Recently a young mother wrote and said, My four and a half year old son has been diagnosed with PDD-NOS, and more recently, ODD, but his teacher and I think OCD is more fitting. He also shows some ADD behaviors. Confusing? Definitely. And with so many opinions out there, knowing how to best help such a four year old can be very hard. Here's what I wrote back.

Thank you for writing and for your positive feedback. Know I am so sorry it has taken me so long to reply, especially as it is for a little boy you write. In fact, my heart goes out to you. As you might imagine though, I'm swamped with folks writing to me.

As for my thoughts, please know, whatever I will say is in no way intended to be heard as professional advice. More, it is simply the shared experiences of one human being with another.

As for your son, while I can see what might lead you to hypothesize those diagnoses, from everything you've described, my best guess is your son has a classic case of Asperger's. Why? For one thing he makes what he learns more important than people. For another, what he learns is rigidly precise and cannot be deviated from. A quality he no doubt strives for in all his learning. And for another, when anyone does ask him to deviate from his official "right way," he bluntly corrects them with no regard for the effect this correcting has on others.

Precision, then correction; in this order, are the two most basic qualities of the Asperger's mind. And what happens to these folks when they are forced out of these two patterns is that they rapidly spiral out of control, first into a labyrinth of digressions (actually the correction phase gone terribly wrong), then into blunt outbursts (the only way AS folks have to break out of the digressions).

By the way, the digressions I've just mentioned can be mistakenly seen as a sign of having ADD. However, the ADD mind begins all learning situations already in these digressions, then into bluntness (the i'm not interested in learning responses), while the Asperger's mind only ends up there when there is no precise way to understand something they are trying to learn (AS kids love learning, at least about their special interests, e.g. the insect parts AND the insect song; a very typical cross sense AS trait; everything with the same overall title gets included in the same interest.)

Kids with Asperger's and adults with Asperger's also share another quality; throwing tantrums when being asked to change the official way things are done, arranged, managed, or learned. And while kids with OCD share some of this, they do not usually have the "special interest" thing; meaning, your son's desire to learn in such fine detail. This quality; precisely learning about things, differs markedly from the OCD quality of precisely arranging things. This in fact would be enough for me to tend toward the AS diagnosis over and ADD or an OCD diagnosis.

As for the PDD-NOS, many adult AS clients also have these same odd features; ticks and so on. However, when combined into a comprehensive pattern, the AS fractal emerges as the clear diagnosis.

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