M.R.
The Autistic spectrum is a wonder. Just when you think you have it all figured out, it is going to change because it is a devleopmental disability, and he is a moving target. The adjustment to PDD-NOS just means that he has gained enough skill that he cannot be said to have clasic Kanners Autism, which is terrific, but he is still on the spectrum.
You do not say what kind of therapy you are accessing now. He still needs speech and langaguge therapy because he needed so much help to learn to talk, he will need direct instruction to continue to develop his langague skills in a more typcial way than he can do by himself. His logic is still autistic and he will continue to need to be taught things that other children pick up on without instruction.
I don't know what therapy you droped, I am assuming it was maybe Occupational therapy? That could be part of your answer, and you are seeing why he needed it because he cannot self sooth and sleep well when he is over stimulated as he is right now. The other therapy that would be appropriate would be play therapy and behaviroal therapy, and if you accessed this, he may learn new strategies to trantrums. First thing I would advise you to do is to go back and see if that therapy you passed on will be helpful now.
My other sugestion is that you examine why he is in this schedule to begin with. If what you were doing was working, was it that he turned three and he was offered an IEP to be implemented in a public school? If that is the case, then you need to call a new IEP meeting and lay this out his regression, because this means that the placement and the content of his program is not appropriate.
If you put him in a typical preschool, then you should contact your school district and request an evaluation and therapy, and maybe preschool services from them, depending on what he qualifies for. Start reading about advocacy at www.wrightslaw.com, you will need to learn to navigate this system.
If this is a public program, you may be seeing part of the reality of public serivices. That is, public services are not required to maximize your son's potential. You will always need to supplement his treament plan with private services if you want him to be more than functional in a classroom setting, which is all the school is accountable for. Get him into additonal speech, ot, play therapy, behvioral therapy, medical care (see a psychiatrist to manage his medical needs related to autism, sleep wake disturbances are frequently issues that can be treated sucessfully and will help him be comfortable and make progress) and a little later, seek social skills classes. All of these services are private and are the repsonsiblity of the parents, not the state, because Autsim and ASD stradles the medical-educational boundaries, we get confused about what is the schools responsiblity. They have to educate him, you have to do the rest.
One thing that helped me emnensly when mine was going from the nonverbal to the verbal stage was this: tell him what you want him to do instead of what you want him to stop doing. Easier said than done. Instead of "no screaming" say "use a quiet voice" and a child with langague based processing issues will be much better able to do what you say. One of the things Occupational therapy would help him do is to make his body do what his langague, and the language you use, instructs him to do. It is a complicated issue, called motor planning, and it is universally weak for kids with ASD's. You can't see it as an issue, until he has a melt down over something. OT is not just learning ot hold the scissors, it is so, so much more! If you have not had his motor planning and executive function assessed, ask for this from your developmentalist, and if you have yet to get a full evaluation from a Developmental Pediatrician, get an appointment to have it done. You will likely need to repeat this a few times as he ages, but it is worth knowing how he functions based on data.
Remember too that he thinks in concrete terms, and his melt downs over not getting the cookie when he says please could be his reaction to not having that ABA enviornment where he could predict what would happen when he did something right. If you do something for your son once, he expects it every single time. That is autistic logic. Since he got the food reward in ABA when he used please, he expects it. Please does not mean to him what it means to you, because the idea of manners is not there for him, it litterally means, I say please, get cookie. You changed the rules the way he learned them. It can be fixed, but through therapy and time. It just means that he can only generalize what he learns so far, which is also expected with ASD. Most of your frustration in teaching him in the future will be in getting him to make those essential connections and generalizations of specific knowledge to other similar circumstances. They do not do that without instruction, and for most kids, you just don't have to teach that, they make those connections and generalizations naturally. He sees novelty (a new situation) in almost everything he does, and does not use the information he gathers in simular situations to navagate the next one. It is almost like every time is the first, and for him, it may be. Your job is to know, via the evaluation data, how severe this issue is for him at any given point in his development (again, he is a moving target, thus, why you will need periodic reevaluations.)
I have two on the specturm. They can be polar opposites in some ways. One of them assumes that the world does not know the common sense facts that she has been taught, so she has to explain everything she knows to everyone. She will tell you the most obvious detail, because she really does not know that all the rest of us did not need to learn that, we just knew. The other one assumes that we know everything she knows and is thinking at the time. She has no clue what we need to be keyed in on before she begins to speak, and leaves out critical details, because she thinks we already know. Both issues require theraputic intervention, and they are both autisitic logic. You will learn how your child thinks, and when you can pull out his private evaluation data, and point to a number and then ask the school for an accomodation or a therapy to help him in school, you will be in a much better place, and so will he.
Reading is your key to a lot of this. Wrightslaw has an article about tests and measurments and how to understand them. That will be helpful. But if you are just getting started, I would just start reading everything about PDD-NOS on the site, and all about preschool and advocacy. Mel Levine wrote a book called "All kinds of Minds" that may be helpful, it discusses a great many differences with brain function.
I would also say, your SIL is not far off. Our kids do save up the behavior for us, and dump it out when they get home. We will not kick them to the curb, and they know it, and school for them is terribly hard work. They have to think about and concentrate on things we don't even know we know.
Finally, if no one has mentioned this to you, you should know that care givers should take extra good care of themselves. We are at high risk for exhaustion and depression, and more than half of us will need our own psychatric care at some point in our lives, so don't hessitate to seek help for yourself if you feel hopeless or sad or the whole situation overwhelms you. You are in very good company and there is zero shame in seeking help. Your son needs you to stay healthy.
M.
