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What is your opinion regarding the misdiagnosis of Mixed Receptive-Expressive Language Disorder (MERLD) (DSM IV 315.32) (where the child\'s behavioral symptoms ease as he continues to learn language) as one of the Pervasive Developmental Disorders (DSM IV 299.xx)?
My opinion is that it should not happen! Meaning, one of our biggest "rule-out" diagnoses when a child presents is to make sure that what we are seeing is not accounted for by a diagnosis of a language disorder alone.
Many of the tools that we have specifically assess the quality of the communication deficits to see if the child is displaying symptoms that go beyond a language disorder.
Also, what is your opinion regarding the effect of additional funding for autism intervention (in the form of better insurance coverage or otherwise) on the diagnosis of autism? What are your concerns regarding whether:
- additional funding will increase diagnostic substitution?
- Missouri will see a jump in prevalence if / when the insurance bill is passed?
I admit not having a crystal ball, but we can gather some good guesses based on other State's experiences. There may be a small impact in some areas, but I don't foresee large ones. There may be families more motivated to get an ASD diagnosis given the insurance coverage of therapy, but good professionals will hopefully base their diagnoses on the actual kid in front of them. If anything, more families may move to Missouri from states that don't have the coverage. I am just glad that there is some relief coming for the families who are already heroic in their efforts.
Our son (now 9 years old) was diagnosed with PDD-NOS at the age of 3 by a well-respected pediatric neurologist in the St. Louis area.
Unlike other disabilities, we are not on any kind of regular schedule to see the neuro. We last saw him year before last and he said the best time for another visit would be after his most recent school evaluation. PDD-NOS to me is such a nebulous term. Can that change
to something more specific such as Asperger\'s or classic autism?
PDD-NOS is a diagnoses reflecting either mild symptom or atypical presentation. This is not meant to imply lack of impact, as to get a diagnosis on the spectrum, it has to be having a significant impact on the child's life.
This diagnosis is often seen more in younger children in appreciation for how they may change as they develop. That is, symptoms often become better defined and recognizable as kids age. Research shows that a portion of kids diagnosed with PDD-NOS move into an Autistic Disorder diagnosis as they get older, while another portion (though lower) move off of the ASD diagnosis.
So, to answer your question, the diagnosis of PDD-NOS can and often does change. I am encouraging folks to not think so much about diagnostic categories, though, as this may be changing when the new diagnostic criteria come out. There is a big shift away from categories within ASD (which are not very meaningful from a treatment or etiology standpoint) and more to a diagnosis of ASD and then defining their skills within that overarching diagnosis.
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