Diagnosis of Autism and Related Pervasive Developmental Disorders
Autism and the other pervasive developmental disorders, about which we have said relatively little until now, are formally recognized psychiatric illnesses which are defined in the Diagnostic and Statistical Manual of Mental Disorders (the DSM; currently in its 4th, text-revised edition); the repository for all mental health related disorder definitions. We describe the criteria that must be met before a pervasive developmental disorder diagnosis can be made in the following sections.
Autistic Disorder
First described by Dr. Leo Kanner in 1943, Autistic Disorder is the most commonly recognized pervasive developmental disorder. In order to be diagnosed with autistic disorder, people must display multiple social impairments, stereotyped, repetitive movement issues, and evidence of communication, cognitive processing or adaptive functioning impairments as defined below in the following three criteria (quoted from the DSM-IV-TR):
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 preoccupation 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 (3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.
