Pervasive developmental disorder not otherwise specified

A pervasive developmental disorder not otherwise specified (Including atypical autism) (PDD-NOS)[1] is one of the four autistic spectrum disorders in the DSM-5[2] and also was one of the five disorders classified as a pervasive developmental disorder (PDD) in the DSM-IV.[3] According to the DSM-4, PDD-NOS is a diagnosis that is used for "severe or pervasive impairment 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.[4] PDD-NOS includes atypical autism,[5] because the criteria for autistic disorder are not met, for instance because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.[4] Even though PDD-NOS is considered milder than typical autism, this is not always true. While some characteristics may be milder, others may be more severe.[6]

Not to be confused with Personality disorder not otherwise specified or Persistent Depressive Disorder.
Pervasive developmental disorder not otherwise specified (PDD-NOS), (including atypical autism)
SpecialtyClinical psychology, psychiatry, pediatrics, occupational medicine
Usual onsetfrom birth

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.[3] Characteristics of many individuals with PDD-NOS are:

  • Communication difficulties (e.g., using and understanding language)[7]
  • Difficulty with social behavior
  • Paranoia, a characteristic form of social anxiety, derealization, transient psychosis, and unconventional beliefs if the environment changed without further notice
  • Uneven skill development (strengths in some areas and delays in others)
  • Unusual play with toys and other objects
  • Repetitive body movements or behavior patterns
  • Preoccupation with fantasies that interfere and that are not normal to have at a certain age depending on social, cultural and religious norms.
  • Unconventional perception of the world
  • Maladaptive daydreaming, excessive daydreaming interfering with daily life

Diagnosis

PDD-NOS is an old diagnostic category. It is not included as an option for an Autism Spectrum Disorder and is not part of the DSM-5, but is included in the ICD-10, as either "atypical autism" or "pervasive developmental disorder, unspecified".[8]

The diagnosis of a pervasive developmental disorder not otherwise specified is given to individuals with difficulties in the areas of social interaction, communication, and/or stereotypic behavior patterns or interests, but who do not meet the full DSM-4 criteria for autism or another PDD. This does not necessarily mean that PDD-NOS is a milder disability than the other PDDs. It only means 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.[3]

As for the other pervasive developmental disorders, the diagnosis of PDD-NOS requires 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.[3] 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's 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's 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

Studies suggest that persons with PDD-NOS belong to one of three very different subgroups:[12]

  • A high-functioning group (around 25 percent) whose symptoms more or less overlap with that of Asperger syndrome, while also not meeting the criteria for autistic disorder, but who completely differ from those with Asperger syndrome in terms of having a lag in language development and/or mild cognitive impairment.[12] (The criteria for Asperger syndrome excludes a speech delay or a cognitive delay in early life.[13])
  • Another group (around 25 percent) whose symptoms more closely resemble those of autism, but do not fully meet all its diagnostic signs and symptoms. This is because either the symptoms were recognized at a later age or because they were too young or have cognitive deficits that are too severe to properly identify all the symptoms of autism that they may have.[12][14]
  • The biggest group (around 50 percent) consists of those who meet all the diagnostic criteria for autistic disorder but whose stereotypical and repetitive behaviors are noticeably mild.[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:[3]

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. "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.
  3. "Autism spectrum fact sheet from Illinois" (PDF). pbisillinois.org. Retrieved 3 April 2018.
  4. "First signs". firstsigns.org. Retrieved 3 April 2018.
  5. "What are the PDD-NOS Symptoms?". Staying Healthy. 2009-11-11. Retrieved November 27, 2010.
  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. 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.
  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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