Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

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Pervasive Developmental Disorder-Not Otherwise
Specified (PDD-NOS)

• By Dina Kennedy

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What is PDD-NOS?

• The labels PDD and PDD-NOS have created a
  great deal of disagreement and confusion among
  professionals. According to the Yale School of
  Medicine website(2008) , Pervasive Developmental
  Disorder, Not Otherwise Specified (PDD-NOS) is a
  subthreshold condition in which some but not
  all features of autism or another explicitly
  identified Pervasive Developmental Disorder are
  identified (Retrieved August 1, 2009).
• PDD-NOS falls beneath the umbrella of Autistic
  Spectrum Disorder. PDD-NOS has also been
  referred to as atypical personality
  development, atypical PDD, and atypical
  autism. Symptoms of PDD-NOS can range from mild
  to severe.
• According to an article defining PDD-NOS by the
  American Psychiatric Association (1994), At a
  diagnostic level, when a child is labeled with an
  autistic disorder, they display six or more
  of twelve symptoms in three major areas. These
  areas are social interaction, communication and
  behavior. Children diagnosed with PDD-NOS may
  demonstrate similar behaviors but dont meet the
  specific autistic disorder criteria (Retrieved
  July 24, 2009).
• Lets look at some of the characteristics a child
  with PDD-NOS may display. . .

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Characteristics of Children Diagnosed with
PDD-NOS

• Social Interaction Children may appear withdrawn
  and avoid eye contact, seem insensitive or
  unemotional to other peoples feelings by a lack
  of facial responsiveness, separation anxiety
  and/or stranger anxiety, desire to play in
  isolation avoiding contact with peers.
• Communication Difficulty expressing needs
  appropriately, some verbal abilities are delayed,
  inappropriate laughing , echolalia, may not
  understand humor or sarcasm, difficulty with
  pronunciation and/or grammar, difficulty with
  language pragmatics (for example, A child with
  PDD-NOS may understand, Give me a hand, as
  actually removing an actual hand and giving it to
  someone.) lack of imagination, abstraction or
  emotion.
• Behavior May resist changes in routine, may be
  very physical or very non-physical, may have an
  abnormal response(s) to one or a combination of
  senses sight, hearing, touch, balance, smell,
  taste and reaction to pain, may appear to have
  unreasonable fears without regard to real
  dangers.

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Article 1 Review

• In the study titled Regression of Language and
  Non-Language Skills in Pervasive Developmental
  Disorders by Meilleur and Fombonne (2009), 1 out
  of 5 children diagnosed with PDD suffer from some
  form of regression in language and non-language
  skills. The study also looked at the ages of the
  beginning of the regression. Meilleur and
  Fombonne found that these children demonstrated
  regression due to their repetitive behaviors.
  The study founded that although abnormal
  behaviors appeared to begin at the point of
  regression, it was determined that the abnormal
  behaviors were present before the regression.

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• Meilleur and Fombonne advocate that if a teacher
  can identify the indicators of abnormal
  behavior, regression can be targeted. By using
  a Functional behavioral assessment (FBA) and
  addressing the students needs with a Positive
  behavioral intervention and support (PBIS),
  teachers will better understand the abnormal
  behavior and the factors that surround it. This
  information will assist all members of the
  students support team (general education teacher,
  special education teacher, speech pathologist,
  counselor, psychologist, administrator, parents,
  etc.) in building effective and successful
  Individualized Education Plans (IEPs) for the
  child. Inclusion will be difficult for the child
  diagnosed with PDD but that depends on the
  severity and the management of the behaviors
  present. Meilleur and Fombonne provided some
  useful strategies to work towards improving
  language and non-language skills which included
  direct instruction techniques, behavior
  management and providing instruction in natural
  settings.
• Meilleur, A. Fombonne, E. (2009). Regression of
  language and non-language skills in pervasive
  developmental disorders. Journal of Intellectual
  Disability Research, 53 (2). Retrieved August 1,
  2009, from EBSCOhost database.

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Article 2 Review

• In the article titled, Cognitive Profile
  Difference Between Normally Intelligent Children
  with Aspergers Disorder and Those with Pervasive
  Developmental Disorder Not Otherwise Specified,
  Koyama and Kurita (2008) found that children
  diagnosed with different autistic spectrum
  disorders, but common IQ levels have specific
  cognitive abilities. They studied two groups.
  The first group was children who are normally
  intelligent and diagnosed with Aspergers
  Disorder. The second group was children who are
  normally intelligent and diagnosed with Pervasive
  Development Disorder-Not Otherwise Specified.
  The mean age of both groups was 7.6 years.
  Koyama and Kurita used the Japanese version of
  the Wechsler Intelligence Scale to measure IQ.
  Both groups were assessed in verbal ability,
  freedom from distractibility, arithmetic, coding
  and digit span. The study concluded that both
  groups scored low in comprehension. Children
  with Aspergers scored higher in verbal and
  mathematical abilities. The study did find that
  both groups scores was affected by their extreme
  slowness and drive for perfection.

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• The study comparing the two groups is a powerful
  tool in considering the range of abilities and
  performance levels that may be present in the
  general education setting. The focus on the
  speed of performance amongst both groups provides
  vital information in designing accommodations and
  modifications to curriculum and learning in the
  general education classroom setting. These are
  both essential factors regarding inclusion for
  children with Aspergers and PDD-NOS.
• Koyama, T. Kurita, H. (2008). Cognitive
  profile difference between normally intelligent
  children with Aspergers disorder and those with
  pervasive developmental disorder not otherwise
  specified. Psychiatry and Clinical
  Neurosciences, 62 (6). Retrieved July 11, 2009,
  from EBSCOhost database.

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Article 3 Review

• In the article titled, Educating Students with
  PDD/Autism The Case for Rational Inclusion
  (1998), although slightly dated, Fred Renew
  followed and discussed the educational path of
  two young boys who are diagnosed with PDD-NOS.
  Renew found that a focus on two approaches to
  planning services for students with Pervasive
  Developmental Disabilities was a valuable tool
  for families and professionals in making good
  decisions based on diverse thinking. These two
  approaches separate former allies in the
  special education community. One group believes
  that full inclusion is the answer no matter the
  severity of the disability. Their belief is that
  getting the child into the classroom is the true
  measurement of success. Teacher preparation,
  peer acceptance and classroom modifications can
  happen later. The other group believes that
  inclusion is an ongoing process. They have
  labeled this ongoing process rational
  inclusion. This groups belief is that
  pre-planning for inclusion will make it the most
  successful for the student.

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• The young boy who was part of a rational
  inclusion process proved to be the most
  successful. The sequential and well thought out
  structures that the school leadership team put
  into place provided a strong foundation for the
  young man and his family to depend and rely on.
  The preparation of the teacher, classmates and
  other classroom variables were seen as
  prerequisites to the full inclusion. The study
  concluded that a more rational versus
  doctrinal approach in thinking will result in a
  more successful school inclusion.
• Renew, F. (1998). Educating students with
  PDD/Autism the case for rational inclusion.
  Opinion Papers, 120, 141-150.

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Recommendations for Inclusion for Students With
PDD-NOS

• Diminish distractions in the classroom setting
  (noise, unnecessary visuals, seating in high
  traffic areas, etc,).
• Work one-on-one to address students need for
  perfection on assignments.
• Make modifications to student learning
  concerning verbal communication skills (break
  language acquisition skills into smaller parts).

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Recommendations (continued)

• Work collaboratively to build effective IEPs to
  meet the students academic and social goals.
• Utilize Functional behavioral assessment (FBA) to
  analyze behavior and determine next steps.
• Provide Positive behavioral intervention and
  support (PBIS). This is another tool to use to
  build collaboration and common language within
  the childs support team.

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Recommendations (continued)

• Identify and provide support for families
  (education, training, financial assistance, etc.)
  
• Have learning support systems (speech
  pathologist, psychologist, instructional
  assistants, etc.) in place for the child and work
  together to design the childs learning, ongoing
  assessment and next steps.
• Continue professional development of special
  education teaching skills and current research.

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How I Will Apply This Information to My Own
Classroom?

1. I will provide a classroom environment that is
   not a distraction to my student(s) with PDD-NOS.
   This will include locating the child out of
   high-traffic areas, monitoring the brightness of
   lights and controlling unnecessary noises. For
   example, I know from personal experience, that it
   is important to be informed when emergency drills
   will be taking place due to their noise and
   disturbance of routine.
2. My instructions will be clear and concise. I
   will provide these in a written format as well as
   using visual images. These images will be simple
   illustrations and/or symbols. I will continue to
   experiment with these strategies to determine
   which works best for the child.
3. I will present changes in routine and/or
   curriculum gradually. I can accomplish this
   through strategic planning and pre-teaching my
   student(s). This may include an introduction to
   the lesson and vocabulary development prior to
   the entire class. I will also continue my
   practice of posting a daily schedule on the
   board.
4. I will design the students learning so that they
   have choices. By providing choices, students
   will get more involved in their learning and have
   a sense of control.
5. I continue working collaboratively with my
   special education teaching team and begin using
   an Applied behavior analysis (ABA) to meet the
   social and academic needs of my students. This
   attention to teaching functional skills and
   monitoring the students progress continuously
   should improve students efficacy.

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References

• Anderson, D., Lord, C., Risi, S., Shulman, C.,
  Welch, K., DiLavore, P. S., Thurm, A. Pickles,
  A. (2007). Patterns in growth in verbal abilities
  among children with autism spectrum disorder.
  Journal of Consulting and Clinical Psychology,
  75, 594-604.
• Autism Society of America. (2008). Pervasive
  development disorder (PDD). Retrieved July 24,
  2009, from http//www.autism-society.org.html
• Autism Symptom Checklist. (2008). How to teach
  children with autism. Retrieved August 8, 2009,
  from http//www.autism-pdd.net/checklist.html
• Charman, T., Baron-Cohen, S., Swettenham, J.,
  Baird, G., Drew, A., Cox, A. (2003).
  Predicting language outcomes in infants with
  autism and pervasive developmental disorder.
  International Journal of Language and
  Communication Disorders, 38, 265-285.
• Koyama, T. Kurita, H. (2008). Cognitive
  profile difference between normally intelligent
  children with Aspergers disorder and those with
  pervasive developmental disorder not otherwise
  specified. Psychiatry and Clinical
  Neurosciences, 62 (6). Retrieved July 11, 2009,
  from EBSCOhost database.
• Meilleur, A. Fombonne, E. (2009). Regression of
  language and non-language skills in pervasive
  developmental disorders. Journal of Intellectual
  Disability Research, 53 (2). Retrieved August 1,
  2009, from EBSCOhost database.
• Renew, F. (1998). Educating students with
  PDD/Autism the case for rational inclusion.
  Opinion Papers, 120, 141-150.
• Sivers, S. An overview of PDDNOS for early
  childhood professionals PowerPoint slides.
  Retrieved from http//www.sbbh.pitt.edu/files/powe
  rpoint/pddnos.powerpoint.sivers.ppt
• Yale School of Medicine. (2008). Autism/PDD Yale
  Study Center. Retrieved August 1, 2009, from
  http//www.med.yale.edu/chldstdy/autism/pddnos.htm
  l