Showing posts with label PDD-NOS. Show all posts
Showing posts with label PDD-NOS. Show all posts

Wednesday, April 23, 2014

Autism Song

This morning I was scrolling through Facebook when I saw this link for a new song called "We'll Get By." After reading the short article and listening to the song, I was crying in my office. It's a beautiful song with an important perspective, the child's. I needed to hear it today. Bradley has been doing a little more "movie talking" lately than he had been doing. I've been working on a blog to explain the "movie talk" and will hopefully publish it later tonight or tomorrow. Anyway, I feel like I have been a little tough on him for something he perhaps has a hard time controlling.

Please take time to listen to this song. I will personally be writing the Johnny Orr Band to thank them for doing this. It reminded me that Bradley knows we love him and that he loves us too. He's doing a great job trying to be the best Bradley he can be.





Saturday, October 12, 2013

We Went on a Walk

Whenever we have an upcoming event or fun activity I always debate about when and how to tell Bradley. He still has difficulty understanding the concept of time, so if I tell him too early Bradley is disappointed that we aren't going to the party or event that very minute. If I tell him too late, I miss the opportunity to explain to Bradley where we are going, what we are doing, and who we'll be with. I have found that some planning and discussion of the event helps Bradley feel more comfortable when we arrive at where ever we are going and have a better time during the experience.

About three weeks before the Houston "Walk Now for Autism Speaks" I decided to officially join my friend, Lori's fundraising team, "Amazing Him: Team Erik." Lori invited me to join the team earlier, but the hustle and bustle of the beginning of the school semester had my attention. Once we were team members and fundraisers I was overjoyed with the financial and emotional support friends and family gave. 

I started telling Bradley about the walk about a week before the event date. I told him we'd be "going on a walk for autism with a bunch of people who are special like you" and that he'd make a new friend named Erik. I also explained to Bradley that there would be many people at the walk and that some of them liked the same things he did. Bradley was growing increasingly excited each day that we talked about it, but was most excited to meet his new friend Erik.

The day of the walk finally arrived and the boys and I headed for Reliant Stadium with our Red Rider Wagon in tow. When we arrived I unloaded the wagon and then loaded Max and our bags of supplies and snacks back into the wagon. We found our group and after a short transitional adjustment for Bradley we settled in. Amazing Him: Team Erik was comprised of loving, approachable, and sweet adults and kids who automatically welcomed Bradley upon our arrival. However, Bradley wasn't real sure about what was going on at first and was somewhat negative about changing his shirt and putting on the team shirt that everyone was wearing. 


It is hard for me to understand how Bradley can go from being super excited and talking about this walk for a week, to not wanting to be there and going home instead. This happens so frequently when we do something new. My guess is that Bradley has a specific expectation of what he thinks is going to happen and when reality doesn't equate to that expectation, he panics. While I don't think he means to be rude, Bradley's attitude quickly shifts and he says, "No thanks... I want to go home... I don't want to do this." Needless to say, this is embarrassing for me and then we have to spend several minutes readjusting Bradley's attitude and getting him focused on the current event or task.

Once Bradley was on track to have fun then he and Erik were peas and carrots. Erik was super sweet to Bradley and they played well together.


 

Before we knew it we were about to move forward to the stage for the opening ceremonies. Lori led us in a beautiful group prayer that really resonated with me. In her prayer she thanked God for choosing her and her husband to be Erik's parents. I feel the same way with Bradley. It is an amazing blessing to be Bradley's Mom (and Max's mom too).

Walking up to the starting line we were about 50 yards away and listening to the emcee announce sponsors, donors, leading fundraisers, and special thank yous. Happy and relaxed Bradley and Max soon turned in to impatient, cranky, and frustrated little boys. The announcements lasted at least 20 minutes and the boys only became hotter, sweatier, and increasingly more annoyed. Bradley wanted to start walking, but we were surrounded by hundreds of people with very little wiggle room. Max was miserable. He was hot, didn't want to sit in the wagon, didn't want to be held, and didn't want to be told what to do. Bradley kept urging us to walk, "Come on Mom. Let's go. Move. Let's go." But it wasn't time to go and no matter how patiently I explained this to Bradley he just didn't understand.

After what felt like an eternity of waiting, the official start began and we were all excited. However, we weren't really moving. We literally inched our way up to the start line a mere one step at a time. The starting archway was narrow and the crowd was wide. It was wonderful to have such an amazing turnout for the event, but getting everyone through the narrow arch was a headache. At this point Max was screaming, literally screaming in my face. Max was screaming at the top of his lungs. He did NOT want to be held. Max wanted to run around the crowd of hundreds. Sorry Max- not an option. Max screamed in protest. I whispered into Max's ear, "It's okay Max. Mama's here. We're moving now. Look! We're going under some balloons soon." Nope- didn't work. Max continued to scream.

As we inched our way closer I tried to stay positive.I was sweating my face off. Sweet Erik noticed I was sweating and demonstrated how to cool myself off by quickly pulling at the front of my shirt. There was no cooling off for me. It was hot and the stress of Max screaming in my ear, Bradley's impatience, hundreds of people around me, the fear of losing track of one of my kids, people pushing by us, inching our way forward, being cut off by other impatient walkers, and the Texas sun were too much for me to keep my composure. On the verge of tears I began to complain. "Don't these organizers realize that autistic kids have a hard time waiting? What are they thinking? I am absolutely miserable! Uggh! This is not fun." I said these things out loud. Strangers heard and looked at me with pity.

We finally made our way through the inflatable, blue archway and I felt defeated. I felt horrible that I was complaining during this time of empowerment for so many. I continued to fight back tears but felt so alone. How strange... I felt alone in a sea of hundreds of other people. I didn't see anyone else struggling like me. I saw tons of teams helping with the kids. I saw fathers there with their children. My husband was bow hunting for deer. Someone asked where my brother was. He was bow hunting too. I felt alone. I felt incredibly frustrated. I wanted to cry.

We caught up with the rest of our team, but I couldn't stop to wait for the remainder of the team members. Bradley and Max were finally happy that we were moving and I didn't want to stop. We had about 2 miles to walk around the stadium parking lot and my arms were already shaking from caring 30 pound Max and pulling 50 pound Bradley in the wagon uphill. Thankfully several of our team members offered to help me with the boys and I finally accepted help from Lori's brother, Adrian. He is a childhood friend of my brother, so I've known Adrian for 20 years or more. Adrian is young and athletic so I didn't feel too guilty about him pulling Bradley in the wagon. I immediately felt relief. I still regretted my bad attitude earlier and hoped that no one in our team had noticed. Now I was enjoying the walk and enjoying my conversation with Adrian.


Throughout the course my stress went away and my heart filled with joy. Bradley was having a blast! He was smiling at, waving to, and hugging strangers along the course. Volunteers were cheering for Bradley as we passed and complimenting his Angry Birds rain boots. I really enjoyed visiting with Adrian and Lori and I shared our experiences with raising the sons we love on the autism spectrum. We talked about the tough times and the progress our kids have made. Somewhere along the way Max fell asleep in my arms and we moved him to the wagon and Bradley marched along side us.




As we approached the end of the course Bradley recognized that we were almost finished with the walk. He became very excited when he saw the pedestrian bridge we crossed at the beginning of the course. Bradley's excitement turned in to a jog toward the bridge, so I ran after him since Adrian was comfortable pulling sleeping Max in the wagon. The closer we got to the finish line the happier Bradley became. "Look Mom! We're almost there!" Bradley cheered as we walked back through the blue arch, "Hooray! We did it! Hooray!" I was so happy and proud of Bradley's fantastic attitude and joy.



Bradley wanted to play on one of the inflatable slides in the parking lot so after we found Adrian we wheeled sleeping Max toward Bradley's slide of choice and stood in line. Again- autistic kids and lines don't exactly mesh at times. Many of the kids waiting didn't want to wait but their parents stood strong and made them. I was very proud of Bradley's willingness to wait his turn. Bradley's turn was up next and it began to rain. After sweating for over an hour, the cool rain was a welcomed blessing. Kids crawled out of the netted slide and left with their parents. I asked if we could still let Bradley jump and play in the inflatable playground and the volunteers agreed. Bradley jumped and slid and had fun while the rain came down. Surprisingly, Max continued to sleep through the rain.


We could see more rain clouds approaching and hurried back to our team's spot to gather our things. Thanks to the help of Lori and her husband we were able to gather up our many bags very quickly and head toward the car. Adrian helped with the wagon again and we found my vehicle among the sea of cars.

Before the end of the walk I realized that the walk experience was incredibly significant to me because it was so congruent with how my life has been with Bradley's autism spectrum diagnosis. In the beginning (before diagnosis) I was frustrated with the lack of progress Bradley was making in his speech. People were telling me something was wrong but I wasn't handling it well. I felt heavy burdened by this uncertainty. I'm sure I complained quite a bit. I was anxious and scared of losing my child. I lacked confidence in his future... our future. I was rude to diagnosticians and service providers who were merely trying to help. I resisted diagnosis because I feared a label. I envied other families who looked like they had it together. I felt lost.

As we walked through the archway of diagnosis I began to feel some relief, but I was still panicked. We had such a long journey to go and I was already physically and emotionally exhausted. How am I going to do this alone? People are offering to help, but I don't know them. I can't expect them to carry my burden. Gosh this is so hard! Why don't I have the support I need? Well, maybe I do have support. Yes- I do have people wanting to help me. Maybe not who I expected, but they genuinely want to help. Yes! Thank you for your help. (Don't cry). Thank you for your help! You promise to help me through all of this, right? 'Til the end? Please?

Somewhere in the midst of the walk of treatment I am gaining confidence. I can do this. I can be the mom Bradley needs. I can be there for Bradley AND for Max. I can get us through this. I am not alone. There are people here with me and for me. They "get" me. They understand Bradley. They love Bradley. I love Bradley even more. Bradley is happy and Max is relaxed. I have friends who understand. I have friends who understand me even when I don't talk. They love me for who I am and know that my focus HAS to be on Bradley if I'm going to be the mother God desires me to be for Bradley and Max.

As we approach the finish line Bradley is happy. Max is relaxed. My friends and supporters are behind me. My burdens are distant. My God is providing me with the love, peace, and relief that I need. Bradley is overjoyed and smiling. Bradley eagerly runs toward our future with his hand in mine. I love Bradley even more.

For the rest of that day Bradley told everyone, and I mean EVERYONE, we met that he "went on a walk today." He shared his experience with strangers at Chick-Fil-A, police officers we met, and our family members later that day and weekend. Bradley loved our walk and asked if we could come back again. I promised Bradley we would and I can't wait to keep that promise next year and walk with Max and Bradley again.

Sunday, June 9, 2013

Hospital Anxiety

Bradley has been fearful of doctors since age 2 or 3. I'm not sure what prompted his hospital anxiety, but going to check-ups (even when Bradley didn't get immunizations) use to be incredibly stressful!!! Bradley would scream, kick, cry, drool excessively, and yell while I did whatever I could to calm him. By the time we'd leave the clinic or doctor's office I would be a sweaty mess in need of reapplication of deodorant. Parenting tip- if you are a sweaty woman like me, carry at least two sticks of deodorant with you at all times!

Where did this anxiety come from?
Maybe it's genetic- my father really doesn't like hospitals, but he tolerated them enough to visit me for both deliveries of his grandkids and when I had an appendectomy at age 12. Maybe I influenced it some how. At Bradley's 2 day check up he was jaundice and our pediatrician told me Bradley may need to be admitted back into the hospital to treat it with special lights. I immediately started crying and did not want my baby to be away from me. I know Bradley can't remember that- he was probably asleep at the time, but I've wondered if my little breakdown affected him in some way. As he grew older, Bradley was not happy at all about going to the doctor. 


2 day old Bradley- you can see the yellow tinge of jaundice in his face

Bradley also appears to have extreme sensitivity to anticipated/perceived pain. He expects procedures to be painful, and therefor perceives pain during non-painful procedures and/or has anxiety related to anticipated pain. When I clip Bradley's fingernails 9 times out of 10 he adamantly protests and cries until I clip a few nails to remind him that it doesn't hurt. We rationalize that clipping his nails and toenails doesn't hurt and that Mommy would never do anything to hurt him. Even though nail clipping time is less dramatic than it use to be, it's still no walk in the park. This hypersensitivity is likely related to his PDD-NOS, specifically the sensation and perception differences experienced by ASD individuals compared to non-autistic individuals.

Incidents that haven't helped the anxiety
At Bradley's 4 year check up the nurse was training a new nurse who was suppose to give Bradley his booster shots in each thigh. I was 9 months pregnant with our son, Max, and my job was to hold Brad's arms down. Four-year-olds are a LOT stronger than they look! With one swift move Bradley jerked free from my hold and grabbed the syringe from "Newbie Nurse," scratching his upper thigh with the needle, breaking the skin, and screaming the entire time. Newbie Nurse just looked at me, mortified. I'm pretty sure I yelled at her to "hurry up and do something" as she squeezed the vaccine into the air and then slowly prepped a new needle. More Experienced Nurse jumped in and quickly gave Bradley his shots. It was horribly traumatic for Bradley who already feared hospitals and for his very pregnant and hormonal mother!

At his 5 year check-up Bradley's doctor promised no vaccines (phew!) but ordered a "routine" Complete Blood Count (are you kidding me?). Long story short- I also had Max with me for his one year check-up, the phlebotomist couldn't collect the blood from Bradley fast enough, Bradley apparently bleeds very slowly, I had a screaming kid in my face (Bradley, not Max), Brad's blood clotted in vile, Phlebotomist says, "sorry- I need to prick another finger" while both of my children scream and cry, Phlebotomist retrieves what we think is a good sample, a few days later the second blood sample returns with abnormalities, doctor wants another CBC because he suspects lab error, more screaming and drooling a few days later, phlebotomist gets a good sample, CBC comes back normal). When I got the call about the abnormalities I was walking in to teach my class, so it was difficult to compose myself after your pediatrician a nurse says your child has abnormal bloodwork, but the doctor doesn't want to say what the abnormalities are. Part of me was worried, but a part of me wondered if Bradley's PDD-NOS could be explained by these mysterious blood abnormalities and then possibly treated and cured... Even with that thought, I was happy to hear the second CBC was perfect.

How do I help manage Bradley's hospital anxiety?
No matter what I have tried, Bradley hates every minute of the doctor's appointment up until the moment we are leaving. Then he is everyone's best friend and is incredibly gracious to the entire staff as we are walking out the door. Now that he's a little older I try my best to talk Bradley through it by explaining procedures before hand, although not too far in advance because Bradley thinks very immediately. If I tell him he has an upcoming doctor's appointment, he thinks I mean that same day. We talk about what to expect and I always promise something fun if he does well at the appointment (an ice cream cone, a TV show or movie he wants to watch). If I keep reminding Bradley of the incentive I promised we can make it through the doctor's visit, leaving with less tears, sweat, and exhaustion.

Bradley celebrating his 4th birthday at day care

Bradley and Max celebrating their 5th and 1st birthdays with a fruit rainbow

Monday, May 20, 2013

What does autism feel like?

This link offers a glimpse into the sensory experiences of someone with autism. Not everyone with autism might experience the same symptoms or to the same degree, but this is a great way to try to understand what individuals with autism experience every day. Please take the time to visit Carly's Cafe and listen to her story. I highly recommend exploring the site, viewing the film version, and clicking on the "Carlysvoice.com" link to understand the cafe experience through Carly's perspective.


I am incredibly thankful for Carly's story, because it helps me understand Bradley's anxiety, distraction, and absorption in a more real way.  I pray that this will help you understand my son and others with autism better. Their experience of our world is more different than you realize.


Sunday, April 28, 2013

Speech Delay: Pre-Diagnosis

This is a video of Bradley at Christmas time 2010. Bradley was about 2 years, 9 months. I have included a transcript at the bottom of this post. Watch the video first and see if you can understand what Bradley is saying. Then check out the transcript to see what I now know Bradley was saying. The audio volume is very weak, so you'll need to turn your volume up pretty loud and/or use headphones. If I can figure out how to edit the original movie to enhance the sound I'll re-post with improved sound quality.


"He's not autistic. He just has a speech delay." That's what I remember telling myself and others countless times prior to Bradley's PDD-NOS diagnosis at age 3.  At times I even had a hard time admitting Bradley had a speech delay. I was a talkative child... and I'm a talkative adult. I was an award winning speaker in high school- winning state medals in both cross-examination debate and informative extemporaneous speaking. As a psychology instructor, I speak for a living.  How could my child have a speech delay?  My mother-in-law told me that my husband had a speech delay as a child and didn't consistently use effective, understandable speech until he was two or three. This was comforting to me, but the longer the "speech delay" went on, the more I realized Bradley was falling behind his peers with his speech.

I remember Bradley saying "Momma" and "Dada" before he was one year old. He cooed (produced "aaahhh" and "ooohhh" sounds) as a baby within the average developmental time frame. I think he did a little babbling (vowel-consonant sounds like babababa), but now I realize it was not as much as my younger son babbled. After his first birthday Bradley wasn't adding many new words to his speaking vocabulary. I didn't worry at first, because I knew boys are sometimes slower in adding to their vocabulary than girls.  A few more months went by and at 17 months Bradley entered public daycare in August 2009.  At first Bradley didn't seem significantly behind his peers in the daycare class, but by Christmas time the daycare director suggested I allow an Early Childhood Intervention (ECI) diagnostician assess Bradley's speech.  It hurts to hear someone tell you they think your child is not developing appropriately... really hurts.  I know the suggestion for assessment was made because the daycare director cared for my child. I know that early intervention is the best treatment for just about any and EVERY physical and psychological concern.  Diagnosticians know the benefits of early intervention, but they don't know the hurt.

After an assessment with ECI, Bradley was recommended to participate in speech therapy treatment and began receiving services.  I don't remember the frequency of his initial speech therapy, but I think it was one 30 minute session per week.  Bradley's first speech therapist was a woman named Kori. She was very energetic, nice, and positive. Kori gave me a lot of hope and Bradley seemed to like her.  However, I didn't think I was learning how I could help Bradley.  I guess I was expecting to have a pragmatic treatment plan for me to follow.  Bradley participated in the ECI speech therapy, but I wasn't seeing significant improvement in his speech.  I don't know if my expectations of improvement were too high, but I grew rather impatient with the quality of speech therapy (specifically about the lack of resources and direction given to me as the parent).  While Bradley's two and a half year old class mates were now speaking in sentences and carrying on conversations with their parents, we were getting only 1-2 words at a time with lots of unintelligible talk. Bradley also had excessive saliva that would dribble down his mouth. We would notice this excessive saliva pretty consistently- almost on a daily basis. Meanwhile- speech therapy included blowing bubbles and playing with whistles, and I was growing impatient.

Video Transcript
Mom: Jingle Bells. Jingle Bells. Jingle all the way. Oh what fun it is to ride in a one horse open sleigh.
Bradley: Hey
Mom: Hey- What does Santa Claus say?
Bradley: Clan Saus say (Santa Claus say)
Mom: Ho ho ho
Bradley: Ho Ho. Chris (Ho Ho. Merry Christmas)
Mom: Ho Ho Ho.
Bradley: May mis (Merry Christmas)
Mom: M&Ms??? (at the time I thought he was saying M&Ms)
Bradley: M&Ms
Mom: Can you say Jingle Bells?
Bradley: Ho Ho. Tick a tick. Tick a tick. Tick a tick (Bradley would frequently say "tick a tick" or something along that lines rather than meaningful speech)
Mom: Sing Jingle Bells
Bradley: Tick a tick. Tick a tick. Tick AHH. Tick a tick! (I think he was trying to sing Jingle Bells)
Mom: Jingle Bells. Jingle Bells. Somebody's here. Say, "Who is it?"
Bradley: (whispers) Who's it
Mom: Who is it?
Bradley: Dada
Mom: You think that's Daddy? Let's see. Who is it?
Dad walks in...

Monday, April 15, 2013

Autism Symptoms Explained

As a Licensed Professional Counselor in Texas, I knew about autism before Bradley was diagnosed. Well.., I thought I knew about autism. I was a practicing therapist (and continue to maintain my LPC license), however I had primarily worked with juvenile delinquents and the elderly.  My youngest client had been 10 years old, so my first experience working with very young children was when I began working with my own child.  As an instructor of psychology, I knew enough about autism. Again- I thought I did. I read material in my pediatrician's office and knew that the three basic early detection signs were: "1. My child looks at objects that I point at. 2. My child points at interesting things and 3. My child make believe plays." Yes. Yes. Yes. But I didn't understand the more comprehensive symptoms.

The Diagnostic & Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV, TR, 2006) is a clinical book that helps therapists, psychologists, doctors, and other mental health professionals (who are trained to diagnose clients) effectively diagnose clinically recognized disorders.  The DSM-IV, TR defines Pervasive Developmental Disorders (PDDs) as disorders, "characterized by severe and pervasive impairment in several areas of development: reciprocal social interacion skills, communication skills, or the presence of stereotyped behavior, interests, and activities." Furthermore, the DSM-IV, TR notes that these impairments are "distinctly deviant for the individual's developmental level or mental age."  In the case of children with PDDs, the child exhibits symptoms that are clinically considered abnormal compared to other children their actual age or mental age (meaning that diagnosticians have considered projected IQ and intellectual deficits if they are present). Different types of PDDs include: Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.

The following symptoms for Autistic Disorder are from the DSM-IV, TR (2006).  At the time of this blog post, the DSM has released the 5th edition that includes modification to autism diagnostic criteria.  I will address these changes in an upcoming blog.

*Notice that a specific number of criteria from specific letters must be identified to receive the diagnosis.   **I have included my commentary behind the symptoms.

Autistic Disorder
I. A total of six (or more) items from heading (A), (B) and (C) with at least two from (A) and one each from (B) and (C):

(A) Qualitative impairment in social interaction as manifested by at least two of the following:
1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture and gestures to regulate social interaction.
**One of the more common types is poor eye contact. For a while Bradley would not make eye contact during with others he was communicating with or those communicating with him.
2. Failure to develop peer relationships appropriate to developmental level.
**This is tough for first time parents to recognize, because it's difficult to understand what the peer relationships norm is like if the child with autism is their first child to interact with.
3. A lack of spontaneous seeking to share enjoyment, interests or achievements with other people, (e.g. a lack of showing, bringing or pointing out objects of interest to other people).
**The child may not attempt to draw attention to exciting things or things that need attention.
4. A lack of social or emotional reciprocity.
**The child may not demonstrate or express feelings of love, frustration, embarrassment, confusion, or sadness and may not readily recognize these emotions in others.

(B) Qualitative impairments in communication as manifested by at least one of the following:
1. Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).
**They are not effectively utilizing intelligible, expressive speech that is understandable to the lay person. This means that although Mom or Dad may understand some of their speech, the average person will not understand most of what the child is saying.  In more severe cases of autism, speech may be completely absent, with no effort for expressive speech.
2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
**This child may not initiate conversation with others or may not understand the dynamics of social conversation, like ending the communication abruptly.
3. Stereotyped and repetitive use of language or idiosyncratic language
**Ecolalia is one example- this is a repeating of language the child heard from a person, movie, or television show. This phrase may be repeated multiple times, could be repeated long after the timing of the initial hearing, and at times may appear to sound like meaningful language. For example, if a child repeats movie lines, sometimes adults may mistake that repetitive speech as an attempt to express needs. It may be fitting of the situation and seem appropriate, but at other times it may not make sense to the current situation.
Echolalia link: http://www.autism-help.org/communication-echolalia-autism.htm
4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

(C) Restricted repetitive and stereotyped patterns of behavior, interests and activities as manifested by at least two of the following:
-Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
**The child may be limited in the type of toys they like to play with and may often appear "absorbed" in that particular area of play.
-Apparently inflexible adherence to specific nonfunctional routines or rituals
**Transitioning from a desired to a non-desired activity can be very difficult for this child when compared to others their age.  Someone unaware of their autism diagnosis may unfairly and mistakingly label the child as a "spoiled brat, throwing a tantrum to get their way." The truth is, this child may not actually understand why the transition is occurring or the dynamics of waiting in line, taking turns, and group play.
-Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
**These behaviors may not seem extreme or abnormal in younger children, but if they continue it will be more apparent how they can interfere with learning or may become socially awkward among peers.
-Persistent preoccupation with parts of objects
**An example of this is being very interested in wheels and spinning. Rather than pushing a truck or car along a table or floor like age-appropriate play, the child repeatedly spins a wheel around and around and around.  They are more interested in this aspect of the truck/car, rather than the intended function of the toy.

II. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) Social interaction
(B) Language used in social communication
(C) Symbolic or imaginative play

My son, Bradley, received a PDD-NOS rather than an Autism diagnosis because his symptoms were subthreshold, meaning they were relatively mild compared to the Autism spectrum, but (left untreated) impair his social development and learning process. For more information about PDD-NOS check out this link:
http://www.autismspeaks.org/what-autism/pdd-nos