A Story of Pervasive Developmental Disorder – Not Otherwise Specified

CME WebsitesChild Development, Parenting a Child with Special Needs, Special Needs Diagnoses

Trevor is a 5 year old boy who was diagnosed at age 2 with Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS). Trevor had a typical first two years, although his speech was delayed and his parents noticed the onset of some self stimulating behaviors. Their pediatrician was extremely supportive and suggested his parents contact state and local agencies to acquire early intervention (EI) services, even though Trevor’s eligibility would be terminated on his 3rd birthday.

With the help of a pediatrician, a short stint with EI services, family, friends and a caring preschool Trevor has made great strides over the past 2 years. Trevor can dress himself in the morning, although he needs lots of prompts to do this. He can eat by himself but needs enticement to remain at the table through the entire meal. He interacts well with his parents, his sister, and adults with whom he is familiar, but even so, he has poor social skills. Trevor likes to be around his peers yet he parallel plays with other children and has a hard time initiating interactions. Like most boys his age, Trevor loves cars (he knows everyone’s make, model and color!), trucks and trains.

Trevor’s next milestone will be this fall when he enters a public Kindergarten. Trevor’s parents’ goal is for Trevor to thrive academically and succeed socially. They want him to fit in and not become the recipient of bullying because he is different. Trevor, however, still exhibits behaviors that will inhibit his ability to attain these goals. His physical and verbal “stims” interfere with daily life, as well as in the classroom. Following directions at home and school is hard for him. Trevor seeks out movement and makes noises just for the sake of hearing them. He will appear not to hear what is being said to him even though it is clear he is listening. Trevor responds poorly to loud noises, which can be problematic with givens such as a gymnasium full of kids or a full bus en route to school.

To help Trevor achieve a productive school experience his parents sought the assistance of a pediatric occupational therapist (OT). The OT identified a number of sensory processing issues, which are common to children with Sensory Processing Disorders (SPD). SPD is a condition that exists when sensory input does not get organized into appropriate responses. Individuals with SPD may experience difficulties with transitions, everyday activities and routines. This often can lead to behavioral problems, depression and anxiety when not addressed. Children with SPD have exaggerated or understated reactions to all types of stimuli.

Trevor’s processing dysfunction is attributed to two categories within SPD: Modulation Disorder and Self-Regulation Disorder. Modulation Disorder occurs in the lower brainstem, is expressed behaviorally and affects children psychosocially. Self-Regulation Disorder occurs in the upper brainstem and cerebellum. It is expressed by inconsistent behaviors and skills. It affects children in the areas of psychosocial, motor coordination and language.

Intensive, short duration occupational therapy was recommended to address Trevor’s sensory processing issues. A strong vestibular program was implemented to increase body and spatial awareness. Proprioceptive activities were utilized to improve visual attention, focus on tasks, coping skills, and to decrease self stimulating behaviors.

Parental involvement is key to the success of any therapy program related to SPD. A home “diet” prescribed by the occupational therapist orders activities for balanced sensory experience and maximum brain related benefit. If parents are vigilant, sensory processing improvements are likely to occur within a month1.

Trevor began to make visible progress after two full weeks of therapy. Trevor’s teacher and Therapeutic Support Staff (TSS) reported the absence of “stimming” and disruptive behaviors that interfered with Trevor’s or his classmates’ learning. In therapy, Trevor began to mention friends and talked about who is doing what. Trevor is conducting himself in a more age appropriate and socially acceptable manner.
It is still difficult for Trevor to remain controlled in both school AND in therapy. From classroom reports, it appears that Trevor is making the correct decision!

1 Sensory Chef, Julia Harper MS OTR/L; President of Therapeeds, Inc.