Shopping for an ADHD diagnosis?

One of the members of the ADD Forums discussion board recently claimed she knows a family who got a diagnosis of ADHD for their child to be able to enroll that child in a gifted program (see posts #42 and #52 of the thread “Re: Unwrapping the Gift of ADD” Program).

I find it hard to believe that there really are people who would do that. I have never met a parent who wanted their child to be diagnosd with ADHD.

Positively ADD by Cathy A. Corman and Edward Hallowell — Part Six of the Unwrapping the Gift of ADD Series

Guest of the sixth lecture (Tuesday, April 29, 2008) in the Unwrapping the Gift of ADD series was Cathy A. Corman, Ph.D.

Cathy Corman, a former assistant professor of history at Harvard University, with a Ph.D. from Yale’s Program in American Studies, and a mother of triplets all of whom have learning differences and ADD, is a co-author of Positively ADD: Real Success Stories to Inspire Your Dreams, a book for 9 to 12-year-olds which she co-wrote with Dr. Edward M. Hallowell, published in 2006 by the Walker Books for Young Readers.

Positively ADD: Real Success Stories to Inspire Your Dreams profiles seventeen successful adults with ADHD:

(disclaimer: I am not 100% sure that the links I posted are about the same person or just a person with the same name, if you think I posted an incorrect link, or think a different link would be more suitable, please do let me know.)

As Corman reported, she got the inspiration to write a book about successful people with ADHD during a trip with her family – while on a flight she read an article about a successful person with ADD and after giving the article to her son to read, he started asking “Could I do that?” as if asking “Could I have a good life as well, like this person?”

Corman discovered that there were no books for children about adults thriving with ADD, people who are happy in life, showing that ADHD doesn’t have to hold one back.

The people Corman and Hallowell interviewed for the book recall having lots of trouble in school, being kicked out of class, feeling ashamed and guilty, or flunking college. However, as adults, they have found a way to turn their ADHD into a “gift” – they come to terms with the diagnosis and found their strengths coming from it.

In closing, Corman emphasized that children with ADHD also need to find a passion, find something that’s fun and that they’re good at, just like the people profiled in Positively ADD: Real Success Stories to Inspire Your Dreams.

You can also read what another successful person (an attorney!) with ADD had to say about this show on the discussion about the series carried on the ADD Forums discussion board.

Peter S. Jensen – Part Five of the Unwrapping the Gift of ADD Series

Guest of the fifth lecture (Monday, April 28, 2008) in the Unwrapping the Gift of ADD series was Dr. Peter S. Jensen.

Dr. Jensen earned his medical degree from George Washington University Medical School and currently is the CEO and Director of the REACH Institute, the Resource for Advancing Children’s Health, created “to accelerate the acceptance and effective use of proven interventions that foster children’s emotional and behavioral health” (formally launched in July, 2007).

From 1989 to 2000, Dr. Jensen was the Associate Director of Child and Adolescent Research at the National Institute of Mental Health (NIMH) and while at NIMH he served as the lead NIMH investigator on the six-site NIMH and Department of Education-funded study of Multimodal Treatment of ADHD (the MTA Study). He has also been involved with the follow-up study of children who participated in the initial MTA Study, the findings of which are discussed in a July 20, 2007 press release from the NIMH titled “Improvement Following ADHD Treatment Sustained in Most Children, But Linked Problems Persist Into Adolescence – Major Follow-up Study”.

Dr. Jensen is also a co-chair of the School Mental Health Alliance, “a coalition of over 25 organizations with interests in advancing school-based mental health services,” which in 2005 released a 37-page-long position paper “Working Together to Promote Academic Performance, Social and Emotional Learning, and Mental Health for All Children,” distributed to members of the Senate by Senators Pete Domenici and Edward Kennedy.

Last but not least, in addition to writing numerous articles for scholarly and academic journals, Dr. Jensen is also the author of Making the System Work for Your Child with ADHD (Making the System Work for Your Child), published in 2004, by Guilford Press; co-author of Toward a New Diagnostic System for Child Psychopathology: Moving Beyond the DSM, published in 2006 also by Guilford Press, and co-editor of Parent Empowerment Advisors Guide (Improving Children’s Mental Health Through Parent Empowerment: A Guide to Assisting Families) published by Oxford University Press in 2008.

Dr. Jensen’s message tied in with what Dr. Hallowell and Kathy Kolbe were saying in previous interviews – unconditional love and support of the family and other adults make the biggest difference over time in a child’s life. Children need to know that they are loved and that ADHD will not hold them back in reaching the stars. He also emphasized the importance of having good relationship with all people involved in child’s treatment, therapy, and schooling, so that both the child and the parents feel comfortable with everyone on the “team.”

Later in the program Dr. Jensen discussed adult ADHD, and the need for practitioners to be adequately trained and educated in diagnosing adult ADHD which manifests itself differently than childhood ADHD, and might show up in being inattentive, impulsive, missing deadlines, and failing to make up to promises. He commented that even though the Civil Rights Law guarantees accommodations for people with disabilities, many individuals with ADHD are unwilling to admit that they have ADHD to their boss and co-workers and request for accommodations for the fear of losing their job. Yet, Dr. Jensen noted, even adults need to have a supportive team around them to succeed – their spouse, their family, their doctor, maybe a coach, and if possible an understanding boss and co-workers.

Non-verbal Autism and Intelligence – some myths debunked

The idea that non-verbal autistics have low IQ in general and are unaware of their surroundings is a myth that has to be debunked.

Consider Amanda Baggs, featured in the article “The Truth About Autism: Scientists Reconsider What They Think They Know” by David Wolman in the March 2008 issue of Wired Magazine.

The 27-year-old Amanda Baggs is autistic and “non-verbal” – she cannot speak, but that does not mean she does not communicate. If it wasn’t for technology, nobody would know what she’s thinking, how she’s feeling, and, quite frankly, that she’s a pretty amazing person. Luckily, she can communicate through the DynaVox VMax computer and through her very powerful YouTube videos and her blog Ballastexistenz, has become an advocate for human rights for the disabled and for the acceptance of people like her.

(As a sidenote, I have linked to the “About” page on Amanda Baggs’ blog because that’s where she explains the title of the blog and refers to the “German eugenics movement against disabled people — which, for reference, predated Nazism” and “was heavily influenced by American ideas.” By the way, Stephen Murdoch, the author of IQ: A Smart History of a Failed Idea also wrote about the eugenics movement in his book.)

Baggs’s “In My Language” video, “is a statement about what gets considered thought, intelligence, personhood, language, and communication, and what does not.” I hope you’ll watch it.

David Wolman’s piece also mentions an article by Michelle Dawson, Isabelle Soulières, Morton Ann Gernsbacher, and Laurent Mottron, titled “The Level and Nature of Autistic Intelligence” published in the August 2007 issue of the Psychological Science, a journal of the Association for Psychological Science, published by Blackwell Publishing.

You can’t see the full text of the article unless you are a member of the Association for Psychological Science or have a subscription to the journal, but you can see the abstract.

The first author of the article, Michelle Dawson, is autistic as well. In her blog entry about the article being accepted for publication she writes “there should be a lot more caution than is currently the case, when making assumptions about what autistics can or can’t do. Some serious rethinking is necessary, about intelligence in autism and possibly intelligence in general.”

Current APS President, Morton Ann Gernsbacher, the Vilas Research Professor and Sir Frederic C. Bartlett Professor of Psychology at the University of Wisconsin-Madison, and a co-author of “The Level and Nature of Autistic Intelligence” wrote for the April 2007 issue of the Observer (also published by the APS) an article titled “The True Meaning of Research Participation” which is worth reading as well.

ADDA – Attention Deficit Disorder Association – Part Four of the Unwrapping the Gift of ADD series

Guests of the fourth session (Thursday, April 24, 2008) in the Unwrapping the Gift of ADD Series were board members of the Attention Deficit Disorder Association (ADDA), “the worlds leading adult ADHD organization dedicated to providing information, resources and networking opportunities to adults with Attention Deficit/Hyperactivity Disorder (AD/HD) and the professionals who serve them.”

The association organizes an annual national conference, which this year will take place on July 10-13, 2008 at the Hyatt Regency Minneapolis, Minnesota.

Members of ADDA also receive FOCUS, the quarterly publication of the organization and have access to weekly teleclasses on ADHD.

ADDA has again led the way for the creation of a U.S. Senate resolution designating September 19, 2007 as “National AD/HD Awareness Day.”

The following guests participated in the conversation about ADDA and coaching individuals with ADDA:

David Giwerc, immediate past president of ADDA, also Master Certified Coach (MCC) and Founder/President of the ADD Coach Academy, “a nationally recognized, comprehensive training program designed to teach the skills essential for powerful coaching of individuals with AD/HD.”

Linda S. Anderson, current president of ADDA, also MA, MCC, SCAC, a member of the International Coach Federation (ICF), a Golden Circle member of the National Association of Professional Organizers (NAPO) and co-founder of the Philadelphia NAPO chapter, and founder of Getting Clear coaching practice, specializing in coaching adults with ADHD.

Evelyn Polk Green, MS.Ed, President Elect, a Past President of the CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder) National Board of Directors, an adult with AD/HD and the mother of two sons, both of whom are also diagnosed with AD/HD.

Beverly Rohman, ADDA board member, ADHD coach and consultant for learning differences and school searches. She is the founder of The Learning Connections, a coaching practice “working with students, families and adults with Attention Deficit Disorder and other learning and life challenges.”

The organization seems to be geared mostly toward adults with ADHD, however, in the FAQ I was glad to find a reference to an organization I did not know existed – Council of Parent Attorneys and Advocates, Inc. (COPAA), “an independent, nonprofit, §501(c)(3) tax-exempt organization of attorneys, advocates and parents” whose “primary mission is to secure high quality educational services for children with disabilities.”

Kathy Kolbe and Conation – Part Three of the Unwrapping the Gift of ADD series

The guest of the third session (Wednesday, April 23, 2008) in the Unwrapping the Gift of ADD Series was Kathy Kolbe.

Kathy Kolbe is a great speaker and her message was very inspiring – we are who we are, each of us is different, and we have to accept each other for who we are and not criticize one another and try to change one another to behave and think “our way.”

Kathy Kolbe is the daughter of Eldon F. Wonderlic, a pioneer in the field of Industrial Psychology (cognitive testing) and founder of Wonderlic,Inc.

During the show, Kolbe recalled how she used to ask her father about his tests and questioned the premise and the importance of cognitive (or IQ) testing. She disagreed with the idea that someone’s intelligence is the most crucial measure of a person and wondered “how how smart you are can have anything to do with what you can do in this world.” She thought there’s more to a person than intelligence and her father suggested she go and try to find it out.

So she did and founded Kolbe Corp.

And while the mission of the company her father founded is to help “thousands of employers worldwide hire and keep the best employees” the goal of her company, as stated on the “About Kolbe Corp.” page is to “provide materials, insights, and experts to help people of all ages identify their instinctive talents, develop their confidence, and use their innate abilities to succeed in a plethora of situations, from getting through school to running a business.”

Kolbe emphasized during the show that everyone was created to be perfect at something, so there are no best (and worst) among us, we just have a different way of seeing and doing things. We all can be successful and happy in life if we have the freedom to do things the way that shows our strengths. We also have to allow children to do the same.

To help figure out what drives us, what makes us tick, our Modus Operandi (MO), she “developed an instrument to measure the instinctive action and problem-solving styles of individuals. This dimension of the mind, called ‘conation,’ determines the way in which each individual might feel most comfortable and perform best in undertaking any action.”

On the Kolbe Corp. web site you can read more about the Kolbe Concept, about “conation,” and about the “Four Action Modes.”

You can also read about this idea in Kathy Kolbe’s books: The Conative Connection : Acting on Instinct published in 1997; Powered by Instinct: 5 Rules for Trusting Your Guts published in 2003; and Pure Instinct published in 2004.

When asked why we need to know about “conation,” Kolbe answered that there’s a tendency to misidentify ADHD as a cognitive issue, when in fact, it’s just the matter of Modus Operandi.

Kolbe used a term “false ADHD” when she talked about how some children whose Modus Operandi is to resist structure, to be active, and to learn by doing and touching, can be misidentified as having ADHD. (Unfortunately, neither Dr. Hallowell nor Dr. Handelman asked her what the difference between “false” and “true” ADHD is. I would have like that explained.)

While talking about schools, school rules, and curriculum Kolbe said something I found very interesting – that while 20% of general population has a tendency to insist on structure, following procedures, etc., as much as 70% of teachers are like that (because they instinctively choose a profession that is highly structured and organized).

Children whose MO is different from their teachers’ MO, suffer at school and are told that they have a problem, when in real world their tendency to multitask, be always “on the go” and skip the details for the big picture usually turns out to be a great strength.

Another interesting thing Kolbe said about schools is that it’s an environment where everyone has the same job, which has to be done the same way, every day after day, while in the real workplace there may not be much consistency, pretty much everyone does something different or in a different way and employees often need to switch gears, jump from project to project, etc.

(I ought to note that Kolbe pointed out that teachers do not intend to make suffer, they just simply may not understand that some of their pupils have a completely different way of doing and learning things, they need to have that pointed out and explained to them.)

Kolbe also talked about relationships and how a lot of conflicts are due to the fact that people don’t understand the “nature” of the other person and try to change them when in reality, that’s impossible and just makes the other person miserable.

To measure people’s Modus Operandi and help them explain what they’re good at, the company offers several “Kolbe Indexes/Instinct Assessments” which can be taken online (for a fee of course). You can see the questions and sample results without paying. If you don’t have much time to spend on the Kolbe Corp. site, at least view (listen to) the Sample Result for Youth (you have to allow pop-ups to be able to open that).

In closing, Dr. Hallowell praised the concept of “conation” saying we should “embrace it” because “it’s a tool to help in understanding who we are, it’s freeing and validating – I’m the way I should be.”

DaVinci Method and LENS – Part Two of the Unwrapping the Gift of ADD series

The guests of the second session (Tuesday, April 22, 2008) in the Unwrapping the Gift of ADD Series were Garret LoPorto and Rebecca Shafir.

Garret LoPorto, a successful entrepreneur with ADHD, is the author of The Da Vinci Method – Break Out & Express Your Fire, published in 2005, by (I believe) his own company, Media for Your Mind, Inc.

LoPorto shared that despite great social life in school he had a low self-esteem as a student and dropped out of college. When he started his own business, he realized the traits of ADHD which caused trouble for him in college were helping him be successful in his business.

He says on his web site that “virtually all self-made millionaires, billionaires, leaders and captains of industry have the same personality type” – they “like thrill, excitement and risk, are a highly creative problem solvers, impulsive in nature, ambitious and industrious, have tons of energy for things they are interested in, and love to be the hero in an emergency.”

Apparently on the Myers Briggs Personality Tests people like that are categorized as N (Intuition) types who intuitively “pay more attention to the patterns and possibilities that they see in the information they receive”) and P (Perceiving) types who “use their perceiving function […] in their outer life” and prefer “a more flexible and adaptable lifestyle”).

LoPorto calls this combination the Da Vinci personality and as examples lists among others: Richard Branson (owner of the Virgin Empire), Bill Clinton, Ben Cohen (co-founder of Ben & Jerry’s), George Lucas (Creator of Star Wars), and others.

LoPorto’s book, The Da Vinci Method – Break Out & Express Your Fire, gives tips on how to master this “fiery” personality. Now he has a new product – a “Psychoactive Soundâ„¢ CD Audio Set” that “brings together technologies from brain research with innovative recording and sound-processing techniques” and is “designed to trigger your brain to produce brainwave patterns that match exactly the state you want to experience.” The set includes CDs for “Alert Focus, Inspired Tranquility, Deep Meditation & Prayer, ‘Better than Coffee,’ and Deep HGH Recovery.”

Rebecca Shafir is the director of the Low Energy Neurofeedback System (LENS) program at the Hallowell Center. The LENS program is “a safe and non-invasive procedure that monitors and analyzes EEG (brain activity) using brain wave monitors on the scalp. The LENS system uses that information as feedback for sending signals back to the brain to normalize brain activity for those whose brain waves are disrupted. Conditions that improve with LENS feedback training include bipolar, depression, anxiety, OCD, fibromyalgia and Asperger’s. […] The LENS method accomplishes improved functioning in about one third the time compared with traditional neurofeedback approaches, with the same durability of treatment effects.”

During the show Rebecca said that while the traditional neurofeedback methods requires on average 40 to 60 or more visits, with the LENS method the patients see improvement with an average of 15 sessions.

Dr. Hallowell pointed out that while both methods anecdotally have great results, it can’t be said that they are “scientifically proven” yet, because there have not yet been any double-blind studies done to prove their effectiveness.

The difference between both methods is that you can listen to the “Da Vinci Brainwaves” when and where you feel like it – you choose the CD and the time; but you have to monitor your reaction yourself – LoPorto cautioned to listen to only one rotation at a time.

With the LENS method you have to make an appointment and travel to the clinic, making it more inconvenient than the Da Vinci Brainwaves, but a trained technician monitors your brainwaves and can adjust the “feedback” as not to overdo the amount of stimulation.

The Gift of ADD – Part One of the Unwrapping the Gift of ADD series

One of the most recognizable people in the ADHD (Attention Deficit Hyperactivity Disorder ) circles, Dr. Ned Hallowell, author of, among others, Driven To Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood; Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder; and The Childhood Roots of Adult Happiness: Five Steps to Help Kids Create and Sustain Lifelong Joy, and founder of the Hallowell Center is on a campaign for people to recognize and accept that ADHD is not a disability and hindrance but a gift that one has to unwrap.

Today (April 21, 2008) was the first of a series of eight one-hour lectures that he and Dr. Kenny Handelman organized to be aired on the Internet through their web site,

I think initially they wanted to limit the access to just under 500 people, but there was so much interest in the series, that somehow they were able to increase it to over 3,700. I think it’s still possible to sign up for the following lectures – three that will be aired this week, and four next week

After registering, through the web site you can also download a 16-page report authored by both doctors titled “Find the Genius in ADD.”

What Dr. Hallowell and Dr. Handelman are saying is that looking at ADHD as a disability and pathology is wrong and leads to a “downward spiral” of thinking that “this ‘disorder’ is going to ruin [...] lives.” What they propose instead is thinking of ADHD as a gift.

During the first lecture Dr. Hallowell was saying that distractibility is basically a higher form of curiosity.

He’s got that right! My six-year-old has calmed down somewhat since the time he dismantled the faucet at his daycare when he was two, but he still begs me to allow him do experiments with vinegar and soda, and likes to mix various ingredients to see what happens and how they react. So far it’s been relatively harmless, but he says he really would like to turn his bedroom into a chemistry lab. He also likes learning about electricity but I told him to never ever try the experiment I did once when I was his age of checking what will happen when you put a paper clip into the outlet. (I was lucky, when I saw the sparks I let go off the clip fast enough not to get hurt and only blew the fuses for the whole place, but my parents, who had guests over that evening, weren’t too happy with me.)

As far as impulsivity goes – Dr. Hallowell linked impulsivity with creativity which, as he says, depends, and in fact thrives on spontaneity and lack of inhibition.

It’s all very positive and hope inspiring. I think I should read “Find the Genius in ADD” at the beginning of each day to remember its message when my son makes a mess in the kitchen while getting too enthusiastic with vinegar and soda or carves with a nail a big heart and “I love you” on another piece of furniture (like he did on my antique dresser).

By the way, a guest speaker during the first lecture was Blake Taylor, an 18-year-old who was diagnosed with ADHD at five, who recently published a quickly-gaining fame book ADHD & Me: What I Learned from Lighting Fires at the Dinner Table, published by the New Harbinger Publications. He said that because his mother treated his ADHD as a gift from the beginning and motivated him, it made a difference in how he viewed his ADHD. Now, he’s a student at UC, Berkeley.

Beyond the Wall, by Stephen Shore

I already mentioned Beyond the Wall: Personal Experiences with Autism and Asperger Syndrome, by Stephen Shore, published by the Autism Asperger Publishing Company (AAPC), in the post “Understanding Autism (for Dummies, by Stephen Shore)” but I’d like to add a few words about it.

It’s an autobiography and while someone might think that writing an autobiography is an exercise in vanity, what makes this autobiography so interesting is reading about growing up and life in general from a point of view of a person with autism.

Overall, Beyond the Wall, game me a lot of “Oh, that’s why..” moments. Stephen Shore remembers (and writes about) events that happened when he was very young and pretty much non-verbal. He explains how he could not explain to his parents that the reason he hated haircuts was because he could feel each single hair being pulled and that it hurt. He also recalled how trips to a grocery store used to cause sensory overload because of the overpowering mixture of smells in the produce section and the flickering of lights overhead. After reading that I finally understood my son’s behavior whenever we go shopping – the sensory overload may be just too overwhelming for him and that’s why he goes “wild”.

The parts about living with autism as an adult are quite fascinating too and point out how some things that most people overlook might be overwhelming to people with sensory differences – such as (but not only) the ticking of the clock at night, the singing birds in the morning, or the smell of people on public transportation. (Personally, the ticking of the clock at night used to drive me nuts so much I got a digital clock which doesn’t bother me, as long as I turn the clock so that the green numbers “shine” in another direction and not in my eyes.)

Check it out, I hope you’ll find this book interesting and learn something new as well.

Autism 101: A basic definition

What is autism? The Autism Society of America, “the nation’s leading grassroots autism organization,” founded in 1965, says on their introductory web page that “Autism is a complex developmental disability that […] affects a person’s ability to communicate and interact with others. Autism is defined by a certain set of behaviors and is a ‘spectrum disorder’ that affects individuals differently and to varying degrees.”

The term “spectrum disorder” is very important here, because the severity of the disability varies from person to person.

Stephen Shore, mentioned in my post “Understanding Autism (for Dummies, by Stephen Shore),” posted on his web site the “autism spectrum wedge” – a diagram of the autism spectrum severity created by Dr. Dan Rosenn, MD. (scroll down the page to the second graph to see it)

On the left are individuals whose autism is severe and debilitating – they are not only non-verbal, they may be unable to show to the “outside” world what they think, how they feel, or what they want or don’t want. It may look like they are completely unaware of what’s happening around them, they seem to be in their own world. (In reality, we now know they are aware of their surroundings, but that’s a topic for another post)

Stephen Shore places himself as a non-verbal four-year-old in the middle of the wedge – true, he was non-verbal, but despite not being able to talk, he was able to interact with his mother. The different shapes in the wedge are supposed to represent a variation in autistic characteristics – there is more variety among individuals with moderate autism in how they behave and which functions are impaired.

On the right side of the wedge are people with the so called “HFA – highly functioning autism” or “AS – the Asperger Syndrome.” At this point on the spectrum, the variation among people is the largest and each person’s autism might manifest itself in a completely different manner.

So what do they all have in common?

You can go to the Centers for Disease Control and Prevention section “Autism Information Center” to see the full definition for each disorder.

But in short, according to the Diagnostic and Statistical Manual (DSM), fourth edition, published by the American Psychiatric Association in 1994, 299.00 – Autistic Disorder—is characterized by:

1) qualitative impairment in social interaction

2) qualitative impairments in communication, and

3) restricted, repetitive and stereotyped patterns of behavior, interest, and activities.

The DSM makes a distinction between 299.00 and Asperger’s Disorder, which shares the code 299.80 with Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism). But only the requirement for “qualitative impairments in communication” is missing from the definition for 299.80.

The common part is the “impairment in social interaction” and the “restricted, repetitive and stereotyped patterns of behavior, interest, and activities.”

By the way, the definition for the Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism), or PDD-NOS for short, does not have a specific list of criteria. It just states:

“This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes atypical autism – presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.”

The most important word in this definition is “or.” To get a diagnosis of PDD-NOS not all three areas (social, communication, and behavior) from the autism diagnosis have to be impaired; it could be just one. So a child could get a diagnosis of PDD-NOS even if he or she was not exhibiting “restricted, repetitive and stereotyped patterns of behavior, interest, and activities”— the requirement for both the Autistic Disorder and the Asperger’s Disorder diagnosis.

That’s why one of the specialists that saw our son made a diagnosis of PDD-NOS, because his “peer relationships” were not “appropriate to developmental level,” his “ability to initiate or sustain a conversation with others” was also impaired, and he was exhibiting “lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.”