Sat Jul 27, 2013 1:29 pm by 
1. What is PDD or autism?
PDD or pervasive developmental disorder is a behavioral disorder of speech, communication, social interaction, and repetitive type compulsive behavior. Autism is a form of PDD. There are five types of PDD's. The most commonly encountered are PDD NOS (pervasive developmental disorder not otherwise specified), childhood autism, and Asperger's syndrome. All these "different" conditions have common diagnostic and physiologic features but differ slightly by the specific diagnostic criteria. (See The DSMV IV criteria for autistic disorders).
2. How is PDD or autism diagnosed?
The diagnosis of PDD is clinical, meaning "what you see is what you've got." One needs to meet specific diagnostic criteria for the different conditions, but the general requirements are that one must have symptoms that belong to the three main areas of impairments:
Speech
Social interactions
Repetitive stereotype behaviors
These symptoms coupled with a severe impairment in speech, social skills, or repetitive stereotyped behavior qualifies one for PDD NOS in the milder situations and for the other autistic conditions in the more severe presentations.
At times, especially when diagnosed early, it may be difficult to predict what the final outcome will be. Even though PDD's are life long disorders, some children will do better than others and a small proportion may "outgrow" some of the difficulties. Subtle changes, however, persist universally, even in the best of situations throughout life, and involve mostly social interaction skills and some obsessive-compulsive behaviors.
A simplified way of understanding the diagnosis of autism is looking at the PDD assessment scale questionnaire. In order to qualify for an autism diagnosis, one needs to have some behavioral features from each one of the three subgroups listed. This, of course, must be associated with a severe speech, social, or repetitive behavior impairment. A more comprehensive understanding of the condition and its diagnostic differentiation to the five different subgroups is provided by the DSM IV criteria for the autistic disorders.
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3. The DSM IV criteria for the autistic disorders
The full diagnostic criteria for the pervasive developmental disorders are outlined below. As mentioned above, the diagnostic criteria for the autistic (PDD) disorders are defined by the DSM IV criteria.
Childhood autism
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):
Qualitative impairment in social interaction, as manifested by at least two of the following:
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.
failure to develop peer relationships appropriate to developmental level
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)
lack of social or emotional reciprocity
Qualitative impairments in communication as manifested by at least one of the following:
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)
in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
stereotyped and repetitive use of language or idiosyncratic language
lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of one of the following:
encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
persistent preoccupation with parts of objects
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.
The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.
Asperger's syndrome
Qualitative impairment in social interaction, as manifested by at least two of the following:
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
failure to develop peer relationships appropriate to developmental level
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)
lack of social or emotional reciprocity
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of one of the following:
encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
persistent preoccupation with parts of objects
The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
There is no clinically significant delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
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.
Criteria are not met for another specific pervasive developmental disorder or schizophrenia.
Rett's disorder
All of the following:
apparently normal prenatal and perinatal development
apparently normal psychomotor development through the first five months after birth
normal head circumference at birth
Onset of all of the following after the period of normal development:
deceleration of head growth between ages 5 and 48 months
loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., handwringing or handwashing)
loss of social engagement early in the course (although often social interaction develops later)
appearance of poorly coordinated gait or trunk movements
severely impaired expressive and receptive language development with severe psychomotor retardation
Childhood disintegrative disorder
Apparently normal development for at least the first two years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior
Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
expressive or receptive language
social skills or adaptive behavior
bowel or bladder control
play
motor skills
Abnormalities of functioning in at least two of the following areas:
qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)
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)
restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms)
The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.
PDD NOS
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 at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.
PDD or pervasive developmental disorder is a behavioral disorder of speech, communication, social interaction, and repetitive type compulsive behavior. Autism is a form of PDD. There are five types of PDD's. The most commonly encountered are PDD NOS (pervasive developmental disorder not otherwise specified), childhood autism, and Asperger's syndrome. All these "different" conditions have common diagnostic and physiologic features but differ slightly by the specific diagnostic criteria. (See The DSMV IV criteria for autistic disorders).
2. How is PDD or autism diagnosed?
The diagnosis of PDD is clinical, meaning "what you see is what you've got." One needs to meet specific diagnostic criteria for the different conditions, but the general requirements are that one must have symptoms that belong to the three main areas of impairments:
Speech
Social interactions
Repetitive stereotype behaviors
These symptoms coupled with a severe impairment in speech, social skills, or repetitive stereotyped behavior qualifies one for PDD NOS in the milder situations and for the other autistic conditions in the more severe presentations.
At times, especially when diagnosed early, it may be difficult to predict what the final outcome will be. Even though PDD's are life long disorders, some children will do better than others and a small proportion may "outgrow" some of the difficulties. Subtle changes, however, persist universally, even in the best of situations throughout life, and involve mostly social interaction skills and some obsessive-compulsive behaviors.
A simplified way of understanding the diagnosis of autism is looking at the PDD assessment scale questionnaire. In order to qualify for an autism diagnosis, one needs to have some behavioral features from each one of the three subgroups listed. This, of course, must be associated with a severe speech, social, or repetitive behavior impairment. A more comprehensive understanding of the condition and its diagnostic differentiation to the five different subgroups is provided by the DSM IV criteria for the autistic disorders.
[back to top]
3. The DSM IV criteria for the autistic disorders
The full diagnostic criteria for the pervasive developmental disorders are outlined below. As mentioned above, the diagnostic criteria for the autistic (PDD) disorders are defined by the DSM IV criteria.
Childhood autism
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):
Qualitative impairment in social interaction, as manifested by at least two of the following:
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.
failure to develop peer relationships appropriate to developmental level
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)
lack of social or emotional reciprocity
Qualitative impairments in communication as manifested by at least one of the following:
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)
in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
stereotyped and repetitive use of language or idiosyncratic language
lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of one of the following:
encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
persistent preoccupation with parts of objects
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.
The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.
Asperger's syndrome
Qualitative impairment in social interaction, as manifested by at least two of the following:
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
failure to develop peer relationships appropriate to developmental level
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)
lack of social or emotional reciprocity
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of one of the following:
encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
apparently inflexible adherence to specific, nonfunctional routines or rituals
stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
persistent preoccupation with parts of objects
The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
There is no clinically significant delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
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.
Criteria are not met for another specific pervasive developmental disorder or schizophrenia.
Rett's disorder
All of the following:
apparently normal prenatal and perinatal development
apparently normal psychomotor development through the first five months after birth
normal head circumference at birth
Onset of all of the following after the period of normal development:
deceleration of head growth between ages 5 and 48 months
loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., handwringing or handwashing)
loss of social engagement early in the course (although often social interaction develops later)
appearance of poorly coordinated gait or trunk movements
severely impaired expressive and receptive language development with severe psychomotor retardation
Childhood disintegrative disorder
Apparently normal development for at least the first two years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior
Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
expressive or receptive language
social skills or adaptive behavior
bowel or bladder control
play
motor skills
Abnormalities of functioning in at least two of the following areas:
qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)
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)
restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms)
The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.
PDD NOS
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 at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.
