may pdd-nos be seen as nearly a form or a mild form of asper

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anbuend
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13 May 2010, 1:22 am

No it's not. It's meeting the criteria for AS except having a speech delay, and then not meeting enough criteria for autism.


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carltcwc
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13 May 2010, 1:25 am

There are only two things that I can think of that PDD-NOS could mean
-Has speech delay but does not meet the criteria for Kanners
-Mild Aspergers

I was diagnosed with this before but they replaced the diagnosis with Aspergers. Ive also been diagnosed with Kanners but I didnt have speech delay. I got the Autistic Disorder DX because I guess I seemed more HFA to the psychologist and she didnt ask me anything about if I had speech delay or not. Its hard to always tell the differance in adults because someone with Aspergers can meet the criteria for HFA except for speech delay and get misdiagnosed easily.



Horus
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13 May 2010, 1:29 am

Callista wrote:
PDD-NOS has no set definition.

It is simply autism that does not fit into the set categories. Another name for it is "atypical autism".

PDD-NOS varies in severity from extreme (some cases are diagnosed as PDD-NOS because the person's skills cannot be evaluated due to their profound disability) to very mild (cases where only one or two traits are present and barely strong enough to cause problems). In between, there are cases with combinations of traits and/or history that don't fit the established definitions, as well as cases complicated by other conditions which make diagnosis more difficult and ambiguous.

The only common factor between PDD-NOS cases is that they do not fit into the typical classifications.

PDD-NOS is the most common autism spectrum diagnosis. It represents 65% of the Spectrum.

Regarding the relationship of PDD-NOS and Asperger's:
*Someone who has Asperger's traits without impairment does not warrant any kind of diagnosis. If you are talking about "not quite there" in these terms, then this would be classed as "broader autism phenotype" and would not be an official diagnosis of any sort.

*If you mean "not quite there" in terms of number of traits, rather than presence or absence of impairment, then someone who has traits that are too few for Asperger's, which do not qualify for any other diagnosis, but which do cause impairment, would be diagnosed PDD-NOS.

*Someone whose traits are identical to Asperger's, but who has a history of speech delay or developmental delay, is also diagnosed PDD-NOS. These are generally people originally diagnosed with classical autism.



Correct me if i'm wrong, but aren't alot of people who fit the general NVLD profile officially Dx-ed PDD-NOS?

I myself fit said profile though I was always Dx-ed with LD-NOS or Mathematics Disorder.



katzefrau
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13 May 2010, 1:42 am

anbuend wrote:
No it's not. It's meeting the criteria for AS except having a speech delay, and then not meeting enough criteria for autism.


i guess i'm confused about how functionality is defined as used in "high functioning" ..

does it mean your overall functionality is high (for any reason - intellect, for example) or strictly that the level of impairment due to the autism is low?

and then, is AS actually part of the spectrum, with no distinct line separating it from more severe presentations of autism, or is it really its own thing - and if so, why are they eliminating it?

i had envisioned autism as one spectrum, intelligence as another; and then the two can intersect virtually anywhere, so that would explain the vast expanse in different presentations. but maybe i've got it all wrong.

anbuend, you are very good at explaining these things. can you clarify?


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13 May 2010, 9:30 am

The labels also vary between countries. My son was diagnosed with atypical autism, which is sometimes translated as PDD-NOS but in his case the requirement was that he had to meet 5 criteria instead of 6 for autism. If it had been 4 he would have been diagnosed with autistic traits!

My friend's son has been diagnosed with PDD-NOS and fulfills all the criteria for communication and behavior, but has not been proven to show any in the social category. (The reason for this is that it has to be observed in two separate environments and the diagnostic process had been going on for so long that his parents didn't want to wait for the psychologist to observe him in kindergarten. So they settled for the PDD-NOS diagnosis until later)

In Sweden it seems there are generally four ways the diagnosis can go;

-classic autism (6 criteria including speech delay etc),

-AS (no speech delay, sometimes kids are bumped from classic to AS when they get older, which seems illogical to me),

-atypical autism/PDD-NOS, if the child meets at least 5 criteria for classic autism or criteria from only two out of three categories.

-autistic traits for the rest. This doesn't qualify as a disability in the official sense.

So it seems atypical autism is a more narrow category than in the US. It's sometimes defined as autism with either later onset or autism where some traits do not meet a clinically significant level, but I've never actually talked to anyone who has been diagnosed under those conditions. Rather, it seems to be the diagnosis given when 5 criteria are met.



Callista
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13 May 2010, 10:12 am

katzefrau wrote:
Callista wrote:
PDD-NOS has no set definition.

It is simply autism that does not fit into the set categories. Another name for it is "atypical autism".
...

PDD-NOS is the most common autism spectrum diagnosis. It represents 65% of the Spectrum


sounds to me like the classification system for different types and degrees of autism is somewhat arbitrary, or subjective. or it needs to be refined better.

how can the most common diagnosis mean nothing in particular or be "atypical"?

Callista, i don't mean to imply you have your facts wrong - i'm just confused.
Oh, I'm confused, too! And I totally agree with you: The classification system is arbitrary; it does need to be improved; and it is very subjective There's not too much agreement between psychologists--my case, for example, could be diagnosed as AS, PDD-NOS, or classic autism depending on the doctor; but it would almost always be recognized as autism if the doctor in question knew what autism looked like, in general. PDD-NOS is "atypical" in the sense that any case in that category doesn't fit into established categories, not because it contains the smallest number of cases.

Quote:
Callista wrote:
*Someone whose traits are identical to Asperger's, but who has a history of speech delay or developmental delay, is also diagnosed PDD-NOS. These are generally people originally diagnosed with classical autism.


isn't that pretty much the same as HFA then?
Not quite. There's a little bit of a gap between AS and regular autism because there's also a different number of required traits. AS requires three traits; regular autism requires six. AS excludes all cases with speech delay. So, a case with a person who had three traits plus a history of speech delay would qualify for neither one. That's one of the oddities, actually: You can, as a child, have classic autism (six traits, with one of them being speech delay), lose just one trait (let's say you learn to make friends), and no longer be diagnosable as classic autism. In those cases, it's entirely possible that the history of speech delay is the only thing that rules out the Asperger's diagnosis.


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Last edited by Callista on 13 May 2010, 10:16 am, edited 1 time in total.

anbuend
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13 May 2010, 10:15 am

Functioning level is extremely varied in what people mean by it. Just like PDDNOS is. 

It is often used as a pure IQ cutoff of anywhere between 70-85. 

Other than that, it's used in a way where all it tells you is which skill is valued and which is devalued. Well the IQ one does too. But what people do is define it as the presence or absence (or rather apparent presence or absence of them because a person may speak without communicating, or fail to show typical signs of awareness but be completely aware, but people who use functioning level don't tend to understand such subtleties) of certain skills. Usually only between one and three from what I can tell. 

The big ones I usually see are any of the following:

IQ, as already noted (which is even more ridiculous than the others because if you could measure autism by IQ then autism would be MR, it's just as bad as defining severity of cerebral palsy by IQ)

Presence or absence of superficially fluent speech.   Regardless of how communicative it is, if present.  Sometimes people add typing in this. Usually they don't. 

Self-care skills. Again sometimes this is presumed by appearances as well. People can assume if you sound "intelligent" you cannot have severe impairments in self-care.  When even studies show that has nothing to do with it.   

Whether you "look retarded" or not. That's the word people tend to think. Again, there is one specific appearance that some people see as nerdy and some see as MR. And very few such people realize the exact same look can be seen as the other and that they are relying entirely on contextual cues.  So again it becomes a judgement call. 

The amount you have unusual repetitive mannerisms in public. 

Very unusual reactions to surroundings. Like going after things based on sensory qualities rather than the accepted use of the item.

Apparent level of interest in people, including how much awareness of the existence of people the person appears by nonautistic eyes to show. Which as usual can be incredibly deceiving. 

Where you live. As in people assume people from large institutions are the lowest functioning, then smaller institutions or private ones, then even smaller ones like group homes, then living with parents or roommates, then living on your own. The reality is of course different:  There is not necessarily a greater level of care going on the larger or more stereotypical the institution is. And the population inside and outside institutions is basically identical. Institutions don't spring up around people with certain problems. People are put into them based on what policies are in place. Not based on how much care they need.

What kind of school you go or went to. See above. 

Apparent level of violence towards self and/or others.  Cutting usually counts less than headbanging or self-biting for some reason. Probably to do with stereotypes. And of course this is "apparent". Doing things in private doesn't count and neither does the reason you are doing things. Even if it's self defence it's still violence. Sometimes especially if it is, if you're being judged by people who you have to defend yourself from. 

How much you have screaming meltdowns.  

And many other forms of deviance from the norm. The more deviant the lower functioning. Generally people only pick between one and three of these things and judge entirely on that. 

Personally I find functioning level to be incredibly degrading.  When people call me low or high functioning what they are doing is telling me which of my skills they value and which they devalue. There's no accuracy to be had. On anybody. It's just stereotypes, guesswork, and ableism. You cannot just rate humans on a scale like this. 

(When I talk about having been called low functioning I am talking entirely about people's opinions of me. I am not claiming that as a label. Failing to claim that as a label is not the same as claiming to be high functioning. I reject all functioning labels for myself and everyone else. When I talk about people who get called high functioning and people who get called low functioning I am not discussing innate types of people. I am discussing a societal positioning thing.)

And of course we are judged on these thngs even if they're nothing to do with autism. When I could walk I developed awful leg pain if I didn't shift foot to foot all the time. And people who knew I was autistic automatically blamed this on autism and adjusted my functioning level accordingly. 


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anbuend
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13 May 2010, 10:21 am

And, my detailed description of official and unofficial uses of PDDNOS:

http://ballastexistenz.autistics.org/?p=347


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Callista
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13 May 2010, 10:21 am

IQ is somewhat useful in predicting academic performance... But then, that's like saying a screwdriver is somewhat useful for hammering nails into the walls. There are better tools.

I think, if we revised the IQ test and added some measures for other skills, we might be able to use it to gauge a person's abilities across a lot of sub-domains, so we could get a profile of what they're good at and bad at. That would actually be useful, as opposed to the "one number fits all" approach the IQ test takes.

More on the autism/asperger's/pdd-nos issue.

Okay, here's me as a kid:
Autism criteria: http://www.autreat.com/dsm4-autism.html
Section 1: Three traits; two required.
Section 2: One or possibly two traits (depending on how idiosyncratic language has to be). One required.
Section 3: Three traits; two required.
Section 4: Check--impairment present.

So that's a diagnosable classic autism case--without, incidentally, any speech delay; I learned speech on time, I just lagged behind on making up my own sentences on the fly and having conversations.

Me as an adult, compared to the autism list:
Section 1: Three traits; two required.
Section 2: No traits. I've lost the scripted language and I've learned to hold a conversation.
Section 3: Four traits; two required. (Yeah, I've gained a "preoccupation with parts of objects" I didn't have as a little kid. Go figure.)

So, now I no longer fit into the classic autism category, but I'm definitely still on the spectrum. What does the diagnosis change to?

Compare to Asperger Syndrome:
Diagnostic criteria. http://www.autreat.com/dsm4-aspergers.html
Section 1: Three traits; two required.
Section 2: Four traits; one required.
Section 3: Yes, impairment present. Check.
Section 4: Nope, no language delay. Check.

Seems like a shoo-in for Asperger's, right? Think again...
Section 5: Oops. Yes, there was a "clinically significant delay in... adaptive skills". Most sixteen-year-olds remember to take showers, and can do so in less than two hours, for example.

I don't fit classic autism anymore. But I can't be diagnosed with Asperger's because of the adaptive-skill issues. That leaves me in the PDD-NOS category. Had I had a language delay rather than adaptive-skills problems, it might have been very similar.

Very common issue. It doesn't seem to matter when it comes to treatment, because the various shrink types just proceed on the assumption of Asperger's, which works as well as any other label for getting me whatever help I need.


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13 May 2010, 6:03 pm

Horus wrote:
Correct me if i'm wrong, but aren't alot of people who fit the general NVLD profile officially Dx-ed PDD-NOS? I myself fit said profile though I was always Dx-ed with LD-NOS or Mathematics Disorder.


i am also curious about that since the only aspect of me that has shown no improvement is my sensory/perceptual issues, which affect my attention and memory. it makes sense that the perceptual differences in asd would cause social impairment because of how nonverbal cues are interpreted. i do nto think that lack of social intent alone, can cause asd, since nts can also be antisocial. my whole family is unsocial but they do not have asd.

i sometimes think that nld is the same as a.s. and h.f.a. the only difference between nld/a.s. and h.f.a. is the functioning level. those with h.f.a. are only seen as less functional because of their language skills.

i am not even sure if all people with h.f.a. have poor language skills or if their lack of social attention simply affects those skills. if someone with autism does not notice any people, than it makes sense that he or she would not notice any words either.

i am not sure about this, but pdd-nos is divided into several categories the first one being h.f.a. that is subclinical, the second one being language disorders such as hyperlexia, one being multiplex developmental disorder, and another is called multisystem developmental disorder. the last one entails sensory/perceptual/attentional problems which are supposed to cause the asd symptoms.

i seem to fit the last one. if many with pdd-nos fit that last category then it is no wonder that they receive an nld diagnosis.



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13 May 2010, 6:45 pm

actually thought I would get PDDNOS, I was surprised when i got the AS DX. It was a bit of close one anyway... I think the man looked at me and decided I was very, very odd and that, and the 32 AQ score, was the deciding factor.


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13 May 2010, 6:59 pm

I'm PDD-NOS. In most cases it's the most mild version. I think of it's closer to ADHD than to autism. It's like the polar opposite of ADHD with equal amount of impairment. I'm not saying this is the same for everyone. It's just my experience and most others with PDD-NOS. Sometimes, I've heard of people being diagnosed with severe PDD-NOS and I think it's the reason they are lumping everything together in 2012 as just autism, high or low functioning. None of the labels really categorize levels of impairment, which is what they were meant to do in the first place...I think. My pschcologist said that I actually fit all the symptoms of AS but because I'm able to live by myself, go to a pschycologist by myself, ect. I was diagnosed PDD-NOS only for the purpose of defining me as more mild. Even though it doesn't really work that way, but I'm not the doctor.