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At least two of the following abnormalities of functioning:

• qualitative impairment in social interaction (impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)

• qualitative impairments in communication (delay or lack of spoken language, inability to initiate or sustain conversation, stereotyped and repetitive use of language, lack of varied make-believe play)

• restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms

Symptoms not better explained by another specific pervasive developmental disorder or schizophrenia

(continued)

DSM-IV-TR Criteria for Pervasive Developmental Disorders—continued

Rett's Disorder (DSM code 299.80)

Apparently normal prenatal and perinatal development, apparently normal psychomotor development through first five months after birth, and normal head circumference at birth

Onset of all the following after the period of normal development:

• deceleration of head growth between five and forty-eight months of age

• loss of previously acquired purposeful hand skills between five and thirty months of age, with the subsequent development of stereotyped hand movements

• loss of social engagement early in course (although often social interaction develops later)

• poorly coordinated gait or trunk movements

• severely impaired expressive and receptive language development, with severe psychomotor retardation

Pervasive Developmental Disorder Not Otherwise Specified (DSM code 299.80)

ministered by the medical staff in the delivery room at one minute, five minutes, and, if there are complications, at ten and fifteen minutes after birth. It measures the effects of various complications of labor and birth and determines the need for resuscitation. The test assesses physical responsiveness, development, and overall state of health using a scale of five items rated from 0 to 2. A low Apgar score at birth can signal the potential for a developmental disability.

Measurement of head circumference is a useful tool for predicting whether an infant is likely to have a neurodevelopmental impairment such as microcephaly. A blood test screening can be done for phenylketonuria (PKU), congenital hypothyroidism, galactosemia, maple syrup urine disease, homocystinuria, and biotinidase deficiency. Early detection of these conditions and appropriate intervention may reduce the severity of the resulting disability.

An older child can be referred to a developmental pediatrician for assessment of a developmental disability if the child has not attained expected age-appropriate developmental milestones, exhibits atypical development or behavior, or regresses to a previous level of development. Correcting for prematurity in developmental testing is necessary. An instrument commonly used is the Denver Developmental Screening Test. The more severely affected a child is, the clearer is the diagnosis, as an individual's failure to meet developmental milestones may represent a short-term problem that resolves over time as the child "catches up." Even readily identifiable indicators of potential disability do not always result in expected delays.

Related issues such as feeding, elimination, and cardiorespiratory problems; pressure sores; and infection control are also considered as part of the diagnosis. Screening for lead poisoning or psychological testing may be recommended.

At whatever age the person is referred, a multidisciplinary evaluation attempts to establish a baseline of the present level of performance, including both skills and deficits. Activities of daily living (ADLs) such as bathing, eating, and dressing are widely used in assessing this population. Needing assistance with ADLs becomes an important criterion for determining eligibility for public and private disability benefits. An appraisal is made of those deficits that can be remedied and those that require accommodation. The predictive accuracy of the diagnosis improves with the individual's age.

Language development is another predictor variable. Individuals with developmental disabilities may have little or no apparent intent to communicate and may not understand that they can affect their environment through communication. Though developmental disabilities, by definition, are severe, it is possible that a child not previously identified could be detected by routine public school prekindergarten screening.

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