Expert: James Michael Roan - 9/2/2008

Question
QUESTION: James,

My 5 year old son was diagnosed with PDD-NOS at age 3.  His main characteristics are language delay and social inappropriateness.  He treats adults the same as his peers, will not respond to their instruction unless and until the adult/teacher speaks very firmly to him and or threatens to put in time out, etc.  He just entered kindergarten in public school and he was sent to the principal twice in his first week.  He just doesn't seem to understand the rules and routine of being in a classroom.  He wants to play with toys and other kids things and will not listen to the teacher.  We have tried everything for discipline - taking away priveledges, spanking, trying to reason with him, rewarding him for good behavior, etc.  I just don't know what else to do.  Is there any advice you can give me?  Is there a book that I can read on discipline for PDD kids?  Do you think medication would help? What can I do to help him focus and follow direction?
Thank you,
Kim in Houston   


ANSWER: Hi Kim;

First, ask the school psychologist to reevaluate him specifically for executive functions and attention. I use the Behavior Rating Inventory of Executive Functioning-Preschool Version (BRIEF-P) and the Brown ADD Scales. These areas are usually impaired in children with PDD-NOS. You want to first determine whether he is capable of "independent" self-regulation and to what degree. Tony Attwood has a really good book: http://www.amazon.com/Complete-Guide-Aspergers-Syndrome/dp/1843106698/ref=pd_bxg

Tony Attwood, other than myself (!), is the definitive expert in this area and explains everything in depth. Children with AS teach us how much our behavior, thinking, and perception is determined by social considerations. It is this latter, "social filtering" that is missing for the most part in these children that makes their behavior so perplexing to us. Our social filtering is natural for us but not for them. The teacher will have to provide a lot of support around the classroom rules perhaps mentioning them at the start of every activity and before the end of a relevant activity. He's not likely to respond in kind when seeing others putting their toys away. That's a social response.

Kind regards,
James

---------- FOLLOW-UP ----------

QUESTION: James,
Thank you for the quick response!  What I am confused about is that you mentioned AS.  I assume you are referring to Aspergers?  My son was not specifically diagnosed with Aspergers but to be honest, I often wonder if it is PDD-NOS or Aspergers.  But, he doesn't seem to have specific characteristics of Aspergers.  He is very friendly, personable, talkative.  He loves to play with other kids and will approach anyone to talk to them. In fact, at first, you would not know that he has any type of PDD until you spend a little time with himH and then you clearly see the characteristics of PDD.  However, as I said, I suspect that he may have some Asperger characteristics and you are the first person to suggest that to me so I would like to hear your opinion on PDD-NOS vs Aspergers.  Is PDD-NOS the same as Aspergers?  
Thank you,
Kim

Answer
Hi Kim;

There are no reliable differences between high functioning autism, AS, or PDD-NOS. They arose at different times by different people or groups. Psychologists began to realize that, although there were children who did not meet all criteria for a diagnosis of autism they certainly shared some characteristics in common with them, and therefore needed another diagnostic category. The category of Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) was born. Meanwhile, in the 1980s, Lorna Wing stumbled across a body of work collected by Hans Asperger in 1944 who was studying a cohort of boys later to be known as having Asperger's syndrome (AS), a phrase coined by Lorna Wing. While Dr. Wing was beginning to publish some of her earlier work, medical doctors, psychologists, and others began to use the unofficial phrase of "high functioning autism," separated from classic autism by an IQ above 70 and typically being in the Average to High-average range. In fact, IQ is the best single predictor of future adjustment by these folks. Finally, around this same time in the recognition that autism did not present as a homogeneous fixed category, that it was best described as an "autism spectrum disorder," which is a descriptive label and not an official diagnostic categorical label. Whew!

Kind regards,
James