caduceus PDD/Autism --


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5. How does a typical child with autism present?

Most kids with PDD's simply present with a language delay. Some never acquire language, but most will have a slight regression, losing the ability to say a few words that they've already learned. This may occur at around 18 months of age. Most parents will report no difficulties prior to this period, but some may observe a "different interactive," eye contact or socialization impairment, lack of pleasure with regard to being touched, or other unusual behavior from as early as 1 to 3 months of age, in extreme situations.

Typically, kids with PDD's will not get diagnosed initially. The statistics indicate that only about 10% of kids with autistic disorders get diagnosed following the initial complaint of the parents that "something is wrong" with their child.

At the onset of symptoms, when the child regresses, several difficulties appear. There is loss of eye contact, the child drifts into his own world, may sit quietly for prolonged periods of time, and develops pervasive ignoring of other people. This means that he may be called several times, even very loudly, and ignore the calling as if he is deaf, yet when he hears even the slightest sound of something he likes, such as song from a favorite video, he runs to it immediately. Some of the kids develop hand flapping, toe walking, and severe temper tantrums, especially when required to change from a favorite activity to some other activity. Arranging toys in rows, spinning themselves or objects, or showing fascination in spinning objects, straight lines, or trains is a common behavior.

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Language delay or lack of language may be expected. Language may be replaced by some unusual, infantile squeals or shrieking, and repetitive, unintelligible gibberish is common. Once language has developed, repeating heard words is common. For instance, instead of answering the question "What's your name?" a child will repeat the question and say, "What's your name?" Other unusual use of language may be present including perseveration into a certain sentence or television commercial that is repetitively said out of context and without having any communicative purpose. Some children are becoming interested in numbers or letters and some may even read fluently without being able to talk communicatively. A savant ability or restricted skill, superior to age group, such as math, reading, or drawing skills in a toddler, may develop.

Many of the children who have PDD may be also hyperactive. Some are very difficult due to their hyperactivity and temper tantrums and some are "very easy" because they sit for hours without requiring special attention or stimulation from their caregivers.

Some children in PDD NOS may be so hyperactive that their hyperactivity overwhelms the clinical picture therefore resulting in a misdiagnosis as AD/HD, overlooking some significant difficulties related to the PDD aspect of the condition. In a situation where there is a coexistence of PDD and AD/HD symptoms, the PDD diagnosis prevails. Per definition (see DSM IV criteria for AD/HD), the existence of PDD rules out the diagnosis of AD/HD. This is not to indicate that children with PDD will not respond to the same medications used for AD/HD to manage their hyperactivity.

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At an early point, most parents deny the problem and since they are told that language will develop later and "some kids are late bloomers," the initial concerns become suppressed. A typical problem that develops at this point is that parents give in to temper tantrums. This in turn develops a "pathologic" situation, where instead of the parents teaching their abnormal children normal socially accepted behavior, the entire family "learns" the abnormal behavior from their affected children. This causes the child to lose his chance of being appropriately directed into socially accepted behavior from early on, as should be done.

As a rule, parents who change their normal behavior in order to accommodate their children's abnormal behavior are doing a severe disservice to their children and to themselves. The correct approach must include a firm, strict discipline to correct all their child's abnormal autistic behavior (see behavior modification). Typical mistakes in this regard include letting the kids run around with food because they refuse to sit by the table, allowing their children to carry an exaggerated variety of objects or toys everywhere they go in order to pacify them, letting their kids get away with holding their bottles or pacifiers, or refusal to eat certain consistencies of foods in order to keep the peace and prevent temper tantrums.

In the long run, however, tantrums are unavoidable because there is a point where the parents cannot keep up with their children's unreasonable requirements, and if the response of the parents to the unreasonable request is not fast enough or not complete enough, the tantrum will occur. The best way to stop the tantrums right from the onset is to help the child adjust to the requirements of society. In the long and short run, it will be easier to change the child's behavior rather than "change the world" and society to adjust to the child's abnormal requirements.

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The presentation of children with pervasive developmental disorders, as described above, may be variable and may include different types of unusual behavior as listed on the PDD assessment scale questionnaire. Most commonly, the diagnosis will be PDD NOS or a mild form of autism. Children who are more severe may present with childhood autism as described above and by the DSM IV criteria.

Asperger's syndrome will present with better language skills and the presence of a restricted interest and "savant ability," where the child has genius abilities in a restricted field yet is impaired from the social aspect and seems odd or "socially inept." As they grow up, these kids have frequent social difficulties, mostly related to their inability to clearly understand how other people perceive their behavior, facial expression, tone of voice, and communication in general. They also have difficulties expressing their own emotions in a correct way. This causes them to be considered "strange" and may result in their inability to benefit from their talent because of this social impairment.

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Other topics in the PDD/Autism section:
PDD Main Page
1. What is PDD or autism? | 2. How is PDD or autism diagnosed?
3. The DSMV IV criteria
4. Review of the different PDDs
5. How does a typical child with autism present?
6. The PDD assessment questionnaire
7. Who should be evaluated for PDD?
8. What are the causes? | 9. Lab testing, medical consensus guidelines
10. What is the best treatment?
11. Behavioral modification
12. Prognosis (long term outcome) of autism
13. Differential diagnosis for autism
14. Secretin and autism
15. PDD and the educational system
16. Associations related to PDD (Links)
[Print entire PDD section]

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