I have a 4-year-old son who has been diagnosed PDD-NOS and possibly ADD by a neurologist. This has also been considered and is being considered by a Kaiser neuropsychologist. However, the diagnosis has been ruled out by the Diagnostic Center (last week). What are your criteria for ruling this out? I believe that my son has many of the PDD NOS autistic spectrum components. He is a twin and his sister, though language impaired and gross/fine motor delayed as well, share none of the social problems, behavior problems, or problems processing information that he has. I feel that he is so close, maybe borderline or on the spectrum, because of the different things he does. Would you happen to know if the state requirements and medical descriptions do not confer?

Thank you, Heather

Answer:

There is much variation in the way that different professionals come to a diagnosis of autism. The issue is further complicated by the different overlapping or related disorders such as Asperger's Syndrome or Pervasive Developmental Disorder. All of these diagnosis are what I call "symptom complex disorders" in that they have a group of "symptoms" or characteristics which, when combined together, lead to the diagnosis.

The most common way of diagnosing autism is to see if the child meets the criterion set forth in the latest Diagnostic and Statistical Manual (DSM IV), published in 1994. This "Manual" has a list of criteria which for each of the psychological/psychiatric diagnosis that we commonly use. There is a great deal of work that goes in to creating the list of attributes it takes to diagnose each of these disorders.

There are a variety of ways that professionals use to decide if a given child has sufficient numbers of the criterion to make the diagnosis. There is no difference between what constitutes the diagnosis among professionals but there is often disagreement about whether a given child, particularly if the diagnosis is borderline, fits the criterion.

Some professionals use an autism checklist, a questionnaire for parents and teachers that goes through the different criterion, symptoms, that a child has. From this a score can be determined that can make the diagnosis definitive or perhaps "maybe". Other professionals observe a child and determine for themselves whether the necessary criterion is met. A child can look very different in different situations so sometimes seeing a child in an office setting or the school setting or in his or her home can lead to varying opinions about the degree to which the particular symptoms are present and interfere with that child's normal functioning. This is the reason that, here at the Diagnostic Center, we often see a child in at least two different settings when trying to determine the extent of symptomatology present.

The following reference leads to the criterion for the diagnosis of autism in schools according to the education code (3030g). While similar to the DSM IV definition, this one appears to be broader in scope and allow for more leeway in qualifying a child for services. I hope this has answered your question. When all is said and done, what is important is that a child receives the appropriate interventions for their particular needs.