PDD-NOSPDD-NOSPervasive Developmental Pervasive Developmental

Disorder-Not Otherwise SpecifiedDisorder-Not Otherwise Specified

By Katie Kerr and Caitlin TullyBy Katie Kerr and Caitlin Tully

PDD-NOSPDD-NOS On the autism spectrum (atypical On the autism spectrum (atypical

autism).autism). ““Pervasive” means it affects Pervasive” means it affects

multiple types of development.multiple types of development. PDD-NOS diagnosis maybe made PDD-NOS diagnosis maybe made

when a child does not meet the when a child does not meet the criteria for a specific diagnosis, but criteria for a specific diagnosis, but there is severe and pervasive there is severe and pervasive impairment in specified behaviors.impairment in specified behaviors.

This disorder is also referred to as This disorder is also referred to as atypical personality development, atypical personality development, atypical PDD, or atypical autism. atypical PDD, or atypical autism. This is a catchall diagnosis to This is a catchall diagnosis to include children who share some of include children who share some of the signs and symptoms of the the signs and symptoms of the pervasive developmental disorders, pervasive developmental disorders, but do not meet the diagnostic but do not meet the diagnostic criteria of any particular disorder. criteria of any particular disorder.

SymptomsSymptomsChildren with PDD vary widely in abilities, intelligence and

behaviors

Communication Communication - children with PDD may be verbal or non-verbal.- children with PDD may be verbal or non-verbal. difficulty in the understanding and use of language. difficulty in the understanding and use of language.

Socialization Socialization - children with PDD may have difficulty in understanding - children with PDD may have difficulty in understanding and relating to people, events, and objects in the environment. Limited and relating to people, events, and objects in the environment. Limited social skills are common in children with PDD.social skills are common in children with PDD.

Unable to understand and process social cues.Unable to understand and process social cues.

Stimulation Stimulation - may experience over/under sensitivities in the five senses, - may experience over/under sensitivities in the five senses, exhibit repeated body movements (hand flapping, rocking), and exhibit repeated body movements (hand flapping, rocking), and aggressive and/or self-injurious behaviors may be present. Unusual aggressive and/or self-injurious behaviors may be present. Unusual responses to sensory information, such as; light or loud noise, is responses to sensory information, such as; light or loud noise, is common.common.

Routines Routines - many children with PDD are resistant to changes in routines - many children with PDD are resistant to changes in routines and may have a great deal of difficulty with transitions. They also may and may have a great deal of difficulty with transitions. They also may exhibit repetitive play skills.exhibit repetitive play skills.

Personal Experience?Personal Experience?

Has anyone had any experience Has anyone had any experience working with a child with PDD?working with a child with PDD?

What PDD may look like What PDD may look like in the classroomin the classroom

Children may show signs of:Children may show signs of: Problems understanding and using languageProblems understanding and using language Difficulty relating to people, objects and eventsDifficulty relating to people, objects and events Unusual play with toys and other objectsUnusual play with toys and other objects Difficulty with changes in routine or in familiar surroundingsDifficulty with changes in routine or in familiar surroundings Repetitive body movements or behavior patternsRepetitive body movements or behavior patterns““PDD not otherwise specified may describe a child aged 9 years with poor peer interactions, 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 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 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 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.” to detail often tires the patience of peers with similar interests who are developing normally.”

What the disorder may look like earlier in life….What the disorder may look like earlier in life….Children may not have the capacity to share joint attention, for example; pointing to Children may not have the capacity to share joint attention, for example; pointing to

an object and engaging in communication with adultsan object and engaging in communication with adults

Specific Behaviors Specific Behaviors Linked to PDDLinked to PDD

DevelopmentalDevelopmental Doesn’t babble or make Doesn’t babble or make

meaningful gestures by 1 meaningful gestures by 1 year of age.year of age.

Doesn’t speak one word by Doesn’t speak one word by 16 months.16 months.

Doesn’t combine two words Doesn’t combine two words by 2 years.by 2 years.

Doesn’t respond to his Doesn’t respond to his name. Doesn’t make normal name. Doesn’t make normal eye contact. Doesn’t know eye contact. Doesn’t know how to play with toys. how to play with toys. Doesn’t smile.Doesn’t smile.

Doesn’t seem to hearDoesn’t seem to hear Becomes overly attached Becomes overly attached

to one particular tto one particular toy.oy.

SocialSocial Seems to prefer being alone.Seems to prefer being alone. Seems indifferent to other people.Seems indifferent to other people. Resists hugs or cuddling.Resists hugs or cuddling. Doesn’t respond to parent’s display of Doesn’t respond to parent’s display of

affection or anger.affection or anger. Doesn’t read or observe social cues.Doesn’t read or observe social cues. Has difficulty regulating his emotionsHas difficulty regulating his emotions Displays "immature" behavior such as Displays "immature" behavior such as

inappropriate crying or verbal outbursts.inappropriate crying or verbal outbursts. Is disruptive and physically aggressive.Is disruptive and physically aggressive. Loses control in a strange Loses control in a strange

environment.environment. Loses control when angry or Loses control when angry or

frustrated.frustrated. Acts aggressively, including breaking Acts aggressively, including breaking

things or attacking others.things or attacking others. Hurts himself by banging his heads, Hurts himself by banging his heads,

pulling his hair, or biting his arms.pulling his hair, or biting his arms.

Prevalence and Prevalence and DiagnosisDiagnosis

More common in boys than More common in boys than girls.girls.

The characteristic The characteristic behaviors of Autism behaviors of Autism Spectrum Disorders may or Spectrum Disorders may or may not be apparentmay not be apparent

in infancy (18 to 24 in infancy (18 to 24 months), but usually months), but usually become obvious during become obvious during early childhood (24early childhood (24

months to 6 years).months to 6 years). The current estimate is that The current estimate is that

they occur in from 2 to 6 they occur in from 2 to 6 per 1,000 children.per 1,000 children.

CausesCauses No specific cause is known.No specific cause is known. The ASA states that current research links PDD to The ASA states that current research links PDD to

biological and neurological differences in the brain. biological and neurological differences in the brain. There does appear to be a genetic basis to theThere does appear to be a genetic basis to thedisorder because of the pattern of autism and related disorder because of the pattern of autism and related

disabilities in families. But no gene has been directly disabilities in families. But no gene has been directly linked to autism.linked to autism.

Recent research in genetics reveal that different Recent research in genetics reveal that different combinations of defective genes, and one gene itself may combinations of defective genes, and one gene itself may result in the same presentation of PDDresult in the same presentation of PDD

Other factors that may play a role in the etiology: levels of Other factors that may play a role in the etiology: levels of dysfunction in the CNS system, the immune system, and dysfunction in the CNS system, the immune system, and other cognitive deficitsother cognitive deficits

What is known is that autism is not a mental illness, What is known is that autism is not a mental illness, children with autism do not choose to behave in the children with autism do not choose to behave in the manner that they do, and it is not caused by poor manner that they do, and it is not caused by poor parentingparenting..

CureCure Medically, there is no cure for the differences Medically, there is no cure for the differences

in the brain which result in autism. in the brain which result in autism. Better understanding of the disorder has led to Better understanding of the disorder has led to

the development of better coping mechanisms the development of better coping mechanisms and strategies. Some of these symptoms may and strategies. Some of these symptoms may lessen as the child ages; others may disappear lessen as the child ages; others may disappear altogether. With appropriate intervention, altogether. With appropriate intervention, some behaviors can be positively changed.some behaviors can be positively changed.

The majority of children and adults will, The majority of children and adults will, however, continue to exhibit some however, continue to exhibit some manifestations of autism to some degree manifestations of autism to some degree throughout their entire lives.throughout their entire lives.

TreatmentTreatment There is no known cure for PDDThere is no known cure for PDD Early intervention plays a critical role in improving Early intervention plays a critical role in improving

the outcome of children with PDDthe outcome of children with PDD Education is the most effective treatment for school Education is the most effective treatment for school

aged children with PDDaged children with PDD Children with PDD have unusual intellectual and Children with PDD have unusual intellectual and

academic profiles that vary:academic profiles that vary: No two children are alike. Therefore, no one program exists No two children are alike. Therefore, no one program exists

that will meet the needs of every individual with PDD. that will meet the needs of every individual with PDD. To meet the needs of the individual child, it is critical To meet the needs of the individual child, it is critical

to examine the child’s strengths, weaknesses and to examine the child’s strengths, weaknesses and unique needs when determining an appropriate unique needs when determining an appropriate educational placement and developing an educational placement and developing an Individualized Educational Plan (IEP).Individualized Educational Plan (IEP).

Education Plan for PDD-Education Plan for PDD-NOSNOS When formulating a program for a child with PDD:When formulating a program for a child with PDD:

1.1. An effective, comprehensive program should reflect an understanding An effective, comprehensive program should reflect an understanding and awareness of autism and PDDand awareness of autism and PDD

2.2. Parent-professional communication and collaboration is essential Parent-professional communication and collaboration is essential 3.3. On-going training and education in autism for parents and On-going training and education in autism for parents and

professionals who work with individuals with autism. professionals who work with individuals with autism. 4.4. Inclusion with typically developing peers is important for a child with Inclusion with typically developing peers is important for a child with

autism. Peers are the best models for language and social/play skills. 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 However, the child will not learn by simply being in the environment. It is also necessary to facilitate activities that will address specific skills.is also necessary to facilitate activities that will address specific skills.

5.5. A comprehensive IEP should be based on the child’s strengths and A comprehensive IEP should be based on the child’s strengths and weaknessesweaknesses

6.6. Goals-communication, social behavior, challenging behavior, and Goals-communication, social behavior, challenging behavior, and academic and functional skills.academic and functional skills.

Some children benefit the most with:Some children benefit the most with:Small class sizeSmall class sizeSpecialized classroom with one on one instruction Specialized classroom with one on one instruction Integrated classrooms with additional support Integrated classrooms with additional support

Education with PDDEducation with PDD

Post a schedule for Post a schedule for the day, write the day, write instructions on the instructions on the board or on their board or on their paper. Make sure paper. Make sure to send home to send home important important announcements announcements and written and written instructions for instructions for assignments. assignments.

Easier to understand with a visual representation of elapsed time.

Social StoriesSocial Stories prepares the child for an uncertain event, shares prepares the child for an uncertain event, shares

important information, and gives her a strategy to important information, and gives her a strategy to deal with it.deal with it.

used to increase the student’s understanding of a used to increase the student’s understanding of a situation, make the student feel more comfortable, situation, make the student feel more comfortable, and provide appropriate responses for the situation.  and provide appropriate responses for the situation. 

Social stories work especially well for children with Social stories work especially well for children with autism spectrum disorders because often they lack autism spectrum disorders because often they lack the ability to see situations from thethe ability to see situations from the

perspective of others, may miss important social cues perspective of others, may miss important social cues , tend to dislike surprises, and tend to respond well to , tend to dislike surprises, and tend to respond well to repetition.repetition. recommended that you also incorporate visuals recommended that you also incorporate visuals

into the stories.into the stories.

Example 1Example 1When Other Children Get UpsetWhen Other Children Get UpsetSometimes other children get upset and cry. Sometimes other children get upset and cry. When this happens their teacher or babysitter might try to When this happens their teacher or babysitter might try to

help them.help them.The teacher or babysitter might try to help them by talking to The teacher or babysitter might try to help them by talking to

them or holding them.them or holding them.This is okay.This is okay.Sometimes when other children get upset and cry, it makes Sometimes when other children get upset and cry, it makes

me upset and angry.me upset and angry.I can use words to tell my teacher or babysitter that I am I can use words to tell my teacher or babysitter that I am

upset.upset.I can say, "That makes me mad!" or "I'm upset!"I can say, "That makes me mad!" or "I'm upset!"It is okay to use words about how I feel.It is okay to use words about how I feel.When I get upset I will try to use words about how I feel.When I get upset I will try to use words about how I feel.

How to Write a Social How to Write a Social StoryStory Define the problemDefine the problem

Affirmative statement of the solutionAffirmative statement of the solution Write down what works & where. There is a logical Write down what works & where. There is a logical

solution to the problem.solution to the problem. Make a planMake a plan Indicate the benefits for that child, the way they Indicate the benefits for that child, the way they

would see itwould see it Great resources to find free social stories to print: Great resources to find free social stories to print:

http://www.freewebs.com/kidscandream/page13.htm

http://www.thewatsoninstitute.org/teacher-http://www.thewatsoninstitute.org/teacher-resources2.jsp?resources2.jsp?pageId=2161392240601226415747290pageId=2161392240601226415747290

Now It’s Your Turn!Now It’s Your Turn!

Choose from the following and make Choose from the following and make a social story that you think would a social story that you think would benefit a child with PDDbenefit a child with PDD Taking turns when playing a game.Taking turns when playing a game. Waiting in line.Waiting in line. Being nice to friends.Being nice to friends. Making a mistakeMaking a mistake Or come up with your own!Or come up with your own!

Social ScriptsSocial ScriptsExamples: Lunch time and School Examples: Lunch time and School

FriendsFriends What kind of ice cream do you like best?What kind of ice cream do you like best? Chocolate __________Chocolate __________ Vanilla ____________Vanilla ____________ Strawberry ________Strawberry ________ Pickle _____________Pickle _____________ Other _____________Other _____________

What is your favorite school subject?What is your favorite school subject? Math ______________Math ______________ Reading ____________Reading ____________ History _____________History _____________ Science _____________Science _____________

Other_______________Other_______________

used for students who have trouble with starting conversations

Other Treatment OptionsOther Treatment Options Applied Behavior Analysis (ABA)-most effective way to Applied Behavior Analysis (ABA)-most effective way to

teach young childrenteach young children Specific skills are taught by breaking them into small Specific skills are taught by breaking them into small

steps that build on each other (B.F Skinner-all behavior steps that build on each other (B.F Skinner-all behavior is motivated by the consequences of our actions.)is motivated by the consequences of our actions.)

Therapy for children with PDD should be specialized Therapy for children with PDD should be specialized according to need according to need

Sensory integration (SI)- assisting individuals to process Sensory integration (SI)- assisting individuals to process and use sensory information.and use sensory information.

Auditory Integration Therapy (assistive technology piece)Auditory Integration Therapy (assistive technology piece) Medications are sometimes prescribed to address certain Medications are sometimes prescribed to address certain

behaviors, such as; Ritalin for a hyperactivity componentbehaviors, such as; Ritalin for a hyperactivity component

Treatment-Cont.Treatment-Cont.

Nutrition diets for Nutrition diets for individuals with individuals with PPD:PPD:

Gluten-free, Gluten-free, anti-yeast, anti-yeast, Feingold diet (no Feingold diet (no

artificial colors and artificial colors and flavorings)flavorings)

The role of the family of The role of the family of a Child with PDDa Child with PDD

For the family of a child with For the family of a child with PDD (important to focus on PDD (important to focus on family as well as child)family as well as child) Do not isolate yourself and Do not isolate yourself and

your childyour child Get over caring about what Get over caring about what

other people thinkother people think Get your child’s worst Get your child’s worst

behaviors under controlbehaviors under control Keep your sense of humor and Keep your sense of humor and

take time to laughtake time to laugh Do what you can to stay Do what you can to stay

healthyhealthy Remember that you are only Remember that you are only

humanhumanTeach your child:Teach your child: Basic communicationBasic communication To waitTo wait Create schedulesCreate schedules Be consistentBe consistent

Fun for Children with Fun for Children with PDDPDD Occupational Therapy Sensory Occupational Therapy Sensory

Integration Summer Day Integration Summer Day CampCamp

fun stimulating activities.fun stimulating activities. Sensory-Driven decision Sensory-Driven decision

making and priority setting-making and priority setting-based on children’s needsbased on children’s needs

starts "low & slow", letting starts "low & slow", letting each child grow and learn at each child grow and learn at his or her own speed. Our his or her own speed. Our approach builds from the approach builds from the bottom up and from the bottom up and from the outside in.outside in.

Any child who needs to escape Any child who needs to escape the camp's routine has several the camp's routine has several options such as the "Moon options such as the "Moon Room“ and the playground. Room“ and the playground.

The Moon Room is lit with The Moon Room is lit with black lights which illuminate black lights which illuminate lots of day-glow stars, moons, lots of day-glow stars, moons, and squishy toys. It is lined and squishy toys. It is lined with crash cushions, mats, and with crash cushions, mats, and pillows.pillows.

ReferencesReferencesChantal, S-K. (2004). Chantal, S-K. (2004). Autism spectrum disorders.Autism spectrum disorders. New York: A Perigee Book. 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 This resource truly was the complete guide to understanding autism and autism spectrum disorders.  It focuses on diagnosis and treatment of these disorders.disorders.

  

Lathe, R. (2006). Lathe, R. (2006). Autism, brain, and environment.Autism, brain, and environment. London: Jessica Kingsley Publishers. 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 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.  diagnosis  and factors that influence PDD and other spectrum disorders.  

NICHCY (2003). NICHCY (2003). Autism spectrum disordersAutism spectrum disorders. Accessed July 1,2011 from:. Accessed July 1,2011 from:

http://nichcy.org/disability/specific/autismhttp://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 NICHCY stands for the national dissemination center for children with disabilities.  This website provided a PDF of facts and statistics about autism spectrum disorders. autism spectrum disorders. 

  

Wallin, J. (2010). Wallin, J. (2010). Teaching children with autism. Teaching children with autism. Accessed July 12, 2011 from http://www.polyxo.com/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 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 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.  strategy to deal with it.  

National Institute of Neurological Disorders and Stroke, www. Ninds.nih.gov/disorders/pdd/pdd.htm 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 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.see in children who present as PDD.

www.medicineonline.comwww.medicineonline.com

This website is a great resource for families and educators to read about the many treatment options available for children with PDD.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.htmwww.enzymestuff.com/conditionpdd.htm

This website offers detailed information on diet as treatment options for symptoms of PDD.This website offers detailed information on diet as treatment options for symptoms of PDD.

http://addadhdadvances.com/PDD.htmlhttp://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 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.possible treatments.

https://mail.wheelock.edu/exchweb/bin/redir.asp?URL=http://www.oneplaceforspecialneeds.com/resources_online/resource_online_results.html?https://mail.wheelock.edu/exchweb/bin/redir.asp?URL=http://www.oneplaceforspecialneeds.com/resources_online/resource_online_results.html?words=social%2Bstorieswords=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.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.htmhttp://www.freewebs.com/kidscandream/page13.htm

http://www.thewatsoninstitute.org/teacher-resources2.jsp?pageId=2161392240601226415747290http://www.thewatsoninstitute.org/teacher-resources2.jsp?pageId=2161392240601226415747290

Another great site that offers free printables to use at home or in the classroom.Another great site that offers free printables to use at home or in the classroom.