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31st March 2022.
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Pervasive Development Disorder-Not Otherwise Specified (PDD-NOS), defined
Children with PDD–NOS have some symptoms similar to those associated with Autistic disorder and Asperger syndrome. Usually, these involve delays in the development of many basic skills concerned with understanding the social world; the ability to socialize, to communicate, to empathize in the right way and at the right moment, and to use imagination.
To complicate matters somewhat, PDD–NOS is also be referred to as 'atypical personality development,' 'atypical PDD,' or 'atypical Autism'. There seems to be a myth that when a child is identified with PDD-NOS it means that they also have autism. This is where it gets complicated. To explain this complication, a child may display mild symptoms of a Pervasive Developmental Disorder and still qualify for the PDD-NOS label. Yet, they may present with very severe language and communication skill delays, but still not qualify for an autism diagnosis.
Typically, the symptoms are observed in children before they are 3 years old (this is why it is considered a Pervasive Development Disorder). Parents often notice problems in their toddler because they are not walking, talking, or developing as well as other children the same age. Another difficulty here is that although a toddler's behavior might seem to fit the criteria, the behaviours could just be part of his or her developing personality. It is wise to understand that the boundaries between PDD–NOS and non-autistic conditions have never been fully resolved. It is not unusual to see a PDD–NOS diagnosis followed up by an autism diagnosis a few years later. Interestingly, in the proposed DSM-V, PDD–NOS would disappear and be replaced by Autism Spectrum Disorder.
While some argue that PDD–NOS is a catch-all diagnosis it is described as an impairment in one or two of the three areas usually required for an Autism Spectrum Disorder diagnosis (namely social interaction, communication and restrictive/ compulsive/ repetitive behaviours). Though, not all of the features of Autism Spectrum Disorder are apparent.
Indicators usually include;
1. Social interaction
- social 'reserve' or 'distance' that leads to a failure to develop friendships
- will seek the company of others without engaging in a two-way social interaction (e.g. poor reciprocal skills
- and one-sided conversations which tend to be repetitive, with the same question or phrase repeated)
- poor eye contact
- difficulties grasping basic social rules resulting in unintentional socially embarrassing comments / moments
- difficulty understanding the motivation, perspectives and feelings of others
- increased use of non-verbal communication behaviours, such as facial expressions and gestures
- difficulty starting and maintaining conversation with others
- a stereotyped use of language (e.g. using statements they have heard others use without really understanding its meaning)
- seen as a 'loner' who has difficulties with social interaction. Tends to enjoy solitary activities
3. Restrictive / compulsive / repetitive behaviours
- Repetitive behaviours may be seen as hand flapping, making sounds, head rolling, or body rocking
- Typical compulsive or ritualistic behaviours - must follow rules, must do it the same way such as arranging objects in stacks or lines, sticking to a rigid pattern of daily activities, such as same food or same dressing ritual, even insisting drawing outlines on the floor so that the furniture will not be moved
- Restricted behaviour – limited focus, interest, or activity, such as obsessed by a single television programme, toy, or game.
What interventions are worth considering?
To achieve the best possible progress children identified with PDD–NOS need focused support and intervention early on. And, the intervention programme must be tailored to suit the child's specific needs. The overriding aim is to promote better socialising and communication, and reduce behaviors that can interfere with learning and functioning.
Aprogram of intervention addresses the child's needs at home and at school. The best intervention plan always involves a cooperative effort between parents, health care professionals and educators. Elements may include;
- Special Education - this is the concept of tailoring or adapting day to day education to specifically meet a child's unique learning needs. This may include modified curriculum and modified reporting systems. It is obligatory in most developed countries.
- Establish an Individualised Educational Plan (IEP) or a Negotiated Educational Plan (NEP) - this is a plan formulated by school staff, specialists and parent input. This plan lays the groundwork for necessary therapies and academic training. IEP’s and NEP’s can be developed as funded or unfunded options.
- Behavior Modification - the development of positive strategies to support the behaviour of the child to improve their learning and functioning (Applied Behavior Analysis makes use of reinforcements so that the child learns to respond in a particular manner. It rewards positive behaviours and ignores the undesirable ones. The desired outcomes are broken down into attainable, success-based tasks. This teaches the child how to learn so that they can then move on to academic work)
- Teaching and learning - quite often, these children simply require a little more time to learn and respond. Their learning is always buoyed by additional visual input. Never underestimate the positive impact on learning when a student and teacher (and parents) have the best of relationship.
- Develop visual aids; schedules, planners and timetables - these children often resist change to their routines. It is important to provide them with a plan so they know what activities are first, next, and last. If they are unable to read, then use picture cues on the schedule. These kids are reliant on advanced notice of imminent changes.
- Speech Therapy - this specialisedadditional work is often needed to correct specific letter and word pronunciations. When necessary, language skills are addressed to help the child learn how to respond appropriately to certain phrases and questions. This type of therapy is often administered on an individualised basis, by a speech therapist. It is very appropriate for therapy to occur during the course of the school day.
- Occupational Therapy - offers designs to increase the child's day to day and classroom functional abilities (sensory integration therapy). Sensory problems often cause children to be overly sensitive to textures, noises, smells and sounds. If the child has problems with fine motor skills that hinder writing and other class tasks, therapy can be used to address these problems as well. Again, it is very appropriate for therapy to occur during the course of the school day.
- Medication - considered to treat specific secondary symptoms such as anxiety, depression, hyperactivity and highly aggressive or reactive behaviours
- Social Skills Training - where children are explicitly taught pro-social behaviours; how to interact with their peers in specific situations
- Complementary Therapies - martial arts, gymnastics and music therapy, assist children flex their muscles, literally and figuratively, as they learn how to function in a group setting away from school