Re: strange language behavior typical for autism

Posted By Karen on October 29, 1998 at 17:15:14:

In Reply to: strange language behavior typical for autism posted by CCF Neuro[P] MD, RPS on October 29, 1998 at 16:46:19:






: My son, who will be 4 in January has been diagnosed with PDD-NOS. He has severe social & language delays with other "autistic" traits such as occasional hand-flapping when excited and single interests ie: swords, dinosours. At home he has begun speaking in 4 to 5 word sentences and using pronouns, and questions. The problem is he will not speak to us outside of the home, at the babysitters house (he has been there daily since he was 6 months) he does not speak there or anywhere else. For speech assessments he responds to therapists buy pointing or gasping but never verbally. The minute he leaves the office,he will tell me how much fun he has had. He is in a early childhood program for children with disabilities but he will not speak there either. I made a tape recording for them to show them he does speak to us in the home. They are now trying to change his diagnosis because they think he has more of a behavioral problem because of speech inconsistancies. My son will talk to strangers in our home but not to familiar people outside our home. It is very frusturating! Is this speech behavior typical in PDD children? I feel in my heart the PDD-NOS is a correct diagnosis. He could repeat Peter Pan line by line before he could put 3 word sentences together. He has had a significant medical past he lost a kidney at 3 weeks (hydroneophrosis) had 1 unexplained seizure and several high fevers and fever seizures. He has had several severe bouts of croup which have required hospitalizations, he takes steroids for this as needed and had exploratory throat surgery to rule out abnormalities. I do not want the school to change his diagnosis at this time.
I also have a 4-year old with PDD and, though he doesn't display those same sort of speech problems, he has atypical patterns etc.
It's my understanding that speech problems can be "all over the map" with PDD, in other words, almost any "weird" pattern can occur.  What you describe doesn't sound that farfetched to me, in the context of a PDD diagnosis.  Of course, I'm not a clinician.
There are other symptoms related to the autistic spectrum, other than the speech problems; you mention the social issues, obsession with swords and dinosaurs (my son is in love with garbage trucks ) etc., which sound like PDD to me.
I know you have input on what the school district does as part of your son's program - you can certainly fight a re-diagnosis.  Maybe there is a behavioral component, but there can certainly be behavioral problems *as well as* the PDD. Make sure they don't drop other aspects of his treatment as part of handling the supposed "behavior problem"!
Sorry I don't have any more concrete advice, just wanted to let you know I think you are right on target in your assessment of your son.
...Marie
Dear Karen:
First, I think you are correct and your son has PDD.  PDD is difficult to diagnose accurately.  There are no definitive laboratory tests for PDD, rather children are diagnosed based upon having a variety of key features or behaviors.  PDD is somewhat of a diagnostic catch-all category.  The current diagnostic manual for mental disorders uses the term PDD-NOS for any child who shows signs of PDD but does not meet full criteria for autistic or asperger's disorder.  Children diagnosed with PDD typically display difficulties beginning in infancy or pre-school, and parents oftern report that their child seems to be significantly "different" form peers.  The primary areas of deficit in children with PDD are SOCIAL, COGNITIVE, COMMUNICATION/LANGUAGE, SENSORY, PERCEPTUAL-MOTOR, AND AFFECTIVE/EMOTIONAL.  At yojng ages , children with PDD generally have difficulty with social skills and the "give and take" of social play.  They often prefer to be alone or with close family members.  When they do seek out peers, they may be rejected or act inappropriately.  As they move into the school age years, children continue to have social difficulties and seem to have problems empathizing with peers.  These children are often teased or ignored by peers and may be viewed by age-mates as "different or odd".  Impairments in thinking/cognitive processing are common.  These thought patterns may include perserverative, rigid, or ritualistic thinking, as well as very personal interpretations of situations.  It is typical for such children to be very set in their activities and to have significant difficulty changing routines.  While intelligence varies from borderline to gifted, children with PDD often have uneven cognitive development and mya have one or more areas of delay such as lnaguage, speech, writing, or reading.  Thinking is often very concrete and literal or may be tangential.  Communications skills may be impaired and often there are problems with the social component of language as welll as with intonation and prosody.  Many have a history of language delays and may require speech and language therapy for articulation or on higher order communication problems such as pragmatic language, problem solving, or abstract reasoning.  Speech may also include some autistic-like behaviors such as echolalia or unusual speech patterns.  They may also display unusual sensory reactions.  Overreaction to tactile sensations are common and some children with PDD seem to have a very high or very low pain threshold.  Difficulties with motor or perceptual-motor skills are also relatively common.  Children may seem awkward or clumsy form an early age and may be somewhat behind peers in motor development.  they may engage in stereotyped motor behaviors such as rocking or spinning in early life.  They mal also become fascinated by touching certain objects or by movements and engage in them repetitively.  Written language problems in later school years are frequently noted.  Occupational therapy evaluation may be helpful in outlining specific perceptual-
motor and sensory deficits.  The affective or emotional funciton is also a concern for most families.  Problems appear in two primary areas 1) the understanding of emotions in self and others and 2) the regulation and expression of emotions and feelins.  The difficulty with perception of other's feeling can lead to significant difficuties with peers or family members.  Children with PDD may seem extreme in their behavior and emotions.  They may become easily distressed and upset, or, alternatively show no reaction to a normally distressing situation.  They may display anxieties or fears that seem unreasonable for the situation.  Regardless of the label, children diagnosed with PDD require appropriate ASSESSMENT AND TREATMENT by professionals familiar with this disorder.
I hope that this long discourse helps.  Let us know if we can do anything to help.
Sincerely,
CCF Neuro:Pediatrics MD, RPS

Dear CCF Neuro:Pediatrics MD, RPS,
Thank you for your informative reply. My son had the initial PDD-NOS diagnosis by a Developmental Peditrician. We then had a hearing test done for my son and a Fragile X test done for him as well which came back negative. He is just got evaluated at Tx Childrens Speech & Language center and is beginning intensive speech therapy and also recieving OT and speech at school district early childhood program. I know he could benifit from many more things but there just isn't enough time in a day and working for me is mandatory. The developmental peditrician suggests we see him every 6 months to monitor any intervention needs, he can guide me on which specialists are most important for my son. From my understanding top priority right now is speech. He dosen't seem to have unusual sensory reactions, gross motor skils are up to level. He does have delays in fine motor skills and severe social delays. I appreciate your reponse.
Marie: Thank you for responding to my post. It is nice to have people take out time to help others. It is really nice to talk to someone who understands! Even my own family dosen't seem to understand the diagnosis and realize his limitations!