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.
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 [See footnote]
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.
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