Expert: Paul Johnson - 11/14/2009

Question
Hi, Several years ago my now 13 year old son was given the label of PDD-NOS through difficulties with making friends at school.  Since his transition to high school he has encountered difficulties with some of his male peers, namely through verbal bullying.  He has had difficulties making good friends, but does talk to other children.  Due to concerns by the school about the friction between him and these other boys, I was encouraged to apply for an autistic review of my son, but the review team felt he did not meet the criteria for a diagnosis of high functioning autism.  My son is deemed to be partly responsible for the friction, because the teachers say he will retort back to someone who tries to annoy him or hit back. He has been told to report any incidents.

The problem I have at home with him is that he steals on and off from myself, my father and his brother and sisters.  If money or treats are left lying about, he is sorely tempted.  We expect it to happen, so we don't leave anything lying around often.  I seldom have problems about him communicating with me until he steals something.  Most of the time he will outright deny he had anything to do with it and appear trustworthy.  However, if he knows I am aware he did it, I will meet a wall of silence on this single subject - he will communicate on other things, but divulge no information about what was taken. The money is usually taken for things to eat - at times I think he comfort eats.  I also feel he uses the money to 'fit in' at school, but he tells me he mostly buys junk food with it.  I find it hard to know how to discipline him correctly for stealing.  I'm aware he is under emotional pressure yet I have to deter him from taking without permission.  I always make him pay back what he owes from Christmas and birthday money and pocket money no matter how long it takes and I give him chores to do, but he willingly does the chores and causes no fuss.  I have also banned him from using the computer which I don't like doing, because I feel it is like a lifeline for him, but I don't know how to break the habit.  He seldom mixes with friends outside school.  In general my relationship with him is very warm and loving - he just becomes silent if I question him about something he shouldn't have been doing and he will not respond to my questions for some time, giving me very little eye contact either.  At school I have been told he generally gives very good eye contact.  Any suggestions you might have would be welcomed.

Answer
Hey Cara,

Thank you for you interesting and challenging question. It does appear that your son is on the spectrum but I am not sure why he did not qualify for HFA. This would help the school to understand him better. I think he needs assistance to discover exactly what his diaagnosis is because PDD-NOS is quite the watered down diagnosis and is in general what a clincian gives when they do not know what to diagnose. It is akin to a zoo having an animal on display that is called a critter. A critter is not a scientific specific classification and thus the special qualities and needs of the aninmal can not be attended to nor appreciated.

It is clear your son is challenged to express himself clearly and will need to be rewarded for expressing himself more. He needs to tell the school what he needs. He needs to tell the bully boys to back off and he needs to tell you what he needs. Do you see the pattern?

He needs to be able to tell you what he needs and the resources necessary. Lieing is a sign that he does not know how to explain his needs. It is easy to lie when one does not know how to justify their needs.

My son is 14 and he was diagnosed with PDD-NOS 3 months ago and I see there is a need to help him develop a "voice". He does not talk much and people do not appreciate his knowledge and inimical strengths. You will need to require him to share much more what he needs and how he will intends to interact with the world. Without these skills, (which he is capable of doing),
you are looking at a life time of dependency on others to do things for him. The likelihood of being victimze is high without the skills of expressing himself.

One last note. It is going to take more advocay on our parts as parents for clincians to be more accurate with their diagnosis because we are talking about peoples lives here. The DSM V,(manual for mental diagnosis) is due in 2011 and recommendations are accepted in a couple of months. I recommend that the designation of PDD-NOS be eliminated.