Helping the Child With PDD

Q: I have three young children, the oldest of whom is five years old. He recently was evaluated and given the diagnosis of PDD. Baruch Hashem, I was told that the extent of his problem is mild. I have read that some children on the PDD spectrum can be autistic or have Asperger’s syndrome. It is very worrisome to me that such a small child can have such difficult struggles to deal with.

Certain situations make my son very nervous, so I try to avoid them. These include encountering new people or going to new places. He doesn’t seem particularly frightened; he’s just very uncomfortable. He daydreams and distances himself from the situation — as if he doesn’t want to be there — and this is how he escapes. His teacher sees this behavior in school, and she feels that it happens too often.

Whether or not they are exaggerating the extent of my son’s problem, I need to know how to deal with his behavior. Can you suggest any techniques or ways I can work with my son to help bring out the best in him?

A: The degree of intensity and scope of limitations vary among children with issues of Pervasive Developmental Disorder (PDD). Clearly, children with autism are at one extreme of the spectrum, and their treatment is very specific (depending on the theoretic framework that is applied in each given case). That issue is not being discussed here.

The ideas in this column are more focused towards young children who exhibit milder degrees of PDD. These children may be helped by a parent’s involvement and assistance from various therapists during the early years.

Children who seem too self-absorbed and have limited social skills benefit from continual engagement in conversation and requests for making eye contact: “I love to see your beautiful brown eyes. Where are they?” A parent can ask an opinion of a 4- or 5-year-old, expect appropriate affect and not accept a response given in a monotone: “I don’t hear the lebedig Miriam that I know and love!”

A parent needs to initiate dialogue with such a child (even when verbal response is limited) to show that ideas are thought about and discussed with others. Parents need to discuss fears — common in children with PDD — in order to allow the child’s involvement in everyday life to be more comfortable and less frightening. Avoiding uncomfortable situations is not a long-term solution for a child exhibiting anxiety.

Reflecting feelings that your child may possibly be experiencing is the beginning of decreasing anxiety. The discomfort of transitions and changes can be verbally expressed. It helps a child to know beforehand what possible realistic expectations to anticipate from the upcoming activity.

You can say, for example, “I can see that going to this new house can feel a little different; you’ll be meeting children you never met before. Getting used to new things can sometimes take time.”

A parent can also offer possible solutions to fearful situations that she herself has encountered in life, to help reassure her child that she, too, can overcome her fears.

Positive reinforcement charts are helpful to motivate such a child to attempt new tasks or initiate conversation with classmates. Give extra points for maintaining eye contact or not repeating certain statements continually (a hallmark sign of a child with PDD).

The techniques mentioned here are often used by school therapists. A wise parent can implement similar initiatives at home to help reinforce changes her child needs to make in order to integrate more successfully into mainstream social situations.

Much hatzlachah in this most worthy endeavor!