3. Types of autism

Brain abnormalities thought to underline autism typically produce anomalies in psychological functioning that surface early in development and persist throughout adulthood. The appearance of symptoms in the first few years of life distinguishes autism from such psychiatric disorders as schizophrenia in which evidence of the condition emerges later in life. Since symptoms in autism may change, and in some cases disappear, with age, an accurate diagnosis of the disorder must include a developmental profile of early childhood. (Wolfberg P, 1999, 16).

Autistic disorder can be distinguished from other Pervasive Developmental Disorders in a number of ways. (Wolfberg P, 1999, 17).

Two similar systems for diagnosing autism are the International Classification of Diseases (ICD-10), prepared by the World Health Organization (1987), and the Diagnosis and Statistical Manual of Mental Dosirders (DSM-IV), issued by the American Psychiatric Association (1994). (Wolfberg P, 1999, 16). (Change, because the same in chapter of autism)

DSM-IV Diagnosis Criteria for Autistic Disorder:

1. A total of 6 (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 interactions, 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 regular 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)

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 gesture or mime)

2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

3. stereotyped and 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 and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

4. persistent preoccupation with parts of objects

2. 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.

3. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

DSM-IV Diagnostic Criteria for Rett’s Disorder:

1. All of the following

1. apparently normal prenatal and perinatal development

2. apparently normal psychomotor development through the fist five months after birth

3. normal head circumference at birth

2. Onset of all of the following after the period of normal development:

1. deceleration of head growth between ages of 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 (e.g., 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

Rett’s Disorder is rare condition that has been diagnosed only in females. There is characteristic pattern of diminished head growth, loss of purposeful hand skills, and poorly coordinated motor movements. (Wolfberg P, 1999, 17).

DSM-IV Diagnostic Criteria for 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 interactions (e.g., impairment in nonverbal behaviors, failure to develop peer relationship, lack of social or emotional reciprocity)

2. qualitative impairments in communication (e.g., delay or lack pf 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 stereotyped and mannerisms

4. The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia.

Childhood Disintegrative Disorder ferers to a group of children who regress after developing normal communication, social relationships, play, and adaptive behavior in the first 2 years of life. (Wolfberg P, 1999, 17).

DSM-IV Diagnostic Criteria for Asperger’s Disorder

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 share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest to other people)

4. lack of social or emotional reciprocity

2. 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

3. The disturbance causes clinically significant impairment 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 for another specific Pervasive Developmental Disorder or Schizophrenia.

Asperger’s Disorder is sometimes described as high-functioning form of autism in which individuals have fairly normal language development and intelligence but present persistent problems in social interaction and stereotyped patterns of behavior, interests, and activities. (Wolfberg P, 1999, 17).

DSM-IV 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 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. (Sewell K, 1998, 10). (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994).

PDD-NOS, sometimes referred to as “atypical autism,” is used as a diagnostic category when criteria are not met for a specific Pervasive Developmental Disorder. (Wolfberg P, 1999, 17).