Aspiring Minds

1. 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:
      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 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 manners (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.

                                                         Diagnostic Criteria for 299.80 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 a 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 of 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 met for another specific Pervasive Developmental Disorder or Schizophrenia.

               299.80 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 associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities, 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 sub-threshold symptomatology, or all of these.

Diagnostic Criteria for 299.80 Rett's Disorder

1. All of the following:
   1. apparently normal prenatal and prenatal development
   2. apparently normal psychomotor development through the first 5 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 5 and 48 months
2. loss of previously acquired purposeful hand skills between 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

Diagnostic Criteria for 299.10 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 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, interest, and activities, including motor stereotypes and mannerisms
4. The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia. 

When reviewing the clinical features of Asperger's 2 domains, as listed above, it quickly becomes apparent that they are also included in the diagnosis for Autistic Disorder, with on slight difference. The one deviation between the two is within the "social domain" criteria for autism: "a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. lack of spontaneous seeking to share enjoyment, interest, or achievements with other people)".

What is most obviously missing in the diagnostic criteria for Asperger's Disorder is the qualitative impairment in the communication domain. With Asperger's there is "no clinically significant general delay in language". Additionally, 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".

In other words, what we see in children with Asperger's Disorder is similar to what we see in individuals with autism, ex except for the early childhood language delays.  Additionally, many children with autism have cognitive impairment whereas individuals with Asperger's have average to superior intelligence.  For this reason and others, much controversy has surrounded the debate over whether Asperger's Disorder is nothing more than "high-functioning autism". It has also cast doubt on the claim of Asperger's Disorder as a separate diagnosis that requires alternative treatment methodologies.

What is important to remember from a behavioral intervention standpoint is that we are describing degrees of qualitative impairment between autism and Asperger's Disorder. A child with Asperger is far different from a very low-functioning child with autism. Language, cognitive and adaptive skills are at or above normal proficiency.