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National Collaborating Centre for Women’s and Children’s Health (UK). Autism: Recognition, Referral and Diagnosis of Children and Young People on the Autism Spectrum. London: RCOG Press; 2011 Sep. (NICE Clinical Guidelines, No. 128.)

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Autism: Recognition, Referral and Diagnosis of Children and Young People on the Autism Spectrum.

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Appendix IDiagnostic criteria

International Statistical Classification of Diseases and Related Health Problem (ICD-10)

Clinical descriptions and diagnostic guidelines

Reproduced with permission from World Health Organization (http://www.who.int/classifications/icd/en/bluebook.pdf [accessed on 29-07-2011])

F84 Pervasive developmental disorders

This group of disorders is characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a pervasive feature of the individual's functioning in all situations, although they may vary in degree. In most cases, development is abnormal from infancy and, with only a few exceptions, the conditions become manifest during the first 5 years of life. It is usual, but not invariable, for there to be some degree of general cognitive impairment but the disorders are defined in terms of behaviour that is deviant in relation to mental age (whether the individual is retarded or not). There is some disagreement on the subdivision of this overall group of pervasive developmental disorders. In some cases the disorders are associated with, and presumably due to, some medical condition, of which infantile spasms, congenital rubella, tuberous sclerosis, cerebral lipidosis, and the fragile X chromosome anomaly are among the most common. However, the disorder should be diagnosed on the basis of the behavioural features, irrespective of the presence or absence of any associated medical conditions; any such associated condition must, nevertheless, be separately coded. If mental retardation is present, it is important that it too should be separately coded, under F70-F79, because it is not a universal feature of the pervasive developmental disorders.

F84.0. Childhood autism

A pervasive developmental disorder defined by the presence of abnormal and/or impaired development that is manifest before the age of 3 years, and by the characteristic type of abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour. The disorder occurs in boys three to four times more often than in girls.

Diagnostic guidelines

Usually there is no prior period of unequivocally normal development but, if there is, abnormalities become apparent before the age of 3 years. There are always qualitative impairments in reciprocal social interaction. These take the form of an inadequate appreciation of socio-emotional cues, as shown by a lack of responses to other people's emotions and/or a lack of modulation of behaviour according to social context; poor use of social signals and a weak integration of social, emotional, and communicative behaviours; and, especially, a lack of socio-emotional reciprocity. Similarly, qualitative impairments in communications are universal. These take the form of a lack of social usage of whatever language skills are present; impairment in make-believe and social imitative play; poor synchrony and lack of reciprocity in conversational interchange; poor flexibility in language expression and a relative lack of creativity and fantasy in thought processes; lack of emotional response to other people's verbal and nonverbal overtures; impaired use of variations in cadence or emphasis to reflect communicative modulation; and a similar lack of accompanying gesture to provide emphasis or aid meaning in spoken communication.

The condition is also characterized by restricted, repetitive, and stereotyped patterns of behaviour, interests, and activities. These take the form of a tendency to impose rigidity and routine on a wide range of aspects of day-to-day functioning; this usually applies to novel activities as well as to familiar habits and play patterns. In early childhood particularly, there may be specific attachment to unusual, typically non-soft objects. The children may insist on the performance of particular routines in rituals of a nonfunctional character; there may be stereotyped preoccupations with interests such as dates, routes or timetables; often there are motor stereotypies; a specific interest in nonfunctional elements of objects (such as their smell or feel) is common; and there may be a resistance to changes in routine or in details of the personal environment (such as the movement of ornaments or furniture in the family home).

In addition to these specific diagnostic features, it is frequent for children with autism to show a range of other nonspecific problems such as fear/phobias, sleeping and eating disturbances, temper tantrums, and aggression. Self-injury (e.g. by wrist-biting) is fairly common, especially when there is associated severe mental retardation. Most individuals with autism lack spontaneity, initiative, and creativity in the organization of their leisure time and have difficulty applying conceptualizations in decision-making in work (even when the tasks themselves are well within their capacity). The specific manifestation of deficits characteristic of autism change as the children grow older, but the deficits continue into and through adult life with a broadly similar pattern of problems in socialization, communication, and interest patterns. Developmental abnormalities must have been present in the first 3 years for the diagnosis to be made, but the syndrome can be diagnosed in all age groups.

All levels of IQ can occur in association with autism, but there is significant mental retardation in some three-quarters of cases.

Includes:

  • autistic disorder
  • infantile autism
  • infantile psychosis
  • Kanner's syndrome

Differential diagnosis. Apart from the other varieties of pervasive developmental disorder it is important to consider: specific developmental disorder of receptive language (F80.2) with secondary socio-emotional problems; reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F79) with some associated emotional/behavioural disorder; schizophrenia (F20.-) of unusually early onset; and Rett's syndrome (F84.2).

Excludes: autistic psychopathy (F84.5)

F84.1. Atypical autism

A pervasive developmental disorder that differs from autism in terms either of age of onset or of failure to fulfil all three sets of diagnostic criteria. Thus, abnormal and/or impaired development becomes manifest for the first time only after age 3 years; and/or there are insufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restrictive, stereotyped, repetitive behaviour) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals whose very low level of functioning provides little scope for exhibition of the specific deviant behaviours required for the diagnosis of autism; it also occurs in individuals with a severe specific developmental disorder of receptive language. Atypical autism thus constitutes a meaningfully separate condition from autism.

Includes:

  • atypical childhood psychosis
  • mental retardation with autistic features
F84.2. Rett's syndrome

A condition of unknown cause, so far reported only in girls, which has been differentiated on the basis of a characteristic onset, course, and pattern of symptomatology. Typically, apparently normal or near-normal early development is followed by partial or complete loss of acquired hand skills and of speech, together with deceleration in head growth, usually with an onset between 7 and 24 months of age. Hand-wringing stereotypies, hyperventilation and loss of purposive hand movements are particularly characteristic. Social and play development are arrested in the first 2 or 3 years, but social interest tends to be maintained. During middle childhood, trunk ataxia and apraxia, associated with scoliosis or kyphoscoliosis tend to develop and sometimes there are choreoathetoid movements. Severe mental handicap invariably results. Fits frequently develop during early or middle childhood.

Diagnostic guidelines

In most cases onset is between 7 and 24 months of age. The most characteristic feature is a loss of purposive hand movements and acquired fine motor manipulative skills. This is accompanied by loss, partial loss or lack of development of language; distinctive stereotyped tortuous wringing or "hand-washing" movements, with the arms flexed in front of the chest or chin; stereotypic wetting of the hands with saliva; lack of proper chewing of food; often episodes of hyperventilation; almost always a failure to gain bowel and bladder control; often excessive drooling and protrusion of the tongue; and a loss of social engagement. Typically, the children retain a kind of "social smile", looking at or "through" people, but not interacting socially with them in early childhood (although social interaction often develops later). The stance and gait tend to become broad-based, the muscles are hypotonic, trunk movements usually become poorly coordinated, and scoliosis or kyphoscoliosis usually develops. Spinal atrophies, with severe motor disability, develop in adolescence or adulthood in about half the cases. Later, rigid spasticity may become manifest, and is usually more pronounced in the lower than in the upper limbs. Epileptic fits, usually involving some type of minor attack, and with an onset generally before the age of 8 years, occur in the majority of cases. In contrast to autism, both deliberate self-injury and complex stereotyped preoccupations or routines are rare.

Differential diagnosis. Initially, Rett's syndrome is differentiated primarily on the basis of the lack of purposive hand movements, deceleration of head growth, ataxia, stereotypic "hand-washing" movements, and lack of proper chewing. The course of the disorder, in terms of progressive motor deterioration, confirms the diagnosis.

F84.3. Other childhood disintegrative disorder

A pervasive developmental disorder (other than Rett's syndrome) that is defined by a period of normal development before onset, and by a definite loss, over the course of a few months, of previously acquired skills in at least several areas of development, together with the onset of characteristic abnormalities of social, communicative, and behavioural functioning. Often there is a prodromic period of vague illness; the child becomes restive, irritable, anxious, and overactive. This is followed by impoverishment and then loss of speech and language, accompanied by behavioural disintegration. In some cases the loss of skills is persistently progressive (usually when the disorder is associated with a progressive diagnosable neurological condition), but more often the decline over a period of some months is followed by a plateau and then a limited improvement. The prognosis is usually very poor, and most individuals are left with severe mental retardation. There is uncertainty about the extent to which this condition differs from autism. In some cases the disorder can be shown to be due to some associated encephalopathy, but the diagnosis should be made on the behavioural features. Any associated neurological condition should be separately coded.

Diagnostic guidelines

Diagnosis is based on an apparently normal development up to the age of at least 2 years, followed by a definite loss of previously acquired skills; this is accompanied by qualitatively abnormal social functioning. It is usual for there to be a profound regression in, or loss of, language, a regression in the level of play, social skills, and adaptive behaviour, and often a loss of bowel or bladder control, sometimes with a deteriorating motor control. Typically, this is accompanied by a general loss of interest in the environment, by stereotyped, repetitive motor mannerisms, and by an autistic-like impairment of social interaction and communication. In some respects, the syndrome resembles dementia in adult life, but it differs in three key respects: there is usually no evidence of any identifiable organic disease or damage (although organic brain dysfunction of some type is usually inferred); the loss of skills may be followed by a degree of recovery; and the impairment in socialization and communication has deviant qualities typical of autism rather than of intellectual decline. For all these reasons the syndrome is included here rather than under F00-F09.

Includes:

  • dementia infantilis
  • disintegrative psychosis
  • Heller's syndrome
  • symbiotic psychosis

Excludes:

  • acquired aphasia with epilepsy (F80.3)
  • elective mutism (F94.0)
  • Rett's syndrome (F84.2)
  • schizophrenia (F20.-)
F84.4. Overactive disorder associated with mental retardation and stereotyped movements

This is an ill-defined disorder of uncertain nosological validity. The category is included here because of the evidence that children with moderate to severe mental retardation (IQ below 50) who exhibit major problems in hyperactivity and inattention frequently show stereotyped behaviours; such children tend not to benefit from stimulant drugs (unlike those with an IQ in the normal range) and may exhibit a severe dysphoric reaction (sometimes with psychomotor retardation) when given stimulants; in adolescence the overactivity tends to be replaced by underactivity (a pattern that is not usual in hyperkinetic children with normal intelligence). It is also common for the syndrome to be associated with a variety of developmental delays, either specific or global. The extent to which the behavioural pattern is a function of low IQ or of organic brain damage is not known, neither is it clear whether the disorders in children with mild mental retardation who show the hyperkinetic syndrome would be better classified here or under F90.-; at present they are included in F90-.

Diagnostic guidelines

Diagnosis depends on the combination of developmentally inappropriate severe overactivity, motor stereotypies, and moderate to severe mental retardation; all three must be present for the diagnosis. If the diagnostic criteria for F84.0, F84.1 or F84.2 are met, that condition should be diagnosed instead.

F84.5. Asperger's syndrome

A disorder of uncertain nosological validity, characterized by the same kind of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. The disorder differs from autism primarily in that there is no general delay or retardation in language or in cognitive development. Most individuals are of normal general intelligence but it is common for them to be markedly clumsy; the condition occurs predominantly in boys (in a ratio of about eight boys to one girl). It seems highly likely that at least some cases represent mild varieties of autism, but it is uncertain whether or not that is so for all. There is a strong tendency for the abnormalities to persist into adolescence and adult life and it seems that they represent individual characteristics that are not greatly affected by environmental influences. Psychotic episodes occasionally occur in early adult life.

Diagnostic guidelines

Diagnosis is based on the combination of a lack of any clinically significant general delay in language or cognitive development plus, as with autism, the presence of qualitative deficiencies in reciprocal social interaction and restricted, repetitive, stereotyped patterns of behaviour, interests, and activities.

There may or may not be problems in communication similar to those associated with autism, but significant language retardation would rule out the diagnosis.

Includes:

  • autistic psychopathy
  • schizoid disorder of childhood

Excludes:

  • anankastic personality disorder (F60.5)
  • attachment disorders of childhood (F94.1, F94.2)
  • obsessive-compulsive disorder (F42.-)
  • schizotypal disorder (F21)
  • simple schizophrenia (F20.6)
F84.8. Other pervasive developmental disorders
F84.9. Pervasive developmental disorder, unspecified

This is a residual diagnostic category that should be used for disorders which fit the general description for pervasive developmental disorders but in which a lack of adequate information, or contradictory findings, means that the criteria for any of the other F84 codes cannot be met.

Diagnostic criteria for research

Reproduced with permission from World Health Organization (http://apps.who.int/classifications/apps/icd/icd10online/ [accessed on 12-05-2011]).

F84.0. Childhood autism

  1. Presence of abnormal or impaired development before the age of three years, in at least one out of the following areas:
    1. receptive or expressive language as used in social communication;
    2. the development of selective social attachments or of reciprocal social interaction;
    3. functional or symbolic play.
  2. Qualitative abnormalities in reciprocal social interaction, manifest in at least one of the following areas:
    1. failure adequately to use eye-to-eye gaze, facial expression, body posture and gesture to regulate social interaction;
    2. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
    3. A lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people's emotions; or lack of modulation of behaviour according to social context, or a weak integration of social, emotional and communicative behaviours.
  3. Qualitative abnormalities in communication, manifest in at least two of the following areas:
    1. a delay in, or total lack of development of spoken language that is not accompanied by an attempt to compensate through the use of gesture or mime as alternative modes of communication (often preceded by a lack of communicative babbling);
    2. relative failure to initiate or sustain conversational interchange (at whatever level of language skills are present) in which there is reciprocal to and from responsiveness to the communications of the other person;
    3. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;
    4. abnormalities in pitch, stress, rate, rhythm and intonation of speech;
  4. Restricted, repetitive, and stereotyped patterns of behaviour, interests and activities, manifest in at least two of the following areas:
    1. an encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature although not abnormal in their content or focus.
    2. apparently compulsive adherence to specific, non-functional, routines or rituals;
    3. stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting, or complex whole body movements;
    4. preoccupations with part-objects or non-functional elements of play materials (such as their odour, the feel of their surface, or the noise or vibration that they generate);
    5. distress over changes in small, non-functional, details of the environment.
  5. The clinical picture is not attributable to the other varieties of pervasive developmental disorder; specific developmental disorder of receptive language (F80.2) with secondary socio-emotional problems; reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioural disorder; schizophrenia (F20) of unusually early onset; and Rett's syndrome (F84.2).

F84.1. Atypical autism

  1. Presence of abnormal or impaired development at or after age three years (criteria as for autism except for age of manifestation).
  2. Qualitative abnormalities in reciprocal social interaction or in communication, or restricted, repetitive and stereotyped patterns of behaviour, interests and activities (criteria as for autism except that it is not necessary to meet the criteria in terms of number of areas of abnormality).
  3. The disorder does not meet the diagnostic criteria for autism (F84.0).

Autism may be atypical in either age of onset (F84.11) or phenomenology (84.12), these two types being differentiated with a fifth character for research purposes. Syndromes that are atypical in both respects should be coded F84.12.

F84.10. Atypicality in age of onset

  1. Does not meet criterion A for autism. That is, abnormal or impaired development is evident only at or after age three years.
  2. Meets criteria B, C, D and E for autism (F84.0).

F84.11. Atypicality in symptomatology

  1. Meets criterion A for autism (i.e. presence of abnormal or impaired development before the age of three years).
  2. Qualitative abnormalities in reciprocal social interactions or in communication, or restricted, repetitive and stereotyped patterns of behaviour, interests and activities (criteria as for autism except that it is not necessary to meet the criteria in terms of number of areas of abnormality).
  3. Meets criterion E for autism.
  4. Does not meet the full criteria B, C and D for autism (F84.0).

F84.12. Atypicality in both age of onset and symptomatology

  1. Does not meet criterion A for autism. That is abnormal or impaired development is evident only at or after the age of three years.
  2. Qualitative abnormalities in reciprocal social interactions or in communication, or restricted, repetitive and stereotyped patterns of behaviour, interests and activities (criteria as for autism except that it is not necessary to meet the criteria in terms of number of areas of abnormality).
  3. Meets criterion E for autism.
  4. Does not meet the full criteria B, C and D for autism (F84.0).

F84.2. Rett's syndrome

  1. Apparently normal prenatal and perinatal period and apparently normal psychomotor development through the first six months and normal head circumference at birth.
  2. Deceleration of head growth between five months and four years and loss of acquired purposeful hand skills between six and 30 months of age that is associated with concurrent communication dysfunction and impaired social interactions and appearance of poorly coordinated/unstable gait and/or trunk movements.
  3. Development of severely impaired expressive and receptive language, together with severe psychomotor retardation.
  4. Stereotyped midline hand movements (such as hand wringing or washing) with an onset at or after the time that purposeful hand movements are lost.

F84.3. Other childhood disintegrative disorder

  1. An apparently normal development up to the age of at least two years. The presence of normal age-appropriate skills in communication, social relationships, play, and adaptive behaviour at age two years or later is required for diagnosis.
  2. A definite loss of previously acquired skills at about the time of onset of the disorder. The diagnosis requires a clinically significant loss of skills (and not just a failure to use them in certain situations) in at least two out of the following areas:
    1. expressive or receptive language;
    2. play;
    3. social skills or adaptive behaviour;
    4. bowel or bladder control;
    5. motor skills.
  3. Qualitatively abnormal social functioning, manifest in at least two of the following areas:
    1. qualitative abnormalities in reciprocal social interaction (of the type defined for autism);
    2. qualitative abnormalities in communication (of the type defined for autism);
    3. restricted, repetitive and stereotyped patterns of behaviour, interests and activities including motor stereotypies and mannerisms;
    4. a general loss of interest in objects and in the environment.
  4. The disorder is not attributable to the other varieties of pervasive developmental disorder; acquired aphasia with epilepsy (F80.6); elective mutism (F94.0); schizophrenia (F20-F29); Rett's syndrome (F84.2).

F84.4. Overactive disorder associated with mental retardation and stereotyped movements

  1. Severe motor hyperactivity manifest by at least two of the following problems in activity and attention:
    1. continuous motor restlessness, manifest in running, jumping and other movements of the whole body.
    2. marked difficulty in remaining seated: will ordinarily remain seated for a few seconds at most except when engaged in a stereotypic activity (see criterion B).
    3. grossly excessive activity in situations expecting relative stillness.
    4. very rapid changes of activity, so that in general activities last for less than a minute on end (occasional longer periods on highly favoured activities do not exclude this; and very long periods spent in stereotypic activities can also be compatible with this problem being present at other times).
  2. Repetitive and stereotyped patterns of behaviour and activity manifest by at least one of the following:
    1. fixed and frequently repeated motor mannerisms: these may involve either complex movements of the whole body or partial movements such as hand-flapping.
    2. the excessive and non-functional repetition of activities that are constant in form: this may be play with a single object (e.g. running water) or a ritual of activities (either alone or involving other people).
    3. repetitive self-injury.
  3. IQ less than 50.
  4. An absence of the autistic type of social impairment, i.e. the child must show at least three of the following:
    1. developmentally appropriate use of eye gaze, expression, and posture to regulate social interaction.
    2. developmentally appropriate peer relationships that include sharing of interests, activities, etc.
    3. at least sometimes approaches other people for comfort and affection.
    4. can sometimes share other people's enjoyment. Other forms of social impairment, e.g. a disinhibited approach to strangers, are compatible with the diagnosis.
  5. Does not meet diagnostic criteria for autism (F84.0 and F84.1), childhood disintegrative disorder (F84.3) or hyperkinetic disorders (F90.-).

F84.5. Asperger's syndrome

  1. A lack of any clinically significant general delay in spoken or receptive language or cognitive development.
    Diagnosis requires that single words should have developed by two years of age or earlier and that communicative phrases be used by three years of age or earlier. Self-help skills, adaptive behaviour and curiosity about the environment during the first three years should be at a level consistent with normal intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual (although not a necessary diagnostic feature). Isolated special skills, often related to abnormal preoccupations, are common, but are not required for diagnosis.
  2. Qualitative abnormalities in reciprocal social interaction (criteria as for autism).
  3. An unusually intense circumscribed interest or restricted, repetitive, and stereotyped patterns of behaviour, interests and activities (criteria as for autism; however it would be less usual for these to include either motor mannerisms or preoccupations with part-objects or non-functional elements of play materials).
  4. The disorder is not attributable to the other varieties of pervasive developmental disorder; schizotypal disorder (F21); simple schizophrenia (F20.6); reactive and disinhibited attachment disorder of childhood (F94.1 and .2); obsessional personality disorder (F60.5); obsessive-compulsive disorder (F42).

F84.8. Other pervasive developmental disorders

F84.9. Pervasive developmental disorder, unspecified

This is a residual diagnostic category that should be used for disorders which fit the general description for pervasive developmental disorders but in which a lack of adequate information, or contradictory findings, means that the criteria for any of the other F84 codes cannot be met.

Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (Copyright ©2000). American Psychiatric Association.

299.00. Autistic Disorder

A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one from (2) and (3):

  1. 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 sheer enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest)
    4. lack of social or emotional reciprocity
  2. qualitative impairments in communication as manifested by at least one of the following:
    1. 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 gestures or mine)
    2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
    3. stereotyped or repetitive use of language or idiosyncratic language
    4. 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:
    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 or repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
    4. persistent preoccupation with parts of objects

Delays or abnormal functioning in a least one of the following areas, with onset prior to age 3 years:

  1. social interaction
  2. language is 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.

299.10. Childhood Disintegrative Disorder

  1. 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.
  2. 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
  3. Abnormalities of functioning in at least two of the following areas:
    1. qualitative impairment 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 stereotypies and mannerisms
  4. The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia.

299.80. Asperger's Disorder

  1. Qualitative impairment in social interaction, as manifested by at least two of the following:
    1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, 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, interest 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
  2. Restricted repetitive & 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
  3. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
  4. 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)
  5. 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.
  6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

299.80. Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism)

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities, 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.

Copyright © 2011, National Collaborating Centre for Women’s and Children’s Health.

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Bookshelf ID: NBK92974

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