Hello everyone. I am new here. First off, I really like this board. I've been doing some reading and have enjoyed the threads I've looked at. Very informative.
I have a quick question. My 5 year old was just diagnosed as PDDNOS. She has been in speech since 27 months. She does not exhibit traits from area C of the DSMIV but iwas seen with qualitative impairment in 1A, 1B and 2B with a mild amount of 2A and 2C.
I am getting conflicting info (as I am sure is typical!). Some specialists are telling me a PDDNOS diagnosis at age 5 is unusual. Her former speech teacher does not think she is PDDNOS but has more of a pragmatic speech delay. The other thing is that her issues are not the same in all environments. For example, 1A, 1B and 2B on the DSMIV are more mild at home and around familiar people.
Any thoughts? I am told to keep the diagnosis because she will get services, but I just want to be sure we aren't missing anything here. She does have hypersensitivity to touch and sound.
Thanks for your input. My dd starts kindergarten in 2 weeks, and I am a nervous wreck!
hi
i am shell mum of 6 two with autism one with traits one with lbd
if i can help in any way please ask
http://groups.msn.com/autismaspergersinthefamily
Sorry, I dont know what "1A, 1B, 2A,B, or C is..not memorized.
... what signs is she showing? Thanks:)
Pdd is the dx people get when the diagnosis of autism is missed by one or two of the triad of impairments
this is a litlle about spd which i have copyed from my group
if you need anyhthing please ask or visit my group
Semantic Pragmatic Language Disorder
The term semantic pragmatic disorder (SPD) is sometimes used for a group of children who show possible autistic spectrum tendencies and specific language difficulties that cause complex communication problems.
The following features are common to children with SPD: -
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Inappropriate eye contact/facial expression•
Speech is fluent but lacks content and direction•
Explanations and answers to questions are not specific•
Comprehension is poor, particularly of abstract concepts and understanding can be literal•
Interactive and imaginative play is poorly developed and there is difficulty in recognising and expressing emotion•
There is difficulty following the ‘unwritten’ rules of conversation such as turn-taking,appropriateness and non-verbal language•
Weak temporal concepts cause confusion over school routine and chronological events•
Auditory memory is poor but rote learning is often a strength•
There are poor attention skills, erratic motivation and distractibility•
They rarely ask for help or seek clarification•
Behaviour can be described as naïve or eccentric•
Mechanical reading skills are good but there is limited understanding•
Self esteem is low (this is not a criteria for SPD but is often an unfortunate consequence)•
Can appear rude, arrogant, gaucheA significant contributing factor to the majority of these features is poor auditory-processingskills; the ability to select, assimilate, memorise and systematically store information has enormous impact on language skills of both comprehension and expression. Children with SPD are unable to use language with the same understanding and flexibility as other children.
Possible difficulties in whole class activities
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Lack of attention•
Easily distracted•
Lack of understanding of text and/or vocabulary•
Word retrieval – find it hard to store information about word meaning and need prompts torecall words
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Inability to follow quick verbal interchange•
Slow to respond or inappropriate responses – not applicable/too much•
Inability to follow changes of topic in discussion•
Misuse of tenses through weak concepts of time•
Inability to understand implied meaningStrategies for Whole Class Activities
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Cue in with use of name, key words or other signal•
Use visual cues such as pictures or written word and refer to it frequently•
Encourage attention towards and active processing of key words/phrases by highlighting,underlining and focus on physical aspects of the word.
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List key vocabulary and explain at the beginning of a session. Repeat, recap and refer to this frequently•
Use an individual word box for use with LSA to practice and learn new vocabulary•
Revise relevant words before a session and introduce new words practically if possible • Repeat key information and link to written language and/or vocabulary•
Interrupt inappropriate responses, explaining why you have done this. Make links with what has been offered if possible•
Allow time for thinking•
Use differentiated questioning – closed questions that can be answered or offer multiple choices•
Make clear breaks between changes in topic, point these out if necessary•
Use spatial timeline to aid understanding of past, present and future tenses•
Use an LSA to support and maintain focus on key teaching points•
Explain exactly what you mean or expect the child to do. Make the implicit explicit•
Use visual maps to link ideas for planning, writing or showing sequential story developmentGeneral Strategies
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Child is likely to be a visual ‘hands-on’ learner so give lots of opportunity to take part in practical tasks•
Child likes routine so use a picture diary which signals what is happening now and later• Give short, individual, explicit instructions. For example, ‘Put the cars in the box’, not ‘tidy up’
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Give clear explicit rules including rules for ‘good talking’ and ‘good waiting’•
Explain through the use of role-play, why we need a particular rule•
Praise him constantly when he observes the rule. For example, ‘Good listening Ben’•
Give him practice at giving instructions to other children•
Give him practice at small group conversation skills. These can include a social use of language programme • Pre-tutoring. Tell parents in advance what topics you are going to do or what stories you are going to read in literacy hour•
Develop a positive behaviour programme which ignores unwanted behaviour and praisesthe child when he is right. This avoids dependency on prompts
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Use visual support to teach abstract words, for example; time, quantity and feelings•
Most children with SPD have a limited use of language to explain how they feel. Build uptheir repertoire by commenting as events occur, for example ‘Ben is sad’. If they understand the labels we use to describe their own feelings then they will make a connection with ours
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Try to find some skill with which the child can compete on equal terms with his peers and use it to build his own self-esteem•
Provide a distraction reduced environment to help reduce inappropriate behaviours like flapping, biting and spitting•
Remember that parents may describe very different behaviours at home. Try putting aside a regular time to meet up with them and discuss•
An achievement book may be useful. The rules are described in the back and the front records the child’s progress – for example, going to bed on time, dressing or completing work•
Joint focus between home and school can help children to overcome their resistance to try out new activities
DSMIV
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
1. Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
2. Failure to develop peer relationships appropriate to developmental level
3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
4. Lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. Apparently inflexible adherence to specific, nonfunctional routines or rituals
3. Stereotyped and repetitive motor mannerisms
4. Persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)
E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood
F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
Onset criteria
In DSM-IV, the individual's history must show "a lack of any clinically significant general delay" in language acquisition, cognitive development and adaptive behavior (other than in social interaction). This contrasts with typical developmental accounts of autistic children who show marked deficits and deviance in these areas prior to the age of 3 years. Although the onset criterion is in agreement with Asperger's account, Wing (1981) noted the presence of deficits in the use of language for communication, if not in more specific language skills, in some of her case studies. It is currently uncertain whether the lack of delays in the prescribed areas is a differential factor between AS and autism or, alternatively, a simple reflection of the higher developmental level associated with the usage of the term AS. Other common descriptions of the early development of individuals with AS include a certain precociousness in learning to talk ("he talked before he could walk"), a fascination with letters and numbers -- in fact, the young child may even be able to decode words although with little or no understanding ("hyperlexia") -- and the establishment of attachment patterns to family members but inappropriate approaches to peers and other persons, rather than withdrawal or aloofness as in autism (e.g., the child may attempt to initiate contact with other children by hugging them or screaming at them and then puzzle at their responses). Again, these behaviors are not uncommonly described for higher-functioning autistic children as well, albeit much more infrequently. Qualititative Impairments in Reciprocal Social Interaction
Although the social criteria for AS and autism are identical, the former condition usually involves fewer symptoms and has a generally different presentation than does the latter. Individuals with AS are often socially isolated but are not unaware of the presence of others, even though their approaches may be inappropriate and peculiar. For example, they may engage the interlocutor, usually an adult, in one-sided conversation characterized by long-winded, pedantic speech, about a favorite and often unusual and narrow topic. Also, although individuals with AS are often self-described "loners", they often express a great interest in making friendships and meeting people. These wishes are invariably thwarted by their awkward approaches and insensitivity to other person's feelings, intentions, and nonliteral and implied communications (e.g., signs of boredom, haste to leave, and need for privacy). Chronically frustrated by their repeated failures to engage others and make friendships, some of these individuals develop symptoms of depression that may require treatment, including medication. In regard to the emotional aspects of social transactions, individuals with AS may react inappropriately to, or fail to interpret the valence of, the context of the affective interaction, often conveying a sense of insensitivity, formality, or disregard to the other person's emotional expressions. That notwithstanding, they may be able to describe correctly, in a cognitive and often formalistic fashion, other people's emotions, expected intentions and social conventions, but are unable to act upon this knowledge in an intuitive and spontaneous fashion, thus losing the tempo of the interaction. Such poor intuition and lack of spontaneous adaptation are accompanied by marked reliance on formalistic rules of behavior and rigid social conventions. This presentation is largely responsible for the impression of social naiveté and behavioral rigidity that is so forcefully conveyed by these individuals. As with the majority of the behavioral aspects used to describe AS, at least some of these characteristics are also exhibited by individuals with higher-functioning autism, though, again, probably to a lesser extent. More typically, autistic persons are withdrawn and may seem to be unaware of, and disinterested in, other persons. Individuals with AS, on the other hand, are often keen, sometimes painfully so, to relate to others, but lack the skills to successfully engage them. Qualitative Impairments in Communication
In contrast to autism, there are no symptoms in this area of functioning in the definition of AS. Although significant abnormalities of speech are not typical of AS, there are at least three aspects of these individuals' communication skills which are of clinical interest. First, though inflection and intonation may not be as rigid and monotonic as in autism, speech may be marked by poor prosody. For example, there may a constricted range of intonation patterns that is used with little regard to the communicative functioning of the utterance (assertions of fact, humorous remarks, etc.). Second, speech may often be tangential and circumstantial, conveying a sense of looseness of associations and incoherence. Even though in some cases this symptom may be an indicator of a possible thought disorder, it is often the case that the lack of coherence and reciprocity in speech is a result of the one-sided, egocentric conversational style (e.g., unrelenting monologues about the names, codes, and attributes of innumerable TV stations in the country), failure to provide the background for comments and to clearly demarcate changes in topic, and failure to suppress the vocal output accompanying internal thoughts. The third aspect typifying the communication patterns of individuals with AS concerns the marked verbosity observed, which some authors see as one of the most prominent differential features of the disorder. The child or adult may talk incessantly, usually about their favorite subject, often in complete disregard to whether the listener might be interested, engaged, or attempting to interject a comment, or change the subject of conversation. Despite such long-winded monologues, the individual may never come to a point or conclusion. Attempts by the interlocutor to elaborate on issues of content or logic, or to shift the interchange to related topics, are often unsuccessful. Despite the possibility that all of these symptoms may be accounted for in terms of significant deficits in pragmatics skills and/or lack of insight into, and awareness of, other people's expectations, the challenge remains to understand this phenomenon developmentally as strategies of social adaptation. Restrictive, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities
Although in the DSM-IV definition the criteria for AS and autism are identical, requiring the presence of at least one of the symptoms in the list provided (see table above), it appears that the most commonly observed symptom in this cluster refers to an encompassing preoccupation with restricted patterns of interest. In contrast to autism, where other symptoms in this area may be very pronounced, individuals with AS are not commonly reported to exhibit them with the exception of the all-absorbing preoccupation with an unusual and circumscribed topic, about which vast amounts of factual knowledge are acquired and all too readily demonstrated at the first opportunity in social interaction. Although the actual topic may change from time to time (e.g., every year or two years), it may dominate the content of social interchange as well as the activities of individuals with AS, often immersing the whole family in the subject for long periods of time. Even though this symptom may not be easily recognized in childhood (because strong interests in dinosaurs or fashionable fictional characters are so ubiquitous among young children), it may become more salient later on as interests shift to unusual and narrow topics. This behavior is peculiar in the sense that often times extraordinary amounts of factual information are learned about very circumscribed topics (e.g., snakes, names of stars, maps, TV guides, or railway schedules). Motor Clumsiness
In addition to the required criteria specified above, an additional symptom is given as an associated feature though not a required criterion for the diagnosis of AS, namely delayed motor milestones and presence of "motor clumsiness". Individuals with AS may have a history of delayed acquisition of motor skills such as pedaling a bike, catching a ball, opening jars, climbing "monkey-bars", and so on. They are often visibly awkward, exhibiting rigid gait patterns, odd posture, poor manipulative skills, and significant deficits in visual-motor coordination. Although this presentation contrasts with the pattern of motor development in autistic children, for whom the area of motor skills is often a relative strength, it is similar in some respects to what is observed in older autistic individuals. Nevertheless, the commonality in later life may result from different underlying factors, for example, psychomotor deficits in the case of AS, and poor body image and sense of self in the case of autism. This highlights the importance of describing this symptom in developmental terms.
http://groups.msn.com/autismaspergersinthefamily