PDD-NOS

1. PDD-NOS Pervasive Developmental Disorder-Not Otherwise Specified By Katie Kerr and Caitlin Tully

2. PDD-NOS • On the autism spectrum (atypical autism). • “Pervasive” means it affects multiple types of development. • PDD-NOS diagnosis maybe made when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors. • This disorder is also referred to as atypical personality development, atypical PDD, or atypical autism. This is a catchall diagnosis to include children who share some of the signs and symptoms of the pervasive developmental disorders, but do not meet the diagnostic criteria of any particular disorder.

3. Symptoms Children with PDD vary widely in abilities, intelligence and behaviors Communication - children with PDD may be verbal or non-verbal. difficulty in the understanding and use of language. Socialization - children with PDD may have difficulty in understanding and relating to people, events, and objects in the environment. Limited social skills are common in children with PDD. Unable to understand and process social cues. Stimulation - may experience over/under sensitivities in the five senses, exhibit repeated body movements (hand flapping, rocking), and aggressive and/or self-injurious behaviors may be present. Unusual responses to sensory information, such as; light or loud noise, is common. Routines - many children with PDD are resistant to changes in routines and may have a great deal of difficulty with transitions. They also may exhibit repetitive play skills.

4. Personal Experience? • Has anyone had any experience working with a child with PDD?

5. What PDD may look like in the classroom • Children may show signs of: • Problems understanding and using language • Difficulty relating to people, objects and events • Unusual play with toys and other objects • Difficulty with changes in routine or in familiar surroundings • Repetitive body movements or behavior patterns “PDD not otherwise specified may describe a child aged 9 years with poor peer interactions, normal verbal abilities, and mild nonverbal disabilities. The mild nonverbal disabilities make it difficult for the child to follow subtle social cues that most children easily interpret as anxiety, anger, or sadness. The child's preoccupation with a restricted interest and attention to detail often tires the patience of peers with similar interests who are developing normally.” What the disorder may look like earlier in life…. Children may not have the capacity to share joint attention, for example; pointing to an object and engaging in communication with adults

6. Specific Behaviors Linked to PDD Developmental Social Seems to prefer being alone. Seems indifferent to other people. Resists hugs or cuddling. Doesn’t respond to parent’s display of affection or anger. Doesn’t read or observe social cues. Has difficulty regulating his emotions Displays "immature" behavior such as inappropriate crying or verbal outbursts. Is disruptive and physically aggressive. Loses control in a strange environment. Loses control when angry or frustrated. Acts aggressively, including breaking things or attacking others. Hurts himself by banging his heads, pulling his hair, or biting his arms. • Doesn’t babble or make meaningful gestures by 1 year of age. • Doesn’t speak one word by 16 months. • Doesn’t combine two words by 2 years. • Doesn’t respond to his name. Doesn’t make normal eye contact. Doesn’t know how to play with toys. Doesn’t smile. • Doesn’t seem to hear • Becomes overly attached to one particular toy.

7. Prevalence and Diagnosis • More common in boys than girls. • The characteristic behaviors of Autism Spectrum Disorders may or may not be apparent • in infancy (18 to 24 months), but usually become obvious during early childhood (24 months to 6 years). • The current estimate is that they occur in from 2 to 6 per 1,000 children.

8. Causes • No specific cause is known. • The ASA states that current research links PDD to biological and neurological differences in the brain. • There does appear to be a genetic basis to the disorder because of the pattern of autism and related disabilities in families. But no gene has been directly linked to autism. • Recent research in genetics reveal that different combinations of defective genes, and one gene itself may result in the same presentation of PDD • Other factors that may play a role in the etiology: levels of dysfunction in the CNS system, the immune system, and other cognitive deficits • What is known is that autism is not a mental illness, children with autism do not choose to behave in the manner that they do, and it is not caused by poor parenting.

9. Cure • Medically, there is no cure for the differences in the brain which result in autism. • Better understanding of the disorder has led to the development of better coping mechanisms and strategies. Some of these symptoms may lessen as the child ages; others may disappear altogether. With appropriate intervention, some behaviors can be positively changed. • The majority of children and adults will, however, continue to exhibit some manifestations of autism to some degree throughout their entire lives.

10. Treatment • There is no known cure for PDD • Early intervention plays a critical role in improving the outcome of children with PDD • Education is the most effective treatment for school aged children with PDD • Children with PDD have unusual intellectual and academic profiles that vary: • No two children are alike. Therefore, no one program exists that will meet the needs of every individual with PDD. • To meet the needs of the individual child, it is critical to examine the child’s strengths, weaknesses and unique needs when determining an appropriate educational placement and developing an Individualized Educational Plan (IEP).

11. Education Plan for PDD-NOS • When formulating a program for a child with PDD: • An effective, comprehensive program should reflect an understanding and awareness of autism and PDD • Parent-professional communication and collaboration is essential • On-going training and education in autism for parents and professionals who work with individuals with autism. • Inclusion with typically developing peers is important for a child with autism. Peers are the best models for language and social/play skills. However, the child will not learn by simply being in the environment. It is also necessary to facilitate activities that will address specific skills. • A comprehensive IEP should be based on the child’s strengths and weaknesses • Goals-communication, social behavior, challenging behavior, and academic and functional skills. Some children benefit the most with: Small class size Specialized classroom with one on one instruction Integrated classrooms with additional support

12. Education with PDD • Post a schedule for the day, write instructions on the board or on their paper. Make sure to send home important announcements and written instructions for assignments. Easier to understand with a visual representation of elapsed time.

13. Social Stories • prepares the child for an uncertain event, shares important information, and gives her a strategy to deal with it. • used to increase the student’s understanding of a situation, make the student feel more comfortable, and provide appropriate responses for the situation.  • Social stories work especially well for children with autism spectrum disorders because often they lack the ability to see situations from the • perspective of others, may miss important social cues , tend to dislike surprises, and tend to respond well to repetition. • recommended that you also incorporate visuals into the stories.

14. Example 1 When Other Children Get Upset Sometimes other children get upset and cry. When this happens their teacher or babysitter might try to help them. The teacher or babysitter might try to help them by talking to them or holding them. This is okay. Sometimes when other children get upset and cry, it makes me upset and angry. I can use words to tell my teacher or babysitter that I am upset. I can say, "That makes me mad!" or "I'm upset!" It is okay to use words about how I feel. When I get upset I will try to use words about how I feel.

15. How to Write a Social Story • Define the problem • Affirmative statement of the solution • Write down what works & where. There is a logical solution to the problem. • Make a plan • Indicate the benefits for that child, the way they would see it • Great resources to find free social stories to print: http://www.freewebs.com/kidscandream/page13.htm http://www.thewatsoninstitute.org/teacher-resources2.jsp?pageId=2161392240601226415747290

16. Now It’s Your Turn! • Choose from the following and make a social story that you think would benefit a child with PDD • Taking turns when playing a game. • Waiting in line. • Being nice to friends. • Making a mistake • Or come up with your own!

17. Social ScriptsExamples: Lunch time and School Friends • What kind of ice cream do you like best? • Chocolate __________ • Vanilla ____________ • Strawberry ________ • Pickle _____________ • Other _____________ • What is your favorite school subject? • Math ______________ • Reading ____________ • History _____________ • Science _____________ • Other_______________ used for students who have trouble with starting conversations

18. Other Treatment Options • Applied Behavior Analysis (ABA)-most effective way to teach young children • Specific skills are taught by breaking them into small steps that build on each other (B.F Skinner-all behavior is motivated by the consequences of our actions.) • Therapy for children with PDD should be specialized according to need • Sensory integration (SI)- assisting individuals to process and use sensory information. • Auditory Integration Therapy (assistive technology piece) • Medications are sometimes prescribed to address certain behaviors, such as; Ritalin for a hyperactivity component

19. Treatment-Cont. Nutrition diets for individuals with PPD: • Gluten-free, • anti-yeast, • Feingold diet (no artificial colors and flavorings)

20. The role of the family of a Child with PDD • For the family of a child with PDD (important to focus on family as well as child) • Do not isolate yourself and your child • Get over caring about what other people think • Get your child’s worst behaviors under control • Keep your sense of humor and take time to laugh • Do what you can to stay healthy • Remember that you are only human Teach your child: • Basic communication • To wait • Create schedules • Be consistent

21. Fun for Children with PDD • Occupational Therapy Sensory Integration Summer Day Camp • fun stimulating activities. • Sensory-Driven decision making and priority setting-based on children’s needs • starts "low & slow", letting each child grow and learn at his or her own speed. Our approach builds from the bottom up and from the outside in. • Any child who needs to escape the camp's routine has several options such as the "Moon Room“ and the playground. • The Moon Room is lit with black lights which illuminate lots of day-glow stars, moons, and squishy toys. It is lined with crash cushions, mats, and pillows.

22. References Chantal, S-K. (2004). Autism spectrum disorders. New York: A Perigee Book. This resource truly was the complete guide to understanding autism and autism spectrum disorders.  It focuses on diagnosis and treatment of these disorders. Lathe, R. (2006). Autism, brain, and environment. London: Jessica Kingsley Publishers.              This resource was written by a man who has done an extensive amount of research on autism spectrum disorders.  The book focused on the diagnosis  and factors that influence PDD and other spectrum disorders.   NICHCY (2003). Autism spectrum disorders. Accessed July 1,2011 from: http://nichcy.org/disability/specific/autism             NICHCY stands for the national dissemination center for children with disabilities.  This website provided a PDF of facts and statistics about autism spectrum disorders.  Wallin, J. (2010). Teaching children with autism. Accessed July 12, 2011 from http://www.polyxo.com/     Polyxo.com is a resource for parents, professionals, or anyone interested in teaching children with autism or other related developmental disorders.  This resource discussed how the social stories can prepare children for events that they have are not used and can give them a strategy to deal with it.   National Institute of Neurological Disorders and Stroke, www. Ninds.nih.gov/disorders/pdd/pdd.htm This website offers information and an overview of the disorder. Families and educators can visit this site for an overview of what to expect to see in children who present as PDD. www.medicineonline.com This website is a great resource for families and educators to read about the many treatment options available for children with PDD. www.enzymestuff.com/conditionpdd.htm This website offers detailed information on diet as treatment options for symptoms of PDD. http://addadhdadvances.com/PDD.html This website offers current research on the topic and provides valuable information about PDD and advances in the field of finding the causes and possible treatments. https://mail.wheelock.edu/exchweb/bin/redir.asp?URL=http://www.oneplaceforspecialneeds.com/resources_online/resource_online_results.html?words=social%2Bstories This is a great website for teachers and families to review real social stories and scripts that have worked. The stories and scripts are free to print. http://www.freewebs.com/kidscandream/page13.htm http://www.thewatsoninstitute.org/teacher-resources2.jsp?pageId=2161392240601226415747290 Another great site that offers free printables to use at home or in the classroom.