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First formally described by Kanner (1943), "early infantile autism" was characterized by autistic disinterest in the social environment and obsessive insistence on sameness. Additional features included speech delay, echolalia and pronoun reversal, and unusual repetitive motor behaviors (or stereotypies). Kanner's use of the word autism may have unintentionally contributed to an unfortunate and long-lasting association with Bleuler's description of schizophrenia, and for decades, autism was considered by many to be the first manifestation of schizophrenia. Various terms (e.g., childhood schizophrenia, infantile or symbiotic psychosis) were used in response to prominent theories regarding autism's etiology, and numerous diagnostic criteria were put forth. In 1968, Rutter proposed four essential characteristics that emanated from the existing evidence and were present in nearly all children with autism: 1) lack of social interest and responsiveness, 2) impaired language, 3) bizarre motor behavior, and 4) onset prior to the age of 30 months. In 1980, with the development of DSM-III (American Psychiatric Association 1980), Rutter's basic criteria predominated, and the diagnosis of infantile autism was included with the new class of "pervasive developmental disorders." In DSM-IV (American Psychiatric Association 1994), the diagnosis of autistic disorder was established via a large multisite study (Volkmar et al. 1994), and emphasis was placed on developmental aspects of the disorder. Minor adjustments to the diagnostic criteria were made in DSM-IV-TR in an attempt to facilitate clinical use (Table 21–12).

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Table Reference Number
TABLE 21–12. DSM-IV-TR diagnostic criteria for autistic disorder

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