September 15, 2009

The Specifics

On top of everything else, Jeff and I have started attending an educational series at Stanford for parents of kids with autism spectrum disorders. During our first session last week, we discussed the various types of spectrum disorders, including Autism, Asperger's, PDD-NOS, and the characteristics of each. I thought it would be interesting (for me, anyway) to match Moe's behaviors against the DSM-IV criteria for autism.

The DSM lists 12 criteria for pervasive developmental disorders (PDD), and how many and what type of these criteria a person meets determines the medical diagnosis. There is also an educational category of "autism" that may allow a child to receive certain services, but a child in the educational category may or may not meet the medical definition, and vice versa. Clear?

The criteria are in three categories: Social Impairments, Communication Impairments, and Restricted Routines and Interests (Repetitive Behaviors). A person with Autistic Disorder must meet 6 of the 12 criteria, with at least 2 under social, 1 under communication and 1 under routines.

Social Deficits
  • Impaired nonverbal behavior. Yes. Wesly does not do a lot of pointing or use eye contact to modulate social interactions.
  • Difficulties developing age-appropriate friendships. This is a little unclear since I'm not sure 2-year-olds really have friendships. But certainly, Moe doesn't interact with other kids his own age the way his peers do.
  • Trouble sharing interests with others spontaneously (bringing objects, pointing out objects of interest). Yes, although Moe does do this sometimes, and we are starting to see it more.
  • Lack of social or emotional reciprocity. Like the last one, Moe does show reciprocity but only very inconsistently.
Communication Impairments
  • Delay in the development of language. Yes. Although Moe's language abilities are starting to pick up, this was the big sign that something wasn't quite right.
  • Inability to initiate or sustain a conversation. Doesn't seem really relevant, per above.
  • Stereotyped language (echolalia, repetitive or idiosyncratic speech). Again, not relevant.
  • Lack of pretend or social imitative play. Yes. Another huge tip-off and with language, probably the biggest indicator. During his assessment, he was interested in the baby doll, but mostly how its eyes flicked open and closed, and wouldn't put the baby to bed or have a birthday party for the baby. We are starting to see some growth here. Moe spontaneously "fed" Anabelle some toy peas today and will occasionally talk on his toy phones.
Restricted Routines & Interests
  • Restriced interests (preoccupation with a few interests). Not sure. Moe certainly has his favorite toys that he returns to again and again, but I think this is probably something more relevant to older people.
  • Adherence to nonfunctional routines. I don't think so.
  • Stereotyped motor mannerisms (hand flapping or waving). No.
  • Preoccupation with sensory aspect of objects (spinning wheels, visual inspection, rubbing things). Yes. Moe loves spinning the wheels on toy cars, and checking out how everything works..He will also play with toy cars as cars, but mostly he likes to examine them.
I just compared my observations above with what Dr. S. listed as Moe's criteria for autism, and they match exactly. So I guess that shows that the assessment was accurate.

Some of these characteristics can also be strengths. It isn't inherently bad that a child likes to inspect things and understand how they work. Autistic kids are often very focused and can learn a lot about the topics they are interested in. It is the combination of traits, however, that indicates the problem. The language and social communication skills are our biggest concerns.

The above list does not describe how Moe was diagnosed. Dr. S used a standard test called the Autism Diagnostic Observation Schedule (ADOS). Moe was then given scores for communication skills, reciprocal social interaction, play, and stereotypical behaviors and restricted interests. His numbers on these were also consistent with a diagnosis of autism.

I should note again that I am not a doctor. The above exercise was just one I found interesting to catalog our specific areas of concern. If you think your child may have delays or you suspect autism, talk to your pediatrician. DSM-IV summaries courtesy of Linda Lotspeich and Jennifer Phillips from the Stanford Autism Center at LPCH.

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