Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)

1
Pervasive Developmental Disorder Not Otherwise
Specified (PDDNOS)

• An Overview of PDDNOS for
• Early Childhood Professionals
• By Stephanie Sivers

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Learner Objectives

• Participants in this seminar will be able to
• Define PDDNOS and possible causes
• Identify the differences between PDDNOS and other
  Pervasive Developmental Disorders
• List beneficial ways to support a child with
  PDDNOS in your classroom

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What is PDDNOS?

• PDDNOS is a member of the Pervasive Developmental
  Disorder family
• The different developmental disabilities within
  this category share similar characteristics
• PDDNOS is often referred to as a spectrum
  disorder, meaning that symptoms can range from
  mild to severe

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Diagnostic Criteria for PDDNOS
Any combination of the following characteristics
may be displayed by a child with PDDNOS

• Deficiencies in Social Behavior avoiding eye
  contact, apathy concerning emotions with a lack
  of facial responsiveness, the lack of typical
  attachment behaviors (atypical separation and
  stranger anxiety), lack of interest in playing
  with other children
• Nonverbal Communication Impairment pulling
  caregiver to object of desire, lack of imitation
  (of caregivers or other children), absence of
  gesturing
•  Impairment in Understanding Speech some
  children are able to follow straightforward
  commands paired with gestures, humor and sarcasm
  are not always understood, it is a possibility
  that some children who have PDDNOS and also have
  mental retardation will not develop a complete
  understanding of speech

(Tsai, 2003)
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Diagnostic Criteria (cont.)

• Difficulties Concerning Speech Development
  infants might not babble or they might stop
  babbling, echolalia (repetition of words or
  phrases), flat delivery of speech, problems with
  pronunciation, irregular grammar, lack of
  imagination, abstraction, or emotion
• Unusual Behavioral Patterns opposition to
  changes in routines, ritualistic/compulsive
  behaviors (including repetitive acts), peculiar
  attachments to objects and preoccupation with
  atypical objects or features of an object, under
  or over responsiveness to sensory stimuli
• Movement Disturbances delay in typical motor
  milestones, atypical characteristics such as hand
  flapping or twisting, walking on tiptoes, body
  rocking, head banging

(Tsai, 2003)
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Diagnostic Criteria (cont.)

• Shortfalls in Intelligence and Cognitive
  Abilities in general, children with PDDNOS test
  well in areas concerning visual skills or
  immediate memory, but less so on tasks involving
  abstract or symbolic thought and chronological
  logic. Children oftentimes have difficulties with
  imitation, understanding words and gestures,
  using information already learned, inventive
  learning, applying rules. Due to differences in
  speech development, some children are not able to
  be adequately tested in terms of intelligence.
• Other Features of PDDNOS flat, inappropriate, or
  extreme emotional response, labile affect (sob or
  scream at one time, laughing and silly
  behaviors at another time), seemingly
  unreasonable fears without regard to real
  dangers

(Tsai, 2003)
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How PDDNOS is Diagnosed

• A diagnosis of PDDNOS should be considered if a
  child does not meet the diagnostic criteria for
• A specific Pervasive Developmental Disorder
• Schizophrenia
• Schizotypical Personality Disorder
• Avoidant Personality Disorder

• PDDNOS shares very similar characteristics with
  Autistic Disorder, but they are not the same.
• Onset of Autism is before age 3, PDDNOS may have
  a later onset
• Autistic Disorder must include a certain number
  of items from diagnostic criteria PDDNOS does
  not
• Oftentimes, a diagnosis of PDDNOS is met due to a
  child not quite having enough symptoms of
  Autism

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Assessing and treating PDDNOS is a lot like
trying to put together a puzzle whose pieces do
not quite fitno child is the same or has the
same combinations of symptoms, which makes
understanding this disorder quite challenging.  
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Prevalence

• How common is PDDNOS?

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How Many Children are Affected?

• Due to the ever-changing way in which children
  with Autism Spectrum Disorders are being
  classified, an exact prevalence can only be
  estimated.
• The Center for Disease Controls (CDC) Autism and
  Developmental Disabilities Monitoring (ADDM)
  Network indicated in 2007 that every 1 in 150
  children has an Autism Spectrum Disorder
• Prevalence has increased since 2004 at this
  time the prevalence was 1 in 166
• PDDNOS is four times more likely to affect boys
  than girls
• Ethnicity does not seem to be a factor that
  affects the prevalence of PDDNOS

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What about PDDNOS?

• Exact prevalence of PDDNOS is unknown aside from
  the prevalence of Autism Spectrum Disorders as a
  whole
• Prevalence of Autistic Disorder is higher than
  that of PDDNOS
• PDDNOS is sometimes diagnosed before Autistic
  Disorder due to the young age of a child
• when symptoms typically appear

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What Causes PDDNOS?

• What brings about this disorder?
• What affects it?

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Is There a Known Cause?

• Unfortunately, there is no known cause of PDDNOS.
• Studies strongly suggest that PDDNOS is caused by
  a neurological abnormality
• Brain scans indicate that brains of children with
  Autism are different in shape and structure when
  compared with children who do not have Autism
• Researchers agree that children are born with
  PDDNOS or with the potential to develop it
• In other words, parenting techniques or other
  psychological factors have not been shown to
  cause PDDNOS

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Genetics and Family

• Theoretically, there may be a genetic basis for
  PDDNOS
• A single gene or cluster of genes has not been
  identified
• In some families, a pattern of Pervasive
  Developmental Disorders is apparent
• A lot of research still needs to be conducted in
  order to determine a genetic or inherited cause
  for PDDNOS

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MMR Vaccine

• A lot of attention has been focused on Autism
  (PDDNOS falling under this label) being caused by
  the MMR vaccine
• There is no scientific evidence that supports
  this theory
• A possible explanation for the onset of a
  developmental disorder at the time of the MMR
  vaccine is timing
• Children receive the first round of MMR around
  their first birthday characteristics of
  Autism/PDDNOS commonly begin to show around this
  age as well (some children are diagnosed around
  18 months)

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The Role of the Early Childhood Professional

• You play a vital role in the identification and
  treatment of PDDNOS in the children you encounter.

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Miss Austin, My husband and I are worried about
Denny s interactions with other children. Denny
does not engage with other children during play
dates even if he is familiar with them. By
two and a half, our daughter interacted well with
peers. We are hoping that you could observe
Dennys interactions with the children in day
care. Should we be concerned? Sincerely, Rhonda
Adams
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Why You Are Important

• As an early childhood professional, you see the
  same children in day care or preschool on a
  consistent basis
• You interact with and observe children in a
  setting outside of the home
• You are trained to know the developmental
  milestones that are usually reached by a certain
  age
• You might be the first person to notice something
  that is not typical about a particular child
• Early intervention can be successful for children
  with pervasive developmental disorders but these
  disorders must be identified!

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If You Suspect a Child to Have PDDNOS

• Talk with the parents/caregivers before you take
  any action
• Include them in this process set up a meeting
  and discuss your concerns
• Have information ready for the parents/caregivers
• Chances are they will not know what the next step
  is help them if they request your assistance
• Provide feedback to any professionals that are
  screening the child
• Be as thorough as you can! What you say can
  really help a professional to paint a clear
  picture of the childs difficulties

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Steps to Diagnose PDDNOS

• Doctors should be conducting regular
  developmental screenings during the 9-, 18-, and
  24- or 30-month appointments
• If a child is suspected to display symptoms, he
  or she should undergo a comprehensive evaluation
• Screening for any medical problems (such as
  hearing loss) that could be affecting the childs
  behavior
• Developmental history
• Parent/teacher interviews
• Clinical observations
• Use of one or more screening instruments
  (diagnostic scales)
• Psychological testing

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Common Treatments

• Traditional Treatment Methods
• Positive Behavioral Support (usually works best
  in a structured, consistent environment)
• Appropriate Educational Environment (in some
  cases, special education environment involving
  inclusion)
• Medical Intervention (medication in conjunction
  with other treatments)
• Psychological Care (counseling and ongoing
  evaluations)

• Less Traditional Treatment Methods
• Facilitated Communication Therapy
• Auditory Integration Therapy (AIT)
• Sensory Integration Therapy
• Lovaas Method
• Vitamin Therapy
• Anti-Yeast Therapy
• (A parent should notify you of any less
  traditional method being used)

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How PDDNOS Commonly Affects Life in Day Care or
Preschool

• A child with PDDNOS does not respond well to
  disruptions in the daily schedule
• Field trips, assemblies, and other changes in the
  schedule might elicit tantrums or other
  behavioral difficulties
• There is a good chance that all classroom
  activities will not interest a child with PDDNOS
• Some children with this disorder become fixated
  on particular objects or activities
• Language delay/impairment can affect
  communication abilities
• Due to the individualistic nature of PDDNOS, a
  specific child could have other difficulties in a
  classroom

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Legal Safeguards in Pennsylvania

• The services that should be provided by the state
  government for children with PDDNOS

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Legal Safeguards in PA

• In PA, children under the age of 3 are granted
  Early Intervention (EI) services
• Under the Individual with Disabilities Education
  Act (IDEA) children identified with a disability
  age birth to 3 years are to be granted EI
• EI does not require a diagnosis, but a child must
  exhibit a delay that meets eligibility
  requirements
• There is currently a SHORTAGE of professionals
  who are available to diagnose Autism and related
  developmental disorders
• A school psychologist is eligible in Pennsylvania
  to diagnose Autism

(PA Department of Public Welfare, n.d.)
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Legal Safeguards in PA

• In order to receive educational services, a
  parent must request an evaluation for their child
• A teacher or physician can also recommend to the
  parents that an evaluation is done
• If the child is eligible for EI, then a plan is
  developed to identify the services/support that a
  family will need
• The Individual Family Support Plan (IFSP) for
  birth to 3 years
• And then an Individual Education Plan (IEP) for
  3-5 years and school age
• The services that are provided at school differ
  from county to county based on knowledge of
  Autism Spectrum Disorders

(PA Department of Public Welfare, n.d.)
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Legal Safeguards in PA

• Under IDEA, any child who is determined to have a
  disability is entitled to free appropriate
  public education (FAPE) if his/her disability is
  determined to bring about the need for special
  education in order to help out educationally
• Autism is a part of the disability categories
• It is not always easy to receive help for a child
  with PDDNOS because the disability categories
  specifically include Autism NOT PDDNOS!
• This problem is recognized by PA and funds are
  out there to support children with PDDNOS,
  although sometimes it is short-term
• However, the process of receiving help can be
  frustrating and long for parents of a child does
  not have a diagnosis of Autism

(PA Department of Public Welfare, n.d.)
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Legal Safeguards in PA

• If a child does qualify as having a disability,
  they will most likely receive (given their
  circumstances)
• Special Education (in most cases) with an IEP
• Extended schooling until age 21 (depending on
  cognitive needs)
• Medicaid medical assistance
• Wraparound services to aid the family
• Due to the individualistic nature of PDDNOS,
  services will not be the same for every child
• The major battle is receiving these services in
  the first place!

(PA Department of Public Welfare, n.d.)
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What You Can Do as an Early Childhood Professional

• Actions that might reduce or improve symptoms of
  PDDNOS

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If There is a Child With PDDNOS in Your Classroom

• Learn about PDDNOS and understand the
  characteristics of the disorder that the child
  has
• Create a structured classroom environment
  children with PDDNOS respond well to routines and
  schedules
• If there will be a change in schedule, inform the
  child and prepare him/her for the change

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What to do (cont.)

• Understand what interests the child and create
  activities that incorporates the interests
• Create opportunities for social interactions that
  involve structure and support
• When giving directions, try 2-step verbal
  directions paired with visual and physical
  prompts (as needed)
• Oftentimes, children with PDDNOS need concrete
  directions because they have difficulties
  deciphering tones and expressions
• Consider a reinforcement schedule

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Resources for Early Childhood Professionals

• The childs IEP
• Read very carefully provide specific needs that
  the child may have
• Visit the websites listed at the end of the
  slideshow for more information on PDDNOS
• Resources in Pittsburgh
• National organizations

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What to Avoid

• Actions that Early Childhood Educators should
  stay away from with a child who has PDDNOS

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Try to Avoid

• Inconsistency in the schedule
• An environment that is constantly changing will
  possibly trigger problematic behaviors, such as
  tantrums
• Full inclusion (unless noted otherwise on the
  IEP)
• It is unrealistic in most cases to expect a child
  with PDDNOS to participate in all classroom
  activities due to ability level and interest
• Ignoring the special needs of a child
• In most cases, he/she will be in a special
  education classroom, but in the event that a
  child with PDDNOS (or who may have PDDNOS) is in
  your day care or preschool classroom, avoid
  expecting him/her to function like a child
  without a developmental disorder

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Case Study

• Now, lets look at a case study of Denny a
  child with PDDNOS. He was first introduced in a
  note to his day care teacher earlier in this
  presentation.
• (see page 7)

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Information for Parents

• Included with your handout is a brochure designed
  for parents
• It includes an overview of PDDNOS as well as
  treatment options and additional resources

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Recommended Reading for Children

• In addition to a parent-friendly brochure, some
  child-friendly books are available to help
  siblings (and classmates!) understand PDDNOS
• Andy and His Yellow Frisbee by Mary Thompson
• A new girl at school tries to make friends with
  Andy, an autistic boy. His protective older
  sister watches their interaction.
• Keishas Doors An Autism Story by Marvie Ellis
  (in English and Spanish)
• An older sister is confused as to why her little
  sister (Keisha) wont play with her. The family
  discovers that Keisha has autism and they find
  out what autism means to them.
• All About My Brother by Sarah Peralta
• An eight-year-old author describes her younger
  brother who has autism. Interesting account from
  a childs view.

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Where to Find More Information and Help in
Pittsburgh

• The Autism Center of Pittsburgh
• http//www.autismcenterofpittsburgh.com/
• Provides therapies, parent support, and
  information
• The Autism Society of Pittsburgh
• http//www.autismsocietypgh.org/
• Refers families to programs and services, provide
  legal information
• Advisory Board on Autism and Related Disorders
  (ABOARD)
• http//www.aboard.org/
• Supplies free information and family support

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Online and National Resources

• Pennsylvanias Department of Public Welfare
  Autism Services
• http//www.dpw.state.pa.us/ServicesPrograms/Autism
  /
• Information concerning legal rights to services
  for a child/adult with Autism
• Autism Society of America
• http//www.autism-society.org/
• Community of parents and professionals who know
  about living with Autism
• Autism Speaks Cure Autism Now Foundation
• http//www.autismspeaks.org/
• Opportunities for information and involvement
•  
• Autism-PDD Resources Network
• http//www.autism-pdd.net/
• Information and support network with resources
  and postings for local events/conferences

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Glossary

• Pervasive Developmental Disorders a diagnostic
  category of childhood disorders that includes
  five disorders that are distinguished by delays
  in the development of a variety of basic
  functions. (1)
• Autism Spectrum Disorders Includes Autistic
  Disorder, PDDNOS, and Aspergers Disorder. (1)
• MMR Vaccine a vaccine for the immunization of
  measles, mumps, and rubella (German measles) that
  is first administered to children around their
  first birthday, and then again before they start
  school (ages 4-5). (2)
• Labile a term referring to an affect that is
  unsteady and changing. For example, a child with
  a labile affect might sob or scream at one time,
  and then start laughing or acting silly in
  another instance.

• (Tsai, 2003)
• 2. (U.S. Department of Health and Human
  Services Centers for Disease Control and
  Prevention, 2007)

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Glossary

• Schizophrenia a psychotic disorder in which an
  individual is not quite in touch with reality and
  oftentimes has delusions and hallucinations, as
  well as emotional and behavioral disturbances.
  (3)
• Schizotypical Personality Disorder a personality
  disorder in which an individual has difficulties
  relating to others and has peculiar in behavior,
  thought, and appearance. (3)
• Avoidant Personality Disorder a personality
  disorder that is characterized by keeping away
  from the formation of new relationships due to a
  fear of rejection or humiliation and social
  withdrawal. (3)

3. (American Psychiatric Association, 2000)
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References

• American Psychiatric Association. (2000).
  Diagnostic and statistical manual of mental
  disorders (4th ed. Text Revision). Washington DC
  American Psychiatric Press.
• Autism Society of America. (n.d.). Understanding
  Autism. Retrieved October 21, 2007, from
  http//www.autism-society.org/site/PageServer?page
  nameabout_whatis_home
• Ellis, M. (2005). Keishas doors An autism
  story. Round Rock, TX Speech Kids Texas Press,
  Inc.
• National Dissemination Center for Children with
  Disabilities. (2007). Disability fact sheet no.
  1 Autism/PDD Brochure. NICHCY staff Authors.
• National Institute of Mental Health. (2007).
  Autism spectrum disorders Pervasive
  developmental disorders Brochure. Strock, M.
  Author.
• PA Department of Public Welfare (n.d.)
  Pennsylvania Autism task force subcommittee
  reports. Retrieved October 21, 2007, from
  http//www.dpw.state.pa.us/ServicesPrograms/Autism
  /TaskForce/
• Peralta, S. (2002). All about my brother. Shawnee
  Mission, KS Autism Asperger Publishing Co.
• Thompson, M. (1996). Andy and his yellow frisbee.
  Bethesda, MD Woodbine House, Inc.
• Tsai, L.Y. (2003). Briefing paper Pervasive
  developmental disorders. The National
  Dissemination Center for Children with
  Disabilities, FS20, 1-15.
• U.S. Department of Health and Human Services
  Centers for Disease Control and Prevention.
  (2007). Autism information center. Retrieved
  October 21, 2007, from http//www.cdc.gov/ncbddd/a
  utism/index.htm
• All images obtained through the Microsoft Clip
  Art Gallery.

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Contact information

• Stephanie Sivers
• E-mail steph32185_at_hotmail.com