Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS )

1. Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) By Dina Kennedy

2. What is PDD-NOS? The labels “PDD” and “PDD-NOS” have created a great deal of disagreement and confusion among professionals. According to the Yale School of Medicine website(2008) , Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) “is a ‘subthreshold’ condition in which some –but not all – features of autism or another explicitly identified Pervasive Developmental Disorder are identified” (Retrieved August 1, 2009). PDD-NOS falls beneath the umbrella of Autistic Spectrum Disorder. PDD-NOS has also been referred to as “atypical personality development,” “atypical PDD,” and “atypical autism”. Symptoms of PDD-NOS can range from mild to severe. According to an article defining PDD-NOS by the American Psychiatric Association (1994), “At a diagnostic level, when a child is labeled with an ‘autistic disorder’, they display six or more of twelve symptoms in three major areas. These areas are: social interaction, communication and behavior. Children diagnosed with PDD-NOS may demonstrate similar behaviors but don’t meet the specific ‘autistic disorder’ criteria” (Retrieved July 24, 2009). Let’s look at some of the characteristics a child with PDD-NOS may display. . .

3. Characteristics of Children Diagnosed with PDD-NOS: • Social Interaction: Children may appear withdrawn and avoid eye contact, seem insensitive or unemotional to other people’s feelings by a lack of facial responsiveness, separation anxiety and/or stranger anxiety, desire to play in isolation avoiding contact with peers. • Communication: Difficulty expressing needs appropriately, some verbal abilities are delayed, inappropriate laughing , echolalia, may not understand humor or sarcasm, difficulty with pronunciation and/or grammar, difficulty with language pragmatics (for example, A child with PDD-NOS may understand, “Give me a hand,” as actually removing an actual hand and giving it to someone.) lack of imagination, abstraction or emotion. • Behavior: May resist changes in routine, may be very physical or very non-physical, may have an abnormal response(s) to one or a combination of senses: sight, hearing, touch, balance, smell, taste and reaction to pain, may appear to have unreasonable fears without regard to “real dangers”.

4. Article #1 Review In the study titled Regression of Language and Non-Language Skills in Pervasive Developmental Disorders by Meilleur and Fombonne (2009), 1 out of 5 children diagnosed with PDD suffer from some form of regression in language and non-language skills. The study also looked at the ages of the beginning of the regression. Meilleur and Fombonne found that these children demonstrated regression due to their repetitive behaviors. The study founded that although abnormal behaviors appeared to begin at the point of regression, it was determined that the abnormal behaviors were present before the regression.

5. Meilleur and Fombonne advocate that if a teacher can identify the indicators of “abnormal behavior”, regression can be targeted. By using a Functional behavioral assessment (FBA) and addressing the student’s needs with a Positive behavioral intervention and support (PBIS), teachers will better understand the “abnormal behavior” and the factors that surround it. This information will assist all members of the students support team (general education teacher, special education teacher, speech pathologist, counselor, psychologist, administrator, parents, etc.) in building effective and successful Individualized Education Plans (IEPs) for the child. Inclusion will be difficult for the child diagnosed with PDD but that depends on the severity and the management of the behaviors present. Meilleur and Fombonne provided some useful strategies to work towards improving language and non-language skills which included direct instruction techniques, behavior management and providing instruction in natural settings. Meilleur, A. & Fombonne, E. (2009). Regression of language and non-language skills in pervasive developmental disorders. Journal of Intellectual Disability Research, 53 (2). Retrieved August 1, 2009, from EBSCOhost database.

6. Article #2 Review In the article titled, Cognitive Profile Difference Between Normally Intelligent Children with Asperger’s Disorder and Those with Pervasive Developmental Disorder Not Otherwise Specified, Koyama and Kurita (2008) found that children diagnosed with different autistic spectrum disorders, but common IQ levels have specific cognitive abilities. They studied two groups. The first group was children who are normally intelligent and diagnosed with Asperger’s Disorder. The second group was children who are normally intelligent and diagnosed with Pervasive Development Disorder-Not Otherwise Specified. The mean age of both groups was 7.6 years. Koyama and Kurita used the Japanese version of the Wechsler Intelligence Scale to measure IQ. Both groups were assessed in verbal ability, freedom from distractibility, arithmetic, coding and digit span. The study concluded that both groups scored low in comprehension. Children with Asperger’s scored higher in verbal and mathematical abilities. The study did find that both groups scores was affected by their extreme slowness and drive for perfection.

7. The study comparing the two groups is a powerful tool in considering the range of abilities and performance levels that may be present in the general education setting. The focus on the speed of performance amongst both groups provides vital information in designing accommodations and modifications to curriculum and learning in the general education classroom setting. These are both essential factors regarding inclusion for children with Asperger’s and PDD-NOS. Koyama, T. & Kurita, H. (2008). Cognitive profile difference between normally intelligent children with Asperger’s disorder and those with pervasive developmental disorder not otherwise specified. Psychiatry and Clinical Neurosciences, 62 (6). Retrieved July 11, 2009, from EBSCOhost database.

8. Article #3 Review In the article titled, Educating Students with PDD/Autism: The Case for Rational Inclusion (1998), although slightly dated, Fred Renew followed and discussed the educational path of two young boys who are diagnosed with PDD-NOS. Renew found that a focus on two approaches to planning services for students with Pervasive Developmental Disabilities was a valuable tool for families and professionals in making good decisions based on diverse thinking. These two approaches separate “former allies” in the special education community. One group believes that “full inclusion” is the answer no matter the severity of the disability. Their belief is that getting the child into the classroom is the true measurement of success. Teacher preparation, peer acceptance and classroom modifications can happen later. The other group believes that inclusion is an “ongoing process”. They have labeled this “ongoing process” rational inclusion. This group’s belief is that pre-planning for inclusion will make it the most successful for the student.

9. The young boy who was part of a “rational inclusion” process proved to be the most successful. The sequential and well thought out structures that the school leadership team put into place provided a strong foundation for the young man and his family to depend and rely on. The preparation of the teacher, classmates and other classroom variables were seen as prerequisites to the full inclusion. The study concluded that a more “rational” versus “doctrinal” approach in thinking will result in a more successful school inclusion. Renew, F. (1998). Educating students with PDD/Autism: the case for rational inclusion. Opinion Papers, 120, 141-150.

10. Recommendations for Inclusion for Students With PDD-NOS: • Diminish distractions in the classroom setting (noise, unnecessary visuals, seating in high traffic areas, etc,). • Work one-on-one to address student’s need for perfection on assignments. • Make modifications to student learning concerning verbal communication skills (break language acquisition skills into smaller parts).

11. Recommendations (continued) • Work collaboratively to build effective IEPs to meet the student’s academic and social goals. • Utilize Functional behavioral assessment (FBA) to analyze behavior and determine “next steps”. • Provide Positive behavioral intervention and support (PBIS). This is another tool to use to build collaboration and common language within the child’s support team.

12. Recommendations (continued) • Identify and provide support for families (education, training, financial assistance, etc.) • Have learning support systems (speech pathologist, psychologist, instructional assistants, etc.) in place for the child and work together to design the child’s learning, ongoing assessment and “next steps”. • Continue professional development of special education teaching skills and current research.

13. How I Will Apply This Information to My Own Classroom? • I will provide a classroom environment that is not a distraction to my student(s) with PDD-NOS. This will include locating the child out of high-traffic areas, monitoring the brightness of lights and controlling unnecessary noises. For example, I know from personal experience, that it is important to be informed when emergency drills will be taking place due to their noise and disturbance of routine. • My instructions will be clear and concise. I will provide these in a written format as well as using visual images. These images will be simple illustrations and/or symbols. I will continue to experiment with these strategies to determine which works best for the child. • I will present changes in routine and/or curriculum gradually. I can accomplish this through strategic planning and pre-teaching my student(s). This may include an introduction to the lesson and vocabulary development prior to the entire class. I will also continue my practice of posting a daily schedule on the board. • I will design the students learning so that they have choices. By providing choices, students will get more involved in their learning and have a sense of “control”. • I continue working collaboratively with my special education teaching team and begin using an Applied behavior analysis (ABA) to meet the social and academic needs of my students. This attention to teaching functional skills and monitoring the students progress continuously should improve student’s efficacy.

14. References Anderson, D., Lord, C., Risi, S., Shulman, C., Welch, K., DiLavore, P. S., Thurm, A. & Pickles, A. (2007). Patterns in growth in verbal abilities among children with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 75, 594-604. Autism Society of America. (2008). Pervasive development disorder (PDD). Retrieved July 24, 2009, from http://www.autism-society.org.html Autism Symptom Checklist. (2008). How to teach children with autism. Retrieved August 8, 2009, from http://www.autism-pdd.net/checklist.html Charman, T., Baron-Cohen, S., Swettenham, J., Baird, G., Drew, A., & Cox, A. (2003). Predicting language outcomes in infants with autism and pervasive developmental disorder. International Journal of Language and Communication Disorders, 38, 265-285. Koyama, T. & Kurita, H. (2008). Cognitive profile difference between normally intelligent children with Asperger’s disorder and those with pervasive developmental disorder not otherwise specified. Psychiatry and Clinical Neurosciences, 62 (6). Retrieved July 11, 2009, from EBSCOhost database. Meilleur, A. & Fombonne, E. (2009). Regression of language and non-language skills in pervasive developmental disorders. Journal of Intellectual Disability Research, 53 (2). Retrieved August 1, 2009, from EBSCOhost database. Renew, F. (1998). Educating students with PDD/Autism: the case for rational inclusion. Opinion Papers, 120, 141-150. Sivers, S. An overview of PDDNOS for early childhood professionals [PowerPoint slides]. Retrieved from http://www.sbbh.pitt.edu/files/powerpoint/pddnos.powerpoint.sivers.ppt Yale School of Medicine. (2008). Autism/PDD Yale Study Center. Retrieved August 1, 2009, from http://www.med.yale.edu/chldstdy/autism/pddnos.html