PDD? Asperger's? HFA? What's the Difference?

Eleven years ago I met Christopher, and drove out to Maryland to be with him, sad to be leaving my 36 years of Midwestern roots but gaining a wonderful family in return.  The family included two step children in their early teens, and a history of autism in the family.  Being a special educator at the time (later getting my Masters as a Reading Specialist), I knew that I could handle Chris's son, Dale.  At that time I had been teaching approximately 14 years, mostly Deaf and hard of hearing children.  I had one pre-school in which they placed a non-verbal autistic child in my class.  That was the one and only experience I ever had with autistic children.  This child was a sweet boy, who did learn sign language and hid under my table for much of the day.  Back then, (1988), there were not many identified autistic children.  No one really knew about it, now the diagnosis seems to be rampant.

Chris's children lived with us on a part time basis, and part of the time with his ex-wife.  It was difficult for me to get to know Dale, as part of the time he was at the ex's house, and part of the time he disappeared into his own world.  Dale and Amora spent a lot of time on video games, and had the latest technology.  This was something extremely foreign to me, as I had been living and teaching in Iowa and had just recently acquired a cell phone.  The children did not go outside very much, and at the time I had arrived, they were not in any sports or after school activities.  At age 12, we finally bought a bike for Dale and taught him how to ride.

Dale, Michael and Amora

Having my special education background, I felt I was prepared to be Dale and Amora's mom.  Dale never showed any emotion, he had the typical characteristic of an autistic child with an expressionless face.  Dale was diagnosed as PDD-NOS  (Pervasive Developmental Delay, Not Otherwise Specified) I wondered what in the world that acronym meant.  I had heard of autism and Asperger's, but what was the PDD?  Luckily the school district in which I was working offered an excellent class on autism.  I studied the different labels of the spectrum carefully, and tried to decipher what makes a child High Functioning Autistic versus Asperger's?  What makes a child PDD?   Why aren't they HFA? A child that was labeled low functioning autism was a more clear definition for me.

Dale was functioning pretty well in the public school.  He was in regular classes and getting good grades (As and Bs).  Dale had a flair for math and writing.  He could build anything.   Any model that was handed to him he constructed with ease.  He would spend hours building KNEX and make interesting and intricate designs.  It would take him a mere five minutes to put together a model airplane or complicated lego set up.    Dale was labeled PDD, or was he really?  What do you do with a child labeled PDD?    This was the most vague label of all, at least it was to me.

In the autism class that I took they said that the characteristics of Asperger's was high intelligence, and limited signs of facial expression.  They said that Aspie kids generally do not have difficulty with language, just mostly social skills.  Asperger children usually have hyper-lexia, the ability to read fluently at a very young age.   Dale was intelligent, he didn't show emotion and had terrible social skills.  The one thing that went against the Asperger's diagnosis for him was that he had speech/language issues whereas Asperger kids generally do not.  Dale did go to speech and language, he had a mild articulation problem.  He had difficulty with expressive language and taking things very literally.  He did not understand figurative language such as idioms and jokes.  Dale did not learn to read at a very young age, he did not have hyper-lexia.   Could he be Asperger's, HFA?  Or was he PDD-NOS as the school psychologist had suggested?

Dale, Amora and Amora's boyfriend Matt, Six Flags

Later, when Dale was in high school we ended up taking him to a private psychologist.  Many forms and observations later, Dale's "label" was changed from PDD- to Aspergers.  I'm still not sure if that is correct, perhaps we will never know.  Yet he is definitely on the spectrum.....somewhere.

Michael does not have the "dead pan" facial expression that Dale has.  Michael shows emotions and hugs and snuggles constantly.  He does have difficulty with speech articulation and expressive language.  Michael is functioning well in the regular classroom, and is getting some extra gifted and talented time in math. Michael learned to read by the time he was two.  He "seemed" to be hyper-lexic, but as he reached first grade, that ability has slowed down and now he is in line with the average to above average readers in his class. Michael is intelligent.  He has some social skills issues, not nearly as much as Dale.  Then again, Dale was identified at a much later time and Michael had the good fortune of earlier intervention, consistent intervention and a mom who was a teacher. Very early on the doctors said that Michael was definitely High Functioning Autistic.  He had too much emotion and facial expression to be Aspergers.  Why didn't they label him PDD like they had done with Dale?  I just don't know.  It seems to me that they stick a PDD label on a child when they aren't really sure.  Since autism runs in the family, they knew it was autism for sure.  Maybe having the history in your family makes the doctors be more inclined to give the diagnosis of HFA.

It seems to me that there is a fine line between the Aspergers and HFA diagnosis.  There is also a fine line between HFA and PDD.  The label Pervasive Development Delay is a scary term to me.  The words "Developmental Delay" stand out and I automatically associate this with a child with impaired intelligence.  Developmental Delay is a term I hear when the school psychologist is waffling between labeling a child LD learning disabled or mentally disabled.  Michael does not have any intelligence issues, nor did Dale.  Their brains are just wired differently.  They are still very special people.  They are amazing and interesting human beings.  I'm proud to be the mom of two autistic boys, no matter what their position is on the wide and diversified spectrum.