Pervasive Developmental Disorder—Not Otherwise Specified (PDD-NOS) is a pervasive developmental disorder (PDD), also called an autism spectrum disorder (ASD). PDD-NOS is one of three forms of Autism Spectrum Disorders. PDD-NOS is often called atypical autism.[1]
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Swiss psychologist Eugen Bleuler first used Autism about 100 years ago while defining signs of schizophrenia. Autism comes from the Greek word αὐτός (autós), meaning self.[2] Because the word refers to egocentric thinking, Bleuler defined autism as "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance."[3] This definition would manifest as characteristics of autism such as obsession with small details, or an inability to stray from a routine. In the United States, researchers first used the word Autism in the 1940s "to describe children with emotional or social problems."[4] This definition still holds true, as the main characteristics of Autism disorders are difficulties socializing and communicating. In the 1960s, the benefits of early intervention and parent therapy began to gain importance as well. Early on, no link between genetics and autism existed, while now, autism is seen as "one of the most heritable of all psychiatric conditions." Today, one out of every 110 children born is diagnosed with an Autism spectrum disorder.[5]
PDD-NOS is typically diagnosed by child psychiatrists, psychologists, or pediatric neurologists.[6] No singular specific test can be administered to determine whether a child is on the spectrum. Diagnosis is made through observations, questionnaires, and tests. A parent will usually initiate the quest into the diagnosis with questions for their child's pediatrician about their child's development after noticing abnormalities. From there, doctors will ask questions to gauge the child’s development in comparison to age-appropriate milestones. One test that measures this is the Modified Checklist of Autism in Toddlers (MCHAT). This is a list of questions whose answers will determine whether or not the child should be referred to a specialist such as a Developmental pediatrician, a neurologist, a psychiatrist, or a psychologist. Another checklist, the DSM-IV is a series of characteristics and criteria to qualify for an autism diagnosis.[7]
Because PDD-NOS is a spectrum disorder, not every child shows the same signs. The two main characteristics of the disorder are difficulties with social interaction skills and communication.[8] Signs are often visible in babies but a diagnosis is usually not made until around age 4.[9] Even though PDD-NOS is considered milder than typical autism, this is not always true. While some characteristics may be milder, others may be more severe.[9]
Once a child with PDD-NOS enters school, he or she will often be very eager to interact with classmates, but may act socially different to peers and be unable to make genuine connections. As they age, the closest connections they make are typically with their parents. Children with PDD-NOS have difficulty reading facial expressions and relating to feelings of others. They may not know how to respond when someone is laughing or crying. Literal thinking is also characteristic of PDD-NOS. They will most likely have difficulty understanding figurative speech and sarcasm.[1]
Inhibited communication skills are a sign of PDD-NOS that begins immediately after birth. Infants with PDD-NOS do not babble; as they age, they do not speak at the age at which speech develops in normal persons. Once verbal communication begins, vocabulary is often limited.[6] Some characteristics of language-based patterns are repetitive or rigid language, narrow interests, uneven language development, and poor nonverbal communication.[10] A very common characteristic of PDD-NOS is severe difficulty grasping the difference between pronouns, particularly between you and me when conversing, as in this example:
Here, because the parent used the word me to describe himself or herself, the child thinks that "me" is applicable to the parent regardless of who the speaker is. The child does not understand, without intervention, that the assignment of me depends on the speaker, not to whoever spoke it first.[11]
“Treatment for autism is a very intensive, comprehensive undertaking that involves the child's entire family and a team of professionals. Some programs may take place in the child's home with professionals and trained therapists and may include Parent Training for the child under supervision of a professional. Some programs are delivered in a specialized center, classroom or preschool.”[5] Families usually decide upon one plan of intervention that works best for them. Typical types of intervention are Applied behavior analysis (ABA), Pivotal response therapy (PRT), The P.L.A.Y. Project, Verbal Therapy, Floortime, Relationship Development Intervention (RDI), and The Son-Rise Program.[5]
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