Pervasive Developmental Disorders are characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests, and activities. The qualitative impairments that define these conditions are distinctly deviant relative to the individual’s developmental level or mental age. This section contains Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified. These disorders are usually evident in the first years of life and are often associated with some degree of Mental Retardation, which, if present, should be coded on Axis II. The Pervasive Developmental Disorders are sometimes observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system). If such conditions are present, they should be noted on Axis III. Although terms like "psychosis" and "childhood schizophrenia" were once used to refer to individuals with these conditions, there is considerable evidence to suggest that the Pervasive Developmental Disorders are distinct from Schizophrenia (however, an individual with Pervasive Developmental Disorder may occasionally later develop schizophrenia).

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association, Washington, DC, 1994.

Autistic Disorder Rett’s Disorder Childhood Disintegrative Asperger’s Disorder Pervasive Developmental

A.     Reciprocal Social Interaction

Relate to others with difficulty Want to be alone frequently

Avoid eye contact or use in unusual ways May fear new people or places

Lack understanding of social cues Lack understanding of others feelings

May lack facial expression Impairment in use of body postures

Narrow range of emotions Express emotions differently

Appear to laugh, giggle, scream at random Use objects in unusual ways

Develop strong attachment to objects which can Lack imaginative play

be preoccupying Lack social/sexual understanding

Must be taught to share and cooperate Lack of awareness of others

Failure to develop peer relationships appropriate Lack of showing, bringing, or

to developmental level pointing out objects

May have no concept of the needs of others

B.     Communication

Delay in or lack of spoken language Initiate communication

Slow in using gestures and their understanding infrequently, or not at all

Lack comprehension of content and timing Difficulty with abstract concepts

of communication Perseverate on one topic or ramble

Follow one or several lines of exchanges Have difficulty answering questions

with difficulty Lack of varied spontaneous make-

Stereotyped and repetitive use of language believe play

Abnormal pitch, intonation, rate, rhythm,

stress, of speech

C.     Restricted, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities

Resist change in routine, people, environment Lack fear of real danger

Exhibit repetitive body movements Perseverate/short attention to activities

Exhibit unusual fear of new people or places Restricted range of interest

Persistent preoccupation with parts of objects Insistence on sameness

Abnormalities of posture may be present May line up objects

Unreasonable insistence on following routines Fascination with movement

Highly attached to some inanimate object

D.     Cognitive

Develop unevenly within and across skill areas Sensory issues may be present

Resist change in learning environment, perseverate Usually not competitive

May not generalize skills to other areas, location Difficulty with unstructured time

Difficulty with problem solving Exhibit impulsivity and inconsistency

Rely on cues, learned routines, familiar people Imitation difficult

Difficulty with attention shifts and focus

Adapted from: Indiana Resource Center for Autism, Introduction to Autism, Indiana University, 1992 and Diagnostic and Statistical Manual, Fourth Edition, 1994. 1998 Modification by New Mexico Autism Program, CDD, University of New Mexico.

E.    Diagnostic Criteria for 299.0 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 develop mental 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 t 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, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

The Diagnostic and Statistical Manual, Fourth Edition, American Psychiatric Association, Washington, DC, 1994.

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