Expert: James Michael Roan - 8/24/2008

Question
My son was diagnosed with PDD-NOS by the school district and autism by his developmental pediatrician when he was 3 years old.  He has been through lots of ABA, speech, ocupational, and sensory intergration therapies.  I also use a lot of the floor time approach at home.  He is now 5 years old and his diagnosises remain the same.  Now, I do not deny that my son has serious problems.  He is 5 years 1 month and only became completely potty trained about 2 months ago, he loves playing with his spit ( he has some occasional flapping, but not like he did when he was 3), he doesn't have much imaginary/pretend play (but he does have some, its just limited due to the lang. limitations), his fine motor skills are like a 3 year old, and his expressive language is more like a 2 1/2 year old.  But that said, his receptive language is more like a 3 year old, his academic skills are age appropriate, and he is very affectionate.  He loves to play "chase me" with his little brother, he brings me books for me to read to him all the time, he loves to play hide and seek under the covers with me, and loves hugs and kisses and just cuddling in general.  I have never seen him lining things up, he always turns when I say his name and comes running to me when i call him or when i pick him up after school.  I know my son has serious developmental delays, but I'm begining to doubt the "ASD" diagnosis.  Can you have a serious language processing problem and not have autism spectrum disorder? Or do you think that it is just that as he receives more therapy, he is just becoming higher-functioning, all-be-it, still autistic?

Answer
Hi Leticia;

Both scenarios have an equal likelihood of being true. I know that does not help you, so I will attempt to elaborate. First I'll discuss the option of language disordered with no autism and secondly discuss improvement as a result of intervention.

1. Many behaviors associated with autism, such as stereotypies and the need for sameness are due to impairments in the prefrontal lobe of the brain at the subcortical level. These areas are also associated with impairment in individuals with AD/HD. So, a child can look to some to have autism and not really have it.

2. The second scenario involves improvements in a child, hopefully, as a result of intervention. I have seen near miraculous recoveries, which makes me suspect the first scenario was what was going on all along. In PDD-NOS, which is high functioning autism, you have a child with average to above-average IQ. The higher the IQ, the better the prognosis. Again, it's difficult separate out which contributes most to improvement: IQ or intervention. I'd have to vote for IQ first in that it obviously influences a child's response to intervention.

The only way to know for sure is that when a child suspected of having PDD-NOS is reassessed in all areas affected by autism and found to be in the "normal" typically developing range. I see this 2 or 3 times in 150 children on the spectrum.

Kind regards,
James