DSM-III

In DSM-III, this disorder is called Infantile Autism

Diagnostic Criteria

Infantile Autism, Full Syndrome Present

A. Onset before 30 months of age.

B. Pervasive lack of responsiveness to other people (autism).

C. Gross deficits in language development.

D. If speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal.

E. Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interest in or attachments to animate or inanimate objects.

F. Absence of delusions, hallucinations, loosening of associations, and incoherence as in Schizophrenia.

Infantile Autism, Residual State

A. Once had an illness that met the criteria for Infantile Autism.

B. The current clinical picture no longer meets the full criteria for Infantile Autism, but signs of the illness have persisted to the present, such as oddities of communication and social awkwardness.

Differential Diagnosis

Mental Retardation

In Mental Retardation there are often behavioral abnormalities similar to those seen in Infantile Autism. However, the full syndrome of Infantile Autism is rarely present. When both disorders are present, both diagnoses should be made.

Schizophrenia

In Schizophrenia occurring in childhood there are oddities of behavior; but typically there are hallucinations, delusions, and loosening of associations or incoherence, which are not present in Infantile Autism.

Childhood Onset Pervasive Developmental Disorder

In Childhood Onset Pervasive Developmental Disorder, the age at onset is later than in Infantile Autism and the full syndrome of Infantile Autism is not present.

Hearing impairments

In children with hearing impairments there will be a history of responding consistently only to very loud sounds, whereas in Infantile Autism the response to sounds is inconsistent. An audiogram can rule out the possibility of hearing impairment.

Developmental Language Disorder

In Developmental Language Disorder, Receptive Type, the children generally make eye contact and will often try to communicate appropriately by means of gestures, whereas in Infantile Autism there is a pervasive lack of responsiveness.

DSM-IV

Diagnostic Criteria

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.

Differential Diagnosis

Normal development

Periods of developmental regression may be observed in normal development, but these are neither as severe or as prolonged as in Autistic Disorder.

Other Pervasive Developmental Disorders

Autistic Disorder must be differentiated from other Pervasive Developmental Disorders.

Rett's Disorder

Rett's Disorder differs from Autistic Disorder in its characteristic sex ratio and pattern of deficits. Rett's Disorder has been diagnosed only in females, whereas Autistic Disorder occurs much more frequently in males. In Rett's Disorder, there is a characteristic pattern of head growth deceleration, loss of previously acquired purposeful hand skills, and the appearance of poorly coordinated gait or trunk movements. Particularly during the preschool years, individuals with Rett's Disorder may exhibit difficulties in social interaction similar to those observed in Autistic Disorder, but these tend to be transient.

Childhood Disintegrative Disorder

Autistic Disorder differs from Childhood Disintegrative Disorder, which has a distinctive pattern of developmental regression following at least 2 years of normal development. In Autistic Disorder, developmental abnormalities are usually noted within the first year of life. When information on early development is unavailable or when it is not possible to document the required period or normal development, the diagnosis of Autistic Disorder should be made.

Asperger's Disorder

Asperger's Disorder can be distinguished from Autistic Disorder by the lack of delay in language development. Asperger's Disorder is not diagnosed if the criteria are met for Autistic Disorder.

Schizophrenia

Schizophrenia with childhood onset usually develops after years of normal, or near normal, development. An additional diagnosis of Schizophrenia can be made if an individual with Autistic Disorder develops the characteristic features of Schizophrenia with active-phase symptoms of prominent delusions or hallucinations that last for at least 1 month.

Selective Mutism

In Selective Mutism, the child usually exhibits appropriate communication skills in certain contexts and does not have the severe impairment in social interaction and the restricted patterns of behavior associated with Autistic Disorder.

Language Disorders

In Expressive Language Disorder and Mixed Receptive-Expressive Language Disorder, there is a language impairment, but it is not associated with the presence of a qualitative impairment in social interaction and restricted, repetitive, and stereotyped patterns of behavior.

Mental Retardation

It is sometimes difficult to determine whether an additional diagnosis of Autistic Disorder is warranted in an individual with Mental Retardation, especially if the Mental Retardation is Severe or Profound. An additional diagnosis of Autistic Disorder is reserved for those situations in which there are qualitative deficits in social and communicative skills and the specific behaviors characteristic of Autistic Disorder are present.

Stereotypic Movement Disorder

Motor stereotypies are characteristic of Autistic Disorder; an additional diagnosis of Stereotypic Movement Disorder is not given when these are better accounted for as part of the presentation of Autistic Disorder.

DSM-5

See 'Autism Spectrum Disorder'

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