Expert: James Michael Roan - 1/19/2008

Question
my 18 month old son is being evaluated at the moment.. through this time so many things are being thrown out at us and the most recent that someone said they see him falling into is the category of PPD.  I have tried to research it, but it all comes up the same.  I don't know what it is? nothing is clear about the disorder if it is even one. any information you can give to clarify PPD would be greastly appreciated. thank you

Answer
Hi Nicole;

I assume you are referring to Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)?

Although there continues to be a debate around whether there is a difference between PDD-NOS, high functioning autism (HFA), and Asperger's syndrome (AS). I can find no differnces between them at all.

All three diagnostic labels, as you can see, refer to a high functioning form of autism and they are distinguished from "classic" autism on the basis of an intelligence in the Average to Above-average range.

The outlook for a child with PDD-NOS is quite god although social difficulties extend throughout the life span.

If you have specific questions I can help to answer them.

I have included a copy of information from my web page:

www.autismspectrumdisorderfoundation.org

Asperger’s Syndrome

Portions of this material obtained from the National Institute of Mental Health [ Link to: http://www.ninds.nih.gov/disorders/asperger/asperger.htm]


What is Asperger’s Syndrome?

Asperger’s Syndrome (AS) is an autism spectrum disorder (ASD) and is one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior.  Other ASDs include: classic autism, Rett syndrome, childhood disintegrative disorder, high functioning autism (HFA), and pervasive developmental disorder not otherwise specified (PDD-NOS). Unlike children with autism, children with AS retain their early language skills.

The most distinguishing symptom of AS is a child’s obsessive interest in a single object or topic to the exclusion of any other. Children with AS want to know everything about their topic of interest and their conversations with others will be about little else. Their expertise, high level of vocabulary, and formal speech patterns make them seem like little professors.  Other characteristics of AS include repetitive routines or rituals; peculiarities in speech and language; socially and emotionally inappropriate behavior and the inability to interact successfully with peers; problems with non-verbal communication; and clumsy and uncoordinated motor movements.

Children with AS are isolated because of their poor social skills and narrow interests. They may approach other people, but make normal conversation impossible by inappropriate or eccentric behavior, or by wanting only to talk about their singular interest. Children with AS usually have a history of developmental delays in motor skills such as pedaling a bike, catching a ball, or climbing outdoor play equipment. They are often awkward and poorly coordinated with a walk that can appear either stilted or bouncy.  


How is it diagnosed?

Asperger’s Syndrome, because it is a high functioning form of an ASD, is more difficult to detect as early as more severe forms of ASD. Children with Asperger’s Syndrome (AS) generally develop expressive language earlier than receptive language, thus giving the impression to caregivers of “normal,” even advanced development. Many children with AS are hyperlexic, meaning they can read at a very high level with little or no comprehension. As a result, most children with AS are not identified until the age of 6 or 7, when social impairments begin to stand out to parents and school staff members.

As with autism, the Diagnostic and Statistical Manual-Fourth Edition-Text Revision (DSM-IV TR) provides specific criteria for making a formal diagnosis of AS:

1.   Student must have impairment in social interaction, as manifested by at least two of the following (possible examples with each):

Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
   He makes limited eye contact with the person in which he is speaking.
   Her facial expressions do not change to demonstrate points.

      Failure to develop peer relationships appropriate to developmental level
   Friends are much younger than his actual age.
   Does not have a large group of peer friends.

A lack of spontaneous seeking to share enjoyment, interest or achievements with    other people
   Does not point out objects that would be of interest to other people.
   She does not congratulate the winner of a game.

     Lack of social or emotional reciprocity
   He interrupts others talking in a social setting.
   She does not understand how to appropriately engage in small talk.

2.   Student must have restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
Encompassing preoccupation with one or more stereotyped and restricted patterns  of interest that is abnormal either in intensity or focus
   Student talks continuously about a topic of interest, such as Pokemon. He may be able to tell you specific details about every character.
   Parents learn more about World War II battles than they ever cared to know from their daughter.

        Apparently inflexible adherence to specific, nonfunctional routines or rituals
   Student refuses to go to an assembly at school because it is not part of a normal day.
   School began on a two hour delay and she will not do math at 10:30 because math is done at 8:45 .

         Stereotyped and repetitive motor mannerisms
   Student often engages in hand or finger flapping when frustrated or excited.
   Student rocks in seat during times of frustration.

       Persistent preoccupation with parts of objects
   Student plays with parts of toys instead of how the toy was intended.
   Student would rather take things apart than use the whole object.

3.   The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
4.   There is no clinically significant general delay in language (researchers are debating this topic presently.)
5.   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.
6.   Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

During the last few years, screening instruments have been devised to screen for Asperger’s Syndrome and higher functioning autism. The Autism Spectrum Screening Questionnaire (ASSQ),  the Australian Scale for Asperger's Syndrome [link to: http://www.udel.edu/bkirby/asperger/aspergerscaleAttwood.html], and the most recent, the Childhood Asperger Syndrome Test (CAST) [link to: http://www.autismresearchcentre.com/tests/cast_test.asp], are some of the instruments that are reliable for identification of school-age children with Asperger’s Syndrome or higher functioning autism. These tools concentrate on social and behavioral impairments in children without significant language delay.

Is there any treatment?

The ideal treatment for AS coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness.  There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.  

An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior. It may include social skills training, cognitive behavioral therapy, medication for co-existing conditions, and other measures.

The goal of treatment should not be to “normalize” the person with AS, but to help them to feel good about who they are. Children with AS can have a very difficult time navigating the social world they are immersed in. Treatment should center around ways to make and keep friends, and, to maintain positive self-esteem.



What is the prognosis?

With effective treatment, children with AS can learn to cope with their uniqueness, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.  


Organizations

MAAP Services for Autism, Asperger's, and PDD
P.O. Box 524
Crown Point, IN   46308
info@maapservices.org
http://www.maapservices.org
Tel: 219-662-1311
Fax: 219-662-0638

Autism Network International (ANI)
P.O. Box 35448
Syracuse, NY   13235-5448
jisincla@mailbox.syr.edu
http://ani.autistics.org

Autism Society of America
7910 Woodmont Ave.
Suite 300
Bethesda, MD   20814-3067
http://www.autism-society.org
Tel: 301-657-0881 800-3AUTISM (328-8476)
Fax: 301-657-0869

Autism Research Institute (ARI)
4182 Adams Avenue
San Diego, CA   92116
director@autism.com
http://www.autismresearchinstitute.com
Tel: 619-281-7165
Fax: 619-563-6840

National Institute of Mental Health (NIMH)
National Institutes of Health, DHHS
6001 Executive Blvd. Rm. 8184, MSC 9663
Bethesda, MD   20892-9663
nimhinfo@nih.gov
http://www.nimh.nih.gov
Tel: 301-443-4513/866-615-NIMH (-6464) 301-443-8431 (TTY)
Fax: 301-443-4279

National Institute on Deafness and Other Communication Disorders Information Clearinghouse
1 Communication Avenue
Bethesda, MD   20892-3456
nidcdinfo@nidcd.nih.gov
http://www.nidcd.nih.gov
Tel: 800-241-1044 800-241-1055 (TTD/TTY)


Kind regards,
James