Social and Language Disorders

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Child Neurology > Social and Language Disorders

Social and Language Disorders

A. Autism

One of the pervasive developmental disorders.

  • H&P: Usually normal early milestones, early language development followed by regression at age 1-2 yr. The classic triad is poor language, poor social interaction, and restricted or repetitive behavior and interests (abnormal imitative play, stereotyped movements such as whirling, rocking). Motor skills and memory may be normal.

  • Tests: Audiology, EEG. Imaging usually not indicated.

  • Rx: Behavioral therapy.

  • P.151


  • Syndromes with prominent autistic features:

    • Fragile X syndrome: Most common cause of mental retardation. See also dysmorphic facies, macro-orchidism after puberty, hyperactivity. 1/3 of female heterozygotes are also mildly retarded.

    • Angelman syndrome ( happy puppet syndrome): Same 15q gene deletion as Prader-Willi syndrome, but of the maternal, not paternal, chromosome. Infant feeding problems, severe retardation, autism, microcephaly, jerky puppet-like ataxia, paroxysmal laughter, protruding tongue. By contrast, Prader-Willi syndrome has severe floppiness at birth; dysmorphic, mental retardation, later hyperphagia, hypogonadism, Pickwickian syndrome.

    • Rett syndrome: Idiopathic syndrome seen only in girls, in which autism is associated with progressive microcephaly, ataxia, breathing irregularities, seizures, scoliosis, spasticity, and dystonia.

    • Others: Tuberous sclerosis, TORCH infections, phenylketonuria.

B. Attention-deficit/hyperactivity disorder

  • H&P: Birth history, milestones. School performance: get detailed records. Are behavior problems limited to one domain? Staring spells? Family history of learning disability, stress, or substance abuse?

  • Tests: Use DSM-IV criteria or Conners' Motor Overactivity Scale.

  • Rx: Methylphenidate 5 mg PO qAM, titrate up. Alternatives are dextroamphetamine and pemoline (watch LFTs on the latter). All can cause nausea, anorexia, insomnia, rebound hyperactivity. Tics may worsen.

C. Dyslexia

  • H&P: Family history of dyslexia or left-handedness. Selective difficulty reading and writing with intact visuospatial, mathematical, and memory abilities.

  • Rx: Individualized educational intervention. Experimental rx targets the visual and auditory processing defects.



The Massachusetts General Hospital. Handbook of Neurology
The Massachusetts General Hospital Handbook of Neurology
ISBN: 0781751373
EAN: 2147483647
Year: 2007
Pages: 109

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