Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)

1. Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) An Overview of PDDNOS for Early Childhood Professionals By Stephanie Sivers

2. Learner Objectives Participants in this seminar will be able to: • Define PDDNOS and possible “causes” • Identify the differences between PDDNOS and other Pervasive Developmental Disorders • List beneficial ways to support a child with PDDNOS in your classroom

3. What is PDDNOS? • PDDNOS is a member of the Pervasive Developmental Disorder “family” • The different developmental disabilities within this category share similar characteristics • PDDNOS is often referred to as a “spectrum” disorder, meaning that symptoms can range from mild to severe

4. Diagnostic Criteria for PDDNOS Any combination of the following characteristics may be displayed by a child with PDDNOS: • Deficiencies in Social Behavior: avoiding eye contact, apathy concerning emotions with a lack of facial responsiveness, the lack of typical attachment behaviors (atypical separation and stranger anxiety), lack of interest in playing with other children • Nonverbal Communication Impairment: pulling caregiver to object of desire, lack of imitation (of caregivers or other children), absence of gesturing • Impairment in Understanding Speech:some children are able to follow straightforward commands paired with gestures, humor and sarcasm are not always understood, it is a possibility that some children who have PDDNOS and also have mental retardation will not develop a complete understanding of speech (Tsai, 2003)

5. Diagnostic Criteria (cont.) • Difficulties Concerning Speech Development:infants might not babble or they might stop babbling, echolalia (repetition of words or phrases), flat delivery of speech, problems with pronunciation, irregular grammar, lack of imagination, abstraction, or emotion • Unusual Behavioral Patterns: opposition to changes in routines, ritualistic/compulsive behaviors (including repetitive acts), peculiar attachments to objects and preoccupation with atypical objects or features of an object, under– or over– responsiveness to sensory stimuli • Movement Disturbances: delay in typical motor milestones, atypical characteristics such as hand flapping or twisting, walking on tiptoes, body rocking, head banging (Tsai, 2003)

6. Diagnostic Criteria (cont.) • Shortfalls in Intelligence and Cognitive Abilities:in general, children with PDDNOS test well in areas concerning visual skills or immediate memory, but less so on tasks involving abstract or symbolic thought and chronological logic. Children oftentimes have difficulties with imitation, understanding words and gestures, using information already learned, inventive learning, applying rules. Due to differences in speech development, some children are not able to be adequately tested in terms of intelligence. • Other Features of PDDNOS: flat, inappropriate, or extreme emotional response, labile affect (sob or scream at one time, laughing and “silly” behaviors at another time), seemingly unreasonable fears without regard to “real” dangers (Tsai, 2003)

7. How PDDNOS is Diagnosed • A diagnosis of PDDNOS should be considered if a child does not meet the diagnostic criteria for: • A specific Pervasive Developmental Disorder • Schizophrenia • Schizotypical Personality Disorder • Avoidant Personality Disorder • PDDNOS shares very similar characteristics with Autistic Disorder, but they are not the same. • Onset of Autism is before age 3, PDDNOS may have a later onset • Autistic Disorder must include a certain number of items from diagnostic criteria– PDDNOS does not • Oftentimes, a diagnosis of PDDNOS is met due to a child not quite having “enough” symptoms of Autism

8. Assessing and treating PDDNOS is a lot like trying to put together a puzzle whose pieces do not quite fit—no child is the same or has the same combinations of symptoms, which makes understanding this disorder quite challenging.

9. Prevalence How common is PDDNOS?

10. How Many Children are Affected? • Due to the ever-changing way in which children with Autism Spectrum Disorders are being classified, an exact prevalence can only be estimated. • The Center for Disease Control’s (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network indicated in 2007 that every 1 in 150 children has an Autism Spectrum Disorder • Prevalence has increased since 2004 – at this time the prevalence was 1 in 166 • PDDNOS is four times more likely to affect boys than girls • Ethnicity does not seem to be a factor that affects the prevalence of PDDNOS

11. What about PDDNOS? • Exact prevalence of PDDNOS is unknown aside from the prevalence of Autism Spectrum Disorders as a whole • Prevalence of Autistic Disorder is higher than that of PDDNOS • PDDNOS is sometimes diagnosed before Autistic Disorder due to the young age of a child when symptoms typically appear

12. What Causes PDDNOS? What brings about this disorder? What affects it?

13. Is There a Known Cause? • Unfortunately, there is no known cause of PDDNOS. • Studies strongly suggest that PDDNOS is caused by a neurological abnormality • Brain scans indicate that brains of children with Autism are different in shape and structure when compared with children who do not have Autism • Researchers agree that children are born with PDDNOS or with the potential to develop it • In other words, parenting techniques or other psychological factors have not been shown to cause PDDNOS

14. Genetics and Family • Theoretically, there may be a genetic basis for PDDNOS • A single gene or cluster of genes has not been identified • In some families, a “pattern” of Pervasive Developmental Disorders is apparent • A lot of research still needs to be conducted in order to determine a genetic or inherited cause for PDDNOS

15. MMR Vaccine • A lot of attention has been focused on Autism (PDDNOS falling under this label) being caused by the MMR vaccine • There is no scientific evidencethat supports this theory • A possible explanation for the onset of a developmental disorder at the time of the MMR vaccine is timing • Children receive the first round of MMR around their first birthday… characteristics of Autism/PDDNOS commonly begin to show around this age as well (some children are diagnosed around 18 months)

16. The Role of the Early Childhood Professional You play a vital role in the identification and treatment of PDDNOS in the children you encounter.

17. Miss Austin, My husband and I are worried about Denny ‘s interactions with other children. Denny does not engage with other children during “play dates” – even if he is familiar with them. By two and a half, our daughter interacted well with peers. We are hoping that you could observe Denny’s interactions with the children in day care. Should we be concerned? Sincerely, Rhonda Adams

18. Why You Are Important • As an early childhood professional, you see the same children in day care or preschool on a consistent basis • You interact with and observe children in a setting outside of the home • You are trained to know the developmental milestones that are usually reached by a certain age • You might be the first person to notice something that is “not typical” about a particular child • Early intervention can be successful for children with pervasive developmental disorders… but these disorders must be identified!

19. If You Suspect a Child to Have PDDNOS… • Talk with the parents/caregivers before you take any action • Include them in this process – set up a meeting and discuss your concerns • Have information ready for the parents/caregivers • Chances are they will not know what the next step is – help them if they request your assistance • Provide feedback to any professionals that are screening the child • Be as thorough as you can! What you say can really help a professional to paint a clear picture of the child’s difficulties

20. Steps to Diagnose PDDNOS • Doctors should be conducting regular developmental screenings during the 9-, 18-, and 24- or 30-month appointments • If a child is suspected to display symptoms, he or she should undergo a comprehensive evaluation: • Screening for any medical problems (such as hearing loss) that could be affecting the child’s behavior • Developmental history • Parent/teacher interviews • Clinical observations • Use of one or more screening instruments (diagnostic scales) • Psychological testing

21. Common Treatments • Traditional Treatment Methods: • Positive Behavioral Support (usually works best in a structured, consistent environment) • Appropriate Educational Environment (in some cases, special education environment involving inclusion) • Medical Intervention (medication in conjunction with other treatments) • Psychological Care (counseling and ongoing evaluations) • Less Traditional Treatment Methods: • Facilitated Communication Therapy • Auditory Integration Therapy (AIT) • Sensory Integration Therapy • Lovaas Method • Vitamin Therapy • Anti-Yeast Therapy (*A parent should notify you of any less traditional method being used*)

22. How PDDNOS Commonly Affects Life in Day Care or Preschool • A child with PDDNOS does not respond well to disruptions in the daily schedule • Field trips, assemblies, and other changes in the schedule might elicit tantrums or other behavioral difficulties • There is a good chance that all classroom activities will not interest a child with PDDNOS • Some children with this disorder become fixated on particular objects or activities • Language delay/impairment can affect communication abilities • Due to the individualistic nature of PDDNOS, a specific child could have other difficulties in a classroom

23. Legal Safeguards in Pennsylvania The services that should be provided by the state government for children with PDDNOS

24. Legal Safeguards in PA • In PA, children under the age of 3 are granted Early Intervention (EI) services • Under the Individual with Disabilities Education Act (IDEA) children identified with a disability age birth to 3 years are to be granted EI • EI does not require a diagnosis, but a child must exhibit a delay that meets eligibility requirements • There is currently a SHORTAGE of professionals who are available to diagnose Autism and related developmental disorders • A school psychologist is eligible in Pennsylvania to diagnose Autism (PA Department of Public Welfare, n.d.)

25. Legal Safeguards in PA • In order to receive educational services, a parent must request an evaluation for their child • A teacher or physician can also recommend to the parents that an evaluation is done • If the child is eligible for EI, then a plan is developed to identify the services/support that a family will need: • The Individual Family Support Plan (IFSP) for birth to 3 years • And then an Individual Education Plan (IEP) for 3-5 years and school age • The services that are provided at school differ from county to county based on knowledge of Autism Spectrum Disorders (PA Department of Public Welfare, n.d.)

26. Legal Safeguards in PA • Under IDEA, any child who is determined to have a “disability” is entitled to free appropriate public education (FAPE) if his/her disability is determined to bring about the need for special education in order to help out educationally • Autism is a part of the disability categories • It is not always easy to receive help for a child with PDDNOS because the disability categories specifically include “Autism” – NOT PDDNOS! • This problem is recognized by PA and funds are out there to support children with PDDNOS, although sometimes it is short-term • However, the process of receiving help can be frustrating and long for parents of a child does not have a diagnosis of Autism (PA Department of Public Welfare, n.d.)

27. Legal Safeguards in PA • If a child does qualify as having a “disability,” they will most likely receive (given their circumstances): • Special Education (in most cases) with an IEP • Extended schooling until age 21 (depending on cognitive needs) • Medicaid medical assistance • Wraparound services to aid the family • Due to the individualistic nature of PDDNOS, services will not be the same for every child • The major “battle” is receiving these services in the first place! (PA Department of Public Welfare, n.d.)

28. What You Can Do as an Early Childhood Professional Actions that might reduce or improve symptoms of PDDNOS

29. If There is a Child With PDDNOS in Your Classroom… • Learn about PDDNOS and understand the characteristics of the disorder that the child has • Create a structured classroom environment – children with PDDNOS respond well to routines and schedules • If there will be a change in schedule, inform the child and prepare him/her for the change

30. What to do (cont.) • Understand what interests the child and create activities that incorporates the interests • Create opportunities for social interactions that involve structure and support • When giving directions, try 2-step verbal directions paired with visual and physical prompts (as needed) • Oftentimes, children with PDDNOS need concrete directions because they have difficulties deciphering tones and expressions • Consider a reinforcement schedule

31. Resources for Early Childhood Professionals • The child’s IEP • Read very carefully – provide specific needs that the child may have • Visit the websites listed at the end of the slideshow for more information on PDDNOS • Resources in Pittsburgh • National organizations

32. What to Avoid Actions that Early Childhood Educators should stay away from with a child who has PDDNOS

33. Try to Avoid… • Inconsistency in the schedule • An environment that is constantly changing will possibly trigger problematic behaviors, such as tantrums • Full inclusion (unless noted otherwise on the IEP) • It is unrealistic in most cases to expect a child with PDDNOS to participate in all classroom activities due to ability level and interest • Ignoring the special needs of a child • In most cases, he/she will be in a special education classroom, but in the event that a child with PDDNOS (or who may have PDDNOS) is in your day care or preschool classroom, avoid expecting him/her to function like a child without a developmental disorder

34. Case Study: Now, let’s look at a case study of Denny – a child with PDDNOS. He was first introduced in a “note” to his day care teacher earlier in this presentation. (see page 7)

35. Information for Parents • Included with your handout is a brochure designed for parents • It includes an overview of PDDNOS as well as treatment options and additional resources Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)

36. Recommended Reading for Children • In addition to a parent-friendly brochure, some child-friendly books are available to help siblings (and classmates!) understand PDDNOS • Andy and His Yellow Frisbee by Mary Thompson • A new girl at school tries to make friends with Andy, an autistic boy. His protective older sister watches their interaction. • Keisha’s Doors: An Autism Story by Marvie Ellis (in English and Spanish) • An older sister is confused as to why her little sister (Keisha) won’t play with her. The family discovers that Keisha has autism and they find out what autism means to them. • All About My Brother by Sarah Peralta • An eight-year-old author describes her younger brother who has autism. Interesting account from a child’s view.

37. Where to Find More Information and Help in Pittsburgh • The Autism Center of Pittsburgh: • http://www.autismcenterofpittsburgh.com/ • Provides therapies, parent support, and information • The Autism Society of Pittsburgh: • http://www.autismsocietypgh.org/ • Refers families to programs and services, provide legal information • Advisory Board on Autism and Related Disorders (ABOARD): • http://www.aboard.org/ • Supplies free information and family support

38. Online and National Resources • Pennsylvania’s Department of Public Welfare – Autism Services • http://www.dpw.state.pa.us/ServicesPrograms/Autism/ • Information concerning legal rights to services for a child/adult with Autism • Autism Society of America: • http://www.autism-society.org/ • Community of parents and professionals who know about living with Autism • Autism Speaks & Cure Autism Now Foundation: • http://www.autismspeaks.org/ • Opportunities for information and involvement • Autism-PDD Resources Network: • http://www.autism-pdd.net/ • Information and support network with resources and postings for local events/conferences

39. Glossary • Pervasive Developmental Disorders: a diagnostic category of childhood disorders that includes five disorders that are distinguished by delays in the development of a variety of “basic” functions. (1) • Autism Spectrum Disorders: Includes Autistic Disorder, PDDNOS, and Asperger’s Disorder. (1) • MMR Vaccine: a vaccine for the immunization of measles, mumps, and rubella (German measles) that is first administered to children around their first birthday, and then again before they start school (ages 4-5). (2) • Labile: a term referring to an affect that is unsteady and changing. For example, a child with a labile affect might sob or scream at one time, and then start laughing or acting “silly” in another instance. • (Tsai, 2003) • 2. (U.S. Department of Health and Human Services: Centers for Disease Control and Prevention, 2007)

40. Glossary • Schizophrenia: a psychotic disorder in which an individual is not quite in touch with reality and oftentimes has delusions and hallucinations, as well as emotional and behavioral disturbances. (3) • Schizotypical Personality Disorder: a personality disorder in which an individual has difficulties relating to others and has peculiar in behavior, thought, and appearance. (3) • Avoidant Personality Disorder: a personality disorder that is characterized by keeping away from the formation of new relationships due to a fear of rejection or humiliation and social withdrawal. (3) 3. (American Psychiatric Association, 2000)

41. References • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. Text Revision). Washington DC: American Psychiatric Press. • Autism Society of America. (n.d.). Understanding Autism. Retrieved October 21, 2007, from http://www.autism-society.org/site/PageServer?pagename=about_whatis_home • Ellis, M. (2005). Keisha’s doors: An autism story. Round Rock, TX: Speech Kids Texas Press, Inc. • National Dissemination Center for Children with Disabilities. (2007). Disability fact sheet– no. 1: Autism/PDD [Brochure]. NICHCY staff: Authors. • National Institute of Mental Health. (2007). Autism spectrum disorders: Pervasive developmental disorders [Brochure]. Strock, M.: Author. • PA Department of Public Welfare (n.d.) Pennsylvania Autism task force subcommittee reports. Retrieved October 21, 2007, from http://www.dpw.state.pa.us/ServicesPrograms/Autism/TaskForce/ • Peralta, S. (2002). All about my brother. Shawnee Mission, KS: Autism Asperger Publishing Co. • Thompson, M. (1996). Andy and his yellow frisbee. Bethesda, MD: Woodbine House, Inc. • Tsai, L.Y. (2003). Briefing paper: Pervasive developmental disorders. The National Dissemination Center for Children with Disabilities, FS20, 1-15. • U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. (2007). Autism information center. Retrieved October 21, 2007, from http://www.cdc.gov/ncbddd/autism/index.htm • All images obtained through the Microsoft Clip Art Gallery.

42. Contact information • Stephanie Sivers • E-mail: steph32185@hotmail.com