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ACQ
Volume 11, Number 3 2009
ACQ
uiring knowledge in speech, language and hearing
Mental health
Nickolina Aloizos
management responses relevant to the communication
needs of the client.
Pervasive developmental disorders
Pervasive developmental disorders (PDD) are a group of
disorders characterised by qualitative abnormalities in reciprocal
social interactions and in patterns of communication, and by
a restricted, stereotyped, repetitive repertoire of interests and
activities in all situations (ICD-10: World Health Organization,
1992). Although PDD is the overarching ICD-10 category,
some services (e.g., Queensland Department of Education)
have adopted autism spectrum disorder (ASD) for those
conditions that are referred to in the literature as either PDD
or autistic spectrum disorders (ASD). These include autistic
disorder, Asperger’s disorder, childhood disintegrative
disorder, Rett’s syndrome, and PDD not otherwise specified.
ASD is a specific diagnosis with a variety of communication
characteristics and social interactions central to the
recognition of the condition (see Whitehouse, this issue, for
further information on the differential diagnosis of ASD).
Although speech pathologists do not diagnose PDD (or
ASD), they are often the first professionals to come into
contact with a young child with ASD (Wetherby, Prizant, &
Hutchinson, 1998), and can assist with the diagnosis and
can provide communication and behaviour interventions. The
co-occurrence of several disorders in the same individual is
not uncommon in the mental health field (Giddan & Milling,
1999). However, the importance of distinguishing ASD from
a mental health disorder becomes crucial because of the
detrimental effects on parents and young people through
inappropriate diagnoses and treatment recommendations
and delays in inappropriate intervention (Sikora, Harley,
McCoy, Gerrard-Morris, & Dill, 2008).
PDD and mental health disorders
There has been a significant increase in the number of cases
diagnosed with PDD and this has been associated with
corresponding decreases in the use of other diagnostic
categories (Shattuck, 2006, p. 1028). However, typical
features of PDD can also be present in other mental health
disorders (i.e., communication, socialisation and repetitive/
restricted behaviours) (Goin-Kochel, Mackintosh, & Meyers,
2006). Diagnostic procedures for PDD may also be
complicated by the confounding factors of behaviour,
childhood schizophrenia, psychosis, anxiety, mood, and
attention disorders (Giddan & Milling, 1999; Sikora et al.,
2008). At CYMHS services in Queensland, an established
referral pathway exists to assist clinicians in making a
Speech and language disorders often overlap
with social, emotional and behavioural
disorders in childhood. For young people who
present to a mental health clinic with these
conditions it is not always clear whether a
diagnosis of a communication disorder, a
pervasive type of developmental disorder and/
or a mental health disorder should be given.
The issue of correct diagnosis is critical, as
precision in the classification and subtypes
carries implication for outcome and response
to treatment (Mahoney et al., 1998). This paper
outlines a systematic approach to critically
appraising the evidence and participating in
the decision-making and assessment and
intervention process for speech pathologists
working in mental health services.
Mental health services for
young people
Child and Youth Mental Health Services (CYMHS) are a
component of Queensland Health’s Mental Health Program.
It targets service delivery to children and young people aged
0–18 years, whose emotional, social or behavioural disorders
are severe and complex, or at risk of becoming so, and
whose needs cannot be met by other services. All clients
entering CYMHS are given a diagnosis following bio-
psychosocial assessment. The diagnostic classification
system used is the
International Classification of Diseases,
Tenth Revision
(ICD-10: World Health Organization, 1992).
Within the mental health team, the speech pathologist
has primary responsibility for the diagnosis and remediation
of communication impairment. Research literature is
consistent in finding that communication disorders are a
pervasive feature of mental health conditions (Cantwell
& Baker, 1991; Gualtieri, Koriath, & Bourgondien, 1983).
The speech pathologists’ area of expertise in mental
health is specialist knowledge of the reciprocal relationship
between communication, bio-psychosocial development,
psychopathology and the impact of adverse psychosocial
contexts. Specialist speech pathology practice requires a
capacity to effectively evaluate communication competence,
to analyse the impact of communication vulnerability in
the context of psychosocial adversity and then to select
Clinical insights
The Autism Diagnostic Observation
Schedule-Generic (ADOS-G):
A clinical referral pathway for young people suspected of
pervasive developmental disorders at a mental health clinic
Nickolina Aloizos