Special Needs

PDD vs. ASD (sorry this got really long)

I am trying to better understand the differences between a PDD diagnosis and an ASD diagnosis. 

We had our annual re-eval done for our 2 1/2 year old at the private clinic where he receives his OT, speech and day treatment services on Saturday.  He has made huge (HUGE!) progress since his initial evaluation a year ago. His expressive and receptive speech went from 2 standard deviations behind to age appropriate.  A year ago he was considered cognitively delayed.  His score in this area jumped almost 35 points, which the evaluator said was one of the biggest jumps she has ever seen in that amount of time.  

Due to this, they decided to give him a PDD diagnosis, not an ASD diagnosis.  They want to keep the door open for "removal of the label" in the future.  However I am looking back at the diagnostic criteria right now and in my mind, he meets the ASD criteria.  (just for clarification purposes, I am not seeking the ASD diagnosis, I am just confused)

SOCIAL (must meet two criteria)

(a)  Problems with nonverbal behaviors such as eye contact, facial expression, body postures and gestures used in social situations

He struggles with eye contact. It seems that as he gets older and becomes more aware of what eye contact means, the more uncomfortable he gets.  As soon as he realizes that someone is trying to engage him his eyes hit the floor and he won't look back up until they stop trying to engage him. 

Other than me, my husband and my MIL that watches him during the day, he closes his body off to others when in a room with them.  He will hide, push people away and tell people they are too close.  

(b)  Does not make friends like other children in same age group.

At 2 1/2,  I don't expect that he would have actual friends, however he does not enjoy parallel play with same-aged peers and would rather play away from the group.  He does enjoy the company of his 6 year old brother and his friends.

(d)    Lack of social (Consisting in dealings or communications with others) and emotional (characterized by emotion) ?give and take?; Does not respond to social or emotional cues

He does not enjoy the company of others and would never seek it out.  

He still needs to be prompted to say hello, goodbye, etc. 

COMMUNICATION (must have at least one)

(b) If child can speak, cannot start or hold up their end of a conversation (appropriately)

At this point, he does not have any sort of conversations.  He requests his needs and he can answer questions such as "which one...." when shown two options.  He is good at requesting and answering some questions, but we have never had a conversation. He will make comments about the color of things, if they are open or closed, soft, etc.

(c) May echo phrases, words, songs, parts of movies etc. 

Up until a few months ago, all of his communication was echolalia.  This is shifting, but now he is able to at least generalize and echo things in the correct context.  Before he would just say every little phrase he knew that people say in a given context, whether it was relative or not.

(d) Does not engage in imaginative play (as peers)

He will only engage in imaginative play if he is directed to, often he still has a difficult time grasping this concept.  I am really not sure what is expected at 2 1/2.

BEHAVIORS AND INTERESTS (at least one in this category)

(a) Child is so focused on an interest that to remove the interest will result in a meltdown

He is OBSESSED with garage doors and air conditioners.  His brother has the Lego fire station and police station.  Both have garage doors.   If he gets a hold of them, it is almost impossible to redirect him away from open and closing the doors without a meltdown.  He will also turn things like the tri-fold game board from Cooties, or flaps on a book into garage doors.  Again, it is difficult to re-direct without causing epic meltdowns.

(b) Routines or rituals must be followed, they appear to have no function 

As an example, when we go to OT/speech/day treatment, he always wants to follow the same routine to get in.  We get out of the car and he says he wants his backpack, I put it on him.  He then comments on the white line for the parking space and walks down the line.  (he does this in every parking lot, every time we get out of the car)  We walk over to the sidewalk.  There are three sprinkler heads along side the sidewalk.  He touches each one and comments that the sprinkler is off today.  We then walk across the bus entry area to the double doors.  He has to open the doors, or meltdown ensues.   There is then a choice of going up the elevator or using the stairs, he always chooses the stairs for going up. We then walk up the stairs to the check-in area.  As we walk up the stairs, he comments that he is holding the railing.  At the top of the stairs at the check in desk there is a giant teddy bear.  Everyday he walks over, hugs the bear's foot and says it is so soft.  He then stands with his back against the wall in a little hallway, across from the check in desk for his therapist to arrive.  When his therapist arrives, we always go down the elevator, never the stairs.  He has to push the down button and the level one button. 

This is just one example.  There are many routines like this that we are having such a difficult time breaking.  I have been trying to sabotage this particular routine by parking in different places, opening doors for him, etc.  It always ends in meltdown.

(d) Preoccupied with parts of objects

If he is not closely attended to while playing, he always gets stuck on pieces of toys.  Things that open and close or spin are his favorites.  If he has someone directing his play he does OK, but if he starts playing on his own with a toy, he gets stuck and is very difficult to re-direct.

I am clearly not trained to evaluate and decide how these criteria are met and what that means, but to mean, I see so many of these behaviors in him.  I am reading too much into things? We will still (for now at least) get coverage under a PDD diagnosis, so I am not too worried about that aspect.  I guess I am just looking for clarification of these diagnostic criteria and if I am understanding things correctly.  It seems to me, that he meets ASD criteria, regardless of the huge progress he has made in the past twelve months. 

 

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Re: PDD vs. ASD (sorry this got really long)

  • Thanks for the reply, Auntie.  Please excuse my lack on making sense.  I am going on week two of sick kids, did way too much this weekend for a third-tri pregnant lady that is supposed to be taking it super easy to avoid bed rest this time around and am all around exhausted and clearly not using my top notch thinking skills today. :)

    I did mean to say PDD-nos vs. classic autism.  I originally had that in my title, but it was so long and then I didn't put it down below instead.  

    Our diagnosis came from a licensed clinical psychologist.  My younger son gets all his private services at an autism center that does evaluations, as well as providing services such a day treatment, OT, speech, music therapy, family therapy, etc.

    I originally pulled up the criteria on the CDC website, but also found a site that explained the criteria in layman's terms.  I referenced back to the CDC website, but didn't copy and paste from there.  Sorry for the confusion.

    I have been wondering about the OCD like behaviors for a long time.  In fact, his rigidity and strict adherence to routines were one of the pieces that tipped us off just over a year ago.  We also have a son with Asperger's that was originally identified about 18 months ago.  As I was going through the process of having him evaluated by the school district and doing his medical diagnosis, I started questioning a lot of what I was seeing in the younger one.  I do wonder if the OCD will become part of his alphabet soup at some point.

    Right now all of his school district services are served in-home and in a community ed class.  The district is going to use our private eval to qualify him for 3-5 services, which will be delivered in a classroom environment.   Part of his evaluation was done by the psychologist observing him in his day treatment room and gathering information from the mental health practitioner in his room and reviewing his goal progress in that setting. 

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  • So is the main difference between a PDD-NOS and a classic ASD diagnosis, the number of criteria the child meets under each category? I am trying to gain an understanding of why the PDD label was given and not an ASD label given the behaviors we are seeing.

    Also, is there a set release date for the DSM-5? We will have to do a re-eval again in one year to continue his day treatment services.  I am wondering if it will be in practice at that point or if I don't really need to worry about it at this point.

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  • I'm in no way certified to tell you what your son should or shouldn't be but I'll give you my experience and hope that helps. C was given a PDD-NOS dx in Feb at just over 2.5.  It was explained to us that he meet some of the criteria on the spectrum but not enough to be considered classically autistic.  Upon returning we did receive the full autism dx in Oct. at just over 3.  They told us that at 2.5 they were unable to fully determine if some of his behaviors or autism based or just age based.  By 3 there were able to identify him in the additional categories for the classic dx. 

     I'm so happy to hear that your son is making such great progress.  I think we all hope for that.   

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  • Autism is just a type of Pervasive Developmental Disorder.  In my opinion (and I've grown up surrounded by Autism and work in the field), people worry way too much about the exact label.  The label can be important, but only in so far as it leads to services and interventions.  For your purpose they are refining this to try and communicate the most about your son and they might change it up a bit more.  We all change and grow and labels change to reflect that.  Since PDD should get you the same services as Autism, I wouldn't worry about it. 
  • I do agree with the issues of Aspies and school services, and I hope the DSM changes help with that.  I have Asperger's Syndrome and Nonverbal Learning Disability.  The only reason I was diagnosed with Asperger's and not High Functioning Autism is because I never had any major language delays.  As someone who tends to be pretty high functioning (I have a graduate degree, friends, work professionally, am married and expecting my first) I sometimes feel like I am less of an Aspie or whatever.  But that isn't the case- I have had to have years of social skills training to learn how to make and keep friends, etc.  I'm looking for more as I know I have no idea how to make friends with other moms and deal with all the various stuff socially.  I've struggled and worked just as hard as anyone with a more severe time of it and in order to function as well as I do I have needed all the services provided and can still use more.  I have a brother with classic Autism.  He needs services too.  His exact needs and abilities are quite different from mine, but in some ways they are remarkably similar-- he also struggles with social skills, for example.  We could both use some speech therapy.  Now what we get out of how those services, like speech therapy, look for each of is is night and day sometimes.  But I don't think anyone subtype is helpful to me-- I sometimes wonder if all of humanity struggles with theory of mind and if our desire to put ourselves into groups isn't a part of that.  If aliens came down from space, would they expect all of us categorized and living in genres, like magazines?  But I'm rambling.  A label is to be used.  You bend the label to fit you and your situation.  You should never feel the need to bend to fit the label.  No matter how many labels I have the one that still fits me best is my name.
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