About this blog.

My son was diagnosed with PDD-NOS at 24 months. I created this blog to bring meaning to the often-confusing label. Sometimes I have answers. Other times, just more questions.

Monday, February 16, 2009

Relationship Between DCD and ASD

Isn't this a PDD blog? What is DCD and why am I blogging about it?

Cue the graphic, courtesy of DANDA:

Click here for a better look. (I couldn't quite figure out how to smoosh the graphic into blogger, and preserve the aspect ratio.)

I blogged about the basics of DCD here. The official term is DCD but it is often referred to as "dyspraxia." Its defining quality is poor coordination. However, there is a statistically significant correlation between DCD, and language and social impairment, as well as a litany of other cognitive issues such as poor working memory and poor ability to multitask.

As the graphic illustrates, Developmental Coordination Disorder/Dyspraxia and Autistic Spectrum Disorder are interlocking sets, meaning many individuals have symptoms of both. However, technically, from a diagnostics perspective, an individual cannot have both. That is, if an individual presents with PDD-NOS, DCD is ruled out as a discrete diagnosis. In her "impression" report, Brad's developmental pediatrician indicated an impression of PDD-NOS, and that he tested "signficant for" hypotonia and DCD, but the final diagnosis was PDD-NOS, not DCD.

Anecdotally, many individuals with asperger's and autism identify as "dyspraxic" even though it's not an official diagnosis.

If I were to put Brad on the graphic, I'd place him in the interlocking set between ASD and DCD, closer to the DCD side than the ASD side. And if I were to hazard a guess, I'd say he's going to cross from the interlocking set into the "pure" DCD bubble some time before he turns 6. (In August 2008, Brad's ADOS score was at the cutoff. Plus he has strength in the social domain, a predictive factor for growing out of the diagnosis. For these reasons, I think there's a very strong chance Brad will lose the PDD diagnosis.)

The graphic illustrates, in part, why I abandoned the differential diagnosis. Is he in this bubble or that bubble? In reality, the lines are blurry, the bubbles intersect with each other and Brad's brain is going to change over time. The bottom line is that he's neurologically different. What label is ascribed to that difference at any point and time is less valuable and probative than the overall developmental trajectory.

What does DCD mean to Brad? I blogged about it a bit here. For starters, he walks like he's drunk. Much less so today than 6 months ago, but he still has an uneven gait. He's got terrible fine motor coordination. He's very floppy, low energy, and unmotivated to move. As an example, he never - and I mean never - stands up in his crib. (Yes, he is still in a crib.) To get him up in the morning or at nap, he needs a lot of prompting and assistance. He has never once stood up in his crib unprompted or unassisted. He drooled persistently until he was 2-1/2. He has poor depth perception and poor ability to track things visually.

Each person who has evaluated Brad has noted he splays his fingers. Here's video of it. As I understand it, this is a result of low tone in his fingers and is an indication that he may have difficulty grasping a pencil in the future. The good news on that front is that there are very specific and effective therapies to develop grasping strength

On the speech front, he has delays and motor issues, such as getting stuck on the first syllable (like stuttering), and more recently "elongation" in the middle of a word or a sentence.

Last, he also is very slow at processing information, sensory data, social cues and language. More on that later.


pslocali said...

hi there,

i have a daughter who has severe global apraxia (dyspraxia) and who also has autism. you should look at the following link. the protocol here has helped her and many other kids with their dyspraxia. some kids are responders and others are not. we have just gotten started and we are seeing some promising results. if anything it makes some things easier for her. she has a long road ahead, but we'll see how it goes.

we wish you all the best!



Patience said...

DD never had any of these problems. Amazing fine motor (stringing beads at age three) If professionals are now talking about children eventually "losing" labels then that is good as I find some parents have a tendency to "accept" a diagnosis and not aim very high after that or lose themselves in the world of the handicapped.
We were told dd had a lifelong impairment and that no matter how good she looked or developed; she would always be behind or that if she appeared to catch up; the gap would eventually widen. (cheers eh?) If that happened to us; then is must happen to others. It is good that your son was identified by people who were more flexible. I did have a typical son who had really poor motor skills and trouble grasping a pencil; he's now training as a chef and hasn't lost any fingers yet so there's hope for Brad. LOL!

Laura said...

pslocali - thanks, and best to you and yours. I will check it out.

patience - Well the person we brought Brad to for a second opinion (August 2008) spent the time to observe him and provided me with a nuanced understanding of his profile. His first opinion (January 2008) was just PDD-NOS, sign him up for 25 hours of services (ABA or other) per week or risk him never developing speech. So while I eventually found a good doc, I've also shared the experience of having a generic dx coupled with alarmist speculation about development. And I agree that a pathology can develop whereby the child can become underestimated.

Anonymous said...

Again, you have totally enlightened me. I think Rhema early on demonstrated some of these symptoms... in fact a dr. thought she might have CP when she was 15 mos. old. She also drooled like CRAZY. But then, almost overnight, she developed great gross motor skills and coordination.

Laura said...

Interesting. Little puzzles, aren't they. I belong to a dyspraxia group, and a lot of the members have children with both dyspraxia and CP.