what are the disorders that make up the autism spectrum disorders group?

[gabriela]

Technically, The Autism Spectrum Disorders include

• Asperger syndrome
• Autism
• Childhood disentegrative Disorder
• Pervasive Developmental Disorder - Not Otherwise Specified
• Rett Syndrome

Asperger syndrome


From DSM IV (p77):





Diagnostic Criteria FOR 299.80 Asperger's Disorder



A. 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 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 a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity

B. 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

C. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning

D. 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)

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia







GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER

1. Severe impairment in reciprocal social interaction

1. (at least two of the following)
   • (a) inability to interact with peers
   • (b) lack of desire to interact with peers
   • (c) lack of appreciation of social cues
   • (d) socially and emotionally inappropriate behavior
   
   
2. All-absorbing narrow interest
   
   
   (at least one of the following)
   • (a) exclusion of other activities
   • (b) repetitive adherence
   • (c) more rote than meaning
   
   
3. Imposition of routines and interests
   
   
   (at least one of the following)
   • (a) on self, in aspects of life
   • (b) on others
   
   
4. Speech and language problems
   
   
   (at least three of the following)
   • (a) delayed development
   • (b) superficially perfect expressive language
   • (c) formal, pedantic language
   • (d) odd prosody, peculiar voice characteristics
   • (e) impairment of comprehension including misinterpretations of literal/implied meanings
   
   
5. Non-verbal communication problems
   
   
   (at least one of the following)
   • (a) limited use of gestures
   • (b) clumsy/gauche body language
   • (c) limited facial expression
   • (d) inappropriate expression
   • (e) peculiar, stiff gaze
   
   
6. Motor clumsiness: poor performance on neurodevelopmental examination

(All six criteria must be met for confirmation of diagnosis.)









A More Down-to-Earth Description by Lois Freisleben-Cook.



NOTE: (This was originally a post to the bit.listserv.autism newsgroup/listserv)

I saw that someone posted the DSM IV criteria for Asperger's but I thought it might be good to provide a more down to earth description. Asperger's Syndrome is a term used when a child or adult has some features of autism but may not have the full blown clinical picture. There is some disagreement about where it fits in the PDD spectrum. A few people with Asperger's syndrome are very successful and until recently were not diagnosed with anything but were seen as brilliant, eccentric, absent minded, socially inept, and a little awkward physically.

Although the criteria state no significant delay in the development of language milestones, what you might see is a "different" way of using language. A child may have a wonderful vocabulary and even demonstrate hyperlexia but not truly understand the nuances of language and have difficulty with language pragmatics. Social pragmatics also tend be weak, leading the person to appear to be walking to the beat of a "different drum". Motor dyspraxia can be reflected in a tendency to be clumsy.

In social interaction, many people with Asperger's syndrome demonstrate gaze avoidance and may actually turn away at the same moment as greeting another. The children I have known do desire interaction with others but have trouble knowing how to make it work. They are, however, able to learn social skills much like you or I would learn to play the piano.

There is a general impression that Asperger's syndrome carries with it superior intelligence and a tendency to become very interested in and preoccupied with a particular subject. Often this preoccupation leads to a specific career at which the adult is very successful. At younger ages, one might see the child being a bit more rigid and apprehensive about changes or about adhering to routines. This can lead to a consideration of OCD but it is not the same phenomenon.

Many of the weaknesses can be remediated with specific types of therapy aimed at teaching social and pragmatic skills. Anxiety leading to significant rigidity can be also treated medically. Although it is harder, adults with Asperger's can have relationships, families, happy and productive lives.

Dr. Lois Freisleben-Cook








* "Asperger's Syndrome Characteristics"







by Roger Meyer

Below is a list of Asperger’s Syndrome characteristics. Most have been extracted from medical diagnostic criteria, descriptions offered by medical and counseling professionals, articles by educators and from employment biographies of approximately a dozen independent-living, medically or self-diagnosed AS adults over the age of 25. While every adult occasionally manifests these characteristics, what distinguishes adults with AS is their consistency of appearance, their intensity, and the sheer number of them appearing simultaneously. Some characteristics do not apply to everyone, so persons consulting this list should not feel compelled to find them all. Adults with AS who wish to compose employment biographies for their own enlightenment and/or as contributions to research should weigh the significance of the ones they share, and have their compositions accurately reflect that impact.

Social Characteristics

• Difficulty in accepting criticism or correction
• Difficulty in offering correction or criticism without appearing harsh, pedantic or insensitive
• Difficulty in perceiving and applying unwritten social rules or protocols
• "Immature" manners
• Failure to distinguish between private and public personal care habits: i.e., brushing, public attention to skin problems, nose picking, teeth picking, ear canal cleaning, clothing arrangement
• Naïve trust in others
• Shyness
• Low or no conversational participation in group meetings or conferences
• Constant anxiety about performance and acceptance, despite recognition and commendation
• Scrupulous honesty, often expressed in an apparently disarming or inappropriate manner or setting
• Bluntness in emotional expression
• "Flat affect"
• Discomfort manipulating or "playing games" with others
• Unmodulated reaction in being manipulated, patronized, or "handled" by others
• Low to medium level of paranoia
• Low to no apparent sense of humor; bizarre sense of humor (often stemming from a "private" internal thread of humor being inserted in public conversation without preparation or warming others up to the reason for the "punchline")
• Difficulty with reciprocal displays of pleasantries and greetings
• Problems expressing empathy or comfort to/with others: sadness, condolence, congratulations, etc.
• Pouting,, ruminating, fixating on bad experiences with people or events for an inordinate length of time
• Difficulty with adopting a social mask to obscure real feelings, moods, reactions
• Using social masks inappropriately (you are "xv" while everyone else is ????)
• Abrupt and strong expression of likes and dislikes
• Rigid adherence to rules and social conventions where flexibility is desirable
• Apparent absence of relaxation, recreational, or "time out" activities
• "Serious" all the time
• Known for single-mindedness
• Flash temper
• Tantrums
• Excessive talk
• Difficulty in forming friendships and intimate relationships; difficulty in distinguishing between acquaintance and friendship
• Social isolation and intense concern for privacy
• Limited clothing preference; discomfort with formal attire or uniforms
• Preference for bland or bare environments in living arrangements
• Difficulty judging others’ personal space
• Limited by intensely pursued interests
• Often perceived as "being in their own world"

Physical Manifestations

• Strong sensory sensitivities: touch and tactile sensations, sounds, lighting and colors, odors, taste
• Clumsiness
• Balance difficulties
• Difficulty in judging distances, height, depth
• Difficulty in recognizing others’ faces (prosopagnosia)
• Stims (self-stimulatory behavior serving to reduce anxiety, stress, or to express pleasure)
• Self-injurious or disfiguring behaviors
• Nail-biting
• Unusual gait, stance, posture
• Gross or fine motor coordination problems
• Low apparent sexual interest
• Depression
• Anxiety
• Sleep difficulties
• Verbosity
• Difficulty expressing anger (excessive or "bottled up")
• Flat or monotone vocal expression; limited range of inflection
• Difficulty with initiating or maintaining eye contact
• Elevated voice volume during periods of stress and frustration
• Strong food preferences and aversions
• Unusual and rigidly adhered to eating behaviors
• Bad or unusual personal hygiene

Morbid (shared, dual, multiple) Diagnostic Conditions

• Learning Disability
• Attention Deficit Disorder (ADD)
• Obsessive Compulsive Disorder (OCD)
• Central Auditory Processing Disorder (CAPD)
• Hyperlexia
• Depression
• Anxiety
• Non-verbal Learning Disorder (NVLD)
• Hypertension
• Semantic Pragmatic Language Disorder
• Tourette’s Syndrome
• Dysthymia

Cognitive Characteristics

• Susceptibility to distraction
• Difficulty in expressing emotions
• Resistance to or failure to respond to talk therapy
• Mental shutdown response to conflicting demands and multi-tasking
• Generalized confusion during periods of stress
• Low understanding of the reciprocal rules of conversation: interrupting, dominating, minimum participation, difficult in shifting topics, problem with initiating or terminating conversation, subject perseveration
• Insensitivity to the non-verbal cues of others (stance, posture, facial expressions)
• Perseveration best characterized by the term "bulldog tenacity"
• Literal interpretation of instructions (failure to read between the lines)
• Interpreting words and phrases literally (problem with colloquialisms, cliches, neologism, turns of phrase, common humorous expressions)
• Preference for visually oriented instruction and training
• Dependence on step-by-step learning procedures (disorientation occurs when a step is assumed, deleted, or otherwise overlooked in instruction)
• Difficulty in generalizing
• Preference for repetitive, often simple routines
• Difficulty in understanding rules for games of social entertainment
• Missing or misconstruing others’ agendas, priorities, preferences
• Impulsiveness
• Compelling need to finish one task completely before starting another
• Rigid adherence to rules and routines
• Difficulty in interpreting meaning to others’ activities; difficulty in drawing relationships between an activity or event and ideas
• Exquisite attention to detail, principally visual, or details which can be visualized ("Thinking in Pictures") or cognitive details (often those learned by rote)
• Concrete thinking
• Distractibility due to focus on external or internal sensations, thoughts, and/or sensory input (appearing to be in a world of one’s own or day-dreaming)
• Difficulty in assessing relative importance of details (an aspect o the trees/forest problem)
• Poor judgment of when a task is finished (often attributable to perfectionism or an apparent unwillingness to follow differential standards for quality)
• Difficulty in imagining others’ thoughts in a similar or identical event or circumstance that are different from one’s own ("Theory of Mind" issues)
• Difficulty with organizing and sequencing (planning and execution; successful performance of tasks in a logical, functional order)
• Difficulty in assessing cause and effect relationships (behaviors and consequences)
• An apparent lack of "common sense"
• Relaxation techniques and developing recreational "release" interest may require formal instruction
• Rage, tantrum, shutdown, self-isolating reactions appearing "out of nowhere"
• Substantial hidden self-anger, anger towards others, and resentment
• Difficulty in estimating time to complete tasks
• Difficulty in learning self-monitoring techniques
• Disinclination to produce expected results in an orthodox manner
• Psychometric testing shows great deviance between verbal and performance results
• Extreme reaction to changes in routine, surroundings, people
• Stilted, pedantic conversational style ("The Professor")

Work Characteristics

Many of the manifestations found in the categories above can immediately translate into work behaviors or preferences. Here are some additional ones:

• Difficulty with "teamwork"
• Deliberate withholding of peak performance due to belief that one’s best efforts may remain unrecognized, unrewarded, or appropriated by others
• Intense pride in expertise or performance, often perceived by others as "flouting behavior"
• Sarcasm, negativism, criticism
• Difficulty in accepting compliments, often responding with quizzical or self-deprecatory language
• Tendency to "lose it" during sensory overload, multitask demands, or when contradictory and confusing priorities have been set
• Difficult in starting project
• Discomfort with competition, out of scale reactions to losing
• Low motivation to perform tasks of no immediate personal interest
• Oversight or forgetting of tasks without formal reminders such as lists or schedules
• Great concern about order and appearance of personal work area
• Slow performance
• Perfectionism
• Difficult with unstructured time
• Reluctance to ask for help or seek comfort
• Excessive questions
• Low sensitivity to risks in the environment to self and/or others
• Difficulty with writing and reports
• Reliance on internal speech process to "talk" oneself through a task or procedure
• Stress, frustration and anger reaction to interruptions
• Difficulty in negotiating either in conflict situations or as a self-advocate
• Ver low level of assertiveness
• Reluctance to accept positions of authority or supervision
• Strong desire to coach or mentor newcomers
• Difficulty in handling relationships with authority figures
• Often viewed as vulnerable or less able to resist harassment and badgering by others
• Punctual and conscientious
• Avoids socializing, "hanging out," or small talk on and off the job

DSM-4 Criteria for Autistic Disorder and Pervasive Developmental Disorder, Not Otherwise Specified (PDD NOS)

To be diagnosed with autistic disorder at least one sign (each) from parts A, B, and C must be present plus at least six overall. Those meeting fewer criteria are diagnosable as PDD NOS.



A. Qualitative impairments in reciprocal social interaction:

1. Marked impairment 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. Lack of spontaneous seeking to share enjoyment, interests, or achievements with others.
4. Lack of socioemotional reciprocity.

B. Qualitative impairments in communication:

1. 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).
2. Marked impairment in the ability to initiate or sustain a conversation with others despite adequate speech.
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.

C. Restricted, repetitive, and stereotyped patterns of behavior, interest, or activity:

1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest, abnormal either in intensity or focus.
2. An apparently compulsive 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.

Abnormal or impaired development prior to age three manifested by delay or abnormal functioning in at least one of the following areas: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.






Autism is the common term for a range of disabilities medically classified as Pervasive Developmental Disorders (PDD). Autism/PDD is characterized by qualitative differences in the development of cognitive, language, social or motor skills, and these are usually apparent before age three. Research evidence suggests that autism may result from an underlying difficulty with expressive movement and its regulation, severely challenging the individual to keep body movements, including sensory responses, in control. These sensorimotor problems can make it difficult to respond consistently and productively to other individuals and to the environment.

Autism/PDD occurs in approximately fifteen out of every 10,000 births and is four times more common among males than females. It is found throughout the world in families of all racial, ethnic and social backgrounds. While autism was once erroneously believed to arise from stresses in a child's psychological environment, modern medical evidence suggests that irregularities in the development of the brain and central nervous system give rise to the syndrome of autism. Causes of this development are diverse and may include chemical exposure, viral and genetic factors.

Autism/PDD is not an illness or a "thing" a person "has." It is a collection of responses which must be viewed in context, and observation is always more productive than labeling. Across the wide spectrum of the autism/PDD syndrome, individual variations on several key features can be recognized. Reciprocal social interactions, both verbal and nonverbal, are unusual in quality and generally difficult to synchronize and to carry out. Impairments of the central nervous system typically result in over-reactions, under-reactions, or inconsistent responses to various sensory stimuli. Because sensory input is difficult to organize and control, the individual's activities and interests may appear restricted in their nature and repertoire, frequently involving significant repetition and a need for predictability rather than change. It is important to view the behavior of people with autism/PDD as meaningful adaptations and to take a positive, respectful approach to them, forgoing the common tendency to judge their competence and capacity on the basis of their sensorimotor challenges.











Diagnostic Criteria for 299.10 Childhood Disintegrative Disorder

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. 1. 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. 1. 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

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

[Sc@tterBr@in_UK]

I liked the explanation in the O.A.S.I.S. guide because it clarifies the terms. Although they are often used interchangeably, ASD <> PDD <> Autism.

PDD is a group of disorders that contains the ASDs but not exclusively.

Rett's disorder for example, while autistic-like, isn't strictly speaking an ASD.

Autism is a sub-category of PDDs but not the only ASD.

[gingagirl]

Has anyone ever heard of Fragile X syndrome being included as an ASD? Where I work, I have heard several people say Fragile X is "on the spectrum", that people with Fragile X have autistic-like behaviors, but I don't really see it. But I've only known one person with Fragile X, so I don't know.

The guy I know is overly-sensitive to other people's feelings -- he has broken down in tears when someone pretends to cry, he fixates on negative events and will apologize repeatedly if he hurts someone or breaks something.

He does not speak much, but this seems to be due to a physical inability speak clearly. He uses a communication device to talk with people, and often won't stop talking. However, he does fixates on certain topics and repeats some words & phrases over and over again. Also, he's content to use the device by himself , repeating messages over & over, but not actually talking to anyone. I guess this would fit with ASD.

He has a lot of difficulty making eye contact.
He has trouble staying near people when talking to them --but does fine if he sits down during conversations -- this may be due to a physical-sensory problem ...I think the OT said he needs to move to monitor where his body is (propriception)

He has difficulties with sensory integration ...so that also fits with ASD.

Hmm, I guess there are enough related symptoms to say Fragile X could be included as an ASD. What do you think?

[Sc@tterBr@in_UK]

While some (few) individuals with Fragile X have autistic traits or even full-blown autism, the majority don't. So no it's not on the Spectrum, it's just that some with Fragile X are.

[Mom of Twins]

HI , What about NT...Neurotypical Disorder / Syndrome?

Has anyone got any input on it? It is supposedly milder(less noticable) than Aspergers. I beleive MY 4 yr old daughter is more then just a little "Independent". She has meltdowns over things all the time , like not being the first to walk throught the front door or if you pass something to her she will freak that she did not get to pick it up herself. This is not just here & there... this is every little thing that happens daily...she will meltdown if she is not in controle. Also her twin brother has now been dx ADHD 2 months ago & is responding to ritilin miraculously.He is getting a lot more possitive attention as apposed to the Negitive he used to get. I think this Frustrates my daughter who was quite happy to be the "Good" child. She also has a little trouble contecting quickly to kids. At the playground she prefers to talk to the moms rather then the kids...her brother on the other hand (ADHD) Is all about the kids. As soon as we arrive at any playground with any kids he Shouts ," Oh good all my friends are here!"

2 other things that make me think she maybe NT is the fact that,
tho she was slightly delayed in beginning to speak....When she did, look out She spoke as clearly as an english proffessor. Never baby talk. She also studies body language to the extreme & uses it to better understand what people are expecting of her.

I welcome any input from Anyone who is familiar with this disorder .

Thanks
MOT

[Lady Lark]

I can't say that I'm familiar with it, cause I've never heard of it before.

[Turbochica]

I found this link with info:
http://www.nichd.nih.gov/health/topics/asd.cfm

[sarek]

Originally Posted by Mom of Twins

HI , What about NT...Neurotypical Disorder / Syndrome?

Has anyone got any input on it? It is supposedly milder(less noticable) than Aspergers. I beleive MY 4 yr old daughter is more then just a little "Independent". She has meltdowns over things all the time , like not being the first to walk throught the front door or if you pass something to her she will freak that she did not get to pick it up herself. This is not just here & there... this is every little thing that happens daily...she will meltdown if she is not in controle. Also her twin brother has now been dx ADHD 2 months ago & is responding to ritilin miraculously.He is getting a lot more possitive attention as apposed to the Negitive he used to get. I think this Frustrates my daughter who was quite happy to be the "Good" child. She also has a little trouble contecting quickly to kids. At the playground she prefers to talk to the moms rather then the kids...her brother on the other hand (ADHD) Is all about the kids. As soon as we arrive at any playground with any kids he Shouts ," Oh good all my friends are here!"

2 other things that make me think she maybe NT is the fact that,
tho she was slightly delayed in beginning to speak....When she did, look out She spoke as clearly as an english proffessor. Never baby talk. She also studies body language to the extreme & uses it to better understand what people are expecting of her.

I welcome any input from Anyone who is familiar with this disorder .

Thanks
MOT

Actually NT is the term commonly used for people who are strictly mainstream. Meaning they have no ADD, no bipolar or ASD or anything else.

I recall some very funny people who run an As site coining the phrase NT disorder and even giving it a fake DSM IV code complete with fake symptoms and treatments. This is the link, but be forewarned, it is fake. Even though most NT's I know are really like that.

http://isnt.autistics.org/

None of this looks like the description you give of your daughters symptoms.
It looks more like it might be something somewhere on the spectrum.