PDD NOS and the new DSM?

abigail912 · May 2014

My 2 year old son recently had an ADOS and the Dr. said she would call in about a week to discuss the results but said that he met the criteria for a PDD NOS diagnosis. I am confused because PDD NOS was removed for the new DSM. Does anyone have any knowledge about what the DSM changes mean for children with PDD NOS? Will insurance recognize this has a diagnosis?

lvisser · May 2014

My son got a pdd-nos under the dsm-iv in December.... So far we haven't had any issues with insurance, ss accepting that diagnosis...

lvisser · May 2014

299.80 And yes... In the us

abigail912 · May 2014

Thanks for the replies. @Ivisser good to know you haven't had any trouble with insurance. Maybe when the Dr. calls with the results I will get more cralification.

mommy0411 · May 2014

I know my son was initially given a PDD-NOS diagnosis a few months before the new DSM went into effect. We got a second opinion and the psychologist that did the ADOS said he met the criteria for autism in the DSM 5. All of his therapies are billed under the 299.00 code.

kcisthebombdotcom · May 2014

They'll likely label it as autism spectrum disorder on the paperwork. My dd has a pdd-nos type presentation as well and that's what her developmental pedi did.

bumpuser511563 · May 2014

DS had PDD-NOS and we had trouble when the switch to DSM5 took place. We were trying to apply for ABA services and they did not accept PDD-NOS because it was not updated to DSM5.

Our Behavioral Therapy Office was diagnosing to the DSM4 until they went to training for the DSM5. I doubt any of the professionals have gone to the training yet.

abigail912 · May 2014

I will make sure to ask for clarification when we get the phone call. I work for a local school district (not the ones my children will go to) so I can talk to some of the people I know in the special needs dept. Thank you guys, this process can feel so overwhelming, so it is nice to have input from people who have been thought it.

Susan_KW · May 2014

We got PDD-NOD and Autism Spectrum Disorder in Oct 2013. They bill whichever diagnosis the insurance accepts. In CA part of that is state mandated service coverage by insurance for certain diagnoses including PDD-NOS. The legislation was written pre-DSM V.

Susan_KW · May 2014

Yeah - the regional center said no diagnosis. Then when we came back with the PDD-NOS/ASD diagnosis they said they only cover autism, not autism spectrum disorder.

Susan_KW · May 2014

? ********************** His diagnosing clinician said autism was different than autism spectrum, and that she was provisionally diagnosing DS as autism spectrum. I honestly still don't understand how the semantics are split. ********************************** At various appts I see kids who appear more impaired than DS and their parents tell me their child does not have a diagnosis but is at high risk for autism. They are waiting to see if the regional center assesses their child as impaired enough to qualify for services. I don't understand why my child has a diagnosis but doesn't qualify for regional center services, and their children do not have a diagnosis, but could qualify for services through the regional center and receive ABA therapy privately and through their school district. It's a puzzle to me. ******************************************* As for the school districts, they make their own determination if a child has an educational diagnosis of autism. DS is qualified under developmental delay and goes to a non-autism pre-school that is the catch all for all sorts of delays. I don't think it is the best placement since DS and the two peer models are the only ones without a severe intellectual delay. But it is what it is. All the other district special education pre-schools are for autism (broken down by high or low functioning). There are 3-4 times as many autism special education pre-schools as there are regular special education pre-schools.

Susan_KW · May 2014

I'm on my tablet - which makes it hard to quote, but *************** 1) Other kids in the waiting room - I think they are more impaired because their parents tell me various behaviors (mainly echolia) and they are receiving 20+ hours of ABA a week. ********************** 2) The ID kids in his class are very delayed. Need to be led by the hand from activity A to B with a blank stare delayed. Throwing a paint brush down and crying like a 12 month old would toss food off a high chair delayed. Using a bottle and sucking on a pacifier and non-verbal delayed. The last two kids act more like a baby would than a three year old. DS is one of the more highly functioning kids in the class. When I found out that DS would be in an inclusive pre-school I was happy because I thought he could learn a lot from peers with various disabilities. But, I didn't imagine the delays would be anything like this. ******************************* The district tested DS specifically for autism and said they didn't see autism behaviors that would make learning in a classroom environment challenging (e.g. difficulty focusing, tantrums, sensory issues, etc). Most of the case load in the district's preschool is autism related - people move into the district for their autism services. At his IEP meeting, I was told DS was too high functioning for the low functioning autism class, but too low functioning (at the time didn't talk or self advocate in a class room setting) for a high functioning autism class. The special day autism classes are also considered "more restrictive" to the non-autism special needs pre-school. ******************************* Stars are to show paragraph breaks

Susan_KW · May 2014

I'll back off the more impaired argument and ABA services discussion. ************************************* In regards to DS at his pre-school, he behaves beautifully for them. He focuses, he transitions, he shows appropriate play and social skills, he pastes, colors and stickers for them. I did an observation recently and the district person was showing me all his skills that I didn't realize he had. He can focus and self direct on a center activity, he continuously social references (e.g. focuses attention on the peer model's functional play but looks at and thn dismisses the non-functional play of another child), he goes up to the peer models and parallel plays a bit with them but then sometimes goes back to what he was doing before, he can follow verbal instructions (e.g. get your folders ready and get in line to go) to the entire class (which involved put putting his folder in his back pack, bringing his back pack to his place in line, sittin on the circle with his picture in lline), he can sit in circle time. He doesn't do any of the behaviors that drive me up the wall - mainly ignoring me, running away from me, running into stuff, whipping his head around, putting stuff in his mouth. ********************************************************** Next year we'll send him to a regular pre-school too in addition to the district special education class. The PT, OT, SLT don't push into non-district class rooms that I know of. Instead you bring your child to a central location where they do group therapy (primarily speech) once a week. Since DS's delays are in pragmatic speech and play/social skills, it was thought that he needed a placement that could support those skills throughout a pre-school setting.

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