Autism/Asperger's Disorder/Pervasive Developmental Disorder (PDD)

Autism is a developmental disorder which is characterized by impairments in social functioning, communication and by restricted and/or repetitive behaviors. Although many are familiar with the more classic definition of autism, research in the field of neurodevelopmental disorders has led to the identification of two additional diagnoses to incorporate children with deficits along the same developmental domains, with milder or slightly varying symptomatic presentations. The diagnoses of Asperger's Disorder and Pervasive Developmental Disorder, Not Otherwise Specified are listed as two other disorders which in addition to Autistic Disorder (or classic 'autism') make up the 'autism spectrum'. Early diagnosis and identification of children who have an autism spectrum disorder is crucial as those who receive early intervention such as behavioral therapies, speech therapy, social skills training, and/or communication skills training yield the most substantial gains.

  1. Autism (or Autistic Disorder): Children who meet the diagnostic criteria for the full diagnosis of Autism demonstrate at least 6 symptoms across 3 domains: deficits in social interaction, communication, and/or restrictive/repetitive behaviors. These deficits are not related to cognitive functioning, as 1/3 of children with autism test with IQs at or above average. Social characteristics observed in children with autism may include: difficulty with appropriate 'give and take' interactions, seeking to direct play, resistance to following the direction of others, difficulty interacting with same-age peers, adhering to personal 'agenda' as opposed to responding to the social expectations of others. Typical communication impairments may include: speech/language delay, a failure to develop appropriate conversational skills compared with same-age peers (in children with adequate speech), repetitive or rote language (e.g. reciting songs or dialogue from memory, using particular phrases learned from adult caregivers repeatedly). Restricted/repetitive behaviors may include: excessive interests in narrow, circumscribed areas (e.g. such as trains, Star Wars, etc.), insistence on things being a 'certain way', behavioral or cognitive rigidity/inflexibility (e.g. resisting change, resisting when things go against their own preferred agenda'), or difficulty with transitions.

  2. Asperger's Disorder: These are children who typically show no history of speech/language delay, and demonstrate advanced verbal skills. They typically possess a highly developed vocabulary and demonstrate outstanding verbal memory for facts and information relevant to their area of interest. Children with Asperger's Disorder typically demonstrate higher than average IQ, and are often described by parents and teachers as being bright, inquisitive, and academically capable. They also are often described as socially awkward, and lacking in social and conversational skills. Children with Asperger's Disorder may also demonstrate gross or fine motor impairments, although this is not required for the diagnosis. Much debate in the field exists as to whether Asperger's Disorder really should be a separate and distinct disorder or whether it simply is an alternate label for 'high functioning autism'.

  3. Pervasive Developmental Disorder, Not Otherwise Specified: For children who show some but not all symptoms of Autism or Asperger's Disorder, OR for children who demonstrate impairments in a limited number of contexts, a diagnosis of PDD, NOS is given. Children in this category show the widest variation in type and severity of symptoms. As the presentation is milder, diagnoses are often made later on in childhood. Many children with PDD, NOS may be misdiagnosed with oppositional-defiant disorder due to their significant rigidity, preference for doing things 'their way' or on 'their schedule', resistance to following direction from parents and/or teachers, and lack of cooperation in non-preferred tasks/activities. In school, children may not participate in social routines (e.g. circle), may not follow directions, may appear inattentive, and may exhibit behaviors which are inappropriate for the classroom context.

A thorough and accurate evaluation incorporating testing, information from parents and teachers, school observations (when appropriate) and in-office assessment is crucial in making a diagnostic determination. Creating an individualized developmental profile of your child's strengths as well as their weaknesses is much more important than the label itself, as it will enable the clinician to provide a tailored action plan that truly promotes your child's growth. For more information on assessments and evaluations, please visit our services page.