Thursday, March 28, 2024

Pervasive Developmental Disorder

Practice Essentials

Historically, pervasive developmental disorder (PDD) described a group of several disparate disorders unified under the main principle of delayed language development and deficits in social interaction. As molecular genetics and cognitive neuroscience developed, furthering the understanding of these disorders, new criteria now grouped them under autism spectrum disorder (ASD), emphasizing deficits in social interaction. This group of disorders will be referred to as ASD throughout the article.

In an effort to increase diagnostic sensitivity and specificity for disorders on the autism spectrum, various revisions to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria were made in 2013. These revisions have generated new diagnostic criteria for ASD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
 Specifiers are used to designate conditions associated with known medical or genetic conditions. Conditions with social communication deficits without clear social interaction issues are now grouped under communication disorders.

The new criteria have raised concerns that a redefinition of the diagnosis of autism may exclude some children and render them ineligible for services. In a study from New York, the new DSM-5 criteria for ASD were found to identify 91% of children previously diagnosed with pervasive developmental disorder (PDD) on the basis of DSM-IV criteria. Many of the remaining 9% would probably have the diagnosis reinstated on the basis of clinician input.
 Even when the researchers examined different PDD subgroups, they found that the new criteria had a high sensitivity for identifying girls with ASD, as well as those in the high-functioning range of cognitive ability and those with a nonverbal IQ of 70 or less. Previous DSM-IV criteria often overidentified children with intellectual disability (IQ of 70 or less) and missed girls or those who were high functioning.

Several additional retrospective studies assessed the impact of DSM-5 changes on diagnostic rates and reported considerably lower sensitivities. These studies demonstrated regional variation in application of  DSM-IV criteria. With the improved specificity of DSM-5 criteria, including the introduction of the new diagnosis “social (pragmatic) communication disorder,” more consistent prevalence rates of communication disorders, distinct from ASDs, were determined. Further molecular genetic and cognitive neuroscience research will likely continue to shape the ASD criteria over time.

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