Diagnostic Considerations

Psychosis is often the most difficult symptom to elicit and diagnose appropriately in children with pervasive developmental disorder (PDD/ASD). Not long ago, children with ASD were often identified as having childhood-onset schizophrenia. The DSM establishes criteria that clearly distinguish ASD from childhood-onset schizophrenia. The DSM recognizes that children with ASD may develop psychotic disorders if they present with clear evidence of auditory, visual, tactile, and/or olfactory hallucinations. Nevertheless, determining whether a child has ASD or psychosis may be difficult during the initial clinical evaluation. For example, individuals with intellectual disability may present with cognitive disorganization; they may link irrelevant thoughts together or have beliefs in magical beings, even as adults. These findings are considered normal in a person with intellectual disability.

Conditions to consider in the differential diagnosis of pervasive developmental disorder, along with those in the next section, include the following:

Reactive attachment disorder
Landau-Kleffner syndrome
Schizotypal personality disorder
Intellectual Disability (Mental retardation)
Selective Mutism

Differential Diagnoses

Workup

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Media Gallery

Young child with fragile X syndrome who does not have obvious dysmorphic features. Courtesy of Randi J Hagerman, MD, FAAP.

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Author

Sufen Chiu, MD, PhD Associate Clinical Professor (Volunteer Faculty), University of California, Davis, School of Medicine; Staff Physician, Mercy Medical Group

Sufen Chiu, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychiatric Association, California Medical Association, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Randi J Hagerman, MD, FAAP Professor of Pediatrics, Medical Director of the MIND Institute, Endowed Chair in Fragile X Research, Division of Developmental/Behavioral Pediatrics, University of California Davis Medical Center

Randi J Hagerman, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Human Genetics, Society for Pediatric Research, Society for Developmental and Behavioral Pediatrics, Western Society for Pediatric Research

Disclosure: Received grant/research funds from Roche for pi on study; Received grant/research funds from Novartis for pi on study; Received grant/research funds from Seaside therapeutics for pi on study; Received grant/research funds from Johnson and Johnson for pi on study; Received grant/research funds from Forest for pi on study; Received grant/research funds from curemark for pi on study.

Sandra M DeJong, MD, MSc Assistant Professor of Psychiatry, Harvard Medical School; Active Staff, Department of Psychiatry, Cambridge Health Alliance

Sandra M DeJong, MD, MSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Association of Directors of Psychiatric Residency Training, American Psychiatric Association, Association of Women Psychiatrists, Massachusetts Psychiatric Society, New England Council of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.