Both PDD and Autism are defined by a core triad of difficulties:

• Language delays,
• Social Cognition weaknesses, and
• Repetitive, "stereotyped", ritualistic and/or self stimulatory behaviors.

This "triad" encompasses a WIDE RANGE of children however, as it says nothing about how severe any or all of the three weaknesses are, nor does it speak to underlying intelligence.  Thus the spectrum of children in this diagnostic category ranges from severely mentally retarded, low functioning kids, to kids who are able to do a lot but who are "in their own world" and relatively out of touch with ours, to very bright even genius level kids who are very odd in the way they relate to others, behave, and communicate.

Much current thinking would do away with any distinction between the terms Autism and PDD, and basically treat them as synonyms which demand qualifying adjectives and narrative description of functional level.  Older attitudes reserved the word "Autism" for the relatively low functioning and out-of-touch end of the spectrum, kids who fit a rather narrow "classic autism" picture, and used the PDD terminology for the higher functioning and less "classic" kids.

Parents are often confused by the letters "NOS" in association with PDD.  This stands for "Not otherwise specified" and is clinically MEANINGLESS.  It is taken from BILLING MANUALS, not clinical texts or research.  For instance, the billing codes manual used by all physicians to submit claims to insurance has one code for "Rheumatoid Arthritis", another for "Osteoarthritis", another for "Septic Arthritis", and one for "Arthritis NOS" which is supposed to be used when the doctor doesn't know yet which kind of arthritis you have, but he/she does think it's arthritis of some sort.  In practice many docs use the "Arthritis NOS" code for ALL types of arthritis because it simplifies work for their billing staff and the insurance company will pay the claims either way.  Well, the way the people who write the billing codes manual "translated" the clinical situation with regard to PDD vs. Autism was to consider "Autism" the more specific diagnosis and "PDD" the equivalent of "NOS".  Silly stuff.  PDD means exactly the same thing with or without the "NOS".  Certainly grandma doesn't go around talking about her "arthritis NOS" so parents shouldn't talk about "PDD-NOS", just PDD or Autism.

An experienced professional can SUSPECT autism (and end up being right >90% of the time) within 5 minutes of meeting a child, but CONFIRMATION of the diagnosis really demands a multidisciplinary approach, with at minimum a physician (Developmental Pediatrician or Child Neurologist), Psychologist, and Speech & Language pathologist each doing evaluations (and hopefully working together as a team). Psychiatrists, social workers, physical & occupational therapists, and early childhood education specialists can round out the team - but are optional.  Anytime PDD/Autism is suspected, the child should be evaluated by such a team.

It is very import for parents of kids with Autism or PDD not to give up hope, and keep advocating for their child. The prognosis is quite VARIABLE and hard to predict in any one child, even for the best experts and teams. I've seen kids who look low functioning at age 2 or 3 make huge progress and not look so bad by age 7-8. I've seen some (at all functional levels) evolve into adult schizophrenia and psychosis. But I've also seen kids with PDD seem to put the "disability" part behind them and become very successful, albeit eccentric, adults both professionally and socially - essentially "evolving" away from PDD/Autism and towards more of an Asperger's picture.  The children most likely to have this happy outcome are those who receive EARLY diagnosis and institution of a treatment program that incorporates ABA techniques.

The exception to the above is a "neuroleptic" or "major tranquilizer" such as Haldol or Mellaril... the same drugs used in adult schizophrenia. While these certainly help, it is debatable whether they help the child vs. the child's caretakers more. In addition, when started in childhood the long term risk of developing complications from such meds such as tardive dyskinesia is HUGE and this is why we are generally very reluctant nowadays to start such meds in autistic childen unless there is just no other option.

SO... in the meantime there are MANY other meds which SOMETIMES work in individual children with PDD, although they don't statistically work better than placebo (or have never been adequately studied) in large groups of PDD kids. They include TCA's (especially Anafranil and Desipramine), SSRI's (such as Prozac), Clonidine, stimulants (such as Ritalin), Depakote, Naltrexone, and Klonipin. I should say that all these meds also sometimes backfire and make the kid considerably worse (especially the stimulants). When trying any and all of the above it helps to pick one or two "target symptoms" and track them closely and semiquantitatively to judge medication effect... relying on the subjective impressions of parents and teachers is not wise because the DESIRE to see some benefit is huge.

The bottom line is that finding a medicine that's right for YOUR child is a trial and error process best undertaken by a physician (Child Psychiatrist, Developmental Pediatrician, or Neurologist) who is very experienced with or specializing in PDD/Autism, who is willing and able to get to know your child WELL before embarking down this road.

There is also no truth to (or evidence to support) such purported causes or treatments of Autism such as "The Yeast Connection", vitamin deficiencies, food allergies or the Feingold Diet. These things are total quackery.

Sensory integration is a relatively new and controversial "construct" coming out of the Occupational Therapy field. It postulates that certain young children have developmental delays on the basis of a neurologically based difficulty "integrating" or processing sensory inputs. Such children become easily over-stimulated and when they do they "shut down" and become defensive, avoidant, and they fail to learn, grow, socialize and relate to their environment in a normal way. The critics of Sensory Integration theory (of which I am one) would hold that this is nothing more than a new way of slicing the same old pie... that such children have a variety (each his or her unique combination) of other more traditionally defined disorders such as ADHD, Autism, PDD, Anxiety, Obsessive Compulsive Disorder, extreme shyness, Motor Dyspraxia, etc. This argument over theory, however, is in some ways beside the point. Whether or not "Sensory Integration" problems are a new and separate diagnosis, the fact remains that "Sensory Integration Therapy" can be VERY BENEFICIAL for many children with any and all of the above diagnosis and as such represents an advance in the treatment we have available.

ABA therapy requires patience, training, and a LOT of one-on-one work by trained therapists.  A typical program involves 30-40 hours per week of highly structured one-on-one teaching for 2 or more years.  At the outset training even the simplest behaviors (e.g. "touch this" or "look at me") can take many hours over many days or even weeks to succeed.  However, as time goes on the the child learns the program, learning accelerates.  This may sound difficult, but the rewards are worth it.  Without ABA therapy around half of all children diagnosed with Autism at an early age end up functioning at a "mentally retarded" level, while with ABA that percentage drops to under 10%.  Without ABA therapy fewer than 5% of children originally diagnosed with Autism end up with "normal functioning" (meaning they can be placed in a regular classroom with special supports or assistance eventually).  ABA increases that percentage to nearly 50%.  No other treatment program for Autism/PDD can boast those kind of results.

For more information about ABA resources in Massachusetts try the following contacts:

The Autism Partnership for ABA (TAP)
508-478-7TAP
Email: MASSTAP@prodigy.com
(Please note this organization has no paid staff, so you may need to leave a message on a machine and someone will get back to you.  They are a good source of referrals to parents in your area with ABA programs up and running in their homes, and they also sponsor monthly meetings.)

CMS Associates
Mashpee, MA.
508-477-2598
(Parent Support & Advocacy)

The May Center for Early Childhood Education
Arlington, MA. 
781-648-9260
(home & school based programs)

The New England Center for Children
Southborough, MA
508-481-1015
(home & school based programs)

Families for Early Autism Treatment (FEAT)
http://www.feat.org/