CUTTING THROUGH THE PSYCHOBABBLE:
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.
Criteria for Autism
To be diagnosed with autism, you must have:
At least SIX (6) of the below
symptoms from categories (1), (2) and (3).
must have TWO (2) symptoms from (1- Social)
And ONE (1) each from (2-
Communication) and (3 Behaviors and Interests)
The other one (or more) can be
from any of the categories.
Social interaction is impaired,
must have TWO from below list of symptoms:
Problems with nonverbal behaviors such as eye
contact, facial expression, body postures and gestures used in social situations
Eye contact – different from peers, may
only meet eye-gaze of certain people or have total lack of eye contact – or
anything in between
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
Body Postures – may hold arms close to
sides, may try to avoid certain types of social contact, may appear
unapproachable due to posture
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
Does not make friends like other children in same age
While peers are learning to play together, the child is off
Children learn to play by imitation, this child is not
imitating the other kids
Seems to have no interesting in socializing with peers
May approach peers, but not to play…watch and see if the
child is approaching in the same way peers approach each other
Does not share objects with others for enjoyment.
Does not bring you something that interests them to share
Does not point in the distance (i.e. to an airplane) to
share with you something that interests them
Look at peers and how they show things they are proud of
(ie. Artwork) and see if child does the same thing
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
not seem to seek out or enjoy the company of others; may be aloof
not smile back when you smile at him/her (without prompting)
not reply “hello” to your greeting (without prompting)
not seem especially happy to see you when you return home after work
not seem to pick up on the ‘vibes’ of others
not become grateful or excited in anticipation of outing or gift (in the same
way a peer would)
not attempt to comfort someone who is crying
(Must have at least ONE of the below symptoms):
Delay in, or total lack of, speech, but does not use
gestures to communicate (Delay = not at same level as peers)
Does not point to what s/he wants
Does not ‘mime’ his/her needs (ie. Mime ‘eating’ if
Does not shake or nod head for ‘no’ or ‘yes’
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)
Will not pretend to drink from toy teacup
Will not pretend to brush doll’s hair
Will not use items for make belief (i.e. a stick for a cane
or a magic wand)
Will not make dolls ‘talk’ to each other
Will not take a toy airplane and ‘fly’ it around the
room while saying ‘zoom’
BEHAVIORS AND INTERESTS
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
up cars is not necessarily playing ‘garage’; if you attempt to join in, the
child will tantrum, walk away, push you aside, etc.
members must always sit in same seats; failure may result in tantrum
take same route home; one deviation may cause meltdown
wear red shirt on Tuesday or risk a tantrum etc
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
wheels of toy cars
on one part of a toy (i.e. doll’s eyes)
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
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.
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!
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
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