BreCKen aNDrew

Here goes. I know that a lot of people are wondering about Brecken and are confused as to what is 'actually going on'. So, here is my best explanation for his diagnosis thus far. In June, we took Brecken to a psychiatrist in Holland to get a better idea of what it is that we were dealing with and what his recommendations were for us. After he observed Brecken, read the pediatricians concerns along with Brecken's Early-On teachers, and got a complete history/background of Brecken's behaviors and struggles - he diagnosed him with PDD-NOS. Which stands for Pervasive Developmental Disorder - Not Otherwise Specified. This means : as of right now, Brecken is PDD-NOS, one of the five Autism Spectrum Disorders (ASD's). It is a confusing diagnosis as some people may say "then my child is not 'autistic'' which ... is un-true. Although there is a specific diagnosis defined in the DSM-IV as Autistic Disorder, this IS a disorder on the LARGE spectrum of autism. However, his diagnosis may change. Only a neurologist can diagnose a child with Autistic Disorder and this brings us to the reason that we have been taking Brecken to Brains in Grand Rapids. Here, he is being more thoroughly assessed and evaluated. The psychiatrist we saw in Holland highly recommended that we take this step in order to find out where exactly Brecken falls on the Autism Spectrum. And also to see if Brecken actually has 'Autistic Disorder'. For those who aren't familiar with the DSM-IV, it is THE manual that is used to diagnose individuals with mental disorders based on a specific set of criteria. I am copying and pasting the page that relates directly to the five ASD's (PDD's).


DSM-IV Criteria
Pervasive Developmental Disorders
(also known as Autism Spectrum Disorders)

Listed below are the diagnostic criteria for the five Pervasive Developmental Disorders (PDDs), also known as Autism Spectrum Disorders (ASDs), as defined by the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), published by the American Psychiatric Association, Washington D.C., 1994, the main diagnostic reference of mental health professionals in the U.S.

299.00 Autistic Disorder
299.80 Pervasive Developmental Disorder, Not Otherwise Specified
299.80 Asperger's Disorder
299.80 Rett's Disorder
299.10 Childhood Disintegrative Disorder

299.00 Autistic Disorder

An autism screening tool must meet all three primary areas defined by the DSM-IV description for autistic disorder (#'s 1-3 under A below) to qualify for a positive rating from First Signs:

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:

(a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication, as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:

(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)

(d) persistent precoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.

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299.80 Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes "atypical autism" --presentations that do not meet the criteria for autistic disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

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299.80 Asperger's Disorder (or Asperger Syndrome)

An Asperger/HFA screening tool must meet all six areas defined by the DSM-IV description of Asperger Syndrome (A-F below) to qualify for a positive rating from First Signs:

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(2) failure to develop peer relationships appropriate to developmental level

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

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299.80 Rett's Disorder (or Rett Syndrome)

A. All of the following:

(1) apparently normal prenatal and perinatal development

(2) apparently normal psychomotor development through the first 5 months after birth

(3) normal head circumference at birth

B. Onset of all of the following after the period of normal development:

(1) deceleration of head growth between ages 5 and 48 months

(2) loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing)

(3) loss of social engagement early in the course (although often social interaction develops later)

(4) appearance of poorly coordinated gait or trunk movements

(5) severely impaired expressive and receptive language development with severe psychomotor retardation

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299.10 Childhood Disintegrative Disorder

A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.

B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:

(1) expressive or receptive language

(2) social skills or adaptive behavior

(3) bowel or bladder control

(4) play

(5) motor skills

C. Abnormalities of functioning in at least two of the following areas:

(1) qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)

(2) qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)

(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms

DD. The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.