What are the DSM-IV Diagnostic Criteria for Autism?

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised Text is used by physicians as a general guide for the diagnosis of autism. This book is really boring and can be used as a sleep aide for your autistic child! The most recent version is called DSM-IV-TR.

This version lists five distinct types of autism along with the specific problems and behaviors that are associated with each of the types of autism. Each type is pervasive involving difficulties in multiple neurological areas. In addition, each type has impairments in communication, social, and behavioral areas.

Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), and Asperger's Disorder (or Asperger's Syndrome) are often unofficially grouped as Autism Spectrum Disorders (ASD). Although the ASD term does not actually exist in the DSM-IV, this expression is used because a continuum of deficits and overlap of impairments exist throughout these disorders. In addition, the DSM-IV does not state how to quantitatively differentiate the severity of symptoms between these disorders which further makes diagnosis less uniform among practitioners.

Another confusing aspect of the DSM-IV in the diagnosis of autism is that PDD and PDD-NOS have similar names. PDD is the general term for the whole autism category. PDD-NOS is the specific term for one type of autism under the PDD umbrella. PDD-NOS is often diagnosed when criteria for Autistic Disorder and Asperger's Disorder (or Asperger's Syndrome) are not completely met.

Other mental and neurological disorders can be found in the DSM-IV. Therefore, an individual with autism may have other diagnoses from the DSM-IV, such as Attention Deficit-Hyperactivity Disorder (ADHD), Bipolar or Manic-Depressive Disorder, Depression, Generalized Anxiety Disorder (GAD), Nonverbal Learning Disorder (NVLD), Obsessive Compulsive Disorder (OCD), Oppositional Defiant Disorder (ODD), Post-Traumatic Stress Disorder (PTSD), Reactive Attachment Disorder, Schizophrenia, Social Phobia, and Tourette's Syndrome.

The DSM-IV may be periodically revised as more information is accumulated and assimilated.

The following descriptions are quoted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR) which was published by the American Psychiatric Association in 2000.

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, or (3) symbolic or imaginative play.

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

DSM-IV 299.80 FOR PERVASIVE DEVELOPMENTAL DISORDER - NOT OTHERWISE SPECIFIED

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 of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

DSM-IV 299.80 FOR ASPERGER'S DISORDER

A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) 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
(2) failure to develop peer relationships appropriate to developmental level
(3) 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 to other people)
(4) lack of social or emotional reciprocity

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. 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.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

DSM-IV 299.80 FOR RETT'S DISORDER

A. All of the following:
(1) apparently normal prenatal and perinatal development
(2) apparently normal psychomotor development through the first 5 months after birth
(3) normal head circumference at birth

B. Onset of all of the following after the period of normal development:
(1) deceleration of head growth between ages 5 and 48 months
(2) loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing)
(3) loss of social engagement early in the course (although often social interaction develops later)
(4) appearance of poorly coordinated gait or trunk movements
(5) severely impaired expressive and receptive language development with severe psychomotor retardation

DSM 299.10 FOR CHILDHOOD DISINTEGRATIVE DISORDER

A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.

B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
(1) expressive or receptive language
(2) social skills or adaptive behavior
(3) bowel or bladder control
(4) play
(5) motor skills

C. Abnormalities of functioning in at least two of the following areas:
(1) qualitative impairement in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)
(2) 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)
(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms

D. The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by schizophrenia.

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