed by others (especially in situations where the interlocutor uses irony or sarcasm).
• Knowledge and level of social understanding appropriate to carry out correct social judgments and elaborate their opinions about the needs and emotional states of others. As expected, there is also a deficit in this area in people affected by SA, so they are unable to adopt different linguistic styles in different contexts based on constantly changing emotional roles or states of the interlocutors.
• Capacity by the individual to understand and apply the rules of discourse and thus guarantee the successful execution of reciprocal conversational exchanges. The deficits in this area are mainly manifested through the specificity and extension with which they express their events of interest, the contribution of excessive amounts of information on terms of minimum relevance, and the centralization of the conversation around their own interests, tastes or needs. In this sense, the conversation becomes incoherent, disconnected and decontextualized.
• Adequate ability to understand and use the nonverbal aspects of communication or paralinguistic elements in order to facilitate social communication. Here there are serious difficulties in the understanding and expression of nonverbal communication in general, basically in relation to eye contact, gestural coordination, the development of a facial expression consistent with the information expressed in the conversation, in the body posture and in the Path and rhythm of speech.

Therefore, despite the fact that one of the differentiating criteria of SA resides in the absence of a delay in language development, as it has been observed, studies conclude that there are alterations in language. They are probably not as clinically significant or as disabling as those presented by those children who suffer autistic disorder, but it is more evidence of the need to establish a dimensional methodology when carrying out the diagnosis of a ASD.

Symptoms in the social skills of Asperger's syndrome

Closely related to language, fundamental element of communication, are the child's social skills. Starting from the existence of serious deficits in language in the subjects suffering from SA, it is not surprising to find anomalies in the development of their communicative abilities. Social skills are understood as "that set of behaviors issued by an individual in an interpersonal context that expresses feelings, attitudes, desires, opinions or rights of that individual in an appropriate way to the situation, respecting those behaviors in others, and that It usually solves the immediate problems of the situation while minimizing the probability of future problems "(Horse, 1986).

Despite not suffering a delay in cognitive function, Children affected by SA They present alterations in the development of their social skills, being compromised areas such as academic, emotional or socialization of the child (Rao et al. 2008). In this sense, according to the authors, the deficits in children with S are in the following areas: lack of guidance towards social stimuli, inadequate use of eye contact, problems starting social interactions, difficulties in the interpretation of social signals both verbal as not verbal, inappropriate emotional response and lack of empathy (Rao et al. 2008). According to Llaneza et al. (2010), the numerous difficulties presented by individuals who suffer from any ASD are due to the lack of what is called "Joint Attention".

This attention would understand an effort to actively share attention instead of passive, observing what others are paying attention. As the authors say, the critical point lies in "sharing knowledge" or "sharing an attitude towards a thing or event". This fact, without a doubt, is one of the most deficient behaviors in individuals suffering from SA.

Joint attention implies the consideration of ourselves and others, thoughts, needs, emotions, beliefs, previous experiences, motives and intentions; In addition to recognizing what are the differences between the self and the others. Therefore, alterations in this type of attention will entail serious problems in social interaction, since it implies difficulties when understanding and realizing the thoughts, feelings and intentions of others, in addition to the inability to verify how own actions are influencing these.

Among the theories that develop an explanation to the deficits in the joint attention of people suffering from Tea, we find those who refer to mirror neurons and the theory of the mind (Villalobos et al. 2005; Williams et al. 2005 cited by Llaneza et al. 2010).

In this way, it is understandable that children suffering from SA are unable to start social interactions with equals, use less time interacting with them, have less quality social interactions and mainly develop capacities for non -social game. This fact seriously limits the opportunity for the development and implementation of all those vital social skills for the child's social independence, in addition to the consequences that this fact entails at a school, family or work level (Owens et al. 2008; Granizo et al. 2006).

Therefore, the alarming need to develop intervention programs that, in some way, establish and develop social communication strategies at an early age in those children who have been diagnosed with SA, with the aim of preventing the possible consequences of a bad social execution by these individuals.

Developed skills: Savant syndrome

In a review of the capacities presented by individuals affected by autistic spectrum disorders conducted by Baron-Coen et al. (2009), it is revealed that there are universal characteristics of autistic brains: excellent attention to detail, strong systematization and sensory hypersensitivity.

The authors recognize that these capacities are linked and depend on each other, that is, so that there is an excellent systematization capacity, it is necessary that the individual be able to serve the details in a very precise way. At this point, it is mandatory to define that the authors understand by systematization. According to Baron-Coen (2006), which defines a system is that this follows certain rules, and when we try to systematize we are trying to identify those rules that govern the system, with the aim of predicting how it will behave in the future. In short, it is about recognizing repetitive patterns in stimuli. The main types of systems are: Collection systems, mechanics, numerical, abstract, natural, social and engines.

The general formulation about what happens in the systematization process lies in the ability of individuals to establish laws in the form "Si P, then Q". This capacity is observed widely developed in those individuals that are characterized by what has come to be called "Savant syndrome".

These patients have an autistic spectrum disorder characterized by mental retard. 2007). In this sense, it has been observed how these individuals have excellent capacities that have been recognized as typical of the right hemisphere, so that the subject is very trained for the development of those functions that have to do with the hemisphere that has not turned out damaged (HD) and very disabled to carry out those behaviors mediated by the left hemisphere (HI).

Some authors, according to the review by Etchepareborda et al. (2007), have identified Three types of Savant syndrome:

• Prodigious: autistic individuals who are considered out of the ordinary by the skills they present. They stand out in each and every one of the CI levels.
• With talent: autistic individuals with great capacities but with high levels of disability
• Of minutiae: They are individuals who have restricted Savant skills. They usually have good visual and auditory memory, although they have numerous social restrictions.

Next, those developed skills that have been found in the different studies carried out with individuals suffering from Savant syndrome (for a more exhaustive review, consulting Etchepareborda et al. 2007).

Hypermnesia

Defined as the exaggerated degree of retention and memory in memory, it is observed as those children characterized by this syndrome are able to memorize extensive data lists, calendars, information lists, etc.

Perpetuity calendar

This ability is characterized by memory or calculation at high speed of days, dates and years as if the individual were consulting the calendar at that time. This ability remains a mystery to researchers, since neither the subjects themselves recognize the procedure by which they find out what they are asked without the possibility of consulting a calendar. Although it has been hypothetized that this ability would be related to the great memoristic of these individuals, this hypothesis is rejected when observed as the subjects are also able to find out dates of the future, of which it is very strange that there are already calendar.

Hypercalculia

Within this category, numerous capacities are recognized that individuals with Savant syndrome are able to carry out with great ease. Among them we find the resolution of complex mathematical problems, analysis of numerical sequences or codes, understanding of mathematical algorithms, counting objects at high speed and ease, even simply remember numbers.

Arts

Artistic capacity is one of the most outstanding and outstanding skills in this group of individuals. The work done are usually of high quality, and the most outstanding areas have been drawing, painting, sculpture and music. There is currently no knowledge about whether their artistic abilities come from their imagination or on the contrary of their memories.

Hyperlexia

Hyperlexia refers to exceptional reading decoding skills observed in children with cognitive and behavioral alterations, which exceed what expected compared to the cognitive and understanding skills of that age (Silberberg and Silberberg 1967, cited by Etchepareborde et al. 2007). This fact is especially relevant when important deficits are found in those linguistic skills that have to do with social communication. In this sense, the absence of understanding the content of the reading must be highlighted, since children with this capacity usually read mechanically with a very limited capacity to understand the content read, which can mean that it is nothing more than another of the systematized skills developed by these individuals, lacking the ability to understand the text read, and therefore of their intentionality.

The degree of systematization developed by this type of individuals that is revealed in the development of each of the capacities described above, would form a possible explanation to the absence of social skills that characterize them. This fact happens because when an individual systematizes, it is better to keep everything constant and only vary one thing every time. In this way, one can see what can be the cause of something, and with the repetition it can be verified that the same pattern or sequence (if p, then q) is obtained all the time, doing in this way that the world is Predictible (Baron-Coen et al. 2009). In this way, obsessions (with mathematics, for example) can be seen in terms of strong systematization.

In that sense, it is logical to think that the absence of skills in the social interaction that individuals with Asperger syndrome would have their origin in the variability that exists in the social world, where in most cases it is impossible to apply logical rules of the Type Yes P, then Q. The strong systematization if reflected in different behaviors or skills that develop those individuals who, despite not being qualified under the Savant term, if they suffer any autistic spectrum disorder and present certain differentiated capabilities of the normal population. According to Baron-Coen, hyper-systematization is reflected in behaviors that individuals with Asperger syndrome such as the following: Mathematical Problems Resolution, Development of Drawing Techniques, Analysis of Dance Techniques or the exhaustive learning of the names of all the plants and the optimal growth characteristics of each of them, among others.

If hyper-systematization entails the need to have an excellent skill in attending to details, this extraordinary attention to details may become Baron-Coen et al. 2009). Different studies cited by the authors, show that there is greater sensitivity in the recognition of visual, auditory and tactile stimuli, however, these results have not been significant in those studies that have investigated hypersensitivity in relation to olfactory stimuli.

Therefore, as detailed throughout this section, there is evidence consistent in relation to the extraordinary capacities presented by individuals suffering from some type of disorder within the autistic spectrum. In its highest expression, these capacities would correspond to what has been called "Savant Syndrome", a syndrome that, in most cases, is present in those individuals who have an autistic spectrum disorder.

The skills that frame within this syndrome are those referred to the right hemisphere (plastic arts, music, calculation, mathematics and other spatial and mechanical capacities). In general, they are capacities that can be the result of rigid systematization processes. The systematization processes would have their origin in the understanding of the world based on logic rules of the type "Si P, then Q", which would allow to establish rigid patterns of behavior to the stimuli surrounding the child, thus giving some sense to the world.

This fact could explain the ability of subjects who suffer from some type of autistic spectrum disorder, such as Asperger's syndrome, when carrying out certain types of behavior, with which they become obsessed, which move around logical rules of this type. In addition, as commented, hyper-systematization implies that there is excellent attention to detail, with the aim of warning the minimum variations in stimuli that allow the individual to establish those patterns of sequence behavior. In turn, the excellent attention to detail is related to the sensory hypersensitivity they present, thus making them the stimuli and their variations in the sequential pattern.

This process could form an explanation to the development of certain capacities presented by individuals who suffer from Asperger's syndrome, which despite not presenting in most cases the excellent capabilities that only some present (Savant syndrome), do manifest capacities that They are not present by norm in the general population.

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