ERIC ED416637: Pervasive Developmental Disorders. NICHCY Briefing Paper FS20.

18 Pages·0.42 MB·English

by  ERIC

DOCUMENT RESUME
EC 306 193
ED 416 637
AUTHOR
Tsai, Luke Y.
Pervasive Developmental Disorders. NICHCY Briefing Paper
TITLE
FS20.
National Information Center for Children and Youth with
INSTITUTION
Disabilities, Washington, DC.
Special Education Programs (ED/OSERS), Washington, DC.
SPONS AGENCY
PUB DATE
1998-01-00
NOTE
17p.
H030A30003
CONTRACT
NICHCY, P.O. Box 1492, Washington, DC 20013; phone:
AVAILABLE FROM
800-695-0285 (voice/TTY); World Wide Web:
http://www.nichcy.org; e-mail: [email protected]
Reports - Descriptive (141)
PUB TYPE
MF01/PC01 Plus Postage.
EDRS PRICE
*Autism; Classification; *Clinical Diagnosis; Communication
DESCRIPTORS
Disorders; Communication Skills; *Definitions; Educational
Needs; Elementary Secondary Education; Interpersonal
Competence; Psychological Patterns; *Symptoms (Individual
Disorders)
Aspergers Syndrome; Childhood Disintegrative Disorder;
IDENTIFIERS
*Pervasive Developmental Disorders; Rett Syndrome
ABSTRACT
This briefing paper is intended to provide basic information
about the diagnosis, educational programming, and special needs of children
and youth with Pervasive Developmental Disorders (PDD), a group of
neurological disorders usually evident by age 3 and characterized by
impairments in social interaction, imaginative activity, and verbal and
nonverbal communication skills, and by a limited number of interests and
activities that tend to be repetitive. After an introduction, definitions and
diagnostic criteria are provided for PDD and its five component disorders:
(3) childhood disintegrative
(2) Rett's disorder,
(1) autistic disorder,
(4) Asperger's disorder, and (5) pervasive developmental disorder
disorder,
not otherwise specified (PDDNOS). PDDNOS is addressed in some detail, noting
the possibility that the disorder is on a continuum with autistic disorder.
Symptoms and signs of PDDNOS, such as deficits in social behavior, impairment
in nonverbal communication, and unusual behavior patterns, are explained.
Problems in the diagnosis of PDDNOS are identified with suggestions. Also
addressed are the special educational needs of children with PDDNOS,
(Contains 34
treatment approaches, and finding a parent support group.
references or additional resources.)
(DB)
********************************************************************************
Reproductions supplied by EDRS are the best that can be made
from the original document.
********************************************************************************
FS20, January 1998
BRIEFING PAPER
Pervasive
Developmental
U.S. DEPARTMENT OF EDUCATION
Improvement
Office of Educational Research and
IONAL RESOURCES INFORMATION
EDU
Disorders
CENTER (ERIC)
This document has been reproduced as
received from the person or organization
originating it.
Minor changes have been made to
improve reproduction quality.
this
By Luke Y. Tsai, M.D.
Points of view or opinions stated in
document do not necessarily represent
official OERI position or policy.
a limited number of interests and
Every year the National Informa-
activities that tend to be repetitive.
tion Center for Children and Youth
The manual used by physicians and
with Disabilities (NICHCY) receives
thousands of requests for information mental health professionals as a guide to
about the diagnosis, educational
diagnosing disorders is the Diagnostic and
programming, and special needs of
children and youth with Pervasive
Developmental Disorders (PDD).
Table of Contents
Over the past few years, PDD has
become a subject of increased atten-
Introduction
tion among parents, professionals,
1
and policymakers across the country.
Definition of the PDD Category and its Five
NICHCY developed this Briefing
Specific Disorders
Paper in response to the growing
concern about, and interest in, this
The Cause of PDDNOS
5
disability. This publication is de-
signed to answer some of the most
The Symptoms and Signs of PDDNOS
6
commonly asked questions regarding
Diagnosing PDDNOS
PDD and to provide concerned
8
individuals with other resources for
Special Education and PDDNOS
9
information and support.
Treatment of PDDNOS
10
Introduction
Finding a Parent Support Group
13
The term Pervasive Develop-
mental Disorders was first used in
Conclusion
13
the 1980s to describe a class of
References
14
disorders. This class of disorders has
in common the following characteris-
Additional Resources
14
tics: impairments in social interac-
tion, imaginative activity, verbal and
Organizations
15
nonverbal communication skills, and
Statistical Manual of Mental
Disorders (DSM). The DSM was
last revised in 1994. In this
)Pervasive Developmental Disorders
latest revision, known as the
DSM-IV, five disorders are
identified under the category of
Pervasive Developmental
Disorders (see chart at right): (1)
Autistic Disorder, (2) Rett's
7'
Disorder, (3) Childhood Disin-
Disinj
Childhood
Asperger's
Rett's
Autistic
tegrative Disorder, (4)
PDDNOS
tegrative Disorder
Disorder
Disorder
Disorder
Asperger's Disorder, and (5)
Pervasive Developmental
Disorder Not Otherwise Speci-
fied, or PDDNOS.
Autistic Disorder have a moderate to
useful to look at the definition of
Many of the questions parents
severe range of communication,
each disorder. Therefore, before we
and education professionals ask
socialization, and behavior prob-
begin our discussion of PDDNOS,
NICHCY have to do with children
lems. Many children with autism
let us look first at the definition of
who have been diagnosed with
also have mental retardation. The
the general category PDD and its
"PDD." Doctors are divided on the
DSM-IV criteria by which Autistic
use of the term PDD. Many profes-
specific disorders.
Disorder is diagnosed are presented
sionals use the term PDD as a short
Definition of the
on page 3.
way of saying PDDNOS. Some
(2) Rett's Disorder. Rett's
doctors, however, are hesitant to
PDD Category and its Five
Disorder, also known as Rett Syn-
diagnose very young children with a
Specific Disorders
drome, is diagnosed primarily in
specific type of PDD, such as
females. In children with Rett's
Autistic Disorder, and therefore only
All types of PDD are neurologi-
Disorder, development proceeds in
use the general category label of
cal disorders that are usually evident
an apparently normal fashion over
PDD. This approach contributes to
by age 3. In general, children who
the first 6 to 18 months at which
the confusion about the term,
have a type of PDD have difficulty
point parents notice a change in
because the term PDD actually
in talking, playing with other chil-
their child's behavior and some
refers to a category of disorders and is
dren, and relating to others, includ-
regression or loss of abilities, espe-
not a diagnostic label. The appropri-
ing their family.
cially in gross motor skills such as
ate diagnostic label to be used is
According to the definition set
walking and moving. This is fol-
PDDNOSPervasive Develop-
forth in the DSM-IV (American
lowed by an obvious loss in abilities
mental Disorder Not Otherwise
Psychiatric Association, 1994),
such as speech, reasoning, and hand
Specifiednot PDD (the umbrella
Pervasive Developmental Disorders
use. The repetition of certain
category under which PDDNOS is
are characterized by severe and
meaningless gestures or movements
found).
pervasive impairment in several
is an important clue to diagnosing
Accordingly, this Briefing Paper
areas of development:
Rett's Disorder; these gestures
will use the term PDD to refer to
social interaction skills;
typically consist of constant hand-
the overall category of Pervasive
communication skills; or
wringing or hand-washing
Developmental Disorders and the
the presence of sterotyped
(Moeschler, Gibbs, & Graham 1990).
term PDDNOS to refer to the
behavior, interests, and activi-
The diagnostic criteria for Rett's
specific disorder, Pervasive Devel-
ties. (p. 65)
Disorder as set forth in the DSM-IV
opmental Disorder Not Otherwise
appear in the second box on page 3.
Specified. The majority of this
(3) Childhood Disintegrative
The Five Types of PDD
Briefing Paper will focus on
Disorder. Childhood Disintegra-
PDDNOS.
tive Disorder, an extremely rare
(1) Autistic Disorder. Autis-
All of the disorders that fall
disorder, is a clearly apparent regres-
tic Disorder, sometimes referred to
under the category of PDD share, to
sion in multiple areas of functioning
some extent, similar characteristics.
as early infantile autism or childhood
(such as the ability to move, bladder
To understand how the disorders
autism, is four times more common
and bowel control, and social and
differ and how they are alike, it's
in boys than in girls. Children with
BEST COPY AVAILABLE
3
1V1CHCY 1-800-695-0285
NICHCY Briefing Paper FS20Januaty 1998
-2
with at least
A. A total of six (or more) items from (1), (2), and (3),
Diagnostic Criteria
(3):
two from (1), and one each from (2) and
manifested
for Rett's Disorder
(1) qualitative impairment in social interaction, as
by at least two of the following:
(a) marked impairment in the use of multiple nonverbal
A. All of the following:
behaviors such as eye-to-eye gaze, facial expression, body
(1) apparently normal
interaction
postures, and gestures to regulate social
prenatal and perinatal
(b) failure to develop peer relationships appropriate to
development
developmental level
(2) apparently normal
(c) a lack of spontaneous seeking to share enjoyment,
psychomotor development
interests, or achievements with other people (e.g., by a
through the first 5 months
lack of showing, bringing, or pointing out objects of inter-
after birth
est)
(3) normal head circumfer-
(d) lack of social or emotional reciprocity
ence at birth
manifested
(2) qualitative impairments in communication as
by at least one of the following:
B. Onset of all of the follow-
(a) delay in, or total lack of, the development of spoken
ing after the period of normal
language (not accompanied by an attempt to compensate
development
through alternative modes of communication such as
(1) deceleration of head
gesture or mime)
growth between ages 5 and
impair-
(b) in individuals with adequate speech, marked
48 months
conversation with
ment in the ability to initiate or sustain a
(2) loss of previously
others
acquired purposeful hand
(c) stereotyped and repetitive use of language or idiosyn-
skills between ages 5 and
cratic language
30 months with the subse-
social
(d) lack of varied, spontaneous make-believe play or
quent development of
imitative play appropriate to developmental level
stereotyped hand move-
behavior,
(3) restricted repetitive and stereotyped patterns of
ments (e.g., hand-wringing
interests, and activities, as manifested by at least one of the
or hand washing)
following:
(3) loss of social engage-
(a) encompassing preoccupation with one or more stereo-
ment early in the course
typed and restricted patterns of interest that is abnormal
(although often social
either in intensity or focus
interaction develops later)
nonfunc-
(b) apparently inflexible adherence to specific,
(4) appearance of poorly
tional routines or rituals
coordinated gait or trunk
(c) stereotyped and repetitive motor mannerisms (e.g.,
movements
whole-body
hand or finger flapping or twisting, or complex
(5) severely impaired
movements)
expressive and receptive
(d) persistent preoccupation with parts of objects
language development with
severe psychomotor retar-
following
B. Delays or abnormal functioning in at least one of the
dation. (APA, 1994, pp. 72-
social interaction, (2)
areas, with onset prior to age 3 years: (1)
73)
language as used in social communication, or (3) symbolic or
imaginative play.
(Reprinted with permission from
the Diagnostic and Statistical
Disorder
Fourth
C. The disturbance is not better accounted for by Rett's
.Manua/ of .1Iental
Disorders.
Edition. Copyright 1994 American
1994, pp. 70-71)
or Childhood Disintegrative Disorder. (APA,
Psychiatric Association.)
of
(Reprinted with permission from the Diagnostic and Statistical Manual
Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric
Association.)
N1CHCY Briefing Paper FS20January 1998
NICHCY: 1-800-695-0285
"high-functioning autism." The
of interests, but normal intelligence
language skills) following a period of
diagnostic criteria for Asperger's
and adequate language skills in the
at least 2 years of apparently normal
Disorder as set forth in the DS \I -IV
areas of vocabulary and grammar.
development. By definition, Child-
are presented in the box on page 5.
Asperger's Disorder appears to have
hood Disintegrative Disorder can
(5) Pervasive Developmental
a somewhat later onset than Autistic
only be diagnosed if the symptoms
Disorder Not Otherwise Speci-
Disorder, or at least is recognized
are preceded by at least 2 years of
fied. Children with PDDNOS
later. An individual with Asperger's
normal development and the onset
either (a) do not fully meet the
Disorder does not possess a signifi-
of decline is prior to age 10 (Ameri-
criteria of symptoms clinicians use
cant delay in language development;
can Psychiatric Association, 1994).
to diagnose any of the four specific
however, he or she may have diffi-
DSM-IV criteria are presented
types of PDD above, and/or (b) do
culty understanding the subtleties
below.
(4) Asperger's Disorder.
not have the degree of impairment
used in conversation, such as irony
described in any of the above four
and humor. Also, while many
Asperger's Disorder, also referred to
PDD specific types.
individuals with autism have mental
as Asperger's or Asperger's Syn-
According to the DSM -IV, this
retardation, a person with Asperger's
drome, is a developmental disorder
category should be used "when
possesses an average to above
characterized by a lack of social
there is a severe and pervasive
average intelligence (Autism Society
skills; difficulty with social relation-
impairment in the development of
of America, 1995). Asperger's is
ships; poor coordination and poor
social interaction or verbal and
sometimes incorrectly referred to as
concentration; and a restricted range
nonverbal communication skills, or
when stereotyped behavior, inter-
Diagnostic Criteria for Childhood Disintegrative Disorder
ests, and activities are present, but
the criteria are not met for a specific
A. Apparently normal development for at least the first 2 years after
Pervasive Developmental Disorder,
birth as manifested by the presence of age-appropriate verbal and
Schizophrenia, Schizotypal Person-
nonverbal communication, social relationships, play, and adaptive
ality Disorder, or Avoidant Personal-
behavior.
ity Disorder" (American Psychiatric
Association, 1994, pp. 77-78).
B. Clinically significant loss of previously acquired skills (before age 10
years) in at least two of the following areas:
The Confusion of
(1) expressive or receptive language
Diagnostic Labels
(2) social skills or adaptive behavior
The intent behind the DSNI-IV
(3) bowel or bladder control
is that the diagnostic criteria not he
(4) play
used as a checklist but, rather, as
(5) motor skills
guidelines for diagnosing pervasive
developmental disorders. There are
C. Abnormalities of functioning in at least two of the following areas:
no clearly established guidelines for
(1) qualitative impairment in social interaction (e.g., impairment in
measuring the severity of a person's
nonverbal behaviors, failure to develop peer relationships, lack of
symptoms. Therefore, the line
social or emotional reciprocity)
between autism and PDDNOS is
(2) qualitative impairments in communication (e.g., delay or lack of
blurry (Boyle, 1995).
spoken language, inability to initiate or sustain a conversation,
As discussed earlier, there is still
stereotyped and repetitive use of language, lack of varied make-
some disagreement among profes-
believe play)
sionals concerning the PDDNOS
(3) restricted, repetitive, and stereotyped patterns of behavior,
label. Some professionals consider
interests, and activities, including motor stereotypes and manner-
"Autistic Disorder- appropriate only
isms
for those who show extreme symp-
toms in every one of several devel-
D. 'I'he disturbance is not better accounted for by another specific
opmental areas related to autism.
Pervasive Developmental Disorder or by Schizophrenia. (APA, 1994,
Other professionals are more com-
pp. 74-75)
fortable with the term Autistic
Disorder and use it to cover a broad
(Reprinted with permission from the Diagnostic and Statistical Manual of
range of symptoms connected with
Mental Disorders. Fourth Edition. Copyright 1994 American Psychiatric
Association.)
5
NICHCY: 1-800-695-0)85
-4
.vicacy Briefing- Paper FS20Januan, 1998
BEST COPY AVAILABLE
on a continuum (i.e., an individual
Jr
c;
Diagiluslic Criteria
.;
1
with Autistic Disorder can im-
prove and be rediagnosed as
least
A. Qualitative impairment in social interaction, as manifested by at
having PDDNOS, or a young
two of the following:
child can begin with PDDNOS,
(1) marked impairment in the use of multiple nonverbal behaviors
develop more autistic features,
such as eye-to-eye gaze, facial expression, body postures, and
and be rediagnosed as having
gestures to regulate social interaction
Autistic Disorder).
(2) failure to develop peer relationships appropriate to developmen-
To add to the list of labels that
tal level
parents, teachers, and others may
(3) a lack of spontaneous seeking to share enjoyment, interests, or
encounter, a new classification
achievements with other people (e.g., by a lack of showing, bring-
system was recently developed by
ing, or pointing out objects of interest)
ZERO TO THREE: National
(4) lack of social or emotional reciprocity
Center for Infants, Toddlers, and
Families (1994). Under this
B. Restricted repetitive and stereotyped patterns of behavior, interests,
system, called the Diagnostic
and activities, as manifested by at least one of the following:
Classification of Mental Health and
(1) encompassing preoccupation with one or more stereotyped and
Developmental Disorders of Infancy
restricted patterns of interest that is abnormal either in intensity or
and Early Childhood, the term
focus
Multisystem Developmental
(2) apparently inflexible adherence to specific, nonfunctional
Disorder, or MSDD, is used to
routines or rituals
describe pervasive developmental
(3) stereotyped and repetitive motor mannerisms (e.g., hand or
disorders.
finger flapping or twisting, or complex whole-body movements)
However, amidst all this confu-
(4) persistent preoccupation with parts of objects
sion, it is very important to
remember that, regardless of
C. The disturbance causes clinically significant impairment in social,
whether a child's diagnostic label
occupational, or other important areas of functioning.
is autism, PDDNOS, or MSDD,
his or her treatment is similar.
D. There is no clinically significant general delay in language (e.g.,
single word used by age 2 years, communicative phrases used by age 3
The Cause
years).
of PDDNOS
E. There is no clinically significant delay in cognitive development or
in the development of age-appropriate self-help skills, adaptive behav-
Both behavioral and biological
ior (other than in social interaction), and curiosity about the environ-
studies have generated sufficient
ment in childhood.
evidence to suggest that
PDDNOS is caused by a neuro-
F. Criteria are not met for another specific Pervasive Developmental
logical abnormalityproblems
Disorder, or Schizophrenia. (APA, 1994, p. 77)
with the nervous system. How-
ever, no specific cause or causes
the Diagnostic and Statistical Manual of .11ental
(Reprinted with permission from
have been identified.
Fourth Edition. Copyright 1994 American Psychiatric Association.)
Disorders,
While studies have found
various nervous-system problems,
no single problem has been
consistently found, and exact causes
or she has some behaviors that are
language and social dysfunction.
are far from clear. This may be due
seeOn autism but does not meet
Therefore, an individual may be
to the current approach of defining
the full DSM-IV criteria for having
diagnosed by one practitioner as
PDDNOS based on behaviors (as
Autistic Disorder. Despite the
having Autistic Disorder and by
opposed to, say, genetic testing).
DSM-IV concept of Autistic Disor-
another practitioner as having
Hence, it is possible that PDDNOS
der and PDDNOS being two
PDDNOS (or PDD, if the practitio-
is the result of several different
distinct types of PDD, there is
ner is abbreviating for PDDNOS).
conditions. If this is the case, it is
clinical evidence suggesting that
Generally, an individual is
Autistic Disorder and PDDNOS are
diagnosed as having PDDNOS if he
_5 S
NICHCY Briefing Paper FS20January 1998
.V1CHCY: 1-800-695-0285
well as a lack of understanding of
obvious until well into the second or
anticipated that future studies will
humor, often results in these young-
third year of life.
identify a range of causes.
sters saying or doing things that can
In early childhood, children with
slow the development of friend-
PDDNOS may continue to show a
The Symptoms
ships.
lack of eye contact, but they may
and Signs of PDDNOS
enjoy a tickle or may passively
Impairment in Nonverbal
accept physical contact. They do not
Generally, children are 3 to 4
Communication
develop typical attachment behav-
years old before they exhibit enough
In early childhood, children with
ior, and there may seem to be a
symptoms for parents to seek a
PDDNOS may develop the con-
failure to bond. Generally, they do
diagnosis. There is no set pattern of
crete gesture of pulling adults by
not follow their parents about the
symptoms and signs in children with
the hand to the object that is
house. The majority do not show
PDDNOS. It is important to realize
wanted. They often do this without
normal separation or stranger anxi-
that a very wide range of diversity is
the typical accompanying facial
ety. These children may approach a
seen in children with PDDNOS. All
expression. They seldom nod or
stranger almost as readily as they do
the items of behavior
shake their heads to
described in this section are
substitute for or to accom-
common in these children,
PDDNOS is a spectrum disorder. It
pany speech. Children
but a single child seldom
with PDDNOS generally
child exhibiting a
can be mild, with the
shows all the features at one
do not participate in games
few symptoms while in the school or
time. In other words, all
that involve imitation.
children with PDDNOS do
They are less likely than
neighborhood environment. Other children
not have the same degree
typical children to copy
form of
may have a more severe
or intensity of the disorder.
their parents' activity.
PDDNOS and have difficulties in all
PDDNOS can be mild,
In middle and late
with the child exhibiting a
childhood, such children
areas of their lives.
few symptoms while in the
may not frequently use
school or neighborhood
gestures, even when they
environment. Other children
understand other people's gestures
their parents. Many such children
may have a more severe form of
fairly well. Some children do de-
show a lack of interest in being with
PDDNOS and have difficulties in
velop imitative play, but this tends
or playing with other children. They
all areas of their lives. Because of
to be repetitive.
may even actively avoid other
the possibility that PDDNOS and
Generally, children with
children.
Autistic Disorder are on a con-
PDDNOS are able to show joy, fear,
In middle childhood, such
tinuum, many clinical features
or anger, but they may only show
children may develop a greater
described in the following section
the extreme of emotions. They
awareness or attachment to parents
are very similar to those being
often do not use facial expressions
and other familiar adults. However,
described in the literature for
that ordinarily show subtle emotion.
social difficulties continue. They
Autistic Disorder.
still have problems with group
Impairment in Understanding
games and forming peer relation-
Deficits in Social Behavior
Speech
ships. Some of the children with less
Some infants with PDDNOS
Comprehension of speech in
severe PDDNOS may become
tend to avoid eye contact and
children with PDDNOS is impaired
involved in other children's games.
demonstrate little interest in the
to varying degrees, depending on
As these children grow older,
human voice. 'They do not usually
where the child is within the wide
they may become affectionate and
put up their arms to be picked up in
spectrum of PDDNOS. Individuals
friendly with their parents and
the way that typical children do.
with PDDNOS who also have
siblings. However, they still have
They may seem indifferent to
mental retardation may never
difficulty understanding the com-
affection and seldom show facial
develop more than a limited under-
plexity of social relationships. Some
responsiveness. As a result, parents
standing of speech. Children who
individuals with less severe impair-
often think the child is deaf. In
have less severe impairments may
ments may have a desire for friend-
children with fewer delays, lack of
follow simple instructions if given in
ships. But a lack of response to other
social responsiveness may not be
an immediate context or with the
people's interests and emotions, as
7
.VICHCY: 1-800-695-0285
-6
.VICHCY Briefing Paper FS20January
1998
PDDNOS, but these often diminish
become lost and may withdraw from
aid of gestures (e.g., telling the child
social contact. Ordinary to-and-fro
as the child gets older. There may
to "put your glass on the counter,"
conversational chatter is lacking.
be a striking contrast between
while pointing to the counter).
Thus, they give the impression of
clearly enunciated echolalic speech
When impairment is mild, only the
talking "at" someone, rather than
and poorly pronounced spontaneous
comprehension of subtle or abstract
"with" someone.
speech. Some children have a
meanings may be affected. Humor,
chanting or singsong speech, with
sarcasm, and common sayings (e.g.,
Unusual Patterns of Behavior
odd prolongation of sounds, syl-
"it's raining cats and dogs") can be
The unusual responses of
lables, and words. A question-like
confusing for individuals with the
children with PDDNOS to the
intonation may be used for state-
most mild PDDNOS.
environment take several forms.
ments. Odd breathing rhythms may
Impairment in Speech
produce staccato speech in some
Resistance to change. Many chil-
dren are upset by changes in the
Development
children.
familiar environment. Even a minor
Abnormal grammar is frequently
Many infants with PDDNOS do
change of everyday routine may lead
present in the spontaneous speech
not babble, or may begin to babble
to tantrums. Some children line up
of verbal children with PDDNOS.
in their first year but then stop.
toys or objects and become very
When the child develops speech, he
As a result:
distressed if these are disturbed.
phrases may be telegraphic
or she often exhibits abnormalities.
Efforts to teach new activities may
(brief and monotone) and
Echolalia (seemingly meaningless
be resisted.
distorted;
repetition of words or phrases) may
words of similar sound or related
Ritualistic or compulsive behaviors.
be the only kind of speech some
Ritualistic or compulsive behaviors
meaning may be muddled;
children acquire. T-hough echolalic
usually involve rigid routines (e.g.,
some objects may be labeled by
speech might be produced quite
insistence on eating particular foods)
their use;
accurately, the child may have
or repetitive acts, such as hand
new words may be coined; and
limited comprehension of the
prepositions,
meaning. In the past, it was thought
conjunctions, and
that echolalia had no real function.
pronouns may be
More recent studies have found that
When children with PDDNOS develop
dropped from
echolalia can serve several func-
speech, they may not use it in ordinary
phrases or used
tions, such as self-stimulation (when
incorrectly.
a child says words or phrases repeat-
ways. They generally have difficulty
When children
edly without a communicative
talking about anything outside of
purposejust because it feels
with PDDNOS do
the immediate context. Ordinary to-
develop functional
good); as a step between a child
speech, they may not
being nonverbal and verbal; or as a
and-fro conversational chatter is
use it in ordinary
way to communicate (Prizant &
lacking. Thus, they give the impression
ways. Such children
Rydell, 1993). Other children
tend to rely on repeti-
of talking "at" someone, rather than
develop the appropriate use of
tive phrases. Their
phrases copied from others. This is
"with" someone.
speech does not
often accompanied by pronoun
usually convey imagi-
reversal in the early stages of lan-
guage development. For instance,
nation, abstraction, or
flapping or finger mannerisms (e.g.,
subtle emotion. They generally
when the child is asked "How are
twisting, flicking movements of
have difficulty talking about any-
you?" he or she may answer "You
hands and fingers carried out near
thing outside of the immediate
are fine."
the face). Some children develop
context. They may talk excessively
The actual production of speech
preoccupations; they may spend a
about their special interests, and
may be impaired. The child's
great deal of time memorizing
they may talk about the same pieces
speech may be like that of a robot,
weather information, state capitals,
of information whenever the same
characterized by a monotonous, flat
or birth dates of family members.
subject is raised. The most able
delivery with little change in pitch,
Abnormal attachments and behav-
persons can exchange concrete
change of emphasis, or emotional
iors. Some children develop intense
pieces of information that interest
expression.
attachments to odd objects, such as
them, but once the conversation
Problems of pronunciation are
pipe cleaners, batteries, or film
departs from this level, they can
common in young children with
8
NICHCY Briefing Paper FS20Januelly 1998
.VICHCY: 1-800-695-0285
the follow-up period without a
Beginning the Search for Information
change in their tested IQ. Follow-up
studies have also shown that retarda-
about
Sam was an active and busy child. But his parents were worried
tion present at the time of initial
him. Compared with the other 3-year-olds they knew, Sam was differ-
diagnosis tends to persist. Those
enthe wasn't talking and he didn't seem to want or try to play with
children with a low IQ show more
his sister. At day care Sam wouldn't join in any activities with the other
severely impaired social develop-
kids, but he really enjoyed playing with water. He would splash and
ment. They are more likely to
play at the sink for hours, with a big smile on his face. After about a
display unusual social responses,
finally
year of expressing concern to their pediatrician, Sam's parents
such as touching or smelling people,
obtained a referral to a developmental psychologist who diagnosed
ritualistic behavior, or self-injury.
The pediatrician also suggested that they
PDDNOS.
Sam as having
get the school to test Sam. The school tested him and said he had
Associated Features
autism. No one seemed to know anything about PDDNOS, and
although Sam's parents had heard of autism, they didn't know much
The emotional expression of
about it. They began their search for information on what PDDNOS
some children with PDDNOS may
was and what autism was.
be flattened, excessive, or inappro-
priate to the situation. For no
obvious reason, they may scream or
darting or pacing, body rocking and
canisters. Some children may have a
sob inconsolably one time, yet
swaying, or head rolling or banging.
preoccupation with certain features
giggle and laugh hysterically another
In some cases the behaviors appear
of favored objects, such as their
time. Real dangers, such as moving
only from time to time; in other
texture, taste, smell, or shape.
vehicles or heights, may be ignored,
cases they are present continuously.
yet the same child might seem
Unusual responses to sensory
experiences. Many children may seem
frightened of a harmless object, such
Intelligence and
underresponsive or overresponsive
as a particular stuffed animal.
Cognitive Deficits
to sensory stimuli. Thus, they may
Generally, children with
be suspected of being deaf or
Diagnosing PDDNOS
PDDNOS do very well on tests
visually impaired. It is common for
requiring manipulative or visual
such young children to be referred
The DSM-IV suggests that the
skills or immediate memory, while
for hearing and vision tests. Some
diagnostic label of PDDNOS be
they do poorly on tasks demanding
children avoid gentle physical
used when there is a severe and
symbolic or abstract thought and
contact, vet react with pleasure to
pervasive impairment in the devel-
sequential logic. The process of
rough-and-tumble games. Some
opment of reciprocal social interac-
learning and thinking in these
children carry food preferences to
tion, verbal and nonverbal commu-
children is impaired, most particu-
extremes, with favored foods eaten
nication skills, or the development
larly in the capacity for imitation,
to excess. Some children limit their
of seemingly meaningless repetitive
comprehension of spoken words and
diet to a small selection, while
behavior, interests, and activities,
gestures, flexibility, inventiveness,
others are hearty eaters who do not
but when the criteria are not com-
learning and applying rules, and
seem to know when they are full.
pletely met for a specific disorder
using acquired information. Yet, a
within the category PDD (e.g.,
small number of children with
Disturbance of Movement
Autistic Disorder, Rett's Disorder,
PDDNOS show excellent rote
The typical motor milestones
Asperger's Disorder). However, the
memories and special skills in
(e.g., throwing, catching, kicking)
DSM-IV framework has not offered
music, mechanics, mathematics, and
may be delayed but are often within
specific techniques or criteria for
reading.
the normal range. Young children
diagnosing PDDNOS.
Because many children with
with PDDNOS usually have diffi-
PDDNOS are either without func-
culty with imitation skills, such as
No Specific Test Available
tional speech or otherwise
clapping hands. Many such children
Currently, no objective biologi-
untestable, some people question
are very overactive, yet tend to
cal test, such as a blood test or an X-
the validity of testing their intelli-
become less overactive in adoles-
ray examination, can confirm a
ob-
gence. Moreover, it has been
cence. Children with PDDNOS
child's PDDNOS diagnosis. Diag-
served that a number of these
may exhibit characteristics such as
nosing PDDNOS is complicated
children show major improvements
grimacing, hand flapping or twisting,
and much like putting together a
in other developmental areas during
toe walking, lunging, jumping,
9
N1CHCY 1-800-695-0285
-8 -
NICHCY Briefing Paper FS20.1anuary
1998
context of the communication, how
about behaviors not observed during
jigsaw puzzle that does not have a
the child communicates (including
the formal testing sessions.
clear border and picture. Therefore,
facial expression, posture, gestures,
Behavior rating scales. Checklists
it is reasonable to say that, when a
etc.), and how well the child under-
of possible problems should be
PDDNOS diagnosis is made, it
stands when others communicate
completed by parents or caretakers
reflects the clinician's best guess.
with him or her. Assessment results
familiar with the child. Many
Obtaining an accurate diagnosis
should be used when designing a
diagnosticians use the checklist for
requires an assessment conducted
communication program for the
autism. However, no scale has yet
by a well-trained professional who
child. This may incorporate one or
been developed specifically to deter-
specializes in developmental disor-
more alternative forms to spoken
mine the diagnosis of PDDNOS.
ders, usually a child psychiatrist,
communication, such as sign lan-
Direct behavioral observations.
developmental pediatrician, pediat-
guage and/or using a communication
The child's behavior is recorded as
ric neurologist, developmental
board (i.e., pointing to pictures to
it happens, and assessment results
pediatrician, child psychologist,
express oneself).
interpreta-
are often graphed to aid
developmental psychologist, or
Occupational assessment. An
tion. This type of assessment can be
neuropsychologist.
occupational therapist may evaluate
carried out either in an artificial
the child to determine the nature of
situation (e.g., a child taking an
PDDNOS Assessment
his or her sensory integrative func-
intelligence test) or in a natural
The purpose of PDDNOS assess-
tioning: how the child's different
situation (e.g., a child's home or
informa-
ment is twofold: to gather
senseshearing, sight, taste, smell,
classroom).
tion to formulate an accurate diagno-
touchwork together. Standardized
Psychological assessment. The
sis and to provide information that
tools are used to assess fine motor
psychologist uses standardized
will form the basis of an appropriate
skills (such as using fingers to pick
instruments to evaluate the child's
intervention plan for the individual
up small objects), gross motor skills
cognitive, social, emotional, behav-
child and family. Assessment of
(such as running and jumping),
ioral, and adaptive functioning.
PDDNOS usually includes the
whether the child is right or left
Parents learn in which areas of
following elements:
handed, and various visual skills
development their child exhibits
Medical assessment. The medical
(such as depth perception).
delays.
evaluation should include a thor-
Evaluation summary. The
Educational assessment. Both
ough birth, developmental, medical,
professional evaluating a child will
formal assessment (such as the use
and family history, and a full physi-
use all the information collected
of standardized tests) and informal
cal and neurological examination.
through these varying techniques to
assessment (such as direct observa-
Not all children with PDDNOS
decide whether that child has a
tion and interviewing the parents)
require laboratory tests such as a
disability that falls under the cat-
should be used to evaluate the child
chromosome study, including a test
egory of PDD. Assessment and
on the following points:
for Fragile X, an EEG (which
evaluation can be done through the
preacademic skills (e.g., shape
measures the brain's electrical
child's local public school or a
and letter naming),
activity), or a brain scan such as
private practitioner.
academic skills (e.g., reading
MRI (an X-ray that gives a picture
and arithmetic),
of the brain's anatomy). The primary
Special Education
daily living skills (e.g., toileting,
care physician determines if these
dressing, eating), and
and PDDNOS
of
are needed. Although the cause
learning style and problem-
PDDNOS is generally unknown,
solving approaches.
the physician may discuss some
By law, schools must make
Communication assessment. For-
medical conditions that do not cause
special services available to eligible
mal testing, observational assess-
PDDNOS but tend to be found in
children with disabilities. These
ment, and interviewing the child's
such childrenfor example, seizure
services are called special education
for
parents are all useful strategies
disorder. Associated conditions can
and related services (discussed more
assessing communication skills. It is
cause or worsen a child's problems.
below). The law that requires this is
important to assess a range of
Interviews with the parents, child,
the Individuals with Disabilities
communication skills, including the
and child's teacher. A child with
Education Act, or IDEA. Under the
child's interest in communication,
PDDNOS may exhibit different
IDEA, school-aged children who are
why (for what purpose) the child
abilities and behaviors in different
thought to have a disability must be
communicates, the content and
settings or situations. Parents and
evaluated by the public schools at
teachers can provide information
n
NICHCY Briefing Paper FS20January 1998
-9 -
NICHCY 1-800-695-0285