New SCD label in DSM5, Social Immaturity in adhd and ppd-nos

[PeterPan]

Moreover, in a study specifically examining the overlap of ADHD and PDD, Frazier et al. (2001) found that 5% of children with ADHD also met criteria for PDD and 83% of children with PDD also met criteria for ADHD. Clark et al. (1999) investigated the presence of autism symptoms in a sample of ADHD children and found the highest mean score on difficulties in social interaction compared with other domains of PDD such as restricted repertoire of activities and interests or problems in verbal and nonverbal communication. Similarly, Luteijn et al. (2000) found that those diagnosed with ADHD were indistinguishable from those diagnosed with PDD-NOS on the Social Insight subscale of one of the measures administered in their investigation. In a study examining twins, those with ADHD-Combined Subtype were the most impaired on a Social Responsiveness Scale when compared to non-ADHD twins (Reiersen, Constantino, Volk, & Todd, 2007). Utilizing the CBCL, Luteijn and colleagues found that the greatest impairments on the Social Problems subscale were in children with PDD-NOS (i.e., the PDD-NOS and comorbid PDD-NOS/ADHD groups). Children diagnosed with only ADHD fared the best on the Social Problems subscale in this study, although these scores were still substantially higher than both clinical and normal control groups (Luteijn et al., 2000). Downs and Smith (2004) investigated the social-emotional abilities of children with autism in comparison to children with ADHD and Oppositional Defiant Disorder (ADHD/ODD) and, contrary to their expectations, discovered that the ADHD/ODD group was more impaired than children with autism or those with no psychiatric diagnoses regarding social-emotional understanding. Collectively, studies demonstrate that the social difficulties present in ADHD and PDD may share similar features as well as severity for certain subgroups of ADHD populations. It remains to be seen, however, if a measure of risk status for PDD might be associated with the particular types of social impairment seen in the ADHD child.

 

 

Social functioning difficulties in ADHD: Association with PDD risk

 

Found this article while doing a little reading.  They mention SCD, but this predates DSM 5.  Has anybody had a run-in with that new SCD label to know anything about it, if they're using it, etc? 

 

The whole article was interesting, because it breaks down the social issues in ways I hadn't heard before.  Obviously I'm not up enough.  Guess I should have known they had these more nuanced tests.  

 

See that's one of the things I can't quantify and why I feel like I have to have evals, because he seems young to me.  It's really just that question of whether I'm out of sync with 5 yos, since we did have a big gap, or if he really objectively is young.  And it's hard to reconcile that he doesn't feel like a rising K5er maturity-wise with someone who's clearly as bright as he is, doing lego technic kits marked age 10+, etc.  It just doesn't jive. And it seems to me that's not going away.  He improves every year, but he just seems so YOUNG.  Even now, with him turning 6 in two months.  

 

Whatever.  I'm mainly just chronicling this article so I can find it again later, but if anybody knows anything about that I'm interested. 

[PeterPan]

Evidence weak for social communication disorder — SFARI.org - Simons Foundation Autism Research Initiative

 

Wow, this lady roasts the use of SCD in DSM5 and says there's little evidence of a distinction and that the kids would have gotten either an autism or SLI label as their historical diagnosis, pre-intervention.  Thunk.  

 

I think the next two months might be a little long.  I'm going to have to take up a new hobby to busy my mind.  Or just finish the projects I already have, oy.  

 

How did you kill time while waiting for your psych eval? Maybe it's not kill time but embrace the time?  

[Crimson Wife]

My $0.02 is that SCD was invented because the new ASD criteria specifiy the child has to exhibit repetitive behaviors. Kids who don't flap, spin, rock, etc. can't qualify for the ASD label under DSM V but they're clearly impaired, hence the creation of SCD.

 

ADHD can definitely cause missed social cues and inpulsive behaviors that interfere with social interactions (interrupting people, acting wild, etc.) That is what our pediatric neurologist thinks is going on with DS. He definitely seems "young" and immature for his chronological age, despite being very advanced in certain areas. He's got a fall birthday, and while I started him in K at not-quite-5 because he was already reading, the ADHD and poor fine motor skills made me decide to do a "transition" year between K and 1.

[Heathermomster]

Evidence weak for social communication disorder — SFARI.org - Simons Foundation Autism Research Initiative

 

Wow, this lady roasts the use of SCD in DSM5 and says there's little evidence of a distinction and that the kids would have gotten either an autism or SLI label as their historical diagnosis, pre-intervention.  Thunk.  

 

I think the next two months might be a little long.  I'm going to have to take up a new hobby to busy my mind.  Or just finish the projects I already have, oy.  

 

How did you kill time while waiting for your psych eval? Maybe it's not kill time but embrace the time?  

 Embrace the time and try not to dwell on everything.  Living itself and managing your family is quite enough for now.  My DS is getting evaluated today and tomorrow for College Board accommodations. :D

[OneStepAtATime]

I agree, just embrace the time, play games, work on things that you and he are interested in, and try not to overthink or stress out.  He IS young.  You have time to sort it all out.  Just enjoy the time you have right now.  It won't last.  The years are going to march forward pretty quickly and you will have so many things to deal with later on that just aren't an issue right now.  Enjoy his being 5 almost 6 and enjoy who he is right at this moment.  Give both of you a bit of grace and time to breathe.  I wish I could get a few years back to do just that.  And I am trying to find ways to do that right now, before they are all grown and gone....hugs.

[Storygirl]

I don't have time to read those articles right at this moment (busy day today, as usual), but they sound fascinating.

 

DS10 has always seemed extremely young for his age. Probably more like an eight year old now. Sometimes seems even younger to me, especially when he is outside the home, interacting with others. He always hangs out with much younger boys in a mixed-age group. On the other hand, he does exhibit typical tween snarkiness toward his siblings and is starting to show curiosity about boy-girl relationships (talking about kissing is one of his new big interests *sigh*). So there is a disparity, although for him it is social, not with academics. He's not 2e, so I suspect a child who is would be likely to show even greater variation in maturity in one area of life versus another. I'd say that what you are seeing with your son is fairly typical among non-NT kids with certain issues. It can definitely make parenting more unpredictable.

[PeterPan]

My $0.02 is that SCD was invented because the new ASD criteria specifiy the child has to exhibit repetitive behaviors. Kids who don't flap, spin, rock, etc. can't qualify for the ASD label under DSM V but they're clearly impaired, hence the creation of SCD.

 

ADHD can definitely cause missed social cues and inpulsive behaviors that interfere with social interactions (interrupting people, acting wild, etc.) That is what our pediatric neurologist thinks is going on with DS. He definitely seems "young" and immature for his chronological age, despite being very advanced in certain areas. He's got a fall birthday, and while I started him in K at not-quite-5 because he was already reading, the ADHD and poor fine motor skills made me decide to do a "transition" year between K and 1.

So then what did you think of this article's mention of testing showing the social impairment of those kids who get the ADHD label, instead of spectrum, in that situation is AS SEVERE (on the same Social Immaturity test) as kids who *do* get the spectrum label?

[PeterPan]

I agree, just embrace the time, play games, work on things that you and he are interested in, and try not to overthink or stress out.  He IS young.  You have time to sort it all out.  Just enjoy the time you have right now.  It won't last.  The years are going to march forward pretty quickly and you will have so many things to deal with later on that just aren't an issue right now.  Enjoy his being 5 almost 6 and enjoy who he is right at this moment.  Give both of you a bit of grace and time to breathe.  I wish I could get a few years back to do just that.  And I am trying to find ways to do that right now, before they are all grown and gone....hugs.

Point well made!

 

And good luck to Heather with your new round of testing!!  :)

[Snow]

After we had our evaluation, I felt bad that we hadn't done it sooner. Early intervention and all. But now I'm realizing that sometimes, for some kids, their symptoms just haven't solidified yet. It's there. You know it but it still needs to form and congeal into something more concrete. That's no ones fault. I'm not saying wait on the evals; it sounds like you need to do it. You need answers. Just that sometimes, you can't will yourself to figure this out.

 

I didn't read the articles but I will tonight.

 

Immaturity isn't really the word to describe my ds. In fact I can think of a couple of examples when he was with kids 3-5 years older than him and he made the more mature decisions, said the more mature things. But he is just sort of unaware. I lovingly refer to my dh as mr oblivious because he just misses anything subtle in conversations. I'm sitting there reading a novel of facial expressions during a conversation and he's just hearing their words. The man has zero intuition. And I think ds is kind of like that. He just lives completely in the physical world. I told the NP, it's like he hasn't taken up residence in his own head yet. From his narrations, I know that he understands peoples underlying motivations, he just doesn't care about it at all in the real world. There is a simplicity there, I think. He lives to play and have fun and cares not one whit about intellectual pursuits or depth or meaning. Dd is completely opposite, so I don't think it's inherent to children. "Mom, there's a lot of slavery in the bible. Someone is always getting captured." Or, "Mom, ds gets really angry over little things sometimes but he doesn't have to." She's 3.

 

I don't know maybe I'm splitting hairs over the word. I guess I like aware versus unaware better. I guess it's really a question of whether he has the capacity for social/deeper understanding but no motivation? or truly just very little capacity?

 

Now I'm just rambling.

 

Waiting sucks. I had many 2am nights during our waiting period. But I hyper focus like that :thumbup:

 

How about writing a homeschool curriculum for SN kids while you've got time to kill? I'd buy it! :hurray:

[Crimson Wife]

So then what did you think of this article's mention of testing showing the social impairment of those kids who get the ADHD label, instead of spectrum, in that situation is AS SEVERE (on the same Social Immaturity test) as kids who *do* get the spectrum label?

 

It's based off of a single checklist that parents filled out. The article notes a distinction between the types of social skills deficits in kids with PDD vs. ADHD.

 

According to the article, PDD kids had problems with: "preference to play alone, impaired ability to play appropriately with toys, a lack of social reciprocity, difficulty reading nonverbal social cues, a one-sided conversational style, and an impaired ability to understand the emotions, motivations and intentions of peers".

 

By contrast, the ADHD kids had problems with: "bossy, intrusive, inflexible, controlling, annoying, explosive, argumentative, easily frustrated, inattentive during organized sports/games, and violating the rules of the game."

 

The researchers also note that only 2 out of the 379 ADHD kids studied were found to meet diagnostic criteria for PDD, and none for "classic" autism.

[PeterPan]

He lives to play and have fun and cares not one whit about intellectual pursuits or depth or meaning.

 

How about writing a homeschool curriculum for SN kids while you've got time to kill? I'd buy it! :hurray:

Yup, that definitely to me is part of what I'm seeing.  You've put it really well.  

 

I know people writing books of their experiences, but really even then it's one person's experiences.  Seems to me very few people transcend, and when they *do* transcend it's still easy to generalize and miss nuances.  So I would never pretend my experiences with ds correlate directly over to someone else's, mercy.  It seems to me like everyone here on the board has a unique situation they have to sort out.

[PeterPan]

It's based off of a single checklist that parents filled out. The article notes a distinction between the types of social skills deficits in kids with PDD vs. ADHD.

 

According to the article, PDD kids had problems with: "preference to play alone, impaired ability to play appropriately with toys, a lack of social reciprocity, difficulty reading nonverbal social cues, a one-sided conversational style, and an impaired ability to understand the emotions, motivations and intentions of peers".

 

By contrast, the ADHD kids had problems with: "bossy, intrusive, inflexible, controlling, annoying, explosive, argumentative, easily frustrated, inattentive during organized sports/games, and violating the rules of the game."

 

The researchers also note that only 2 out of the 379 ADHD kids studied were found to meet diagnostic criteria for PDD, and none for "classic" autism.

Thanks for pulling that out!  I read that, but you get so many things going, it gets all jumbled in your brain.  So if there's a difference in the play, that's informative.

[kbutton]

It's based off of a single checklist that parents filled out. The article notes a distinction between the types of social skills deficits in kids with PDD vs. ADHD.

 

According to the article, PDD kids had problems with: "preference to play alone, impaired ability to play appropriately with toys, a lack of social reciprocity, difficulty reading nonverbal social cues, a one-sided conversational style, and an impaired ability to understand the emotions, motivations and intentions of peers".

 

By contrast, the ADHD kids had problems with: "bossy, intrusive, inflexible, controlling, annoying, explosive, argumentative, easily frustrated, inattentive during organized sports/games, and violating the rules of the game."

 

The researchers also note that only 2 out of the 379 ADHD kids studied were found to meet diagnostic criteria for PDD, and none for "classic" autism.

 

Both of those lists can describe my PDD-NOS kid with comorbid ADHD. :-) Interesting.

[kbutton]

Shellagh Gallagher talks about 2e kids on the spectrum vs. LD kids. I don't remember where she put the ADHD kids in this description. She says that 2e kids with LDs are going to be more like their other gifted age mates socially. Spectrum kids who are 2e are more socially immature--so, gifted kids are asynchronous, 2e kids are more asynchronous, and spectrum 2e kids are going to be asynchronous in a way that lines up brainwise with other 2e kids and socially with younger age mates. 

 

This is a bit fuzzy and unpolished, but it's been well over a year since I heard that particular talk. 

[kbutton]

After we had our evaluation, I felt bad that we hadn't done it sooner. Early intervention and all. But now I'm realizing that sometimes, for some kids, their symptoms just haven't solidified yet. It's there. You know it but it still needs to form and congeal into something more concrete. That's no ones fault. I'm not saying wait on the evals; it sounds like you need to do it. You need answers. Just that sometimes, you can't will yourself to figure this out.

 

I didn't read the articles but I will tonight.

 

Immaturity isn't really the word to describe my ds. In fact I can think of a couple of examples when he was with kids 3-5 years older than him and he made the more mature decisions, said the more mature things. But he is just sort of unaware. I lovingly refer to my dh as mr oblivious because he just misses anything subtle in conversations. I'm sitting there reading a novel of facial expressions during a conversation and he's just hearing their words. The man has zero intuition. And I think ds is kind of like that. He just lives completely in the physical world. I told the NP, it's like he hasn't taken up residence in his own head yet. From his narrations, I know that he understands peoples underlying motivations, he just doesn't care about it at all in the real world. There is a simplicity there, I think. He lives to play and have fun and cares not one whit about intellectual pursuits or depth or meaning. Dd is completely opposite, so I don't think it's inherent to children. "Mom, there's a lot of slavery in the bible. Someone is always getting captured." Or, "Mom, ds gets really angry over little things sometimes but he doesn't have to." She's 3.

 

I don't know maybe I'm splitting hairs over the word. I guess I like aware versus unaware better. I guess it's really a question of whether he has the capacity for social/deeper understanding but no motivation? or truly just very little capacity?

 

Now I'm just rambling.

 

Waiting sucks. I had many 2am nights during our waiting period. But I hyper focus like that :thumbup:

 

How about writing a homeschool curriculum for SN kids while you've got time to kill? I'd buy it! :hurray:

 

My son was diagnosed late, and much of the reason is that he could brain out some of the problems and make himself act like the other kids. At some point, they moved on, and that got to be too difficult. My son is sometimes oblivious, sometimes amazingly mature (he can be the stabilizing force in the room or the tornado!), and sometimes just what the article describes. You never know. He has a lot of some kinds of social understanding, but it's narrow, and it can be work for him. He was deeply affected when a neighbor family (no longer lives here) had a child in the family die after years of cancer. And that child (and siblings) had bullied him from time to time. So, he is a sweet, kind soul, just stuck and odd at times and definitely using a totally different scale to gauge emotional connection, interaction, etc. He's reading from another book, but it has some of the same pages, lol!

 

My 2nd DS sounds SO MUCH like your daughter. He's 6.5 now, but he said stuff like that when he was 3, and it's continued. He's amazingly perceptive.

[PinkyandtheBrains.]

One of my boys has the social issues tag added to his ADHD diagnosis.

 

Eta

 

He's previously had a Hyperlexia diagnosis.

[PeterPan]

Both of those lists can describe my PDD-NOS kid with comorbid ADHD. :-) Interesting.

I've spent all day wondering that after reading what Crimson wrote, so thanks for sharing!  :)

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[Storygirl]

Both of those lists can describe my PDD-NOS kid with comorbid ADHD. :-) Interesting.

 

Both lists describe my son, too, though he has NVLD, ADHD, and SPD.

 

I think the PDD list describes my son partly but does not define his personality (meaning he can be like this but not always and not only -- he always has other things mixed in), whereas the ADHD list made me laugh, because it is so much like DS10.

[kbutton]

Both lists describe my son, too, though he has NVLD, ADHD, and SPD.

 

I think the PDD list describes my son partly but does not define his personality (meaning he can be like this but not always and not only -- he always has other things mixed in), whereas the ADHD list made me laugh, because it is so much like DS10.

 

Yes, not always and not only very much apply in our situation too. 

[Crimson Wife]

Youngest DD has co-morbid ASD and ADHD. She is a mix of traits from both lists. As her functioning level has improved, she has fewer of the PDD traits and more of the ADHD traits. For example, she used to spend a lot of time lost in her own little world ignoring her siblings & peers. Now she is Little Miss Bossy trying to order them around.. It may not be functional social behavior, but it actually is an improvement from where she started.

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[PeterPan]

Elizabeth, my apologies for all the posts lately. I just know you are searching for answers and wanted to remind you, since you have mentioned that your son is more than likely 2e, that different rules apply for 2e kids. Meaning, their profiles will be a mixed bag and what might seem like ADHD for example, may just be a characteristic of the gifted part of your boy. Anyway, I looked over my Misdiagnosis book and realized why it was not one I read cover to cover. Lots does not apply to us anyway, and the part that does is mostly focused on kids that are either Asperger's/HFA or gifted. The focus on dual exceptionalities is small so not the best book for that. Bright not Broken that Crimson Wife recommended is the best read right now. Good reading while you are anxiously awaiting ;) .

 

I wish you all the best and will be back to check how things worked out. You will be in my thoughts :grouphug: .

Canucks, you never offend me.  It does make me chuckle a little though that you think I'm unfamiliar with 2E, since I went to a school for the gifted myself and am not exactly un-quirky. :D   :lol:  Seriously, to me he's actually EASIER to work with than dd and makes MORE sense.  He's basically just like me, just being honest.  

 

At this point what I'm trying to do is make sure I'm getting him all the services he needs, make sure we have the right words for things, make sure I'm not missing things or misinterpreting things.  I talked with the principal at the ps today, and she was SO nice.  I'm very comfortable at this point that we're going to be able to work well together.  They're prepared to be very helpful.  

 

I'm actually just a little worn out, honestly.  I'm getting sort of mentally exhausted and can't handle much more.  I read BnB and Mislabeled several years ago, so I'm at least passingly familiar with the concepts.  Some of it's just going to have to do for now, because I'm getting worn out.  I'm just going to get the ball rolling on the evals, let them do their thing, and see what happens.  Meanwhile I'm keeping a log of things I see.  Hopefully that will take care of it.  I probably won't try reading books on SN again until after I get some eval feedback.  I just can't handle it.  I did watch some videos on youtube, as you said, and some of them were insightful, so thanks for the suggestion.  I found videos tracking a boy with PDD-NOS from little to teen, so that was interesting.  It was also interesting how totally different the boy with the apraxia and PDD-NOS label was on youtube.  I haven't looked for any NVLD youtube clips yet.  Like I said though, it's just sort of slow death for me.  The IEP book was fascinating.  It doesn't seem like the ps is going to give me problems, but one interesting point in the IEP book was to get more connected with people in the community.  I'm making a little move with that, so we'll see.  

 

So that's as far as I've gotten.  But yes, I feel like I've got the gifted side under control.  He doesn't astonish me at all on how to work with him.  In fact, it feels kind of natural.  It was dd who was hard to work with.  Ds and I are very simpatico. Basically I have drawers and piles of stuff, and we do what we want together when he wants.  He listens to an insane amount of audiobooks, especially now that he has his kindle, and he likes educational shows (PM4K, documentaries, etc.).  I just bought him geography stuff using the plans the Jenn/Otter lady posted.  I'm super excited about that and think it can work for him.  I think we'll do geography one day a week as sort of an all day pursuit.  We'll see.  He's very interested in cooking, so I got the cookbook to go with it.  He's interested in photography, so I let him do that.  He likes field guides, so I read him those.  We just roll with it.  There is no way I can do anything with him that resembles traditional forced school.  It's all just this is what he's into, roll with it.  He seems to like the things I bring his way, so our method seems to be working.  

 

The only thing that really holds us back academically is this reading and math thing (well that and handwriting), and that's why I'm getting the evals, because I refuse to push something he isn't developmentally ready for and want good counsel.  I don't know what aspect of what I'm seeing is disability and what is developmental and what is something else entirely.  So for that we just do little dribbles in ways that suit him at a pace that suits him.  If I get counsel to step up that pace for certain elements, I'll consider it.  But for right now, that's where we're at, just being very conservative and going with his flow.  In this way he enjoys everything we do.  It just doesn't give astonishing or fast results.  But he enjoys it and it suits him.

 

That's what we're doing.   :)

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[PeterPan]

Canucks, did you see the WordFun book Timberdoodle put on special today?  Amazon has it as well.  I thought ds might enjoy it.  

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[PeterPan]

Ooo, I hadn't thought about kindle!  They have one volume that has maybe 9 parts of speech in it for $12.  It's the print version, 192 pages.  And I know what you mean on books.  I figured my ds would either like it for some reason or walk away.  He seemed to like it.  I think it was the language interest.  The sentences are more descriptive and interesting than what I would think up on the fly.

 

And oh what a loss never to have ordered from Timberdoodle!!!  I don't necessarily use academic stuff from Timberdoodle, but their taste in games, puzzles, and activities is EXQUISITE.  

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