PERVASIVE DEVELOPMENTAL DISORDERS

by Luke Y. Tsai, M.D.

NICHCY Briefing Paper
#FS20, January 1998
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A publication of NICHCY

National Information Center for Children and Youth with Disabilities
P.O. Box 1492
Washington, DC 20013-1492

1-800-695-0285 (V/TT)
(202) 884-8200 (V/TT)
E-mail: nichcy@aed.org
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This information is copyright free, unless otherwise indicated. Readers are
encouraged to
copy and share it, but please credit the National Information Center for
Children and Youth with
Disabilities (NICHCY).
__________________________

TABLE OF CONTENTS

Introduction
Definition of the PDD Category and its Five Specific Disorders
The Cause of PDDNOS
The Symptoms and Signs of PDDNOS
Diagnosing PDDNOS
Special Education and PDDNOS
Treatment of PDDNOS
Finding a Parent Support Group
Conclusion
References
Additional Resources
Organizations
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Every year the National Information Center for Children and Youth with
Disabilities (NICHCY) receives thousands of requests for information about
the diagnosis, educational programming, and special needs of children and
youth with Pervasive Developmental Disorders (PDD). Over the past few
years, PDD has become a subject of increased attention among parents,
professionals, and policymakers across the country.

NICHCY developed this Briefing Paper in response to the growing concern
about, and interest in, this disability. This publication is designed to
answer some of the most commonly asked questions regarding PDD and to
provide concerned individuals with other resources for information and
support.

INTRODUCTION

The term Pervasive Developmental Disorders was first used in the 1980s to
describe a class of disorders. This class of disorders has in common the
following characteristics: impairments in social interaction, imaginative
activity, verbal and nonverbal communication skills, and a limited number
of interests and activities that tend to be repetitive.

The manual used by physicians and mental health professionals as a guide to
diagnosing disorders is the Diagnostic and Statistical Manual of Mental
Disorders (DSM). The DSM was last revised in 1994. In this latest revision,
known as the DSM-IV, five disorders are identified under the category of
Pervasive Developmental Disorders: (1) Autistic Disorder, (2) Rett's
Disorder, (3) Childhood Disintegrative Disorder, (4) Asperger's Disorder,
and (5) Pervasive Developmental Disorder Not Otherwise Specified, or
PDDNOS.

Many of the questions parents and education professionals ask NICHCY have
to do with children who have been diagnosed with "PDD." Doctors are divided
on the use of the term PDD. Many professionals use the term PDD as a short
way of saying PDDNOS. Some doctors, however, are hesitant to diagnose very
young children with a specific type of PDD, such as Autistic Disorder, and
therefore only use the general category label of PDD. This approach
contributes to the confusion about the term, because the term PDD actually
refers to a category of disorders and is not a diagnostic label. The
appropriate diagnostic label to be used is PDDNOS--Pervasive Developmental
Disorder Not Otherwise Specified--not PDD (the umbrella category under
which PDDNOS is found).

Accordingly, this Briefing Paper will use the term PDD to refer to the
overall category of Pervasive Developmental Disorders and the term PDDNOS
to refer to the specific disorder, Pervasive Developmental Disorder Not
Otherwise Specified. The majority of this Briefing Paper will focus on
PDDNOS.

All of the disorders that fall under the category of PDD share, to some
extent, similar characteristics. To understand how the disorders differ and
how they are alike, it's useful to look at the definition of each disorder.
Therefore, before we begin our discussion of PDDNOS, let us look first at
the definition of the general category PDD and its specific disorders.

DEFINITION OF THE PDD CATEGORY AND ITS FIVE SPECIFIC DISORDERS

All types of PDD are neurological disorders that are usually evident by age
3. In general, children who have a type of PDD have difficulty in talking,
playing with other children, and relating to others, including their
family.

According to the definition set forth in the DSM-IV (American Psychiatric
Association, 1994), Pervasive Developmental Disorders are characterized by
severe and pervasive impairment in several areas of development:
-- social interaction skills;
-- communication skills; or
-- the presence of sterotyped behavior, interests, and activities. (p. 65)

The Five Types of PDD

(1) Autistic Disorder. Autistic Disorder, sometimes referred to as early
infantile autism or childhood autism, is four times more common in boys
than in girls. Children with Autistic Disorder have a moderate to severe
range of communication, socialization, and behavior problems. Many children
with autism also have mental retardation. The DSM-IV criteria by which
Autistic Disorder is diagnosed are presented below.
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(box)
Diagnostic Criteria for Autistic Disorder

A. A total of six (or more) items from (1), (2), and (3), with at least two
from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least
two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as
eye-to-eye gaze, facial expression, body postures, and gestures to regulate
social interaction
(b) failure to develop peer relationships appropriate to developmental
level
(c) a lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing, or
pointing out objects of interest)
(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one
of the following:
(a) delay in, or total lack of, the development of spoken language (not
accompanied by an attempt to compensate through alternative modes of
communication such as gesture or mime)
(b) in individuals with adequate speech, marked impairment in the ability
to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play
appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests,
and activities, as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or
rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger
flapping or twisting, or complex whole-body movements)
(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas,
with onset prior to age 3 years: (1) social interaction, (2) language as
used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's Disorder or
Childhood Disintegrative Disorder. (APA, 1994, pp. 70-71)

(Reprinted with permission from the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric
Association.)
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(2) Rett's Disorder. Rett's Disorder, also known as Rett Syndrome, is
diagnosed primarily in females. In children with Rett's Disorder,
development proceeds in an apparently normal fashion over the first 6 to 18
months at which point parents notice a change in their child's behavior and
some regression or loss of abilities, especially in gross motor skills such
as walking and moving. This is followed by an obvious loss in abilities
such as speech, reasoning, and hand use. The repetition of certain
meaningless gestures or movements is an important clue to diagnosing Rett's
Disorder; these gestures typically consist of constant hand-wringing or
hand-washing (Moeschler, Gibbs, & Graham 1990). The diagnostic criteria for
Rett's Disorder as set forth in the DSM-IV appear below.
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(box)

Diagnostic Criteria for Rett's Disorder

A. All of the following:
(1) apparently normal prenatal and perinatal development
(2) apparently normal psychomotor development through the first 5 months
after birth
(3) normal head circumference at birth

B. Onset of all of the following after the period of normal development
(1) deceleration of head growth between ages 5 and 48 months
(2) loss of previously acquired purposeful hand skills between ages 5 and
30 months with the subsequent development of stereotyped hand movements
(e.g., hand-wringing or hand washing)
(3) loss of social engagement early in the course (although often social
interaction develops later)
(4) appearance of poorly coordinated gait or trunk movements
(5) severely impaired expressive and receptive language development with
severe psychomotor retardation. (APA, 1994, pp. 72-73)

(Reprinted with permission from the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric
Association.)
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(3) Childhood Disintegrative Disorder. Childhood Disintegrative Disorder,
an extremely rare disorder, is a clearly apparent regression in multiple
areas of functioning (such as the ability to move, bladder and bowel
control, and social and language skills) following a period of at least 2
years of apparently normal development. By definition, Childhood
Disintegrative Disorder can only be diagnosed if the symptoms are preceded
by at least 2 years of normal development and the onset of decline is prior
to age 10 (American Psychiatric Association, 1994). DSM-IV criteria are
presented below.
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(box)

Diagnostic Criteria for Childhood Disintegrative Disorder

A. Apparently normal development for at least the first 2 years after birth
as manifested by the presence of age-appropriate verbal and nonverbal
communication, social relationships, play, and adaptive behavior.

B. Clinically significant loss of previously acquired skills (before age 10
years) in at least two of the following areas:
(1) expressive or receptive language
(2) social skills or adaptive behavior
(3) bowel or bladder control
(4) play
(5) motor skills

C. Abnormalities of functioning in at least two of the following areas:
(1) qualitative impairment in social interaction (e.g., impairment in
nonverbal behaviors, failure to develop peer relationships, lack of social
or emotional reciprocity)
(2) qualitative impairments in communication (e.g., delay or lack of spoken
language, inability to initiate or sustain a conversation, stereotyped and
repetitive use of language, lack of varied make-believe play)
(3) restricted, repetitive, and stereotyped patterns of behavior,
interests, and activities, including motor stereotypes and mannerisms

D. The disturbance is not better accounted for by another specific
Pervasive Developmental Disorder or by Schizophrenia. (APA, 1994, pp.
74-75)

(Reprinted with permission from the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric
Association.)
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(4) Asperger's Disorder. Asperger's Disorder, also referred to as
Asperger's or Asperger's Syndrome, is a developmental disorder
characterized by a lack of social skills; difficulty with social
relationships; poor coordination and poor concentration; and a restricted
range of interests, but normal intelligence and adequate language skills in
the areas of vocabulary and grammar. Asperger's Disorder appears to have a
somewhat later onset than Autistic Disorder, or at least is recognized
later. An individual with Asperger's Disorder does not possess a
significant delay in language development; however, he or she may have
difficulty understanding the subtleties used in conversation, such as irony
and humor. Also, while many individuals with autism have mental
retardation, a person with Asperger's possesses an average to above average
intelligence (Autism Society of America, 1995). Asperger's is sometimes
incorrectly referred to as "high-functioning autism." The diagnostic
criteria for Asperger's Disorder as set forth in the DSM-IV are presented
below.
_______________________
(box)

Diagnostic Criteria for Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least
two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors such as
eye-to-eye gaze, facial expression, body postures, and gestures to regulate
social interaction
(2) failure to develop peer relationships appropriate to developmental
level
(3) a lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing, or
pointing out objects of interest)
(4) lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests,
and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or
rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger
flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social,
occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g.,
single word used by age 2 years, communicative phrases used by age 3
years).

E. There is no clinically significant delay in cognitive development or in
the development of age-appropriate self-help skills, adaptive behavior
(other than in social interaction), and curiosity about the environment in
childhood.

F. Criteria are not met for another specific Pervasive Developmental
Disorder, or Schizophrenia. (APA, 1994, p. 77)

(Reprinted with permission from the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric
Association.)
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(5) Pervasive Developmental Disorder Not Otherwise Specified. Children with
PDDNOS either (a) do not fully meet the criteria of symptoms clinicians use
to diagnose any of the four specific types of PDD above, and/or (b) do not
have the degree of impairment described in any of the above four PDD
specific types.

According to the DSM-IV, this category should be used "when there is a
severe and pervasive impairment in the development of social interaction or
verbal and nonverbal communication skills, or when stereotyped behavior,
interests, and activities are present, but the criteria are not met for a
specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal
Personality Disorder, or Avoidant Personality Disorder" (American
Psychiatric Association, 1994, pp. 77-78).

THE CONFUSION OF DIAGNOSTIC LABELS

The intent behind the DSM-IV is that the diagnostic criteria not be used as
a checklist but, rather, as guidelines for diagnosing pervasive
developmental disorders. There are no clearly established guidelines for
measuring the severity of a person's symptoms. Therefore, the line between
autism and PDDNOS is blurry (Boyle, 1995).

As discussed earlier, there is still some disagreement among professionals
concerning the PDDNOS label. Some professionals consider "Autistic
Disorder" appropriate only for those who show extreme symptoms in every one
of several developmental areas related to autism. Other professionals are
more comfortable with the term Autistic Disorder and use it to cover a
broad range of symptoms connected with language and social dysfunction.
Therefore, an individual may be diagnosed by one practitioner as having
Autistic Disorder and by another practitioner as having PDDNOS (or PDD, if
the practitioner is abbreviating for PDDNOS).

Generally, an individual is diagnosed as having PDDNOS if he or she has
some behaviors that are seen in autism but does not meet the full DSM-IV
criteria for having Autistic Disorder. Despite the DSM-IV concept of
Autistic Disorder and PDDNOS being two distinct types of PDD, there is
clinical evidence suggesting that Autistic Disorder and PDDNOS are on a
continuum (i.e., an individual with Autistic Disorder can improve and be
rediagnosed as having PDDNOS, or a young child can begin with PDDNOS,
develop more autistic features, and be rediagnosed as having Autistic
Disorder).

To add to the list of labels that parents, teachers, and others may
encounter, a new classification system was recently developed by ZERO TO
THREE: National Center for Infants, Toddlers, and Families (1994). Under
this system, called the Diagnostic Classification of Mental Health and
Developmental Disorders of Infancy and Early Childhood, the term
Multisystem Developmental Disorder, or MSDD, is used to describe pervasive
developmental disorders.

However, amidst all this confusion, it is very important to remember that,
regardless of whether a child's diagnostic label is autism, PDDNOS, or
MSDD, his or her treatment is similar.

THE CAUSE OF PDDNOS

Both behavioral and biological studies have generated sufficient evidence
to suggest that PDDNOS is caused by a neurological abnormality--problems
with the nervous system. However, no specific cause or causes have been
identified.

While studies have found various nervous-system problems, no single problem
has been consistently found, and exact causes are far from clear. This may
be due to the current approach of defining PDDNOS based on behaviors (as
opposed to, say, genetic testing). Hence, it is possible that PDDNOS is the
result of several different conditions. If this is the case, it is
anticipated that future studies will identify a range of causes.
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(a sidebar)

Beginning the Search for Information

Sam was an active and busy child. But his parents were worried about him.
Compared with the other 3-year-olds they knew, Sam was different--he wasn't
talking and he didn't seem to want or try to play with his sister. At day
care Sam wouldn't join in any activities with the other kids, but he really
enjoyed playing with water. He would splash and play at the sink for hours,
with a big smile on his face. After about a year of expressing concern to
their pediatrician, Sam's parents finally obtained a referral to a
developmental psychologist who diagnosed Sam as having PDDNOS. The
pediatrician also suggested that they get the school to test Sam. The
school tested him and said he had autism. No one seemed to know anything
about PDDNOS, and although Sam's parents had heard of autism, they didn't
know much about it. They began their search for information on what PDDNOS
was and what autism was.
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THE SYMPTOMS AND SIGNS OF PDDNOS

Generally, children are 3 to 4 years old before they exhibit enough
symptoms for parents to seek a diagnosis. There is no set pattern of
symptoms and signs in children with PDDNOS. It is important to realize that
a very wide range of diversity is seen in children with PDDNOS. All the
items of behavior described in this section are common in these children,
but a single child seldom shows all the features at one time. In other
words, all children with PDDNOS do not have the same degree or intensity of
the disorder. PDDNOS can be mild, with the child exhibiting a few symptoms
while in the school or neighborhood environment. Other children may have a
more severe form of PDDNOS and have difficulties in all areas of their
lives. Because of the possibility that PDDNOS and Autistic Disorder are on
a continuum, many clinical features described in the following section are
very similar to those being described in the literature for Autistic
Disorder.

Deficits in Social Behavior

Some infants with PDDNOS tend to avoid eye contact and demonstrate little
interest in the human voice. They do not usually put up their arms to be
picked up in the way that typical children do. They may seem indifferent to
affection and seldom show facial responsiveness. As a result, parents often
think the child is deaf. In children with fewer delays, lack of social
responsiveness may not be obvious until well into the second or third year
of life.

In early childhood, children with PDDNOS may continue to show a lack of eye
contact, but they may enjoy a tickle or may passively accept physical
contact. They do not develop typical attachment behavior, and there may
seem to be a failure to bond. Generally, they do not follow their parents
about the house. The majority do not show normal separation or stranger
anxiety. These children may approach a stranger almost as readily as they
do their parents. Many such children show a lack of interest in being with
or playing with other children. They may even actively avoid other
children.

In middle childhood, such children may develop a greater awareness or
attachment to parents and other familiar adults. However, social
difficulties continue. They still have problems with group games and
forming peer relationships. Some of the children with less severe PDDNOS
may become involved in other children's games.

As these children grow older, they may become affectionate and friendly
with their parents and siblings. However, they still have difficulty
understanding the complexity of social relationships. Some individuals with
less severe impairments may have a desire for friendships. But a lack of
response to other people's interests and emotions, as well as a lack of
understanding of humor, often results in these youngsters saying or doing
things that can slow the development of friendships.

Impairment in Nonverbal Communication

In early childhood, children with PDDNOS may develop the concrete gesture
of pulling adults by the hand to the object that is wanted. They often do
this without the typical accompanying facial expression. They seldom nod or
shake their heads to substitute for or to accompany speech. Children with
PDDNOS generally do not participate in games that involve imitation. They
are less likely than typical children to copy their parents' activity.

In middle and late childhood, such children may not frequently use
gestures, even when they understand other people's gestures fairly well.
Some children do develop imitative play, but this tends to be repetitive.

Generally, children with PDDNOS are able to show joy, fear, or anger, but
they may only show the extreme of emotions. They often do not use facial
expressions that ordinarily show subtle emotion.

Impairment in Understanding Speech

Comprehension of speech in children with PDDNOS is impaired to varying
degrees, depending on where the child is within the wide spectrum of
PDDNOS. Individuals with PDDNOS who also have mental retardation may never
develop more than a limited understanding of speech. Children who have less
severe impairments may follow simple instructions if given in an immediate
context or with the aid of gestures (e.g., telling the child to "put your
glass on the counter," while pointing to the counter). When impairment is
mild, only the comprehension of subtle or abstract meanings may be
affected. Humor, sarcasm, and common sayings (e.g., "it's raining cats and
dogs") can be confusing for individuals with the most mild PDDNOS.

Impairment in Speech Development

Many infants with PDDNOS do not babble, or may begin to babble in their
first year but then stop. When the child develops speech, he or she often
exhibits abnormalities. Echolalia (seemingly meaningless repetition of
words or phrases) may be the only kind of speech some children acquire.
Though echolalic speech might be produced quite accurately, the child may
have limited comprehension of the meaning. In the past, it was thought that
echolalia had no real function. More recent studies have found that
echolalia can serve several functions, such as self-stimulation (when a
child says words or phrases repeatedly without a communicative
purpose--just because it feels good); as a step between a child being
nonverbal and verbal; or as a way to communicate (Prizant & Rydell, 1993).
Other children develop the appropriate use of phrases copied from others.
This is often accompanied by pronoun reversal in the early stages of
language development. For instance, when the child is asked "How are you?"
he or she may answer "You are fine."

The actual production of speech may be impaired. The child's speech may be
like that of a robot, characterized by a monotonous, flat delivery with
little change in pitch, change of emphasis, or emotional expression.

Problems of pronunciation are common in young children with PDDNOS, but
these often diminish as the child gets older. There may be a striking
contrast between clearly enunciated echolalic speech and poorly pronounced
spontaneous speech. Some children have a chanting or singsong speech, with
odd prolongation of sounds, syllables, and words. A question-like
intonation may be used for statements. Odd breathing rhythms may produce
staccato speech in some children.

Abnormal grammar is frequently present in the spontaneous speech of verbal
children with PDDNOS. As a result:
-- phrases may be telegraphic (brief and monotone) and distorted;
-- words of similar sound or related meaning may be muddled;
-- some objects may be labeled by their use;
-- new words may be coined; and
-- prepositions, conjunctions, and pronouns may be dropped from phrases or
used incorrectly.

When children with PDDNOS do develop functional speech, they may not use it
in ordinary ways. Such children tend to rely on repetitive phrases. Their
speech does not usually convey imagination, abstraction, or subtle emotion.
They generally have difficulty talking about anything outside of the
immediate context. They may talk excessively about their special interests,
and they may talk about the same pieces of information whenever the same
subject is raised. The most able persons can exchange concrete pieces of
information that interest them, but once the conversation departs from this
level, they can become lost and may withdraw from social contact. Ordinary
to-and-fro conversational chatter is lacking. Thus, they give the
impression of talking "at" someone, rather than "with" someone.

Unusual Patterns of Behavior

The unusual responses of children with PDDNOS to the environment take
several forms.

Resistance to change. Many children are upset by changes in the familiar
environment. Even a minor change of everyday routine may lead to tantrums.
Some children line up toys or objects and become very distressed if these
are disturbed. Efforts to teach new activities may be resisted.

Ritualistic or compulsive behaviors. Ritualistic or compulsive behaviors
usually involve rigid routines (e.g., insistence on eating particular
foods) or repetitive acts, such as hand flapping or finger mannerisms
(e.g., twisting, flicking movements of hands and fingers carried out near
the face). Some children develop preoccupations; they may spend a great
deal of time memorizing weather information, state capitals, or birth dates
of family members.

Abnormal attachments and behaviors. Some children develop intense
attachments to odd objects, such as pipe cleaners, batteries, or film
canisters. Some children may have a preoccupation with certain features of
favored objects, such as their texture, taste, smell, or shape.

Unusual responses to sensory experiences. Many children may seem
underresponsive or overresponsive to sensory stimuli. Thus, they may be
suspected of being deaf or visually impaired. It is common for such young
children to be referred for hearing and vision tests. Some children avoid
gentle physical contact, yet react with pleasure to rough-and-tumble games.
Some children carry food preferences to extremes, with favored foods eaten
to excess. Some children limit their diet to a small selection, while
others are hearty eaters who do not seem to know when they are full.

Disturbance of Movement

The typical motor milestones (e.g., throwing, catching, kicking) may be
delayed but are often within the normal range. Young children with PDDNOS
usually have difficulty with imitation skills, such as clapping hands. Many
such children are very overactive, yet tend to become less overactive in
adolescence. Children with PDDNOS may exhibit characteristics such as
grimacing, hand flapping or twisting, toe walking, lunging, jumping,
darting or pacing, body rocking and swaying, or head rolling or banging. In
some cases the behaviors appear only from time to time; in other cases they
are present continuously.

Intelligence and Cognitive Deficits

Generally, children with PDDNOS do very well on tests requiring
manipulative or visual skills or immediate memory, while they do poorly on
tasks demanding symbolic or abstract thought and sequential logic. The
process of learning and thinking in these children is impaired, most
particularly in the capacity for imitation, comprehension of spoken words
and gestures, flexibility, inventiveness, learning and applying rules, and
using acquired information. Yet, a small number of children with PDDNOS
show excellent rote memories and special skills in music, mechanics,
mathematics, and reading.

Because many children with PDDNOS are either without functional speech or
otherwise untestable, some people question the validity of testing their
intelligence. Moreover, it has been observed that a number of these
children show major improvements in other developmental areas during the
follow-up period without a change in their tested IQ. Follow-up studies
have also shown that retardation present at the time of initial diagnosis
tends to persist. Those children with a low IQ show more severely impaired
social development. They are more likely to display unusual social
responses, such as touching or smelling people, ritualistic behavior, or
self-injury.

Associated Features

The emotional expression of some children with PDDNOS may be flattened,
excessive, or inappropriate to the situation. For no obvious reason, they
may scream or sob inconsolably one time, yet giggle and laugh hysterically
another time. Real dangers, such as moving vehicles or heights, may be
ignored, yet the same child might seem frightened of a harmless object,
such as a particular stuffed animal.
DIAGNOSING PDDNOS

The DSM-IV suggests that the diagnostic label of PDDNOS be used when there
is a severe and pervasive impairment in the development of reciprocal
social interaction, verbal and nonverbal communication skills, or the
development of seemingly meaningless repetitive behavior, interests, and
activities, but when the criteria are not completely met for a specific
disorder within the category PDD (e.g., Autistic Disorder, Rett's Disorder,
Asperger's Disorder). However, the DSM-IV framework has not offered
specific techniques or criteria for diagnosing PDDNOS.

No Specific Test Available

Currently, no objective biological test, such as a blood test or an X-ray
examination, can confirm a child's PDDNOS diagnosis. Diagnosing PDDNOS is
complicated and much like putting together a jigsaw puzzle that does not
have a clear border and picture. Therefore, it is reasonable to say that,
when a PDDNOS diagnosis is made, it reflects the clinician's best guess.
Obtaining an accurate diagnosis requires an assessment conducted by a
well-trained professional who specializes in developmental disorders,
usually a child psychiatrist, developmental pediatrician, pediatric
neurologist, developmental pediatrician, child psychologist, developmental
psychologist, or neuropsychologist.

PDDNOS Assessment

The purpose of PDDNOS assessment is twofold: to gather information to
formulate an accurate diagnosis and to provide information that will form
the basis of an appropriate intervention plan for the individual child and
family. Assessment of PDDNOS usually includes the following elements:

Medical assessment. The medical evaluation should include a thorough birth,
developmental, medical, and family history, and a full physical and
neurological examination. Not all children with PDDNOS require laboratory
tests such as a chromosome study, including a test for Fragile X, an EEG
(which measures the brain's electrical activity), or a brain scan such as
MRI (an X-ray that gives a picture of the brain's anatomy). The primary
care physician determines if these are needed. Although the cause of PDDNOS
is generally unknown, the physician may discuss some medical conditions
that do not cause PDDNOS but tend to be found in such children--for
example, seizure disorder. Associated conditions can cause or worsen a
child's problems.

Interviews with the parents, child, and child's teacher. A child with
PDDNOS may exhibit different abilities and behaviors in different settings
or situations. Parents and teachers can provide information about behaviors
not observed during the formal testing sessions.

Behavior rating scales. Checklists of possible problems should be completed
by parents or caretakers familiar with the child. Many diagnosticians use
the checklist for autism. However, no scale has yet been developed
specifically to determine the diagnosis of PDDNOS.

Direct behavioral observations. The child's behavior is recorded as it
happens, and assessment results are often graphed to aid interpretation.
This type of assessment can be carried out either in an artificial
situation (e.g., a child taking an intelligence test) or in a natural
situation (e.g., a child's home or classroom).

Psychological assessment. The psychologist uses standardized instruments to
evaluate the child's cognitive, social, emotional, behavioral, and adaptive
functioning. Parents learn in which areas of development their child
exhibits delays.

Educational assessment. Both formal assessment (such as the use of
standardized tests) and informal assessment (such as direct observation and
interviewing the parents) should be used to evaluate the child on the
following points:
-- preacademic skills (e.g., shape and letter naming),
-- academic skills (e.g., reading and arithmetic),
-- daily living skills (e.g., toileting, dressing, eating), and
-- learning style and problem-solving approaches.

Communication assessment. Formal testing, observational assessment, and
interviewing the child's parents are all useful strategies for assessing
communication skills. It is important to assess a range of communication
skills, including the child's interest in communication, why (for what
purpose) the child communicates, the content and context of the
communication, how the child communicates (including facial expression,
posture, gestures, etc.), and how well the child understands when others
communicate with him or her. Assessment results should be used when
designing a communication program for the child. This may incorporate one
or more alternative forms to spoken communication, such as sign language
and/or using a communication board (i.e., pointing to pictures to express
oneself).

Occupational assessment. An occupational therapist may evaluate the child
to determine the nature of his or her sensory integrative functioning: how
the child's different senses--hearing, sight, taste, smell, touch--work
together. Standardized tools are used to assess fine motor skills (such as
using fingers to pick up small objects), gross motor skills (such as
running and jumping), whether the child is right or left handed, and
various visual skills (such as depth perception).

Evaluation summary. The professional evaluating a child will use all the
information collected through these varying techniques to decide whether
that child has a disability that falls under the category of PDD.
Assessment and evaluation can be done through the child's local public
school or a private practitioner.

SPECIAL EDUCATION AND PDDNOS

By law, schools must make special services available to eligible children
with disabilities. These services are called special education and related
services (discussed more below). The law that requires this is the
Individuals with Disabilities Education Act, or IDEA. Under the IDEA,
school-aged children who are thought to have a disability must be evaluated
by the public schools at no cost to parents. Based on the evaluation, a
determination is made as to their eligibility for services.

IDEA defines categories of disability under which a child is considered
eligible for services. These categories are: autism, deaf-blindness,
hearing impairments including deafness, mental retardation, other health
impairments, orthopedic impairments, serious emotional disturbance,
specific learning disabilities, speech or language impairments, traumatic
brain injury, visual impairments including blindness, or multiple
disabilities. If permitted by the state and the local educational agency, a
school may also provide services to a student, from age 3 through age 9,
under the separate category of "developmental delay." Parents should check
with their state department of special education to find out what
guidelines their state uses.

It's important to realize that a child may have a disability and still not
be eligible for special education and related services. For a child to be
determined to be eligible, the child's disability must adversely affect his
or her educational performance.

Special education is instruction that is specially designed to meet a
child's unique educational needs. Related services can include a range of
services that are provided to help the student benefit from his or her
special education. Related services include (but are not limited to) such
services as occupational therapy, speech therapy, or physical therapy. Both
special education and related services must be provided at no cost to the
parents; both can be extremely beneficial for children with PDDNOS.

Services to very young children are also covered under the IDEA. Through
the Program for Infants and Toddlers with Disabilities, states make early
intervention services available to eligible infants and toddlers (birth
through two years). Not all services are free; some may be provided on a
sliding-scale basis (in other words, according to the parents' ability to
pay).

Early intervention services are designed to meet the developmental needs of
the infant or toddler in areas such as their physical development,
cognitive development, communication development, social or emotional
development, or adaptive development. Services include (but are not limited
to) such services as: family training and home visits, special instruction,
speech-language pathology, vision services, and occupational therapy. To
the maximum extent appropriate, early intervention services are to be
provided in natural environments, including the home and community settings
in which children without disabilities participate.

The IFSP and the IEP

The majority of school-aged children with PDDNOS will need some special
education services, just as those who are younger will need early
intervention services. If a school-aged child is found eligible for
services, the parents and the school will develop an Individualized
Education Program (IEP). This is a document that lists, among other things,
the child's strengths and weaknesses, and what special education and
related services the school will provide to address those needs. If the
child is less than 3 years old, he or she will have an Individualized
Family Service Plan, (IFSP). Parents can contact their state parent
training and information center (PTI) or NICHCY for helpful information
about IEP or IFSP development and the special education process.
________________________
(a sidebar)

A Mother's Story

Ryan, always in a whirl of activity, has had many labels. He was diagnosed
with PDDNOS at age three and a half. When he went to preschool, his label
was "developmentally delayed." Now he's 8 years old, and his label is
"autistic." He spends most of his time in a 2nd grade class. He's doing
great, but he still needs lots of extra help--speech therapy, occupational
therapy, and physical therapy. He loves playing soccer with kids in his
class. His disability is only one part of who he is; he also has lots of
strengths and talents. Every day still has its challenges, but we love him.
He's not a label--he's Ryan.
_________________________

TREATMENT OF PDDNOS

On the whole, children with PDDNOS share the social and communicative
disabilities found in children with Autistic Disorder. They often need
services or treatments similar to those provided to children with autism.

Traditional Methods

No one therapy or method will work for all individuals with Autistic
Disorder or PDDNOS. Many professionals and families will use a range of
treatments simultaneously, including behavior modification, structured
educational approaches, medications, speech therapy, occupational therapy,
and counseling. These treatments promote more typical social and
communication behavior and minimize negative behaviors (e.g.,
hyperactivity, meaningless, repetitive behavior, self-injury,
aggressiveness) that interfere with the child's functioning and learning.
There has been an increasing focus on treating preschool children with
PDDNOS by working closely with family members to help the children cope
with the problems encountered at home before they enter school. Many times,
the earlier these children begin treatment, the better the outcome.

Addressing behavior issues. As children with PDDNOS struggle to make sense
of the many things that are confusing to them, they do best in an organized
environment where rules and expectations are clear and consistent. The
child's environment needs to be very structured and predictable.

Many times a behavior problem indicates that the child is trying to
communicate something--confusion, frustration or fear. Think of the child's
behavior problem as a message to be decoded. Try to determine the possible
cause of the behavior. Has the child's routine or schedule changed
recently? Has something new been introduced that may be distressing or
confusing the child? When a child's communication skills improve, behavior
problems often diminish--the child now has a means of expressing what is
bothering him or her, without resorting to negative behavior.

The use of positive behavioral support strategies for these children has
proved effective. It is important to remember that:

1. Programs should be designed on an individual basis, because children
vary greatly in their disabilities and abilities. Treatment approaches that
work in certain cases may not work in others.

2. Children with PDDNOS have difficulty generalizing from one situation to
another. The skills they have learned in school tend not to be transferred
to the home or other settings. It is very important to be consistent in the
treatment of a problem across all areas of the child's life--school,
community, and home. This encourages generalization of behavior changes.

3. A home-community-based approach, which trains parents and special
education teachers to carry out positive behavioral support strategies, can
be instrumental in achieving maximum results.

Appropriate educational program. Education is the primary tool for treating
PDDNOS. Many children with PDDNOS experience the greatest difficulty in
school, where demands for attention and impulse control are virtual
requirements for success. Behavioral difficulties can prevent some children
from adapting to the classroom. However, with appropriate educational help,
a child with PDDNOS can succeed in school.

The most essential ingredient of a quality educational program is a
knowledgeable teacher. Other elements of a quality educational program
include:
-- structured, consistent, predictable classes with schedules and
assignments posted and clearly explained;
-- information presented visually as well as verbally;
-- opportunities to interact with nondisabled peers who model appropriate
language, social, and behavioral skills;
-- a focus on improving a child's communications skills using tools such as
communication devices;
-- reduced class size and an appropriate seating arrangement to help the
child with PDDNOS avoid distraction;
-- modified curriculum based on the particular child's strengths and
weaknesses;
-- using a combination of positive behavioral supports and other
educational interventions; and
-- frequent and adequate communication among teachers, parents, and the
primary care clinician.

Medical treatment. The primary aim of medical treatment of children with
PDDNOS is to ensure physical and psychological health. A good preventive
health care program should include regular physical checkups to monitor
growth, vision, hearing, and blood pressure; immunization according to
schedule; regular visits to the dentist; and attention to diet and hygiene.
An effective medical treatment begins with a thorough medical assessment.
The pretreatment assessment is essential for detecting existing medical
conditions, such as a seizure disorder.

There is no one specific medication that helps all children with PDDNOS.
Some medications have been found to be helpful, but for many children with
autism or PDDNOS, medication levels need to be experimented with until the
optimal combination and dosage are found. Since this differs with each
child, there is no set medical treatment for children with PDDNOS but,
rather, an individual medication regimen for each. Because of these
complexities, in the eyes of many, medication therapy is viewed as a
treatment to be used only when other types of treatment have been
unsuccessful. It is important to note that medication can be effective and
necessary for conditions that may coexist in children with PDDNOS, such as
attention deficit disorder or obsessive compulsive disorder.

Parents' final decision on whether to use medication as part of their
child's therapy is a personal one and should be respected and supported.
Medication should always be used in conjunction with other therapies, and
its effects should be monitored through feedback from the child, parents,
and teachers.

Psychological treatment. Counseling may be helpful to families to help them
adjust to raising a child with a disability. If the child is already
attending a school program, both parents and teachers need to be told of
the symptoms of PDDNOS and how those symptoms may affect the child's
ability to function at home, in the neighborhood, in school, and in social
situations. Psychologists can also provide ongoing assessments, school
consultation, case management, and behavior training. Some children also
benefit from counseling from an experienced practitioner who knows about
PDDNOS. Family teamwork can ease the burden on the primary home caregiver,
who needs a support system.

Other Therapies and Treatments

While exploring the treatment options available to help children with
PDDNOS, parents and others may come across several therapies that can be
used in conjunction with traditional ones. When considering one of these
other therapies for a child, ask questions and carefully assess the
program. It's important to ask for a written description of the program,
including its length, the frequency of sessions, cost, and the rationale,
philosophy, or purpose underlying the program. It's also important to
investigate the credentials of the program director and staff and whether
evidence exists to prove the effectiveness of the program, as well as the
possible negative side effects. Here are some alternative programs
available:

Facilitated communication. This is a method of encouraging people with
communication impairments to express themselves. By providing physical
assistance, a person, called a facilitator, helps the individual to spell
words using a keyboard of a typewriter or computer or other letter display.
Facilitation may involve hand-over-hand support or a simple touch on the
shoulder. The individual with the impairment initiates the movement while
the facilitator offers physical support.

Successful anecdotes of Facilitated Communication therapy have been
reported and published over the past few years. They have also provoked
considerable controversy, because generally they have not been supported by
empirical research. It appears that Facilitated Communication has the
potential for becoming a useful technique for some children with PDDNOS,
particularly those who are precocious readers and good with other forms of
communication such as computer and signs, but who also are severely
impaired in verbal expression skills.

Auditory integration therapy (AIT). AIT uses a device that randomly selects
low and high frequencies from a music source (a cassette or CD player) and
then sends these sounds through headphones to the child.

There are anecdotes about the positive effects from AIT. Some of the
results that have been reported include diminished sensitivity to sounds,
more spontaneous speech, more complex language development, answering
questions on topic, more interaction with peers, and more appropriate
social behavior. However, significant results from a well-designed
treatment study have not been available. It is still unclear how AIT works
and whether people benefit from it.

Sensory integration therapy. Sensory integration is the nervous system's
process of organizing sensory information for functional use. It refers to
a normally occurring process in the brain that allows people to put sights,
sounds, touch, taste, smells, and movements together to understand and
interact with the world around them (Mailloux & Lacroix, 1992).

On the basis of assessment results, an occupational therapist who has been
trained in sensory integration therapy guides an individual through
activities that challenge his or her ability to respond appropriately to
sensory stimulation. This type of therapy is directed toward improving how
an individual's senses process stimulation and work together to respond
appropriately. As with other therapies, no conclusive research demonstrates
clear progress made through sensory integration therapy, but it is used in
many areas.

The Lovaas method. This method (which is a type of Applied Behavior
Analysis [ABA]), developed by psychologist Ivar Lovaas at UCLA, is an
intensive intervention program originally designed for preschool-aged
children with autism. It uses behavioral techniques--molding and rewarding
desired behavior, and ignoring or discouraging undesirable actions--to
achieve its goals. Generally, this method consists of 30 to 40 hours a week
of basic language skills, behavior, and academic training. Therapy usually
consists of 4 to 6 hours per day of one-on-one training, 5 to 7 days a
week. Some research has shown remarkable progress in about 50% of the
children receiving this therapy. The Lovaas Method is getting wide
attention, but, as with other therapies, it needs more study.

Vitamin therapy. Some anecdotal evidence has shown that Vitamin B6 and
magnesium help children with autism and PDDNOS. The rationale for this is
that Vitamin B6 helps the formation of neurotransmitters, which are thought
to malfunction in such children (Dalldorf, 1995).

Dietary intervention. Some individuals with PDDNOS have been found to have
food sensitivities or food allergies. Some parents choose to have their
children evaluated by allergists and, based on the testing results, may
eliminate or decrease foods to which their child shows the most
sensitivity. For example, some foods seem to increase hyperactivity and
autistic-like behavior. Eliminating these from the child's diet has been
found to help decrease negative behaviors.

Anti-yeast therapy. Often the progression of autism and PDDNOS involves
unusual behaviors and communication problems arising around the toddler
stage, when many children are treated with antibiotics for problems such as
middle ear infections. Antibiotics can upset the intestinal flora and
possibly cause "yeast overgrowth." However, the existence of higher yeast
levels in children with autism and PDDNOS could very well be coincidence
(Dalldorf, 1995). Some parents have found that giving their child an
anti-yeast medication decreases some negative behaviors. Some preliminary
study findings support this type of treatment; however, the results are not
conclusive.

Summary. Since well-designed studies of these therapies have not been
conducted, their effectiveness in treating PDDNOS is unclear.

HELPING CHILDREN AT HOME

Parents can use many techniques and treatments to help their young child
with PDDNOS at home. These techniques should be discussed with other family
members and the professionals who are working with the child, so that the
individuals close to the child may employ the same methods. This will help
the child generalize skills learned at home to other settings, such as at
school and in the community. Parents can work at improving communication
skills and social skills. See the "Additional Resources" at the end of this
Briefing Paper for publications on techniques to use with children with
PDDNOS.

FINDING A PARENT SUPPORT GROUP

Children with PDDNOS are not the only ones who need extra help and support.
Parenting a child with special needs is a demanding task. Learning and
accepting that a child has a disability is a very emotional process.
Initially, parents may feel alone and not know where to begin their search
for information, assistance, and support. Parent groups offer parents and
families a place to share information, give and receive emotional and
practical support, and work as a team to address common goals.

Autism parent support groups are located throughout the country. Families
whose child has PDDNOS can benefit from joining these support groups. See
"Organizations" at the end of this publication for details.

CONCLUSION

Children with PDDNOS happen to have a unique disorder that will make
certain parts of life more challenging. Many articles, booklets, and books
contain useful information; however, these resources will probably not be
found at the local library or bookstore. To get these materials, contact
the organizations and publishers listed at the end of this Briefing Paper.
The Internet is also a valuable information-collecting tool. Check out the
helpful Web sites listed on page 15.

Learning more about the special needs of children with PDDNOS can be of
enormous emotional and practical help to those who are involved with, and
who care about, these special children.
_____________________

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual
of mental disorders (4th ed.). Washington, DC: Author.

Autism Society of America. (1995). Asperger's Syndrome information package.
Bethesda, MD: Author.

Boyle, T. (1995). Diagnosing autism and other pervasive development
disorders [excerpt from Autism: Basic information (3rd ed., pp. 6-7)].
Ewing, NJ: The New Jersey Center for Outreach & Services for the Autism
Community, Inc. (COSAC).

Dalldorf, J. (1995). A pediatric view of the treatment options for the
autistic syndrome. Chapel Hill, NC: Division TEACCH (Treatment and
Education of Autistic and Related Communication Handicapped Children).

Mailloux, Z., & Lacroix, J. (1992). Sensory integration and autism.
Torrance, CA: AYERS Clinic.

Moeschler, J., Gibbs, E., & Graham, J., Jr. (1990). A summary of medical
and psychoeducation aspects of Rett Syndrome. Lebanon, NH: Clinical
Genetics and Child Development Center.

Prizant, B. M., & Rydell, P. J. (1993). Assessment and intervention
considerations for unconventional verbal behavior. In J. Reichle & D.
Wacker (Eds.), Communicative alternatives to challenging behaviors (pp.
263-297). Baltimore, MD: Paul H. Brookes.

ZERO TO THREE: National Center for Infants, Toddlers, and Families. (1994).
Diagnostic Classification of Mental Health and Developmental Disorders of
Infancy and Early Childhood. Washington, DC: Author.
_________________________

ADDITIONAL RESOURCES

Autism Society of America. (1995). PDD information package. Washington, DC:
Author. [7910 Woodmont Avenue, Suite 650, Bethesda, MD 20814. Telephone:
1-800-3-AUTISM.]

Berkell, D. E. (Ed.). (1992). Autism: Identification, education, and
treatment. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. [10 Industrial
Ave., Mahwah, NJ 07430. Telephone: (201) 236-9500.]

Cohen, D. J., & Volkmar, F. (1997). Handbook of autism and pervasive
developmental disorders (2nd ed.). New York: John Wiley & Sons. [Orders to:
Eastern Distribution Center, 1 Wiley Dr., Somerset, NJ 08875-1272.
Telephone: 1-800-225-5945; (908) 469-4400.]

Cohen, S. (1998). Targeting Autism. Berkeley, CA: University of California
Press. [Orders to: California Princeton Fulfillment Service, 1445 Lower
Ferry Rd., Ewing, NJ 08618. Telephone: 1-800-777-4726.]

Dalrymple, N. (1992). Helpful responses to some of the behaviors of
individuals with autism. Bloomington, IN: Indiana Resource Center for
Autism. [2853 East 10th Street, Indiana University, Bloomington, IN
47408-2601. Telephone: (812) 855-6508.]

Dalrymple, N. (1992). Helping people with autism manage their behavior.
Bloomington, IN: Indiana Resource Center for Autism. [See contact
information above.]

Dalrymple, N. (1992). Some social communication skill objectives and
teaching strategies for people with autism. Bloomington, IN: Indiana
Resource Center for Autism. [See contact information above.]

Davis, K., & Pratt, C. (1997). A sense of belonging: Including students
with autism in their school community [Video]. Bloomington, IN: Indiana
Resource Center for Autism. [See contact information above.]

Gerlach, E. (1996). Autism treatment guide. Eugene, OR: Four Leaf Press.
[2020 Garfield St., Eugene, OR 97405. Telephone: 1-800-322-1883; (541)
485-4938.]

Harris, S. (1994). Siblings of children with autism: A guide for families.
Bethesda, MD: Woodbine House. [6510 Bells Mill Rd., Bethesda, MD 20817.
Telephone: 1-800-843-7323; (301) 897-3570.]

Hart, C. A. (1993). A parent's guide to autism: Answers to the most common
questions. New York: Simon & Schuster Co. [Attention: Order Department, 200
Old Tappan Rd., Old Tappan, NJ 07675. Telephone: 1-800-223-2336.]

Hegdon, L. A. (1995). Visual strategies for improving communication. Volume
1: Practical support for school and home. Troy, MI: Quirk Roberts
Publishing [PO Box 71, Troy, MI 48099-0071. Telephone: (248) 879-2598.]

Indiana Resource Center for Autism. (1991). Autism: Being friends [Video].
Bloomington, IN: Author. [See contact information above.]

Indiana Resource Center for Autism. (1992). Introduction to autism: Self
instruction module (Rev. ed.). Bloomington, IN: Author. [See contact
information above.]

Journal of Autism and Developmental Disorders. [Available from Plenum
Publishing Corporation, 233 Spring Street, New York, NY 10013. Telephone:
1-800-221-9369; (212) 620-8000.]

MAAP: A newsletter for families of more advanced autistic people. [A
quarterly publication of MAAP Services Inc., P.O. Box 524, Crown Point, IN
46307.]

New Jersey Center for Outreach and Services for the Autism Community
(COSAC). (1995). Autism: Basic information. Ewing, NJ: Author. [1450
Parkside Ave., Suite 22, Ewing, NJ 08638. Telephone: (609) 883-8100.]

Powers, M. (1989). Children with autism: A parent's guide. Bethesda, MD:
Woodbine House. [See contact information above.]

Quill, K. A. (1996). Teaching children with autism: Strategies to enhance
communication and socialization. Albany, NY: Delmar Publishers. [Available
from: ITP, P.O. Box 6904, Florence, KY 41022. Telephone: 1-800-347-7707.]

Schopler, E., & Mesibov, G.B. (Eds.) Several books are available in the
"Current Issues in Autism" book series: Autism in adolescents and adults
(1983); Effects of autism on the family (1984); Communication problems in
autism (1985); Social behavior in autism (1986); High-functioning
individuals with autism (1992); Preschool issues in autism (1993); and
Learning and cognition in autism (1995). [All are available from Plenum
Publishing. See contact information above.]

Simpson, R., & Ziontz, P. (1992). Autism information and resources for
parents, families, and professionals. Austin, TX: Pro-Ed. [8700 Shoal Creek
Blvd., Austin, TX 75757-6897. Telephone: 1-800-897-3202; (512) 451-3246.]

Organizations to Contact for Publication Lists: These organizations do not
have the resources to respond personally to individuals from all across the
country, but they have a number of helpful publications available.

Indiana Resource Center for Autism, 2853 East 10th Street, Indiana
University, Bloomington, IN 47408-2601. Telephone: (812) 855-6508 (V/TTY).
URL: http://www.isdd.indiana.edu/

New Jersey Center for Outreach and Services for the Autism Community
(COSAC), 1450 Parkside Ave., Suite 22, Ewing, NJ 08638. Telephone: (609)
883-8100. URL: http://members.aol.com/njautism

Helpful Web Sites:

Autism Society of America:
http//www.autism-society.org/

Autism at Yale Developmental Disabilities Home Page:
http://info.med.yale.edu/chldstdy/autism/welcome.html

Center for the Study of Autism: http://www.autism.com/

Division TEACCH Home Page:
http://www.unc.edu/depts/teacch/

Syracuse University Autism Resource Page:
http://web.syr.edu/~jmwobus/autism/
_____________________

ORGANIZATIONS

Autism National Committee, 249 Hampshire Drive, Plainsboro, NJ 08536.

Autism Society of America, 7910 Woodmont Avenue, Suite 650, Bethesda, MD
20814. Telephone: (301) 657-0881; (800) 3-AUTISM.
URL: http://www.autism-society.org

National Information Center for Children and Youth with Disabilities
(NICHCY), P.O. Box 1492, Washington, DC 20013. Telephone: 1-800-695-0285;
(202) 884-8200 (V/TTY). E-mail: nichcy@aed.org
URL: http://www.nichcy.org
_____________________

NICHCY Briefing Papers are published several times a year in response to
questions from individuals and organizations that contact the
Clearinghouse. In addition, NICHCY disseminates other materials and can
respond to individual requests for information. For further information and
assistance, or to receive a NICHCY Publications Catalog, contact NICHCY,
P.O. Box 1492, Washington, DC 20013. Telephone: 1-800-695-0285 (Voice/TTY)
and (202) 884-8200 (Voice/TTY). Visit our Web site (http://www.nichcy.org)
or our gopher site (gopher aed.org). You can also send us E-mail at:
nichcy@aed.org.

NICHCY would like to express its gratitude to the reviewers of this
Briefing Paper: Gail Bornfield, Ph.D.; Linda Felini-Smith, Ph.D.,
psychologist; Susan Goodman, attorney and parent; Frank Robbins, Ph.D.,
Quabbin Valley Educational Consultants; Vivian Sisskin, M.S. CCC, speech
and language pathologist; Judy E. Wade, teacher; and Mary Wolf, parent. The
Editor would also like to thank Donna Waghorn for her guidance in
developing this publication.

NICHCY would also like to thank Dr. Peggy Cvach, our Project Officer at the
Office of Special Education Programs, U.S. Department of Education.

Director: Suzanne Ripley

Publications Coordinator: Lisa Kupper

Director of Information Services: Donna Waghorn

Editor: Mary Kate Gutierrez

Author: Luke Y. Tsai, M.D.

This information is copyright free, unless otherwise indicated. Readers are
encouraged to copy and share it, but please credit the National Information
Center for Children and Youth with Disabilities (NICHCY). Please share your
ideas and feedback with our staff by writing to the Editor.
_______________________

Publication of this document is made possible through Cooperative Agreement
#H030A30003 between the Academy for Educational Development and the Office
of Special Education Programs of the U.S. Department of Education. The
contents of this document do not necessarily reflect the views or policies
of the Department of Education, nor does mention of trade names, commercial
products, or organizations imply endorsement by the U.S. Government.

The Academy for Educational Development, founded in 1961, is an
independent, nonprofit service organization committed to addressing human
development needs in the United States and throughout the world. In
partnership with its clients, the Academy seeks to meet today's social,
economic, and environmental challenges through education and human resource
development; to apply state-of-the-art education, training, research,
technology, management, behavioral analysis, and social marketing
techniques to solve problems; and to improve knowledge and skills
throughout the world as the most effective means for stimulating growth,
reducing poverty, and promoting democratic and humanitarian ideals.
  

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