Ok ... what is PDD-NOS?
Pervasive Developmental Disorder, Not Otherwise Specified (tells you nothing, right?). The DSM-4 left open the possibility of saying "this isn't Asperger's, it's not classic autism, and yet the person has many features that suggest he's on the autism spectrum"--those cases that don't meet the AS or "classic autism" definitions have typically been called PDD-NOS.
Technically, that label has now been absorbed into the diagnosis of "autism spectrum disorder" in the DSM-5. It's all "autism" now. But it has been widely reported that none of the borderline cases should now be considered off the spectrum-- that is, if someone was likely to be PDD-NOS before, they have "autism" now, and best practice right now is that doctors are supposed to use the DSM-4 and DSM-5 in tandem to calibrate their judgments during the transition.
For ADD and ADHD - he's been screened several times by different evaluators - two neuropsychs (although the last I didn't trust his results at all for any of the tests), a psychiatrist, a psychologist and the school diagnostician. He doesn't score high enough on any of the screening tests to indicate it - and I'd agree.
Has he ever had an ADOS? This is generally considered the most trusted test for ruling autism in or out.
For the ASD, he doesn't have a couple of the major traits - he has a lot of friends, is a leader, has a strong sense of humor and a couple of the other traits.
Sense of humor does not let you rule in or out autism. Our DS 10 (who definitely has autism) is quite funny, and has always understood puns and other kinds of non-literal humor.
The traits he does have, he has to a pretty strong degree - he will still go to the nurse thinking he is sick and not associating his headache, stomach ache, etc. with anxiety over the test he just took or the problem he just had with a teacher chewing him out for something. He is very literal. Very. He doesn't judge space correctly - always in my way when we're walking, etc. Doesn't always read social cues or pick up on them.
Some of the anecdotes you've posted in the past have been strongly reminiscent of my DS.
But this doctor deals with a lot of autism and gifted kids and says he thinks my son's is more related to his high IQ (which has yet to be detected on a standard test but is very obvious) than to autism. His advice is that if we can get accommodations, there is no need to put a label too soon.
Is your doc generally label-resistant? I guess my feeling on whether it matters to have the label is, yes and no. True, if school is working, you might not need the label; but we have found that the label gets us out-of-school services (social skills training, CBT targeted specifically to his deficits). The label has also helped us both explain DS to others AND raise our own awareness of what to work on, what to watch out for, what is likely to arise, helping us prepare for the next hurdles.
I'm not label-shy... I think it's good for a kid to have a handle on his challenges. Sounds like yours does, so the label may or may not matter to you.
Interesting that his IQ has never registered as high. One neuropsych told us that IQ scores tend to get higher and more coherent (less spiky) as autism is remediated. We have found that to be the case; DS only looks more and more extreme in his giftedness as we work on his ability to understand other people.
I'm not trying to challenge you or your docs. Ultimately, you decide whose professional judgment you trust, and then you take their advice seriously.
It's a very interesting business, isn't it.
DeeDee
