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NEUROPSYCHOLOGY
TODAY
Monthly Newsletter published by Dr. Danov Neuropsychologist, P.C.
December 2009 Issue – Child Neuropsychology: Pervasive Developmental
Disorders
Pervasive Developmental Disorders: Diagnosis and Comorbidity in PDDs Types of PDDs
Introduction
Early identification and intervention in Autism
It is estimated that one child in 166 has PDDs cannot be overemphasized.
Autism is the most common and well-
a pervasive developmental disorder Interestingly, research shows that the
researched of the PDDs. The onset of
(PDD). The prevalence of PDDs has signs of PDD may be detected even
autism is usually between 2 and 3 years
been increasing over the past several before the children reach their first
of age, although such factors as
decades, which is attributed to new birthday, since infants who are later
parental concern, denial, and education,
diagnostic categories and broadening of diagnosed with a PDD may display
as well as the level of associated
the diagnostic criteria. Given the high abnormal muscle tone, posture, and
mental retardation in the child may
prevalence of PDDs and their inactive or disorganized movement
mediate how early the child is
detrimental effects on children’s patterns. Currently, the early signs of
diagnosed.5
development and functioning, early PDDs that are viewed as the “red flags”
diagnosis and referral for behavioral by pediatric health professionals include Autism affects social, communicative,
and educational interventions are vital, lack of social smile, poor eye contact, and cognitive development of children.
as they improve the long-term no babbling, pointing, or gesturing by 12 These children may not like being held
prognosis of PDDs.1,2 months of age, no spoken words by 16- or touched, and may exhibit unusual
PDDs involve dysfunction in such 18 months of age or two-word phrases auditory or tactile sensitivity. Autistic
developmental areas as social by 24 months of age, atypical play children display lack of social reciprocity
interaction, communication and behavior, and regression in terms of and eye contact, lack of joint and/or
language skills, cognitive skills, and loss of acquired language or social symbolic play, and poor understanding
behavior (stereotyped, repetitive skills.1,3 of basic social conventions and
behaviors, restricted activities and These signs are typically first evaluated expectations, as well as atypical
interests). PDDs are highly heritable by the pediatricians, followed by a attachment behaviors, emotional
and most likely involve abnormalities in referral to a multidisciplinary team, expression, and language use
early development of the central which may involve a neuropsychologist, (monotonic speech, lack of conceptual
nervous system. As a result, PDDs pediatric psychiatrist and psychologist, words, extreme literalness, pronoun
interfere with the children’s normal developmental pediatrician, and reversal, echolalia, etc.). Some social
neurocognitive, emotional, behavioral, neurologist. When there are concerns and communicative skills eventually
and academic functioning.1,2 regarding the child’s functioning or improve in autistic children, but the vast
positive result on a PDD screening test, majority continue to have social
PDDs, also referred to as Autistic difficulties throughout adulthood.5
pediatricians are advised to refer
Spectrum Disorders, include autism,
Asperger’s disorder, Rett’s disorder, (Continued on Page 2) With regard to cognitive development,
childhood disintegrative disorder, and autism has been linked to mental
PDD not otherwise specified (NOS). retardation, and the severity of social
Even though these disorders affect the impairment has been found to correlate
same core developmental domains, with IQ in autistic children. During
they are different in terms of clinical cognitive testing, these children typically
features, age of onset, gender perform better when it comes to
distribution, course, and prognosis.1,2 nonverbal measures (matching items,
_______________________________ identifying patterns, solving puzzles,
Inside: etc.) compared to tests involving
Interventions for PDDs ………………. 2
language and conceptual reasoning
skills.5
About Dr. Rimma Danov ..................... 2
Neurological Abnormalities (Continued on Page 3)
in Children with PDDs ….……………. 3
Newsletter, December 2009, Page 1
(“Diagnosis and Comorbidity in PDDs,” assessment of symptomatology of both Analysis (ABA), which has been found
continued from p.1) disorders when present.1 to be effective in reducing inappropriate
behavior and in increasing
children for a comprehensive evaluation As part of the comprehensive
communication and appropriate social
as early as possible and to closely evaluation, children may be referred to
behavior. The central concept of ABA is
monitor the child’s siblings, since they a neuropsychologist. The main focus of
reinforcing desirable behaviors and
are at an increased risk of PDDs.1 pediatric neuropsychological evaluation
reducing undesirable ones. It is
is to assess the child’s fine motor,
To date, there is no single conclusive recommended that behavioral programs
sensori-perceptual, and neurocognitive
test or biological marker for PDDs; are highly structured, build on the
functioning, including attention,
however, there is a number of child’s interests, and teach tasks in a
memory, reasoning, language, non-
screenings and diagnostic tools that the series of simple steps, while actively
verbal and spatial abilities, and learning
aforementioned health specialists utilize engaging the child’s attention. Parental
skills. Additionally, neuropsychologist is
to evaluate children who possibly have involvement is also encouraged.2
qualified to evaluate emotional
a PDD. Primary care physicians usually
symptoms of the child and give the Other interventions for PDDs include
employ “level 1” measures that are
appropriate psychiatric diagnosis.4 medications (e.g., Olanzapine) that may
used to determine whether a child may
help alleviate such behavioral
have a PDD. Other specialists utilize The neuropsychological report includes
symptoms as aggression, self-injury,
“level 2” tests, which help confirm or the results of the objective tests that
and tantrums. Dietary restrictions
refute the PDD diagnosis, differentiate were used during the exam, as they
(avoiding casein and gluten) and
from other developmental disabilities, relate to the child’s everyday
vitamin B6 taken with magnesium are
and identify the type and severity of functioning, and the extent of cognitive
also utilized in some cases.2 A line of
PDD.1,2 and motor deficits in relation to the age
homeopatic remedies to decrease some
norm. Also, the report includes
Additionally, primary care physicians of the emotional and behavioral PDD
diagnosis(es) and recommendations for
need to evaluate the child’s hearing and symptoms has been developed. For
treatment and interventions.4
vision, since disabilities in these areas more information about this line of
may mimic the symptoms of PDDs such Every state guarantees special products and about local tutoring
as lack of eye contact or response to education and related services for all services go to www.55MyTutor.com.
one’s name. Other conditions that eligible children. Public schools are
should be ruled out during differential federally mandated to provide these About Dr. Rimma Danov
diagnosis include lead poisoning, fragile services to eligible children in Dr. Rimma Danov received her PhD in
X syndrome, tuberous sclerosis, mental accordance with the Individuals with clinical psychology from Adelphi
retardation, Down syndrome, Angelman Disabilities Education Act (IDEA). As for University in NY. She completed her
syndrome, etc.1,2 the pre-school children, each state internship in clinical psychology and
neuropsychology at Harvard Medical
provides early intervention programs for
With regard to comorbid disorders, School and postdoctoral fellowship in
children identified to have
PDDs may co-occur with epilepsy and pediatric and adult neuropsychology in a
developmental disorders up to the age private clinic affiliated with NJ Medical
other seizure disorders. Sleep
of 3 years. The neuropsychological School and the Robert Wood Johnson
disturbances, gastrointestinal problems,
report can be used to determine the Medical Center. She is an assistant
dietary restrictions, allergies, and
need for preventative and other clinical professor at Penn State University,
immunologic abnormalities have been
services (speech therapy, occupational Dept. of Kinesiology, and has served as
reported in children with PDDs.1,2 an assistant clinical professor at NYU
therapy, etc.), as well as special
Further, children with PDDs are at an accommodations and individualized School of Medicine, Dept. of Neurology,
increased risk of behavioral and and Adelphi University, Derner Institute. In
educational plan (IEP) at school.2
the past, she worked as a
emotional disturbances, including
Interventions for PDDs neuropsychologist for the NJ Devils
inattention, hyperactivity, obsessive- Hockey Team and was engaged as a co-
compulsive disorder, tics, mood lability, To date, there is no single treatment investigator of TBI in boxers at the NYS
oppositional defiant disorder, anxiety, package that can improve the Athletic Commission.
and depression. It has been estimated symptoms of PDDs. The intervention Presently, Dr. Danov maintains a full-time
that up to 78% of children with PDDs approach is developed for each child private neuropsychology practice where
have symptoms of Attention Deficit individually, depending on his or her she examines neurocognitive and
Hyperactivity Disorder (ADHD), specific deficits, level of functioning, and neurobehavioral functioning of patients 2-
although according to the Diagnostic needs. It is known, however, that early 90 years of age with various neurological
and Statistical Manual of Mental detection and intervention improves and neuropsychiatric disorders, such as
Disorders (DSM-IV-TR), PDD and long-term outcomes in these children. MS, TBI, CVA, Parkinson’s, Alzheimer’s,
ADHD cannot be co-diagnosed, since Most children with PDDs respond well dementia, ADHD, PDD, Autism, learning
disabilities, seizures, and many others,
the assumption is that ADHD symptoms to highly structured, specialized
using state-of-the-art neuropsychological
are due to the developmental and programs.2 techniques. Dr. Danov also conducts and
cognitive disturbances associated with publishes research in these areas. She is
Among the most widely used methods
PDDs. Some researchers believe that available for medico-legal consultations
of treating autism is Applied Behavior
the evaluation should include and testimony.
Newsletter, December 2009, Page 2
(“Types of PDDs,” continued from p.1) display better cognitive and characterized by hypoactivation in the
communicative skills and ability to perigenual anterior cortex, which is
Childhood Disintegrative Disorder
relate compared to autistic children.5 involved in executive functioning, and
Children with this disorder are hypoactivation in right anterior insula,
Neurological Abnormalities in
characterized by normal early recently linked to social cognition (see
Children with PDDs
development, followed by a profound image below). On the other hand,
regression of acquired communication Children with PDD have been found to children with PDDs show more brain
skills with only minimal subsequent have increased prevalence of hypotonia activation in the rostral anterior cingular
recovery. Once established, childhood and hyperflexia, as well as epileptoform cortex region, which is typically
disintegrative disorder is behaviorally EEG results, even among the children suppressed during attentionally
similar to autism, although the without seizures. Further, children demanding nonsocial tasks in normally
prognosis is worse.5 diagnosed with PDDs may have developing children.6
cerebral and cerebellar abnormalities,
Rett Disorder Further, the same study demonstrated
as well as atypical basal ganglia,
that children with PDDs tend to exhibit
Rett disorder is only found in girls, who supplementary motor, and anterior
hypoactivation in amygdala, which plays
develop normally during the first few cingulate regions which may explain
an important role in evaluating others’
months of life and then demonstrate motor deficits seen in PDDs.
facial expressions, affect, and
developmental regression, deceleration Specifically, these children may have
intentions. Importantly, inappropriate
of head growth, and loss of purposeful poor coordination, limb apraxia (inability
recruitment of lower-order processing
hand movement. During preschool to perform a voluntary movement), as
regions in place of higher-order regions
years, Rett disorder resembles autism, well as impaired graphesthesis (finger
has been noted.6
with such symptoms as stereotyped sensory perception), stereognosis
motor behaviors and abnormalities in (hand object recognition), and
gait or trunk movements, while the alternating and sequential movement. Works cited:
associated mental retardation is usually These motor difficulties diminish in 1. Hoffman (2009). Clinical features and
more severe compared to autism. Rett many children over time with diagnosis of autism and other PDDs.
disorder may also involve breath- treatment.3 Primary Psychiatry 16: 36-44.
holding spells and seizures.5 2. NIH, NIMH (2009). Autism spectrum
A recent meta-analysis of numerous
disorders. nimh.nih.gov/health/publica-
Asperger Disorder functional brain imaging studies
tions/autism/complete-index.shtml
revealed that during socially relevant
This condition mostly occurs in boys, 3. Akshoomoff et al. (2007). Abnormalities
tasks, children with PDDs are
and may or may not be associated with on the neurological examination…
mild mental retardation. It is identified in J Autism Dev Disord 37: 887-93.
children somewhat later than autism
4. Morgan & Ricker (eds.; 2008).
due to relatively preserved language Textbook of clinical
and cognitive abilities, but like autism, it neuropsychology. New York: Taylor
is also linked to learning problems. The & Francis.
key features of Asperger disorder
5. Goldstein & Reynolds (eds.; 1999).
include naïve, inappropriate, one-sided Handbook of neurodevelopmental &
social interaction; pedantic, adult-like, genetic disorders in children. New York:
and monotonic speech; often highly Guildford Press.
developed verbal reasoning and
6. Di Martino et al. (2009). Functional
vocabulary skills, but poor nonverbal brain correlates of social and nonsocial
communication and poor understanding processes in autism spectrum
of abstract language (e.g. sarcasm); disorders... Biol Psychiatr 65: 63-74.
difficulty forming friendships and
Image credits:
consequent social isolation; intense
absorption in specific topics; 1. Background image (pp.1,4): Jeff
clumsiness, poor coordination, poor Johnson Biological & Medical Visuals
sensory integration, and odd posture. 2. Girl image (p.1). autism.lovetoknow.
Asperger disorder is associated with com.
better outcomes compared to autism 3. Brain image (p.3). “Works cited” #6.
due to higher intellectual skills.5
Top: healthy children exhibit greater activation in Editor
PDD Not Otherwise Specified (NOS) anterior and posterior cingulate corteces during
socially relevant tasks (orange regions) and in Dr. Rimma Danov, Ph.D.
PDD NOS, also referred to atypical presupplementary motor area during other tasks Layout:
PDD, shares some symptoms with (purple region) compared to children with PDD.
Natalia Shtompel, M. A.
autism, since children with this Bottom: healthy children’s brains are more
Research Coordinator
condition exhibit unusual sensitivities activated in the right anterior insula during socially
and difficulties in social interaction, but relevant tests, and in the middle frontal gyrus Next Issues- Jan’10: Mild Cognitive
during nonsocial tests.6 Impairment; Feb’10: Premature Birth
Newsletter, December 2009, Page 3
We take the following insurance Languages For ALL appointments and
plans: We are very much open to diverse questions call: 718-667-5530
Aetna Magnacare cultures in this practice and value the Office Locations:
Amerigroup Medicare quality of a bilingual neuropsychological
BCBS 1199 exam performed in the patient's native Staten Island: (main office, forward
Cigna MHN language. Dr. Danov is a native all correspondence)
Elderplan Multiplan Russian speaker. Her current clinical 65 Kelvin Ave.
Fidelis No-Fault staff include native Russian, Spanish Staten Island, NY 10306
First Health Tricare and Hebrew speakers.
HealthNet UHC/Oxford Brooklyn:
Health Plus Workers’ Comp 95-11 Shore Rd., Suite C
HIP Brooklyn, NY 11209
Case dependent: Manhattan:
GHI HMO Americhoice 139 Fulton St., Suite 215
Health First Atlantis New York, NY 10038
Each insurance carrier determines the
Queens:
medical necessity of every requested 110-34 70th Rd., Suite A
neuropsychological exam Forest Hills, NY 11375
differently. Our billing staff determines Completed neuropsychological or
whether the exam will be covered by psychoeducational testing? Long Island:
the insurance before the exam begins WHAT'S NEXT? Design effective tutoring 2900 Hempstead Tpke, Suite 217
and works very hard to obtain an goals to remediate learning problems, Levittown, NY 11756
authorization, if needed. If you have raise scores and boost grades. _______________________________
questions about a plan that is not listed 877-55-MyTutor (877-556-9888)
here, contact our office to find out
whether we can obtain an authorization www.55MyTutor.com Advertise with us-
contact Natalia Shtompel:
or have recently joined that plan.
nshtompel@neuropsychNYC.com
____________________________________________________________________________________
Dr. DANOV NEUROPSYCHOLOGIST, P.C.
65 Kelvin Avenue
Staten Island, NY 10306
POSTAGE
Participants with
Multiple Sclerosis (MS)
are needed for a paid
behavioral research study.
No medications, lab tests, or brain
scans involved. One visit only.
To qualify, MS patients must be:
• Between ages of 21-75
• Diagnosed with Relapsing-
Remitting type of MS
• Willing to provide recent
neurological report with MRI info
• Having no other neurological
diagnoses
• US high school/college graduates
Call 718-921-1922 or email
nshtompel@neuropsychnyc.com
Newsletter, December 2009, Page 4
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