General Description
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC
There are four Pervasive Developmental Disorders (PDD) in the DSM-IV and one Not Otherwise Specified category. They are Autistic Disorder (299.00), Rett's Disorder (299.80), Childhood Disintegrative Disorder (299.10), Asperger's Disorder (299.80), Pervasive Developmental Disorder Not Otherwise Specified (including atypical autism) (299.80). The general criteria for a PDD in the DSM-IV are a 'severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests, and activities.
Autistic Disorder (299.00)
The main feature of autistic disorder is the obvious existence of a noticeable abnormality in the development of social interaction and communication. Also a noticeable restriction in activities and interests. The extent of this disorder varies greatly depending on age and developmental level.
Rett's Disorder (299.80)
The main feature of Rett's Disorder is when a child developments multiple deficits after a long period of time of normal behavior after birth.
Childhood Disintegrative Disorder (299.10)
The main feature of this disorder is the child regresses in multiple areas of functioning after having two years of apparent normal development.
Asperger's Disorder (299.80)
The main features of Asperger's Disorder are severe and continuous difficulty with social interaction, and the creation of repeated patterns of behavior, interests, and activities.
Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism) (299.80)
This category should be used when there are obvious impairments in development or social interaction due to a lack of verbal or non-verbal skills, or an obvious behavior, interests, or activity that would indicated a problem. However the symptoms do not meet the criteria for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder.
Diagnostic Criteria
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC
In order for a child to be diagnosed with Autistic Disorder (299.00) they must meet six of more of the following symptoms from the first three sections, with at least two from the first section and one each from the next two section after that.
- Qualitative impairment in social interaction, as seen by:
- the use of nonverbal actions such as a blank stare, facial expressions, body language, and gestures to control social interaction.
- lack of peer relationships that would seem appropriate for the child's developmental level.
- lack of wanting to share enjoyment, interests, and achievements, with others.
- lack of social or emotional interaction.
- Qualitative impairment in communication, as seen by:
- delay or complete lack in spoken language, followed by tries to compensate through alternatives.
- inability to maintain conversation.
- continuous use of the same language.
- lack of make-believe play or social imitative play consist with developmental level.
- Continuous patterns in behavior, interests, and activities, as seen by:
- almost complete focus on one or more restricted patterns of interest that does not correlate with what is consider normal.
- the inability to be flexible with routines and rituals.
- continuous repeated motions such as hand flapping or twisting, or whole-body movements.
- overly occupied with parts of objects.
- Delays and abnormal functioning prior to the age of 3 in either social interaction, communication, and imaginative play.
- These symptoms are not accounted for due to Rett's Disorder or Childhood Disintegrative Disorder.
A child could be diagnosed with Rett's Disorder (299.80) if they have the following symptoms:
- The child must have all of the following:
- What seems to be normal prenatal and perinatal development.
- What seem to be normal psychomotor development during the first 5 months after birth.
- Normal head circumference at birth.
- After a period of normal development the child
- Head growth slows down between 5 to 48 months.
- Loss of hands skills developed between the ages of 5 to 30 months.
- Loss of early social interaction.
- Poorly coordinated gait or trunk movements.
- Severely impaired language development together with severe psychomotor retardation.
A child could be diagnosed with Childhood Disintegrative Disorder (299.10) if the following symptoms are seen.
- What seems to be normal development for at least the first two years after birth.
- Loss of skills that were acquired before the age of 10 years in at least two of the following areas:
- Language skills
- Social skills and adaptive behavior
- Loss of control of the bowel and bladder
- Play
- Motor skills
- Functioning that is not normal in the following areas:
- Social interaction
- Communication
- Patterns of behavior, interest, and activities, including motor skills and mannerisms
- These symptoms are not better accounted for by another PDD or by schizophrenia.
A child could be diagnosed with Asperger's Disorder (299.80) if they display the following symptoms.
- Qualitative difficultly in social interaction, as seen in at least two of the following:
- Noticeable difficulty in using nonverbal behaviors such as eye-to-eye contact, body posture, etc.
- Lack of peer relationships appropriate to the developmental level.
- Does not care to share enjoyment, interests, or achievements with others.
- Deficient in social or emotional responses.
- Repeated patterns of behavior, interests, and activities as seen by at least one of the following:
- Abnormal attention or focus on one restricted pattern of interest.
- Obvious inflexibility to a routine or ritual.
- Repeated movements such as hand of finger flapping, or whole-body movements.
- Overly occupied with object's parts.
- These symptoms cause major difficultly in social, school, or other important settings.
- There is no major delay in language.
- There are no other delays in cognitive development, or self-help skills, and child is curios about surroundings.
- The symptoms are not justified by another Pervasive Developmental Disorder or Schizophrenia.
Etiology
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC
Autistic Disorder is four to five more times likely to occur in males, however females with this disorder are more likely, to exhibit more severe Mental Retardation. Autistic disorder is more likely to occur among siblings of individuals with the disorder.
Preliminary data suggest Rett's Disorder is caused by a genetic mutation. It is commonly associated with Severe or Profound Mental Retardation.
Childhood Disintegrative Disorder is usually associated with Severe Mental Retardation. It seems that this disorder is due to an insult in the developing central nervous system.
Asperger's Disorder appears to run in the family, there also may be an increased risk of Autistic Disorder as well as more general social difficulties. Males are five time more likely to have Asperger's Disorder.
Prevalence
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC
The average rate of people with Autistic Disorder are 5 per 10,000. With reports ranging form 2 to 20 cases per 10,000. The onset for this disorder is prior to the age of three.
Rett's Disorder is less common then Autistic Disorder and has only been found in females.
Childhood Disintegrative Disorder is less common then Autistic Disorder. Newer data has show that the condition is more common in males.
There is no data on the prevalence of Asperger's disorder.
EBP Treatment Approaches
Listed below are either evidence-based practices or promising practices that have been successful at treating Pervasive Developmental Disorders.
Promising Treatments
Behavior Interventions
- Educational and Communication Focused Interventions
- Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) approach
- Natural Language Methods
- Picture Exchange Communication System
- Behavior Intervention
Pharmacological Treatments
(Click on Medications)
References
Tanguay, P. E. (2000, Sept.) Pervasive Developmental Disorders: a 10-year review. Journal of the American Academy of Child & Adolescent Psychiatry. 39(9):1079-1095.
Note - Full text is available through the University at Buffalo Libraries.
Links
Autism Society of America
On-Line Asperger Syndrome Information and Support (O.A.S.I.S.)
Autism Resources
Center for the Study of Autism
Autism-SFTAH Home Page
Tony Attwood's Home Page
Fact Sheets
Fact Sheets from the American Academy of Child and Adolescent Psychiatry
Note - Click on topic. (Please note disclaimer).
The AACAP developed Facts for Families to provide concise and up-to-date information on issues that affect children, teenagers, and their families.
The AACAP website includes facts, statistics, and overviews of different problems children and adolescents face and different mental health disorders that affect children and adolescents.
Fact Sheets from the National Institute of Mental Health
Note - Click on "select a topic".
NIMH offers a variety of publications and other educational resources to help people with mental health disorders, the general public, mental health and health care practitioners, and researchers gain a better understanding of mental illnesses and the research programs of the NIMH.
This website includes facts, statistics, pamphlets, checklists, and overviews of mental health disorders.
Fact Sheets from the National Mental Health Association
Note - Click on topic.
The NMHA offers answers to frequently asked questions, facts, statistics and overviews about different mental health disorders, as well as information about treatments and other problems that affect children and adolescents.
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