Before 2013, this diagnosis was given to individuals with autistic symptoms that didn’t meet full diagnostic criteria. It existed as a sort of “etcetera” category, that now due to the spectrum nature of autism diagnoses, is no longer needed and no longer valid. 

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

Also called Heller’s syndrome or disintegrative psychosis, it refers to a rare condition of late developmental onsets in language, social function, and motor skills (over three years old). First described by Austrian educator Thomas Heller in 1908. Since the DSM-5, it has been bundled into the pervasive developmental disorders category. Often, diagnosis comes about when a child starts to lose previously acquired skills, such as potty training. For diagnosis, an individual must show loss or regression in at least two of the following areas, following normal development: receptive and expressive language skills, social skills, play with peers, motor skills, and bowel/bladder control that previously was maintained. 

Childhood Disintegrative Disorder

Occurring almost exclusively in girls, it is a rare genetic neurological disorder that affects everyday functioning in almost every aspect. Caused by mutations to the X chromosome, specifically on gene MECP2, with severity of the syndrome determined by location, type, and severity of the mutation. A hallmark is near constant and repetitive hand motions, but other symptoms include loss of speech, mobility, and muscle tone, seizures, scoliosis, and breathing problems. 

Rett-Syndrome

Asperger's disorder was a diagnosis in previous editions of the DSM, considered a less severe form of autistic disorder. Individuals with this diagnosis typically had average to high intelligence and a strong vocabulary. However, they showed significant impairments in social interaction and communication, often focusing conversations exclusively on their specific, intense interests.

Asperger's Disorder

The publishing of the DSM-4 in 1994 and revised in 2000 finally saw autism categorized as a spectrum. In this manual, there were 5 sub-categories of related disorders in addition to autism: 
- Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
- Asperger’s Disorder
- Childhood Disintegrative Disorder (CDD)
- Rett-syndrome

University of Rochester

The diagnosis of Autism has changed a lot over time to what it is now. It’s had quite a long and convoluted history as our understanding has changed.

- 1911: The Coining of the Term "Autism"
- ASD in the 1940s-50s
- ASD in the 1950s-60s
- ASD in the 1970s-80s
- ASD in the 1990s-2000s

ASD Diagnostic History

Zeldovich, L. (2018, April 9). The evolution of 'autism' as a diagnosis, explained. Spectrum. https://www.spectrumnews.org/news/evolution-autism-diagnosis-explained/.

The evolution of 'autism' as a diagnosis, explained

The history of autism. Masters in Special Education Degree Program Guide |. (2021, March 19). https://www.masters-in-special-education.com/history-of-autism/.

The history of autism 

Evans B. (2013). How autism became autism: The radical transformation of a central concept of child development in Britain. History of the human sciences, 26(3), 3–31. https://doi.org/10.1177/0952695113484320

How autism became autism: The radical transformation of a central concept of child development in Britain.

Autism as a concept was first introduced by German psychiatrist Eugen Bleuler, and he used it to describe a symptom of severe cases of schizophrenia. He believed autistic thinking involved infantile desires to avoid bad realities, replacing them with fantasies. This definition would carry through into the second DSM. 


1911: The Coining of The Term "Autism" 

In the 1940s, autism was likened to an emotional disturbance. The DSM-2 (1952) had it marked as a psychiatric condition like a childhood schizophrenia. Rather than a developmental disorder, autism was considered a psychiatric disturbance distinguished by social and emotional problems. Around 1943, child psychiatrist Leo Kanner described autism as lack of affective contact, fascination with objects, desire for sameness and non-communicative language before 30 months of age”. 

ASD in the 1940s-50s: Psychiatric Disturbance

In the 1950s-1960s, Autism was blamed on bad and detached mothers, dubbed “refrigerator mothers”. This sprouted from the theories of Leo Kanner, where he described autistic children as being reared in emotional refrigerators due to lack of parental warmth. However, he studied this in a small population of white, educated families that displayed this detachment, making his assumption incorrectly over-generalized. Regardless, Kanner’s “refrigerator mother” theory prevailed for a long time, pushed into the limelight by popular professor Bruno Bettelheim’s public endorsement. 

ASD in the 1950s-1960s: Refrigerator Mothers

Kanner’s “refrigerator mother” hypothesis was disproven in the late 60s to early 70s due to apparent biological roots, thus shifting the DSM-3 in 1980 to categorize it as a developmental disorder that was not related to schizophrenia. The DSM-3 further defined three essential features for a diagnosis of autism: lack of interest in people, impairments in communication and bizarre responses to environmental stimuli, and all developing within the first 30 months of life. This was further revised in 1987, adding a mild diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) and dropping the requirement of onset before 30 months. 

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