Autism Spectrum Disorders?

Question

How can a child have autism *and* aspergers OR autism *and* pdd-nos? I see this kind of thing online often, but according to the neuropsych's information it's impossible. Aspergers is like autism, except it lacks the speech issues. So, how could a child have both? A child either has or doesn't have speech issues...can't be both ways. Pdd-nos is like autism, but a couple features are missing. So, how could a child have both? A child is either missing a couple features or isn't...can't be both ways. Even going by the common misconception of aspergers and pdd-nos simply being high functioning autism, it still doesn't make sense. A child is either high functioning or not...can't be both ways. All are on the spectrum, but have differences which exclude the others and all vary in severity (i.e. a child can be low or high functioning in any of these disorders).

Answer 1

I know how frustrating it can be to want to know exactly what the issue is so you can begin to help your child.  Thre is some good information in the other answers so I won't repeat it here.  But I can tell you that instead of focusing so much where on the Spectrum your child is, start learning about the different methods of treatment.  I suggest reading up on Applied Behavioral Analysis (ABA), Verbal Behavior and the studies of B.F. Skinner, PECS, Natural Environment Teaching (NET), Discrete Trials, Sensory Integration therapy and more.  Join a support group.  You will most assuredly make invaluable friends that can relate to what you are going through.  If your child is over the age of three, contact your school distrct and request an assessment to include speech, OT/sensory integration, academics, etc.  

In short, the specific point where a child lies on the Spectrum isn't as important as finding a methodology to minimize the impact of the disability.  And if you took your child to ten different doctors, you probably will have ten different opinions.  Unfortunately, there is no exact science with autism yet.

Answer 2

IN a perfect world - children would get what they need to be successful.  The world is not perfect.

Based on criteria that is established by individual state - the categories that students can get services under is varied.  I have seen very good outside medical and very bad outside medical and schools typically cannot base services on medical diagnosis.  It is a part for some categories like ADHD but not for all.  What drives the school evaluation is "what are the students educational needs."

In my district we have students with outside medical diagnosis that do not get school services based on no 'need'. I also have students that meet the educational criteria for ASD but not the medical - and they do get services.

The only thing I can tell you is this.  These are ALL complex neurobiological disorders - as a student grows and develops - things change - sometimes they become more clear sometimes even more muddied.  The important thing is to focus on "what does this child need educationally."  "What category best describes his/her needs at this time"  "What should service look like."

I always advise parents not to get too hung up on lables but to look at the bigger picture of needs.

Answer 3

Technically, you are right.  You either have a diagnosis of Asperger's, autism, or pdd-nos, which, by definition, should rule out the other two.  Of course, these three labels are helpful in understanding and supporting the student's need for services.  However, the definitions are complex, consisting of multiple elements.  Accordingly, a hundred students "on the spectrum" may each have manifestations different from each other and none perfectly matching these definitions.  

Diagnosis then becomes an approximation, with enough required and supplemental criteria being met for one of the three labels.  For example, we all have communication problems, some so severe that the student may not talk at all, others may only say a few words, others struggle with speech production in narrow pragmatic settings only.  Are all these the same condition?  Alternatively, could some of the students with these speech challenges be considered "normal" or "not on the spectrum" under certain circumstances?  

Add to this blurry line, a lot of loose use of the terms.  For example, some consider Asperger's Syndrome another name for "high-functioning autism" and therefore place it on the spectrum with the autism label, although you have precisely observed that this common classification does not coincide with the professional classification found in the DSMIV.

Answer 4

I too want to understand the differences and where my kids are at to better help them.  I have been studying this for the past 5 years.  The autistic spectrum is a continuum.  There is overlap in symptoms and diagnosis is based on clinical opinion.  Diagnostics can be either educational or medical.  The spectrum rolls like this:

NT (neurotypicals)---NT's with quirks, PDD.NOS----asperger's----HFA----LFA----(... disorder)

As far as the DSM-IV-TR concerning autistic spectrum, it is only a rough guideline that doesn't hold a lot of weight amoung the entire autistic spectrum community.  It is anticipated that the next addition will make clearer distinctions similar to below.

PDD.NOS- a lot of people don't like this because this is the catch-all and wasn't supposed to be a dx in and of itself.

What PDD.NOS is, is someone with a minimum IQ of 85 (low average), some features of spectrum but not enough to meet criteria for anything else, better social skills than any of the other disorders, fine motor delay, speech/language delay, academic challenges

Asperger's-academically strong IQ usually above average, more anxiety than PDD.NOS kids, social skills worse than PDD.NOS, no speech delay, no fine motor delay, more uneven scattered abilities (not uncommon for a 1st grader to comprehend on an 8th grade level but can't hold a conversation back and forth on topic to the degree of a 4 year old).  Aspie's prefer adult conversations rather than with typical peers.  Aspie's have difficulty recognizing faces, and remembering names.  Do well as any kind of scientist, engineer, computer person.  

HFA-high functioning autism  IQ similar to PDD.NOS low-average to average.  Speech/language delay, fine motor delay, academic challenges, social skills more like asperger's or more impaired than that.   More autistic traits than either of the above.

LFA-low functioning autism IQ is impaired usually below BIF (borderline intellectual functioning) in the EMH-TMH range

(mild to moderate MR mental retardation)  EMH-educable mentally handicapped 55-70 and TMH-trainable mentally handicapped  40-55.  Looking at non-verbal, incontinent, not much attachment to anybody, very dependent living in institutions as an adult, more violent outbursts, more SIB's (self-injurious behaviors), more likely to have seizures, going to an autistic school, no academics only ADL's (attention to daily living), more likely to dart (run away)

A lot of people aren't educated in the differences.  Some people have different opinions.  I have taken my 7 y.o. to one neurologist and she said asperger's, another neurologist said PDD.  I said what gives, the other neurologist said asperger's.  He told me he has traits of both but is more PDD than aspergers.  Ok, he did turn out to be PDD.NOS.  HE is still getting OT services, and is not excelling academically, in a classroom he does not stand out as having a social-communication disorder and upon evaluation needed to be pointed out to the psychologist she couldn't identify who she was to be evaluating by looking for the autistic spectrum kid.  There is a pretty accurate free online PDD assessment at http://www.childbrain.com

Answer 5

You're right.  They can't.  They can either be diagnosed with PDD-NOS, Autism, or Asperger's based on their individual symptoms and situation.  Where are you seeing this double diagnosis on-line?

Answer 6

Autism is a 'spectrum' with wide ranging symptoms, a sort of 'pick and mix' of symptoms if you like!

Imagine a brain in which there are one hundred billion functional neurons, all working in little interconnected patterns called neural networks.  When something goes wrong in that system and produces symptoms considered to be 'autistic' in nature, those neural natworks can be injured in many, many different patterns of injury.  So in effect, the pattern of injury is like a fingerprint and unique to the child.

All of this has the effect of producing some symptoms, which children with autism, or cerebral palsy, or other expressions of brain dysfunction, will have in common.  However, because the exact pattern of injury is unique to the child, at the individual level, the precise problems, which each child displays will not be exactly the same.  

The problem is in the way the medical world labels children, not with the problems they display.  They try to categorise children into either Asperger's or autism, when it is simply a brain dysfunction which can produce either of these two, or depending on the individual pattern of dysfunction, mixed symptoms of both.

Don't go with the categories which are provided, look at it as brain dysfunction which can produce a myriad of different symptoms, any combination of which can appear in any particular individual.

Read this. http://www.lulu.com/content/1225081



or go here.  http://www.snowdrop.cc/info2.cfm?info_id...

Answer 7

Boy oh boy, did you hit a subject that a lot of us parents of kids on spectrum find frustrating! Frankly, the problem is that doctors make a best-guess based on the child's specific difficulties. My son carried a dual of Aspergers & HFA for a while because while he definitely was Aspergers, his academic weaknesses were more along the lines of a child with HFA. He should have carried a PDD-NOS (which is supposedly the catchall for kids who have struggles in both areas), but PDD isn't recognized by a lot of school systems for services & the doctor took that into account. This year, the HFA was dropped & he is labeled Aspergers.

The reality is there needs to be a breakdown different than what is out there right now. There are specific struggles for people on the spectrum, and the diagnosis should be Autism Spectrum Disorder with each individual's challenges laid out (ie. social skills deficits, speech/language delays, attention deficit, sensory integration dysfunction, fine/gross motor delays, etc.) It would make it so much easier to give a proper label & to know what each individual child will need to thrive.