An Overview of PDDNOS for Early Childhood Professionals

By Stephanie Sivers

Learner ObjectivesParticipants in this seminar will be able to:

Define PDDNOS and possible “causes”Identify the differences between PDDNOS and other

Pervasive Developmental DisordersList beneficial ways to support a child with PDDNOS in

your classroom

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

Diagnostic Criteria for 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

Any combination of the following characteristics may be displayed by a child with PDDNOS:

(Tsai, 2003)

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)

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)

How PDDNOS is DiagnosedA diagnosis of PDDNOS

should be considered if a child does not meet the diagnostic criteria for:A specific Pervasive

Developmental DisorderSchizophreniaSchizotypical Personality

DisorderAvoidant 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

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.

 

How common is PDDNOS?

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 DisorderPrevalence has increased since 2004 – at this time the prevalence

was 1 in 166PDDNOS is four times more likely to affect boys than girlsEthnicity does not seem to be a factor that affects the prevalence

of PDDNOS

What about PDDNOS?Exact prevalence of PDDNOS is unknown aside from the

prevalence of Autism Spectrum Disorders as a wholePrevalence of Autistic Disorder is higher than that of

PDDNOSPDDNOS is sometimes diagnosed before Autistic Disorder

due to the young age of a child when symptoms typically appear

What brings about this disorder? What affects it?

Is There a Known Cause?Unfortunately, there is no known cause of PDDNOS.Studies strongly suggest that PDDNOS is caused by a

neurological abnormalityBrain 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 itIn other words, parenting techniques or other

psychological factors have not been shown to cause PDDNOS

Genetics and FamilyTheoretically, there may be a

genetic basis for PDDNOSA single gene or cluster of

genes has not been identifiedIn 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

MMR VaccineA lot of attention has been focused on Autism (PDDNOS

falling under this label) being caused by the MMR vaccineThere is no scientific evidence that supports this theoryA possible explanation for the onset of a developmental

disorder at the time of the MMR vaccine is timingChildren 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)

You play a vital role in the identification and treatment of PDDNOS in the children you encounter.

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

Why You Are ImportantAs an early childhood professional, you see the same

children in day care or preschool on a consistent basisYou interact with and observe children in a setting outside

of the homeYou are trained to know the developmental milestones that

are usually reached by a certain ageYou might be the first person to notice something that is “not

typical” about a particular childEarly intervention can be successful for children with

pervasive developmental disorders… but these disorders must be identified!

If You Suspect a Child to Have PDDNOS…Talk with the parents/caregivers before you take any

actionInclude them in this process – set up a meeting and discuss

your concernsHave 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 childBe as thorough as you can! What you say can really help a

professional to paint a clear picture of the child’s difficulties

Steps to Diagnose PDDNOSDoctors 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 behaviorDevelopmental historyParent/teacher interviewsClinical observationsUse of one or more screening instruments (diagnostic scales)Psychological testing

Common TreatmentsTraditional 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

TherapyAuditory Integration Therapy

(AIT)Sensory Integration TherapyLovaas MethodVitamin TherapyAnti-Yeast Therapy

(*A parent should notify you of any less traditional method being used*)

How PDDNOS Commonly Affects Life in Day Care or PreschoolA child with PDDNOS does not respond well to disruptions in the

daily scheduleField trips, assemblies, and other changes in the schedule might

elicit tantrums or other behavioral difficultiesThere is a good chance that all classroom activities will not

interest a child with PDDNOSSome children with this disorder become fixated on particular

objects or activitiesLanguage delay/impairment can affect communication abilitiesDue to the individualistic nature of PDDNOS, a specific child

could have other difficulties in a classroom

The services that should be provided by the state government for children with PDDNOS

Legal Safeguards in PAIn PA, children under the age of 3 are granted Early

Intervention (EI) servicesUnder 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.)

Legal Safeguards in PAIn order to receive educational services, a parent must request

an evaluation for their childA teacher or physician can also recommend to the parents that an

evaluation is doneIf 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 ageThe 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.)

Legal Safeguards in PAUnder 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 educationallyAutism 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.)

Legal Safeguards in PAIf a child does qualify as having a “disability,” they will most

likely receive (given their circumstances):Special Education (in most cases) with an IEPExtended schooling until age 21 (depending on cognitive

needs)Medicaid medical assistanceWraparound services to aid the family

Due to the individualistic nature of PDDNOS, services will not be the same for every childThe major “battle” is receiving these services in the first place!

(PA Department of Public Welfare, n.d.)

Actions that might reduce or improve symptoms of PDDNOS

If There is a Child With PDDNOS in Your Classroom…Learn about PDDNOS and understand the characteristics of

the disorder that the child hasCreate a structured classroom environment – children with

PDDNOS respond well to routines and schedulesIf there will be a change in schedule, inform the child and

prepare him/her for the change

What to do (cont.)Understand what interests the child and create activities

that incorporates the interestsCreate opportunities for social interactions that involve

structure and supportWhen 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

Resources for Early Childhood ProfessionalsThe 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 PDDNOSResources in PittsburghNational organizations

Actions that Early Childhood Educators should stay away from with a child who has PDDNOS

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 childIn 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

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)

Information for ParentsIncluded 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)

Recommended Reading for ChildrenIn addition to a parent-friendly brochure, some child-friendly books

are available to help siblings (and classmates!) understand PDDNOSAndy 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 PeraltaAn eight-year-old author describes her younger brother who has

autism. Interesting account from a child’s view.

Where to Find More Information and Help in PittsburghThe 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

Online and National ResourcesPennsylvania’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

GlossaryPervasive 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.

1. (Tsai, 2003) 2. (U.S. Department of Health and Human Services: Centers for Disease Control and Prevention, 2007)

GlossarySchizophrenia: 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)

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.

Contact informationStephanie SiversE-mail: steph32185@hotmail.com