Autistic Disorder
The essential features constitute a severe form of Pervasive Developmental
Disorder, with onset in infancy or childhood. The other features of the disorder
are described above.
(Diagnostic Criteria for Autistic Disorder)
At least eight of the following sixteen items are present, these to include at
least two items from A, one from B, and one from C.
Note: Consider a criterion to be met only if the behavior is abnormal for
the person's developmental level.
A. Qualitative impairment in reciprocal social interaction as manifested by the
following:
(The examples within parentheses are arranged so that those first
mentioned are more likely to apply to younger or more handicapped, and
the later ones, to older or less handicapped, persons with this
disorder.)
(1) marked lack of awareness of the existence or feelings of others
(e.g, treats a person as if he or she were a piece of furniture; does not
notice another person's distress; apparently has no concept of the need
of others for privacy)
(2) no or abnormal seeking of comfort at times of distress (e.g., does
not come for comfort even when ill, hurt, or tired; seeks comfort in a
stereotyped way, e.g., says "cheese, cheese, cheese" whenever
hurt)
(3) no or impaired imitation (e.g., does not wave bye-bye; does not
copy mothers domestic activities; mechanical imitation of others' actions
out of context)
(4) no or abnormal social play (e.g., does not actively participate in
simple games; prefers solitary play activities; involves other children in
play only as "mechanical aids")
(5) gross impairment in ability to make peer friendships (e.g., no
interest in making peer friendships; despite interest in making friends,
demonstrates lack of understanding of conventions of social interaction,
for example, reads phone book to uninterested peer)
B. Qualitative impairment in verbal and nonverbal communication, and in
imaginative activity, as manifested by the following:
(The numbered items are arranged so that those first listed are more likely
to apply to younger or more handicapped, and the later ones, to older or
less handicapped, persons with this disorder.)
(1) no mode of communication, such as communicative babbling, facial
expression, gesture, mime, or spoken language
(2) markedly abnormal nonverbal communication, as in the use of
eye-to-eye gaze, facial expression, body posture, or gestures to initiate
or modulate social interaction (e.g., does not anticipate being held,
stiffens when held, does not look at the person or smile when making a
social approach, does not greet parents or visitors, has a fixed stare in
social situations)
(3) absence of imaginative activity, such as playacting of adult roles,
fantasy characters, or animals; lack of interest in stories about
imaginary events
(4) marked abnormalities in the production of speech, including volume,
pitch, stress, rate, rhythm, and intonation (e.g., monotonous tone,
questionlike melody, or high pitch)
(5) marked abnormalities in the form or content of speech, including
stereotyped and repetitive use of speech (e.g., immediate echolaha or
mechanical repetition of television commercial); use of "you" when "I" is
meant (e.g., using "You want cookie?" to mean I want a cookie");
idiosyncratic use of words or phrases (e.g., "Go on green riding" to
mean "1 want to go on the swing"); or frequent irrelevant remarks (e.g.,
starts talking about train schedules during a conversation about
sports)
(6) marked impairment in the ability to initiate or sustain a conversation with
others, despite adequate speech (e.g., indulging in lengthy monologues
on one subject regardless of interjections from others)
C. Markedly restricted repertoire of activities and interests, as manifested by
the following:
(1) stereotyped body movements, e.g., hand-flicking or -twisting, spinning,
head-banging, complex whole-body movements
(2) persistent preoccupation with parts of objects (e.g., sniffing or smelling
objects, repetitive feeling of texture of materials, spinning wheels of toy
cars) or attachment to unusual objects (e.g., insists on carrying around
a
piece of string)
(3) marked distress over changes in trivial aspects of environment, e.g.,
when a vase is moved from usual position
(4) unreasonable insistence on following routines in precise detail, e.g., in�
sisting that exactly the same route always be followed when
shopping
(5) markedly restricted range of interests and a preoccupation with one
narrow interest, e.g., interested only in lining up objects, in amassing
facts about meteorology, or in pretending to be a fantasy character
D. Onset during infancy or childhood.
Pervasive Developmental Disorder Not Otherwise Specified
This category should be used when there is a qualitative impairment in the
development of reciprocal social interaction and of verbal and nonverbal
communication skills, but the criteria are not met for Autistic Disorder,
Schizophrenia, or Schizotypal or Schizoid Personality Disorder. Some people
with this diagnosis will exhibit a markedly restricted repertoire of activities and
interests, but others will not.
SPECIFIC DEVELOPMENTAL DISORDERS
This subclass is for disorders that are characterized by inadequate development
of specific academic, language, speech, and motor skills and that are not due to
demonstrable physical or neuralgic disorders, a Pervasive Developmental
Disorder, Mental Retardation, or deficient educational opportunities. For
example, a marked delay in language development in an otherwise normal child
would be classified as a Specific Developmental Disorder, but a delay in
language development in a child with a Pervasive Developmental Disorder would
be attributed to the Pervasive Developmental Disorder and therefore would not
be classified as a Specific Developmental Disorder. Similarly, a marked delay in
learning to read experienced by an otherwise normal child with adequate
educational opportunities would be classified as a Specific Developmental
Disorder, whereas a delay in learning to read commensurate with general delays
in development would be classified as Mental Retardation, not as a Specific
Developmental Disorder.
The diagnosis of an Academic Skills Disorder (Developmental Arithmetic,
Expressive Writing, and Reading Disorders) is made with the aid of standardized,
individually administered tests that measure both the level of development of the
impaired skill and the person's intellectual capacity. In diagnosing Developmental
Expressive and Receptive Language Disorders, it is necessary to compare
scores obtained from standardized measures of expressive or receptive
language with scores obtained from standardized measures of nonverbal
intellectual capacity.
It should be noted that a diagnosis of Mental Retardation in a child does not
preclude the additional diagnosis of a Specific Developmental Disorder. For
example, a child with an IQ of 60 should, with adequate schooling, be able to
read simple materials If the child's ability to read is markedly below what would
be expected given an IQ of 60, both Mental Retardation and Developmental
Reading Disorder should be diagnosed.
When a child has more than one Specific Developmental Disorder, all should
be diagnosed. A Specific Developmental Disorder that appears to be caused by
another Specific Developmental Disorder should be separately diagnosed. For
example, a child with Developmental Receptive Language Disorder may show
deficits in the development of arithmetic skills that are apparently related to the
language disorder (i.e., a lack of understanding of numerical terms). In this
example, the child would he diagnosed as having both Developmental Receptive
Language Disorder and Developmental Arithmetic Disorder.
The inclusion of these categories in a classification of "mental disorders" is
controversial, since many of the children with these disorders have no other
signs of psycho-pathology. Further, the detection and treatment of many of these
disorders usually take place within schools rather than the mental health
system.
Although many of the clinical features seen in Specific Developmental
Disorders represent functional levels that are normal for very young children
(e.g., inability to do arithmetic), there is no implication that children with these
disorders will "catch up" over time. In fact, children with more severe forms of
these disorders frequently continue to show signs of the disturbance in
adolescence and adulthood; and the relevant diagnosis should be noted when an
adult still has clinically significant signs of the disorder.
Impairment. All of the Specific Developmental Disorders are associated with
impairment in academic functioning in children who are in school; impairment is
most marked when language is affected. If the child is not in school, there is, by
definition, impairment in activities of daily living.
Predisposing factors. There is some evidence that prenatal injury of
various kinds predisposes to the development of Specific Developmental
Disorders.
<
>
Complications. A common complication of Developmental Expressive or
Receptive Language Disorder Is an Academic Skills Disorder. A common
complication of Academic Skills Disorders is Conduct Disorder.
Sex ratio. No information is available for Developmental Arithmetic and
Developmental Coordination Disorders. The other Specific Developmental
Disorders are from two to four times more common in males than in females.
Academic Skills Disorders
Developmental Arithmetic Disorder
The essential feature of this disorder is marked impairment in the development of
arithmetic skills that is not explainable by Mental Retardation, inadequate
schooling, or hearing or visual defects. The diagnosis is made only if this
impairment significantly interferes with academic achievement or with activities of
daily living that require arithmetic skills.
There are a number of different types of skills that may be impaired in
Developmental Arithmetic Disorder. These include: "linguistic" skills (such as
understanding or naming mathematical terms, understanding or naming
mathematical operations or concepts, and decoding written problems into
mathematical symbols); "perceptual" skills (such as recognizing or reading
numerical symbols or arithmetic signs, and clustering objects into groups);
"attention" skills (such as copying figures correctly, remembering to add in
"carried" numbers, and observing operational signs); and "mathematical" skills
(such as following sequences of mathematical steps, counting objects, and
learning multiplication tables).
Associated features. Various associated features have been reported,
including:
Developmental Receptive Language Disorder, Developmental Reading Disorder,
Developmental Expressive Writing Disorder, Developmental Coordination
Disorder, and memory and attention deficits.
Age at onset. This disorder is usually apparent by the time the child is eight
years old (third grade). In some children the disorder is apparent as early as six
years (first grade); in others it may not occur until age ten (fifth grade) or
later.
Course. No information.
Prevalence. The prevalence is unknown, but the disorder is less common
than Developmental Reading Disorder.
Familial pattern. No information.
Differential diagnosis. In Mental Retardation, deficits in arithmetic
achievement
are commensurate with the general impairment in intellectual functioning.
However, in unusual cases of Mild Mental Retardation, arithmetic skills may be
significantly below the expected level, given the person's schooling and level of
Mental Retardation. In such cases the additional diagnosis of Developmental
Arithmetic Disorder should be made, since treatment of the arithmetic difficulties
can be particularly helpful to the child's chances for employment in
adulthood.
Inadequate schooling can result in poor performance on standardized
arithmetic tests. In such cases, however, there is likely to be a history of many
school changes or absences, or most other children in the school are likely to
have similar difficulty.
(Diagnostic Criteria for Developmental Arithmetic Disorder)
A. Arithmetic skills, as measured by a standardized, individually administered
test, are markedly below the expected level, given the person's schooling
and intellectual capacity (as determined by an individually administered IQ
test).
B. The disturbance in a significantly interferes with academic achievement or
activities of daily living requiring arithmetic skills.
C. Not due to a defect in visual or hearing acuity or a neuralgic disorder.
Page 4
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Autistic Disorder
The essential features constitute a severe form of Pervasive Developmental Disorder, with onset in infancy or childhood. The other features of the disorder are described above.
(Diagnostic Criteria for Autistic Disorder)
At least eight of the following sixteen items are present, these to include at least two items from A, one from B, and one from C.
Note: Consider a criterion to be met only if the behavior is abnormal for the person's developmental level.
A. Qualitative impairment in reciprocal social interaction as manifested by the following:
(The examples within parentheses are arranged so that those first mentioned are more likely to apply to younger or more handicapped, and the later ones, to older or less handicapped, persons with this disorder.)
(1) marked lack of awareness of the existence or feelings of others (e.g, treats a person as if he or she were a piece of furniture; does not notice another person's distress; apparently has no concept of the need of others for privacy)
(2) no or abnormal seeking of comfort at times of distress (e.g., does not come for comfort even when ill, hurt, or tired; seeks comfort in a stereotyped way, e.g., says "cheese, cheese, cheese" whenever hurt)
(3) no or impaired imitation (e.g., does not wave bye-bye; does not copy mothers domestic activities; mechanical imitation of others' actions out of context)
(4) no or abnormal social play (e.g., does not actively participate in simple games; prefers solitary play activities; involves other children in play only as "mechanical aids")
(5) gross impairment in ability to make peer friendships (e.g., no interest in making peer friendships; despite interest in making friends, demonstrates lack of understanding of conventions of social interaction, for example, reads phone book to uninterested peer)
B. Qualitative impairment in verbal and nonverbal communication, and in imaginative activity, as manifested by the following:
(The numbered items are arranged so that those first listed are more likely to apply to younger or more handicapped, and the later ones, to older or less handicapped, persons with this disorder.)
(1) no mode of communication, such as communicative babbling, facial expression, gesture, mime, or spoken language
(2) markedly abnormal nonverbal communication, as in the use of eye-to-eye gaze, facial expression, body posture, or gestures to initiate or modulate social interaction (e.g., does not anticipate being held, stiffens when held, does not look at the person or smile when making a social approach, does not greet parents or visitors, has a fixed stare in social situations)
(3) absence of imaginative activity, such as playacting of adult roles, fantasy characters, or animals; lack of interest in stories about imaginary events
(4) marked abnormalities in the production of speech, including volume, pitch, stress, rate, rhythm, and intonation (e.g., monotonous tone, questionlike melody, or high pitch)
(5) marked abnormalities in the form or content of speech, including stereotyped and repetitive use of speech (e.g., immediate echolaha or mechanical repetition of television commercial); use of "you" when "I" is meant (e.g., using "You want cookie?" to mean I want a cookie");
idiosyncratic use of words or phrases (e.g., "Go on green riding" to mean "1 want to go on the swing"); or frequent irrelevant remarks (e.g., starts talking about train schedules during a conversation about sports)
(6) marked impairment in the ability to initiate or sustain a conversation with others, despite adequate speech (e.g., indulging in lengthy monologues on one subject regardless of interjections from others)
C. Markedly restricted repertoire of activities and interests, as manifested by the following:
(1) stereotyped body movements, e.g., hand-flicking or -twisting, spinning, head-banging, complex whole-body movements
(2) persistent preoccupation with parts of objects (e.g., sniffing or smelling objects, repetitive feeling of texture of materials, spinning wheels of toy cars) or attachment to unusual objects (e.g., insists on carrying around a piece of string)
(3) marked distress over changes in trivial aspects of environment, e.g., when a vase is moved from usual position
(4) unreasonable insistence on following routines in precise detail, e.g., in� sisting that exactly the same route always be followed when shopping
(5) markedly restricted range of interests and a preoccupation with one narrow interest, e.g., interested only in lining up objects, in amassing facts about meteorology, or in pretending to be a fantasy character
D. Onset during infancy or childhood.
Pervasive Developmental Disorder Not Otherwise Specified
This category should be used when there is a qualitative impairment in the development of reciprocal social interaction and of verbal and nonverbal communication skills, but the criteria are not met for Autistic Disorder, Schizophrenia, or Schizotypal or Schizoid Personality Disorder. Some people with this diagnosis will exhibit a markedly restricted repertoire of activities and interests, but others will not.
SPECIFIC DEVELOPMENTAL DISORDERS
This subclass is for disorders that are characterized by inadequate development of specific academic, language, speech, and motor skills and that are not due to demonstrable physical or neuralgic disorders, a Pervasive Developmental Disorder, Mental Retardation, or deficient educational opportunities. For example, a marked delay in language development in an otherwise normal child would be classified as a Specific Developmental Disorder, but a delay in language development in a child with a Pervasive Developmental Disorder would be attributed to the Pervasive Developmental Disorder and therefore would not be classified as a Specific Developmental Disorder. Similarly, a marked delay in learning to read experienced by an otherwise normal child with adequate educational opportunities would be classified as a Specific Developmental Disorder, whereas a delay in learning to read commensurate with general delays in development would be classified as Mental Retardation, not as a Specific Developmental Disorder.
The diagnosis of an Academic Skills Disorder (Developmental Arithmetic, Expressive Writing, and Reading Disorders) is made with the aid of standardized, individually administered tests that measure both the level of development of the impaired skill and the person's intellectual capacity. In diagnosing Developmental Expressive and Receptive Language Disorders, it is necessary to compare scores obtained from standardized measures of expressive or receptive language with scores obtained from standardized measures of nonverbal intellectual capacity.
It should be noted that a diagnosis of Mental Retardation in a child does not preclude the additional diagnosis of a Specific Developmental Disorder. For example, a child with an IQ of 60 should, with adequate schooling, be able to read simple materials If the child's ability to read is markedly below what would be expected given an IQ of 60, both Mental Retardation and Developmental Reading Disorder should be diagnosed.
When a child has more than one Specific Developmental Disorder, all should be diagnosed. A Specific Developmental Disorder that appears to be caused by another Specific Developmental Disorder should be separately diagnosed. For example, a child with Developmental Receptive Language Disorder may show deficits in the development of arithmetic skills that are apparently related to the language disorder (i.e., a lack of understanding of numerical terms). In this example, the child would he diagnosed as having both Developmental Receptive Language Disorder and Developmental Arithmetic Disorder.
The inclusion of these categories in a classification of "mental disorders" is controversial, since many of the children with these disorders have no other signs of psycho-pathology. Further, the detection and treatment of many of these disorders usually take place within schools rather than the mental health system.
Although many of the clinical features seen in Specific Developmental Disorders represent functional levels that are normal for very young children (e.g., inability to do arithmetic), there is no implication that children with these disorders will "catch up" over time. In fact, children with more severe forms of these disorders frequently continue to show signs of the disturbance in adolescence and adulthood; and the relevant diagnosis should be noted when an adult still has clinically significant signs of the disorder.
Impairment. All of the Specific Developmental Disorders are associated with impairment in academic functioning in children who are in school; impairment is most marked when language is affected. If the child is not in school, there is, by definition, impairment in activities of daily living.
Predisposing factors. There is some evidence that prenatal injury of various kinds predisposes to the development of Specific Developmental Disorders.
<
> Complications. A common complication of Developmental Expressive or Receptive Language Disorder Is an Academic Skills Disorder. A common complication of Academic Skills Disorders is Conduct Disorder.
Sex ratio. No information is available for Developmental Arithmetic and Developmental Coordination Disorders. The other Specific Developmental Disorders are from two to four times more common in males than in females.
Academic Skills Disorders
Developmental Arithmetic Disorder
The essential feature of this disorder is marked impairment in the development of arithmetic skills that is not explainable by Mental Retardation, inadequate schooling, or hearing or visual defects. The diagnosis is made only if this impairment significantly interferes with academic achievement or with activities of daily living that require arithmetic skills.
There are a number of different types of skills that may be impaired in Developmental Arithmetic Disorder. These include: "linguistic" skills (such as understanding or naming mathematical terms, understanding or naming mathematical operations or concepts, and decoding written problems into mathematical symbols); "perceptual" skills (such as recognizing or reading numerical symbols or arithmetic signs, and clustering objects into groups); "attention" skills (such as copying figures correctly, remembering to add in "carried" numbers, and observing operational signs); and "mathematical" skills (such as following sequences of mathematical steps, counting objects, and learning multiplication tables).
Associated features. Various associated features have been reported, including:
Developmental Receptive Language Disorder, Developmental Reading Disorder, Developmental Expressive Writing Disorder, Developmental Coordination Disorder, and memory and attention deficits.
Age at onset. This disorder is usually apparent by the time the child is eight years old (third grade). In some children the disorder is apparent as early as six years (first grade); in others it may not occur until age ten (fifth grade) or later.
Course. No information.
Prevalence. The prevalence is unknown, but the disorder is less common than Developmental Reading Disorder.
Familial pattern. No information.
Differential diagnosis. In Mental Retardation, deficits in arithmetic achievement are commensurate with the general impairment in intellectual functioning. However, in unusual cases of Mild Mental Retardation, arithmetic skills may be significantly below the expected level, given the person's schooling and level of Mental Retardation. In such cases the additional diagnosis of Developmental Arithmetic Disorder should be made, since treatment of the arithmetic difficulties can be particularly helpful to the child's chances for employment in adulthood.
Inadequate schooling can result in poor performance on standardized arithmetic tests. In such cases, however, there is likely to be a history of many school changes or absences, or most other children in the school are likely to have similar difficulty.
(Diagnostic Criteria for Developmental Arithmetic Disorder)
A. Arithmetic skills, as measured by a standardized, individually administered test, are markedly below the expected level, given the person's schooling and intellectual capacity (as determined by an individually administered IQ test).
B. The disturbance in a significantly interferes with academic achievement or activities of daily living requiring arithmetic skills.
C. Not due to a defect in visual or hearing acuity or a neuralgic disorder.