Pervasive developmental disorder not otherwise specified

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Pervasive developmental disorder not otherwise specified (PDD-NOS), (including atypical autism)
Specialty Clinical psychology, psychiatry, pediatrics, occupational medicine
Usual onsetfrom birth

Pervasive developmental disorder not otherwise specified (PDD-NOS) [1] is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

Contents

According to the earlier DSM-IV, PDD-NOS referred to "mild or severe pervasive deficits in the development of reciprocal social interaction and/or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and/or activities are present, but the criteria are not met for a specific PDD" or for several other disorders. [2]

PDD-NOS was one of four disorders collapsed into the diagnosis of autism spectrum disorder in the DSM-5, [3] and also was one of the five disorders classified as a pervasive developmental disorder (PDD) in the DSM-IV. [4] The ICD-10 equivalents also became part of its definition of autism spectrum disorder, as of the ICD-11.

PDD-NOS included atypical autism, a diagnosis defined in the ICD-10 for the case that the criteria for autistic disorder were not met because of late age of onset, or atypical symptomatology, or both of these. [5]

Even though PDD-NOS was considered milder than typical autism, this was not always true. While some characteristics may be milder, others may be more severe. [6]

Signs and symptoms

It is common for individuals with PDD-NOS to have more intact social skills and a lower level of intellectual deficit than individuals with other PDDs. [4] Characteristics of many individuals with PDD-NOS are:

Diagnosis

PDD-NOS is not a current part of the Diagnostic and Statistical Manual of Mental Disorders typology (as of the DSM-5), which is the most common diagnostic typology used in the United States. In the still used (though deprecated) ICD-10, it is considered "atypical autism" and "pervasive developmental disorder, unspecified". [8]

The diagnosis of a pervasive developmental disorder not otherwise specified was given to individuals with difficulties in the areas of social interaction, communication, and/or stereotypic behavior patterns or interests, but who did not meet the full DSM-IV criteria for autism or another PDD. This does not necessarily mean that PDD-NOS is a milder disability than the other PDDs. It could simply mean that individuals who receive this diagnosis do not meet the diagnostic criteria of the other PDDs, but that there is still a pervasive developmental disorder that affects the individual in the areas of communication, socialization, and behavior. [4]

As for the other pervasive developmental disorders, the diagnosis of PDD-NOS required the involvement of a team of specialists. The individual needs to undergo a full diagnostic evaluation, including a thorough medical, social, adaptive, motor skills and communication history. [4] Other parts of an assessment can be behavioral rating scales, direct behavioral observations, psychological assessment, educational assessment, communication assessment, and occupational assessment. [9]

Description of PDD-NOS merely as a "subthreshold" category without a more specific case definition poses methodological problems for research regarding the relatively heterogeneous group of people who receive this diagnosis. While it is true that children diagnosed with PDD-NOS, as a whole, show fewer intellectual deficits and are higher-functioning than autistic children, many others who fit the criteria for PDD-NOS have some autistic features but also have intellectual deficits that are so severe that it is difficult or impossible to tell whether some of the deficits come from the autism or from the severe to profound degree of intellectual disability itself. Furthermore, some others who fit the criteria for PDD-NOS come to professional attention at a later age, compared to those diagnosed with autism. [10] [11]

Subgroups

In 2004, Walker et al. found that persons with PDD-NOS belonged to one of three very different subgroups: [12]

Treatment

There is no known cure for PDD-NOS, but there are interventions that can have a positive influence.

Some of the more common therapies and services include: [4]

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Formerly recognized neurodevelopmental condition

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a term formerly used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer considered a diagnosis. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. This also encompasses deficiencies in verbal and non-verbal communication styles. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language. This article covers subjects such as diagnosis, the DSM-IV, the DSM-V, and examples like sensory impairments, aphasia, learning disabilities, and speech disorders.

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).

<span class="mw-page-title-main">Conditions comorbid to autism</span> Medical conditions more common in autistic people

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that begins in early childhood, persists throughout adulthood, and affects two crucial areas of development: social communication and restricted, repetitive patterns of behavior. There are many conditions comorbid to autism spectrum disorder such as attention-deficit hyperactivity disorder and epilepsy.

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but had some difficulty in communication, emotion recognition, expression, and/or social interaction.

Nonverbal learning disorder is a proposed category of neurodevelopmental disorder characterized by core deficits in non-verbal skills, especially visual-spatial processing. People with this condition have normal or advanced verbal intelligence and significantly lower nonverbal intelligence. A review of papers found that proposed diagnostic criteria were inconsistent. Proposed additional diagnostic criteria include intact verbal intelligence, and deficits in the following: visuoconstruction abilities, speech prosody, fine motor coordination, mathematical reasoning, visuospatial memory and social skills. NVLD is not recognised by the DSM-5 and is not clinically distinct from learning disorders.

The following outline is provided as an overview of and topical guide to autism:

The epidemiology of autism is the study of the incidence and distribution of autism spectrum disorders (ASD). A 2022 systematic review of global prevalence of autism spectrum disorders found a median prevalence of 1% in children in studies published from 2012 to 2021, with a trend of increasing prevalence over time. However, the study's 1% figure may reflect an underestimate of prevalence in low- and middle-income countries.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

Asperger syndrome (AS) was formerly a separate diagnosis under autism spectrum disorder. Under the DSM-5 and ICD-11, patients formerly diagnosable with Asperger syndrome are diagnosable with Autism Spectrum Disorder. The term is considered offensive by some autistic individuals. It was named after Hans Asperger (1906–80), who was an Austrian psychiatrist and pediatrician. An English psychiatrist, Lorna Wing, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.

<span class="mw-page-title-main">Classic autism</span> Former neurodevelopmental disorder now classified under autism spectrum disorder

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Mental disorders diagnosed in childhood can be neurodevelopmental, emotional, or behavioral disorders. These disorders negatively impact the mental and social wellbeing of a child, and children with these disorders require support from their families and schools. Childhood mental disorders often persist into adulthood. These disorders are usually first diagnosed in infancy, childhood, or adolescence, as laid out in the DSM-5 and in the ICD-11.

In medicine, not otherwise specified (NOS) is a subcategory in systems of disease/disorder classification such as ICD-9, ICD-10, or DSM-IV. It is generally used to note the presence of an illness where the symptoms presented were sufficient to make a general diagnosis, but where a specific diagnosis was not made. The DSM-IV, for example, "applies the term not otherwise specified (NOS) to a disorder or disturbance that does not meet the criteria for the specific disorders already discussed". The term was introduced because "it is sometimes impossible for the practitioner completing the diagnostic assessment to categorize all the symptoms that a client is experiencing into one diagnostic category". In the context of mental health diagnoses, four situations have been outlined for which such a diagnosis may be considered appropriate:

  1. Client meets the general guidelines for a disorder, yet not all of the criteria are met, or the ones present are not considered clinically significant.
  2. Significant behaviors are noted affecting social and occupational functioning, but are not considered part of the usual presentation for a disorder.
  3. Uncertainty about etiology or the cause of the disorder exists. This is especially important when it is suspected that the disorder may be related to a general medical condition.
  4. Insufficient information exists to fully support assigning behaviors to a particular mental disorder in the category, but the general criteria for the category of disorders are evident.

Autism, also called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder characterized by symptoms of deficient reciprocal social communication and the presence of restricted, repetitive, and inflexible patterns of behavior that are impairing in multiple contexts and excessive or atypical to be developmentally and socioculturally inappropriate. Other common signs include difficulty with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hypo-reactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The history of autism spans over a century; autism has been subject to varying treatments, being pathologized or being viewed as a beneficial part of human neurodiversity. The understanding of autism has been shaped by cultural, scientific, and societal factors, and its perception and treatment change over time as scientific understanding of autism develops.

The Ritvo Autism & Asperger Diagnostic Scale (RAADS) is a psychological self-rating scale developed by Dr. Riva Ariella Ritvo. An abridged and translated 14 question version was then developed at the Department of Clinical Neuroscience at the Karolinska Institute, to aid in the identification of patients who may have undiagnosed ASD.

Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by difficulties in the social use of verbal and nonverbal communication. Individuals who are defined by the acronym "SPCD" struggle to effectively indulge in social interactions, interpret social cues, and may struggle to use words appropriately in social contexts.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

References

  1. ↑ Diagnostic and statistical manual of mental disorders : DSM-IV-TR (4th, text revision ed.). Washington, DC: American Psychiatric Association. 2000. pp. 14, 84. ISBN   0-89042-024-6.
  2. ↑ "First signs". firstsigns.org. Retrieved 3 April 2018.
  3. ↑ "Autism spectrum disorder fact sheet" (PDF). DSM5.org. American Psychiatric Publishing. 2013. Archived from the original (PDF) on October 6, 2013. Retrieved October 13, 2013.
  4. 1 2 3 4 5 6 "Autism spectrum fact sheet from Illinois" (PDF). pbisillinois.org. Retrieved 3 April 2018.
  5. ↑ Gray, Kylie M. (2013). "Atypical Autism". In Volkmar, Fred R. (ed.). Encyclopedia of Autism Spectrum Disorders. Springer reference. New York: Springer. pp. 304–309. ISBN   978-1-4419-1698-3.
  6. ↑ "PDD-NOS Signs, Symptoms and Treatment". National Autism Resources.
  7. ↑ Robison, John Elder (2019). "Autism prevalence and outcomes in older adults". Autism Research. 12 (3): 370–374. doi:10.1002/aur.2080. ISSN   1939-3806. PMID   30803153. S2CID   73503042.
  8. ↑ Smith, Isaac C.; Reichow, Brian; Volkmar, Fred R. (2015). "The Effects of DSM-5 Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorder: A Systematic Review". Journal of Autism and Developmental Disorders. 45 (8): 2541–2552. doi:10.1007/s10803-015-2423-8. ISSN   0162-3257. PMID   25796195. S2CID   24217012.
  9. ↑ "briefing paper of the National Dissemination Center for Children with Disabilities" (PDF). nichcy.org. Retrieved 3 April 2018.
  10. ↑ "Autism and Neurodevelopment". Child Study Center: Research. Yale School of Medicine. Retrieved 3 April 2018.
  11. ↑ "ICD-10, Mental and behavioural disorders (F00-F99)". Archived from the original on March 8, 2017.
  12. 1 2 3 4 Walker DR, Thompson A, Zwaigenbaum L, Goldberg J, Bryson SE, Mahoney WJ, Strawbridge CP, Szatmari P (Feb 2004). "Specifying PDD-NOS: a comparison of PDD-NOS, Asperger syndrome, and autism". J Am Acad Child Adolesc Psychiatry. 43 (2): 172–80. doi:10.1097/00004583-200402000-00012. PMID   14726723.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ↑ American Psychiatric Association (2000). "Diagnostic criteria for 299.80 Asperger's Disorder (AD)". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). ISBN   0-89042-025-4 . Retrieved 2007-06-28.[ dead link ]
  14. ↑ Bergman, Joel (Oct 29, 2019). The Textbook of Autism Spectrum Disorders. American Psychiatric Pub. p. 91. ISBN   9781585623419. ISBN   1585623415
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