CUTTING THROUGH THE PSYCHOBABBLE: DIAGNOSING AUTISM AND PDD-NOS PER THE DSM-IV IN LAYMAN’S TERMS

 Pervasive Developmental Disorders (PDD) are a class of conditions to which Autism, Asperger's, Rett Syndrome and others belong. It is not a diagnosis in and of itself. It is simply a descriptive term. Each of the PDD conditions has specific diagnostic criteria which must be met in order to satisfy the requirements of the DSM IV.

CUTTING THROUGH  THE PSYCHOBABBLE:
DIAGNOSING AUTISM AND PDD-NOS PER THE DSM-IV IN LAYMAN’S TERMS
 
This document was born out of confusion experienced by so many parents about the diagnosis of autism or PDD-NOS.  When comparing notes, we discovered that even our physicians did not agree.  One woman told us her psychologist said that a diagnosis of PDD-NOS was reserved for children on the spectrum who are curable; others have been told that PDD-NOS is not even on the spectrum!  We found that many clinicians seem to take a milder diagnosis and simply label it PDD-NOS.

This document takes the DSM-IV criteria for autism and PDD-NOS and translates it into English.  It also attempts to clarify how a diagnosis of PDD-NOS is made.  Please note that not all symptoms may not be present every day.  Look at typically developing children of same age (peers) and use them as markers.  This document is certainly not a diagnostic tool; it was created by and for parents.

To make this easy, (1), (2), (3) are categories, the letters (a), (b); etc that appear under each category will be referred to as symptoms.

DSM-IV Criteria for Autism
299.00 Autism
A.      To be diagnosed with autism, you must have:
o        At least SIX (6) of the below symptoms from categories (1), (2) and (3).
o        You must have TWO (2) symptoms from (1- Social)
o        And ONE (1) each from (2- Communication) and (3 Behaviors and Interests)
o        The other one (or more) can be from any of the categories.
(1) SOCIAL
Social interaction is impaired, must have TWO from below list of symptoms:
(a)  Problems with nonverbal behaviors such as eye contact, facial expression, body postures and gestures used in social situations
Examples:
o        Eye contact – different from peers, may only meet eye-gaze of certain people or have total lack of eye contact – or anything in between
o        Facial expression – may seem inappropriate to what the situation warrants, may have blank gaze, may not greet you with a smile, may have same expression on face most of time – or any combination thereof
o        Body Postures – may hold arms close to sides, may try to avoid certain types of social contact, may appear unapproachable due to posture
o        Gestures – may not respond to a hand held out to shake hands, arms out for hugs etc.  May not understand social ‘cues’ we take for granted
(b)  Does not make friends like other children in same age group.
Examples:
o        While peers are learning to play together, the child is off by themselves
o        Children learn to play by imitation, this child is not imitating the other kids
o        Seems to have no interesting in socializing with peers
o        May approach peers, but not to play…watch and see if the child is approaching in the same way peers approach each other
 (c)   Does not share objects with others for enjoyment.
Examples:
o        Does not bring you something that interests them to share with you
o        Does not point in the distance (i.e. to an airplane) to share with you something that interests them
o        Look at peers and how they show things they are proud of (ie. Artwork) and see if child does the same thing
(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
Examples:
o      Does not seem to seek out or enjoy the company of others; may be aloof
o      Does not smile back when you smile at him/her (without prompting)
o      Does not reply “hello” to your greeting (without prompting)
o      Does not seem especially happy to see you when you return home after work
o      Does not seem to pick up on the ‘vibes’ of others
o      Does not become grateful or excited in anticipation of outing or gift (in the same way a peer would)
o      Does not attempt to comfort someone who is crying
(2) COMMUNICATION
Communication difficulties (Must have at least ONE of the below symptoms):
(a)  Delay in, or total lack of, speech, but does not use gestures to communicate (Delay = not at same level as peers)
Example:
o        Does not point to what s/he wants
o        Does not ‘mime’ his/her needs (ie. Mime ‘eating’ if hungry)
o        Does not shake or nod head for ‘no’ or ‘yes’
o        Does not shrug shoulders to show s/he ‘doesn’t know’
(b) If child can speak, cannot start or hold up their end of a conversation (appropriately)
(c) May echo phrases, words, songs, parts of movies etc.
(d) Does not engage in imaginative play (as peers)
Examples:
o        Will not pretend to drink from toy teacup
o        Will not pretend to brush doll’s hair
o        Will not use items for make belief (i.e. a stick for a cane or a magic wand)
o        Will not make dolls ‘talk’ to each other
o        Will not take a toy airplane and ‘fly’ it around the room while saying ‘zoom’
(3) BEHAVIORS AND INTERESTS
Repetitive behaviors, interests, and activities – child may get angry if this ‘pattern’ is interrupted.  Must have at least ONE of the below symptoms:
(a) Child is so focused on an interest that to remove the interest will result in a meltdown
(b) Routines or rituals must be followed, they appear to have no function

Examples:
o      Lining up cars is not necessarily playing ‘garage’; if you attempt to join in, the child will tantrum, walk away, push you aside, etc.
o      Family members must always sit in same seats; failure may result in tantrum
o      Must take same route home; one deviation may cause meltdown
o      Must wear red shirt on Tuesday or risk a tantrum etc
o      If you go to the video store, you must rent “The Brave Little Toaster” every time or risk a tantrum
(c) Repetitive behavior such as hand flapping, rocking, ear flicking, chewing on clothing, vocal ‘stims’, spinning etc. Establish if this is self-stimulatory by doing a functional assessment like the Durand Motivational Assessment Scale: http://www.monacoassociates.com/mas/MAS.html
(d) Preoccupied with parts of objects
Examples:
o      Spins wheels of toy cars
o      Focus on one part of a toy (i.e. doll’s eyes)
o      Cover parts of book so that s/he can look at one piece
B. Child is either delayed (not same ‘age’ as peers) or acts differently from peers in ONE of the following (must be noticeable before age three): (1) social interaction, (2) language as used in social communication, or (3) pretend play.
C. Child does NOT have Rett’s or Childhood Disintegrative Disorder

299.80 Pervasive Developmental Disorder, Not Otherwise Specified

PDD-NOS is a diagnosis by exclusion.  If a child presents with some symptoms from (1), (2), and/or (3), and their pattern of symptoms is not better described by one of the other PDD diagnoses (i.e., Autistic Disorder, Asperger’s Disorder, Rett’s Disorder, or Childhood Disintegrative disorder) then a professional might decide that a diagnoses of PDD-NOS is warranted.

When comparing PDD-NOS to Autism, PDD-NOS is used when a child has symptoms of autism as above, but not in the configuration needed for an autism diagnosis.  Social component is where the most impairment is seen.  Children who fail to meet criteria for autism and don’t have adequate social impairment typically have a developmental disability, and their symptoms can by accounted for by that.


Looking at above description:
“299.00 Autism - To be diagnosed with autism, you must have at least 6 of the below symptoms from (1), (2) and (3).  You must have two symptoms from (1) and one each from (2) and (3) – the other two can be any of the other symptoms.”
PDD-NOS is most often diagnosed when children have significant social impairments, but don’t have the symptoms in area (3).  A child with PDD-NOS may have the same (or more, or less) number of symptoms as a child with autism, but instead of having 2 from #1 and one each from #2, the child might have 1 symptom from #1 and one from #2, plus two from #3.
A diagnosis of PDD-NOS is not necessarily a less-severe one than a diagnosis of autism, but can be sometimes.
Severity of any spectrum disorder can be determined by the amount and severity of symptoms listed above.
It is imperative to obtain a thorough psychological assessment performed.  If you do not understand during any part of the assessment, ask questions.  You should feel comfortable to go home and ‘digest’ the information given to you, form any questions or concerns and contact the diagnosing clinician to get your answers.

Many thanks go out to R.C. for her help with this project!

A notice to our readers...
This document was put together with input from parents, not physicians.  It is not to be used as a diagnostic tool, nor is it to be considered professional advice.
This document references web sites that may be of interest to the reader.  BBB Autism Support Network makes no presentation or warranty with respect to the accuracy or completeness of the information contained on any of these web sites, and specifically disclaims any liability for any information contained on, or omissions from, them.  Reference to these web sites herein shall not be construed to be an endorsement of them or of the information contained thereon, by BBB Autism Support Network.

(c) BBB Autism – July 2002
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Source Url:  http://www.bbbautism.com/diagnostics_psychobabble.htm

Pathological Demand Avoidance

Pathological Demand Avoidance

http://www.autismpda.org/?page.diagnostic-criteria 

This information sheet has been written in such a style as to try and make it accessible to children as well as adults in an attempt to inform as many people as possible about Pathological Demand Avoidance.

PDA is a pervasive developmental disorder. Dr Elizabeth Newson of Nottingham University identified significant atypical characteristics displayed by children diagnosed as having Autistic Spectrum Disorder (non specified).

PDA is quite rare. No one is really sure of the exact cause but it is believed the brain works in a slightly different way from other people’s brains. Children with PDA are very good at certain things they enjoy but often do not do so well at school, not because they lack intelligence but because they are afraid to make an effort in case it leads to further demands.

Children with PDA can find it difficult to get on with other people. They can get bossy or play a little too rough. They may shout and scream if they do not get their own way or go from being happy to furious very quickly. They might seem to ‘go over the top’ sometimes. Children with PDA find it hard to ‘tune in’ to what other people feel and they often don’t realise that other people’s feelings matter as much as their own. They often interrupt because they do not understand that the social rules for conversation are important.

Children with PDA find being asked to do things difficult, even easy things. They will have dozens of excuses why they cannot do something, will attempt to change the topic of conversation or talk and talk as avoidance strategies. Children with PDA frequently become panicky or agitated and often become very angry.

Children with PDA are ‘obsessional’. Their biggest obsession is avoiding demands. They may ask the same question over and over again, talk about one topic of conversation a lot, get fascinated by certain toys, videos, games or other objects. They say things over and over again to avoid doing what they are asked to do, and they keep blaming others for things.

Children with PDA may become easily upset or angered because they feel under pressure and this is hard to handle. They worry about things we don’t even give a thought to and they feel anxious most of the time. Anxiety increases when they are asked to do something. Imagine how you feel when you have a test or exam to do – a child with PDA feels like that most of the time!

Children with PDA have difficulty telling the difference between real and pretend. Stories and games may be taken seriously. Children with PDA are often taken advantage of because they don’t realise they are being tricked or lied to. They might seem as if they are showing off sometimes, but they don’t realise what other people think. They try to take over situations because don’t understand that they can’t be the adult!

Children with PDA find it difficult to take responsibility for the things they do. It seems that they don’t care about what they should and shouldn’t do. They often do not feel pleased with the good things they do and often do not feel proud or ashamed. Also, they don’t seem to know when they’ve gone too far! They seem very rude or naughty at times because they don’t understand which rules are important and get confused.

Most children with PDA are a bit clumsy; you may notice it when they are running around or doing sports. They often find it hard to hold a pen or pencil and writing can be hard work.

It is frightening and stressful to have PDA. You may have to handle a situation differently with a child with PDA as they often say the wrong thing, go too far or become agitated and argumentative without having any idea that they have been inappropriate.

Children with PDA do not understand themselves very well - they do not understand what being a child really means for them personally. We know how to behave, we understand social rules and how to behave in school and home, we know what to believe and how we feel about ourselves – children with PDA find all of this very difficult to learn even though parents try very hard to teach them this sort of knowledge. They don’t see anything as being their responsibility. They aren’t very good at keeping secrets and they say things that are unkind without understanding the upset these words cause.

There is no cure for PDA but with good teaching and encouragement they can improve all the time. There may have to be different rules for children with PDA as they do not always mean to do or say some things. If you understand why a child behaves in the way that they do you can help to make their lives a little bit easier which in the end will makes yours a little bit easier too!

Based on “Children with Pathological Demand Avoidance Syndrome (PDA) a booklet for brothers and sisters” by Julie Davies, Child Development Research Unit, Nottingham University

PDD-NOS Symptoms

Nov 11th, 2009

PDD-NOS belongs is a type of autism spectrum disorder. Pervasive Developmental Disorder Not Otherwise Specified is a disorder that looks like autism but does not fit all the symptoms. Although this disorder can be seen at e very young age, most often it is diagnosed in toddlers. PDD-NOS symptoms are much a like autism but come in a milder form. You could say that Pervasive Developmental Disorder Not Otherwise Specified is a form of mild autism.

Because it is also a spectrum disorder, all children diagnosed will show different PDD-NOS symptoms. The two symptoms that brings the most problems in social functioning are social interaction with other children and communicating problems with parents.

Autistic traits are noticeable at a very young age. It is aid that even babies show some symptoms of autistic traits. It is not always noticeable but they often do not like to be cuddles and don’t make eye contact. This can be very frustrating for young parents. However, the diagnosis is mostly made when toddlers are 3 or 4 years old. Strange behavior is not always apparent visible. They could play normally with other children and like to play on their own. However, they also don’t have any trouble being separated from their parents or talking to strangers.

DD-NOS comes in a severe form and in a milder form. Children with milder PPD-NOS symptoms often want to make friends or interact with them. However, they often act a bit strange compared to their peers and do not know how to make new friends. When they grow older they often stay close to their parents and other people that are around but they are not well able to make other friends.

Communication is frequent the biggest problem for children with PDD-NOS. It already starts when they were babies and were not able to babble and when they grow older they speak less often than is considered normal. Because of this they have troubles learning new words and their vocabulary is not as large as in a normal development.

Besides communication they could also have problems with recognizing facial expressions and emotions. They don’t know how to act when someone is laughing or crying because they don’t fully understand the meaning of that behavior. Another problem is that they do not understand figural speech. They think rationally and don’t understand jokes or sarcastic remarks.

Just like in autism, children with PDD-NOS symptoms often stick to one topic when they are communicating. They will speak of a topic that they know off.

Although these children have difficulties adapting and grow up normally, a lot is achievable with proper education and  treatment. Therefore it is important that if you recognize these symptoms to talk to a doctor and ask for advice.