ICD-10: Pervasive developmental disorders

Source: http://apps.who.int/classifications/icd10/browse/2010/en
Source: http://www.who.int/classifications/icd/en/GRNBOOK.pdf

F84 PERVASIVE DEVELOPMENTAL DISORDERS

F84.0 Childhood autism

A. Presence of abnormal or impaired development before the age of three years, in at least one out of the following areas:

1. receptive or expressive language as used in social communication;
2. the development of selective social attachments or of reciprocal social interaction;
3. functional or symbolic play.

B. Qualitative abnormalities in reciprocal social interaction, manifest in at least one of the following areas:

1. failure adequately to use eye-to-eye gaze, facial expression, body posture and gesture to regulate social interaction;
2. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
3. A lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s emotions; or lack of modulation of behaviour according to social context, or a weak integration of social, emotional and communicative behaviours.

C. Qualitative abnormalities in communication, manifest in at least two of the following areas:

1. a delay in, or total lack of development of spoken language that is not accompanied by an attempt to compensate through the use of gesture or mime as alternative modes of communication (often preceded by a lack of communicative babbling);
2. relative failure to initiate or sustain conversational interchange (at whatever level of language skills are present) in which there is reciprocal to and from responsiveness to the communications of the other person;
3. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;
4. abnormalities in pitch, stress, rate, rhythm and intonation of speech.

D. Restricted, repetitive, and stereotyped patterns of behaviour, interests and activities, manifest in at least two of the following areas:

1. an encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature although not abnormal in their content or focus;
2. apparently compulsive adherence to specific, non-functional, routines or rituals;
3. stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting, or complex whole body movements;
4. preoccupations with part-objects or non-functional elements of play materials (such as their odour, the feel of their surface, or the noise or vibration that they generate);
5. distress over changes in small, non-functional, details of the environment.

E. The clinical picture is not attributable to the other varieties of pervasive developmental disorder; specific developmental disorder of receptive language (F80.2) with secondary socio-emotional problems; reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioural disorder; schizophrenia (F20) of unusually early onset; and Rett’s syndrome (F84.2).

 

F84.1 Atypical autism

A. Presence of abnormal or impaired development at or after age three years (criteria as for autism except for age of manifestation).

B. Qualitative abnormalities in reciprocal social interaction or in communication, or restricted, repetitive and stereotyped patterns of behaviour, interests and activities (criteria as for autism except that it is not necessary to meet the criteria in terms of number of areas of abnormality).

C. The disorder does not meet the diagnostic criteria for autism (F84.0). Autism may be atypical in either age of onset (F84.11) or phenomenology (84.12), these two types being differentiated with a fifth character for research purposes. Syndromes that are atypical in both respects should be coded F84.12.

 

F84.10 Atypicality in age of onset

A. Does not meet criterion A for autism. That is, abnormal or impaired development is evident only at or after age three years.

B. Meets criteria B, C, D and E for autism (F84.0).

 

F84.11 Atypicality in symptomatology

A. Meets criterion A for autism (i.e. presence of abnormal or impaired development before the age of three years).

B. Qualitative abnormalities in reciprocal social interactions or in communication, or restricted, repetitive and stereotyped patterns of behaviour, interests and activities (criteria as for autism except that it is not necessary to meet the criteria in terms of number of areas of abnormality).

C. Meets criterion E for autism.

D. Does not meet the full criteria B, C and D for autism (F84.0).

 

F84.12 Atypicality in both age of onset and symptomatology

A. Does not meet criterion A for autism. That is abnormal or impaired development is evident only at or after the age of three years.

B. Qualitative abnormalities in reciprocal social interactions or in communication, or restricted, repetitive and stereotyped patterns of behaviour, interests and activities (criteria as for autism except that it is not necessary to meet the criteria in terms of number of areas of abnormality).

C. Meets criterion E for autism.

D. Does not meet the full criteria B, C and D for autism (F84.0).

 

F84.2 Rett’s syndrome

A. Apparently normal prenatal and perinatal period and apparently normal psychomotor development through the first six months and normal head circumference at birth.

B. Deceleration of head growth between five months and four years and loss of acquired purposeful hand skills between six and 30 months of age that is associated with concurrent communication dysfunction and impaired social interactions and appearance of poorly coordinated/unstable gait and/or trunk movements.

C. Development of severely impaired expressive and receptive language, together with severe psychomotor retardation.

D. Stereotyped midline hand movements (such as hand wringing or washing) with an onset at or after the time that purposeful hand movements are lost.

 

F84.3 Other childhood disintegrative disorder

A. An apparently normal development up to the age of at least two years. The presence of normal age-appropriate skills in communication, social relationships, play, and adaptive behaviour at age two years or later is required for diagnosis.

B. A definite loss of previously acquired skills at about the time of onset of the disorder. The diagnosis requires a clinically significant loss of skills (and not just a failure to use them in certain situations) in at least two out of the following areas:

1. expressive or receptive language;
2. play;
3. social skills or adaptive behaviour;
4. bowel or bladder control;
5. motor skills.

C. Qualitatively abnormal social functioning, manifest in at least two of the following areas:

1. qualitative abnormalities in reciprocal social interaction (of the type defined for autism);
2. qualitative abnormalities in communication (of the type defined for autism);
3. restricted, repetitive and stereotyped patterns of behaviour, interests and activities including motor stereotypies and mannerisms;
4. a general loss of interest in objects and in the environment.

D. The disorder is not attributable to the other varieties of pervasive developmental disorder; acquired aphasia with epilepsy (F80.6); elective mutism (F94.0); schizophrenia (F20-F29); Rett’s syndrome (F84.2).

 

F84.4 Overactive disorder associated with mental retardation and stereotyped movements

A. Severe motor hyperactivity manifest by at least two of the following problems in activity and attention:

1. continuous motor restlessness, manifest in running, jumping and other movements of the whole body;
2. marked difficulty in remaining seated: will ordinarily remain seated for a few seconds at most except when engaged in a stereotypic activity (see criterion B);
3. grossly excessive activity in situations expecting relative stillness;
4. very rapid changes of activity, so that in general activities last for less than a minute on end (occasional longer periods on highly favoured activities do not exclude this; and very long periods spent in stereotypic activities can also be compatible with this problem being present at other times).

B. Repetitive and stereotyped patterns of behaviour and activity manifest by at least one of the following:

1. fixed and frequently repeated motor mannerisms: these may involve either complex movements of the whole body or partial movements such as hand-flapping;
2. the excessive and non-functional repetition of activities that are constant in form: this may be play with a single object (e.g. running water) or a ritual of activities (either alone or involving other people);
3. repetitive self-injury.

C. IQ less than 50.

D. An absence of the autistic type of social impairment, i.e. the child must show at least three of the following:

1. developmentally appropriate use of eye gaze, expression, and posture to regulate social interaction;
2. developmentally appropriate peer relationships that include sharing of interests, activities, etc.;
3. at least sometimes approaches other people for comfort and affection;
4. can sometimes share other people’s enjoyment. Other forms of social impairment, e.g. a disinhibited approach to strangers, are compatible with the diagnosis.

E. Does not meet diagnostic criteria for autism (F84.0 and F84.1), childhood disintegrative disorder (F84.3) or hyperkinetic disorders (F90.-).

 

F84.5 Asperger’s syndrome

A. A lack of any clinically significant general delay in spoken or receptive language or cognitive development. Diagnosis requires that single words should have developed by two years of age or earlier and that communicative phrases be used by three years of age or earlier. Self-help skills, adaptive behaviour and curiosity about the environment during the first three years should be at a level consistent with normal intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual (although not a necessary diagnostic feature). Isolated special skills, often related to abnormal preoccupations, are common, but are not required for diagnosis.

B. Qualitative abnormalities in reciprocal social interaction (criteria as for autism).

C. An unusually intense circumscribed interest or restricted, repetitive, and stereotyped patterns of behaviour, interests and activities (criteria as for autism; however it would be less usual for these to include either motor mannerisms or preoccupations with part- objects or non-functional elements of play materials).

D. The disorder is not attributable to the other varieties of pervasive developmental disorder; schizotypal disorder (F21); simple schizophrenia (F20.6); reactive and disinhibited attachment disorder of childhood (F94.1 and .2); obsessional personality disorder (F60.5); obsessive-compulsive disorder (F42).

 

F84.8 Other pervasive developmental disorders

 

F84.9 Pervasive developmental disorder, unspecified
This is a residual diagnostic category that should be used for disorders which fit the general description for pervasive developmental disorders but in which a lack of adequate information, or contradictory findings, means that the criteria for any of the other F84 codes cannot be met.