DSM-IV Criteria, Pervasive Developmental Disorders

299.00 Autistic Disorder

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:

(a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to- eye gaze, facial expression, body postures, and gestures to regulate social interaction

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication, as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:

(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)

(d) persistent precoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.

299.80 Pervasive Developmental Disorder, Not Otherwise Specified

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.

299.80 Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(2) failure to develop peer relationships appropriate to developmental level

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

299.80 Rett's Disorder

A. All of the following:

(1) apparently normal prenatal and perinatal development

(2) apparently normal psychomotor development through the first 5 months after birth

(3) normal head circumference at birth

B. Onset of all of the following after the period of normal development:

(1) deceleration of head growth between ages 5 and 48 months

(2) loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing)

(3) loss of social engagement early in the course (although often social interaction develops later)

(4) appearance of poorly coordinated gait or trunk movements

(5) severely impaired expressive and receptive language development with severe psychomotor retardation

299.10 Childhood Disintegrative Disorder

A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.

B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:

(1) expressive or receptive language

(2) social skills or adaptive behavior

(3) bowel or bladder control

(4) play

(5) motor skills

C. Abnormalities of functioning in at least two of the following areas:

(1) qualitative impairement in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)

(2) qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)

(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms

D. The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.

Diagnostic and Statistical Manual, 4th Edition, ©1994, American Psychiatric Association

There is a lot of curiosity as to the difference between Aspergers and PDD-NOS. This link goes to a page at the Autism Society of America, explaining what Asperger's Syndrome is:

http://www.autism-society.org/site/PageServer?pagename=Aspergers

And if you want to see the DSM IV diagnostic criteria for diagnosing Aspergers, here is the link. Scroll down to see the Asperger's diagnosis criteria specifically:

http://www.autismvoice.com/blog/SignsofAutismDiagnosis

Sandra Sinclair,

www.autismvoice.com

There seems to be a lot of confusion as to what autism and autism spectrum disorders actually are. It's understandable, because persons on the autism spectrum can be so individually different. Some cannot talk. Some talk early. Some are highly intelligent, others have some degree of  mental retardation. Some have extreme sensory issues and some don't. Some have motor planning problems, and some are very athletic. And the list goes on. So with all of these differences between individuals, what do these people have in common?

 

Regardless of diagnosis - Asperger's Syndrome, PDD, PDD-NOS, Autism or any other autism spectrum disorder, what all persons with autism spectrum disorders seem to have in common is their core deficit.

 

Autism spectrum disorders arise from a neurological condition; a weakened area that seems to be located somewhere along the pathway that runs from the prefrontal cortex to the hippocampus of the brain. No one yet knows definitively what causes this condition. All individuals on the autism spectrum have this weakened pathway, which results in the following core deficits:

 

Deficits in: comparative thought and interpretation, flexibility and adaptability to change, creative thought, decision-making, judgment, and memory of past positive feelings about events. 

 

In typical individuals, this pathway creates a hierarchy of comparison, and interprets everything we see, hear, do and feel. It compares one thing to another, compares past to present situations, compares how we felt before to now, separates important from the unimportant, and then uses all of that information to judge situations and come up with with unique solutions.

 

Typical people spend most of the day using this part of their brain effortlessly, sailing through thousands of little moment-to-moment decisions with ease. But for a person on the autism spectrum, all of those tiny moment to moment decisions can be quite difficult and often scary.

 

Because of the weakened brain pathway, individuals on the autism spectrum have a limited ability to compare, interpret and solve new situations. As a result, they remain tied to using solutions they already know, and have limited ability to deal with new or changing situations.

 

Decision-making and judgment abilites that most of us take for granted, such deciding which way to go to the store today, interpreting and understanding the actions of other people, or even figuring out how near or far to walk next to someone often cause confusion and fear in a person with an autism spectrum disorder. 

 

As a result, the world often seems chaotic and scary to individuals on the spectrum, and other people seem to act in abrupt and unexpected ways that are just impossible for them to understand.

 

To try to control some of this chaos and keep things predictable, autistic individuals tend to rely heavily on formulas and repetitive sequences to get through their day.

 

These sequences and formulas rely on a different part of the brain that usually functions quite well in persons on the autism spectrum. It's the area of the brain that runs our "red = stop, green = go", "2+2=4" type thinking - very formulaic, very predictable , and very absolute thought. Unfortunately, this area of the brain is unable to compare, interpret, adapt, or see possiblities.

 

Of course when faced with new or changing situations, when most formulas won't work, persons on the spectrum often fall apart, out of fear of the unknown. Most of the tantrums, escape, or aggressive behaviors that we see at these times are usually "fight or flight" responses, motivated out of fear, not from being stubborn, manipulative or "bad".

 

One of the reasons Relationship Development Intervention is effective is because it addresses this pathway directly, by using different activities to exercise and strengthen it, much like what we do for other persons with weak or damaged brain pathways, such as persons with stroke or head injury, etc.

 

For more information about Relationship Development Intervention, visit http://www.rdiconnect.com. You can also read my article on RDI or listen to the podcast "What is RDI?" - Sandra Sinclair, www.autismvoice.com

 

 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License.

In some situations, it can be helpful to get an outside evaluation from a doctor yourself in addition to the evaluations your local organizations provide.

 

Most evaluations are done by a small group of teachers and therapists. A doctor may or may not be part of the evaluation; however, they may be needed for a diagnosis of an autism spectrum disorder, depending on the laws where you live.

 

In some circumstances, an outside medical evaluation can be very valuable. First, for a child on the autism spectrum, you have a diagnosis, and many doctors are also willing to write specifically how many hours and what types of interventions they feel would best serve the child.  

 

In some circumstances, this can be very helpful at your IEP or IFSP meeting. Every region is a little different in how they do things, and each situation is unique as to whether this would help or not.

 

Therapists, psychologists, and teachers evaluate and recommend services for your child, and you need their recommendations to receive those services. But you may need a MD or psychologist 's diagnosis and recommendations also to receive specific types and quantities of services appropriate for your child, depending on how your area does things. So check.

 

Wrightslaw has a wonderful article "10 Tips How to Use IDEA 2004 to Improve Your Child's Special Education", by Wayne Steedman, which touches on many aspects of the IDEA 2004 changes, including how to pick a diagnostician that's qualified and choosing someone who your school district listens to.

 

A good book to read is "How to Compromise With Your School District Without Compromising Your Child" by Gary Mayerson. He's a child advocate attorney, specializing in special education law. It's a good start to figuring out what to do in the process. In his book, he also touches on this subject of outside evaluations.

 

At this point, you may want to contact a local child advocate attorney for advice on options available to you. You may also want to talk to other parents in your area who went through the same process, to see what they did and what their outcomes were. Often times, other parents and your child advocate are the only people who can tell you what the reality is in your area.

 

If you would like to have a doctor evaluate your child, you may have to ask for it as part of the evaluation, or just get it done yourself privately, either out-of-pocket, or via insurance, if your plan covers it. 

 

 And of course, if you are so fortunate as to find out after evaluations that your child is okay, count your blessings. It was still worth it to find out early on.

 

No matter what the result of your evaluation, trust your gut instincts. If there seems to be something the doctors and therapists missed, ignored, or you feel the evaluation was not accurate in some way, you can always ask for a second opinion and have your child reevaluated. Things can be missed, even by a good evaluator.

 

There is something to be said about the “labeling” your child issue; however, it would be much better for most autistic children to have a diagnosis and receive needed services than to miss out on important interventions. You can work on transitioning to regular class later, if it’s a reasonable solution for your child. Again, a very good question to ask your legal advocate.

 

Of course, if you can pay for evaluations and services yourself, you never need to worry about the labeling issue, because the school system doesn’t have to be involved. Some people do this, but for most of us, the cost of running this kind of program out of pocket would be prohibitive.

 

Again, I'm a layperson, not an attorney, so please get the advice you need from someone who specializes in special education law in your vicinity. This is just a "heads-up" article for those who didn't know that outside evaluations are a possibility.

 

-Sandra Sinclair

www.autismvoice.com

 

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License.

MP3 File

This show is about diagnosis and first evaluations -our personal experience. - Sandra Sinclair, www.autismvoice.com

This is a great page at the Autism Society of America about signs of autism, possible causes, and prevalence. The ASA is a terrific resource for families. -- Sandra Sinclair