DSM-III

In DSM-III, this disorder is called Childhood Onset Pervasive Developmental Disorder

Diagnostic Criteria

Childhood Onset Pervasive Development Disorder, Full Syndrome Present

A. Gross and sustained impairment in social relationships, e.g., lack of appropriate affective responsivity, inappropriate clinging, asociality, lack of empathy.

B. At least three of the following:

  1. sudden excessive anxiety manifested by such symptoms as free-floating anxiety, catastrophic reactions to everyday occurrences, inability to be consoled when upset, unexplained panic attacks
  2. constricted or inappropriate affect, including lack of appropriate fear reactions, unexplained rage reactions, and extreme mood lability
  3. resistance to change in the environment (e.g., upset if dinner time is changed), or insistence on doing things in the same manner every time (e.g., putting on clothes always in the same order)
  4. oddities of motor movement, such as peculiar posturing, peculiar hand or finger movements, or walking on tiptoe
  5. abnormalities of speech, such as questionlike melody, monotonous voice
  6. hyper- or hypo-sensitivity to sensory stimuli, e.g., hyperacusis
  7. self-mutilation, e.g., biting or hitting self, head banging

C. Onset of the full syndrome after 30 months of age and before 12 years of age.

D. Absence of delusions, hallucinations, incoherence, or marked loosening of associations.

Childhood Onset Pervasive Developmental Disorder, Residual State

A. Once had an illness that met the criteria for Childhood Onset Pervasive Developmental Disorder.

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

Differential Diagnosis

Schizotypal Personality Disorder

In Schizotypal Personality Disorder there are also oddities of behavior and communication, but any disturbance in social relations is mild in comparison with the profound disturbance present in Childhood Onset Pervasive Developmental Disorder. Furthermore, symptoms such as disturbances in motor movement, inappropriate affect, and self-mutilation are not present in Schizotypal Personality Disorder.

DSM-IV

Diagnostic Criteria

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 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 activites, including motor stereotypies and mannerisms

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

Differential Diagnosis

Normal development

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

Other Pervasive Developmental Disorders

Childhood Disintegrative Disorder must be differentiated from other Pervasive Developmental Disorders.

Autistic 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.

Rett's Disorder

Rett's Disorder differs from Childhood Disintegrative Disorder in its characteristic sex ratio, onset, and pattern of deficits. Rett's Disorder has been diagnosed only in females, whereas Childhood Disintegrative Disorder appears to be more common in males. The onset of symptoms in Rett's Disorder can begin as early as age 5 months, whereas in Childhood Disintegrative Disorder the period of normal development is typically more prolonged (i.e., at least until age 2 years). 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.

Asperger's Disorder

In contrast to Asperger's Disorder, Childhood Disintegrative Disorder is characterized by a clinically significant loss in previously acquired skills and a greater likelihood of Mental Retardation. In Asperger's Disorder, there is no delay in language development and no marked loss of developmental skills.

Dementia

Childhood Disintegrative Disorder must be differentiated from a dementia with onset during infancy or childhood. Dementia occurs as a consequence of the direct physiological effects of a general medical condition (e.g., head trauma), whereas Childhood Disintegrative disorder typically occurs in the absence of an associated general medical condition.

DSM-5

See 'Autism Spectrum Disorder'

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