PDD/NOS and the "Autism Spectrum"

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I read somewhere (I think in a paper linked here at WP) that most (or almost all) cases of PDD/NOS have not "restricted interests/repetitive behaviors". But, attending that autism is traditionally defined as a "triad of impairments" (comunication, socialization and interests) and most theoretical models about autism are derived from that, this not mean than many cases of PDD/NOS are not really autism, but probably some different thing, possibly with a different cause? Something like the eyes of the squids, who are very similar to human eyes, but with a different evolutionary history.

And, if we came to the conclusion that many cases of PDD/NOS don't really belong to the autism spectrum, this more the fact that PDD/NOS is the most common ASD, perhaps this could mean that the numbers about ASD are really overstimated?

Possibel counter-argument - if they have problems very similar to autistics and aspies, perhaps is largely irrelevant in practice if they have really an ASD or some mimetic condition.

PDD-NOS is very interesting. I always wondered if my brother has this, but I can't be sure really. When he was 2 he was like a typical Autistic child - had intense interests, literally watched the same video over and over and over, and he knew how to work the TV set at 1 and a half. And he hardly ever cried as a toddler - in fact he was the most easiest toddler to have, and my mum said she could of had 6 of him and still been relaxed. But watching the same video over and over is quite typical in most small children, because I knew a lot of children who did this. And all children have repetitive behaviours too, like if you took a child to a slide, they usually climb up the ladder, slide down, climb up the ladder, slide down, climb up the ladder, slide down....they could do it for hours. But anyway - back to my brother - he didn't show any more signs when he started preschool, and he was like all the other typically developing children when he started school, and no teachers had any concerns from him, and usually ASD children do show some sort of odd behaviour that stands out from the other kids, like anxieties, frequent tantrums over things what the others wouldn't have, sensitivity to noise, and, most of all, speech delays or if not, social interaction delays. I showed a lot of these traits when I started school. Now, as an adult, my brother is just like any other NT.

It's funny - I apparently showed no ASD traits as a toddler but I did when I started school onwards, and my brother showed quite a lot of ASD or ''odd'' traits as a toddler but grew out of them when he started school onwards.

Hmm---this is interesting. I really don't know the answer to your question...or suggestion...whatever it is. I do think if your observation is correct though, that with the new criteria for ASD, those who would have qualified for PDDNOS in the future--if they were keeping dsm-iv standards--might not qualify for ASD in the future. I did not realize most people with PDDNOS did not have restricted interests and repetitive behaviour. So if this is the case, perhaps ASD diagnoses will actually begin to level out and go down.

I'm diagnosed PDD NOS and I'm more typically aspie in my interests than in my social skills. (I have milder social difficulties than usual for AS.)

You really can't generalize about PDD NOS. It's anyone who doesn't fit neatly into the other boxes but seems to be autistic nonetheless.

According to this study, virtually all kids with severe social impairments also had significant repetitive behavior, but that study was focused more on LFA-style social difficulties. As far as I know, no one's assessed whether mild-moderate social impairment usually comes along with repetitive behavior. I can think of several syndromes where, at least in theory, social impairment should be present without repetitive behavior, such as ADHD, NVLD and semantic-pragmatic disorder. Whether those conditions belong on the autism spectrum is a matter for debate.

I guess it comes down to: is the triad of impairments what should be used to diagnose whether someone is on the spectrum or not. That seems to be quite logical given that there is such a spectrum of severities out there--at least they know to look for these three symptoms regardless of severity level. Those with ADHD, NVLD, and whatever else who do not have an ASD, will not have the triad of impairments. Social impairment for ADHD (and no ASD) for example, is not at all like the social impairment one would find in those with an ASD, so their impairment would not be part of the triad since it stems from something else.

A kind of study about that:

http://www.psyc.bbk.ac.uk/research/DNL/ ... Plomin.pdf

If you have say liver function tests, and results show your readings are poor but only to a lesser degree, you are told you are fine and healthy. Once you exceed a certain level, you have a diagnosis of liver dysfunction.... (much like BMI body mass index, over a certain weight you are considered fat or obese)

Diagnostic criteria has cut off points. Therein lies the problem with modern day diagnosis.

PS: going back to BMI.... even super fit top level footballers and heavier basketball players are considered obese!

crazy
stupid
DX
methodology

Last edited by Surfman on 14 Sep 2011, 6:02 pm, edited 1 time in total.

I presented the study a couple of times here. It was limited to one group of individuals diganosed with PDD NOS, and the numbers identified without significant Restrictive interests and Repetitive behaviors RIRB's were 64 out of 66. I haven't heard any statistics in the general population.

The researcher that identified information in his blog was responding back and forth to the DSMV work group member to get an opinion on what might happen in the future if these statistics are indicative of the general population.

The DSMV working group member suggested that the individuals without the RIRB's might be placed in a new category in the DSMV called Social Communication Disorder (SCD). If so, Social communication disorder is not part of the Autism Spectrum Disorder category, so these individuals would no longer be considered on the Autism Spectrum.

The other problem identified though, is that many of these individuals need as much support provided by educational support programs targeted at children diagnosed with Autism Spectrum Disorders, as any of the other individuals in these programs, so there is a concern there that may motivate further revision in the DSMV before it is finalized.

I'm a little surprised that it was not until June of this year, that this issue seems to have been publically discussed by a DSMV working group member. On the DSMV website, there is quite a bit of discussion on Aspergers and the elimination of it, but not any discussion at all on PDD NOS that I could see, although I haven't looked back at it in a while so that may have changed.

The majority of children with ASD's have been identified and diagnosed with PDD NOS, so there would be some logistical issues in how to handle this in the school education programs specific to ASD's.

Perhaps, if they are moved over to the Social communication Disorder, those in that category will continue in the same educational programs they are in now.

The 1 in 110 number we hear stated on Autism Spectrum Disorders in the US studied by the CDC, is largely derived from eight year olds in special education programs; my understanding is that the majority are diagnosed with PDD NOS.

Often these children are re-assessed, so if the SCD scenario plays out, statistically speaking unless actual numbers of Autism continue to go up or another screening method is used, one would expect the statistics on prevalence of ASD's to decrease dramatically in the future.

Even if they weren't re-assessed, the new cases without RIRB's would not likely meet the criteria for ASD in the DSMV, so if 8 year olds continue to be used for statistics, in a decade, they will no longer exist in the demographic studied.

Rett's Syndrome will no longer be part of the spectrum, so while the percentage aren't high of those individuals on the spectrum, that in itself will likely affect future prevalence numbers some as well.

It is only an assumption that you can use the Triad of Impairments to infer a different "evolution" or "proper autistic-ness." That may be attributing more explanatory power to the ToI than it really has. Ultimately, it is a concept that was made up by some psychiatrists because it seemed to make sense of things to them. So, maybe it does get at some fundamental issues of autism, or maybe it doesn't. I.e. Perhaps cognitive profiles would be a better/more-useful characterization.

Ultimately, it's a "legal" question. If the law defines crime X as having 3 criteria, and a person only meets 2, then they can't be charged with that crime. -- But that's only a matter of (arbitrary) definitions.

That's an interesting point, the only real cognitive profile associated with Aspergers at this point, in the DSMIV, is a lack of language delay and cognitive delays in development other than social interaction.





It appears that they are moving more toward a behavioral than cognitive perspective of Autism, in the DSMV, that allows those with Aspergers to continue to be diagnosed within the new criteria. Language and cognitive delays associated with Autism Disorder in the DSMIV, have been replaced by behavioral impairments that the authors of the DSMV see as necessary components of Autism Spectrum; namely Social/communication impairments and Restrictive Interests and Repetitive behaviors. Problems with sensory issues have been added in, which are inherent, but some behaviors associated with them can still be identified.

I guess pervasive development disorder will no longer be as an appropriate phrase used to describe Autism Spectrum Disorders as it once was.

Last edited by aghogday on 14 Sep 2011, 9:09 pm, edited 1 time in total.

Many people diagnosed with AS have delays outside of social impairments, as well. The lines have always been blurry.

My son was diagnosed with PDD-NOS at 2.5 yrs old, and I am thinking this is the best diagnosis for him. He is definitely does not have classic autism, and he doesn't appear to have total Aspergers although at 6 yrs old, he seems to be heading more in that direction. I have read and read and tried to determine what he has, and I have just come to the conclusion that he has "mild autism" Here is a description of my son (if anyone is interested) :

Delayed walker (21.5 mos) Still very clumsy at 6, has delays in gross motor skills and balance issues.

No real language delay, he had words at about 8 or 9 mos, but over time we realized he was not using words to communicate with us, he was just repeating a lot of words for his own pleasure. However, now that he is 6, he is pretty much fully verbal and is able to have small conversations even though some of his thoughts seem jumbled. His language continues to improve day after day. He is speaking in full sentences and now asking questions and making comments about things. He is still repetitive in his language at times, but some times he will say things that sound just like a typically developing child. He does get caught up on phrases and words and will repeat them over and over and he makes lots of random noises. However, when we go places, he can talk to people (mainly adults) and sound somewhat typical although his voices can sometimes sound like a computer (not always though) He does not speak like a "little professor" though which makes me feel that he does not have AS.

Lack of interest in his peers----Has never wanted to play with other kids. Never really played with toys much either. Would prefer to hang around with the adults for the most part.

Repetive interests and repetitious behavior----He is diagnosed as PDD_NOS and he definitely has these! He is hooked on car makes and models. He knows the makes and models of every car out there! He loves to talk about them all the time. He asks repetitive questions. He mimics what he hears other people say. He can be somewhat flexible, but sometimes he does want things to go a certain way.

He is not a picky eater, he has always had good eye contact, he does not have extreme meltdowns, does not avoid people at all, but doesn't really know how to have a conversation with his peers.

He flaps his hands and sometimes hits himself in the head, and makes lots of strange sounds although he can control these things when we go out in public.

When he was 4, the school system tested his IQ and it came back that he was borderline mentally ret*d (which I totally disagreed with) and now that he is 6, he is doing fairly well. He is reading and he is making 100's on all of his spelling tests. He is asking questions and making observations. I would not say he is a genius or anything, but I know he is not mentally ret*d.

So, that is it. I just tell people that he has "mild autism" because I am not sure, but I know he fits the mold to be on the spectrum.

Also, he was potty trained by 4 yrs old, although he still has some trouble with self help skills like buttoning and zipping.

I agree. My reference here is specific to the cognitive profile listed in the DSMIV, humans are much more complicated than what appears to be simple criteria.

To be more specific, quoted from the DSMIV: