Reversible PDD

The interesting article of Fein D et al. ‘Pervasive Developmental Disorders can evolve into ADHD: case illustrations’ (Journal of Autism and Developmental Disorders, 35; 525–534) deserves some additional comments. Fein et al’s state that, to their knowledge, ‘no studies have reported on cases of PDD that evolved into another distinct clinical syndrome’. Unfortunately the Authors have missed some references: from 1974 until 2005 a number of cases, totally more than 80, have been described by myself concerning young children with PDD who subsequently evolved into ADHD and GTS, defined as dysmaturational syndrome (Zappella, 1994, 1998, 1999, 2002, 2005a, b). These children had clinical features similar to the cases described by Fein et al: most of them were boys, they usually had a normal behaviour in the first year and a half of life, followed by a regression. A positive family history for tics and ADHD was frequent. Their usual outcome was ADHD plus tics or GTS, including an I.Q. within the normal range. Fein et al. do not mention the presence of tics, motor and vocal, which were observed in our cases, coincident with the regression and often increasing in adolescence. In some cases, however, tics disappeared in subsequent years and only ADHD was the prominent feature (Zappella, 2005b). Other cases of reversible autistic behaviour following a pharmacological treatment have been described in well defined, early onset epileptic syndromes like Landau and Kleffner syndrome (Deonna, 1995; Deonna et al., 1993, 1995). These data suggest that probably most cases of reversible autistic behaviour belong to specific syndromes. The children described by myself were treated with a developmental approach conducted by parents and teachers where emphasis was placed in promoting physical play, affiliation, exploration of the other, etc and speech therapy (Zappella 2005a). They were mainstreamed. None of them was treated with ABA. It must be noticed that in my clinical practice I have also observed children belonging to this subgroup who achieved a complete spontaneous recovery. It is therefore unlikely, in my opinion at least, that ABA has a specific advantage in favouring this outcome. Fein et al. note in their discussion that ‘the percentage of children of the PDD spectrum who follow this clinical course ... is not insignificant’ and this statement corresponds to my experience: in my outpatient’ clinic 13.3% of all young children initially diagnosed as belonging to the autistic spectrum were examples of the dysmaturational syndrome, i.e. they lost the features of autistic behaviour and remained as ADHD with or without GTS (Zappella, 2002). In spite of some different opinions I feel that their article is a useful contribution which may be of help to clarify the relevant subject of prognosis of PDD. …