DSM5 criteria for Neurodevelopmental Disorders

1. NEURODEVELOPMENTAL
DISORDERS
Psychopathology and Diagnosis
Waynesburg University
James M. Hepburn, PhD

2. INTELLECTUAL (DEVELOPMENTAL)
DISABILITY
A move away from relying exclusively on IQ scores
and toward using additional measures of adaptive
functioning. DSM-IV criteria had required an IQ score
of 70 as the cutoff for diagnosis; the new criteria
recommend IQ testing and describe “deficits in
adaptive functioning that result in failure to meet
developmental and sociocultural standards for
personal independence and social responsibility.”

3. DEFICITS IN GENERAL MENTAL ABILITY
 a. Reasoning
 b. Problem solving
 c. Planning
 d. Abstract thinking
 e. Judgment
 f. Academic learning
 g. Learning from experience

4. IMPAIRMENTS OF ADAPTIVE FUNCTIONING
 i. Conceptual
 ii. Social
 iii. Practical
 Deficits in Adaptive Functioning is met when at
least one domain of adaptive functioning requires
ongoing support for the person to perform
adequately in one or more life settings

5. CHANGES IN SEVERITY LEVELS
OVER THE LIFESPAN
 Diagnostic assessments must determine whether
improved adaptive skills are the result of a stable,
generalized new skill acquisition (in which case the
diagnosis of intellectual disability may no longer be
appropriate)
 The improvement is contingent on the presence of
supports and ongoing interventions (in which case
the diagnosis of intellectual disability may still be
appropriate.

6. GLOBAL DEVELOPMENTAL DELAY
 Reserved for individuals under the age of 5. The
child fails to meet expected developmental
milestones in several areas of intellectual
functioning and cannot be assessed.

7. UNSPECIFIED INTELLECTUAL DISABILITY
 This diagnosis is appropriate for individuals over
the age of 5, where formal assessment is
compromised by physical disability such as
blindness or loco-motor disabilities.

8. COMMUNICATION DISORDERS
 Communication Disorders include deficits in
language, speech and communication and includes
the following: language disorder, speech sound
disorder, childhood –onset fluency disorder, social
(pragmatic) communication disorder, and other
specified and unspecified communication disorders.

9. LANGUAGE DISORDER
 Difficulties in the acquisition and use of language
due to deficits in the comprehension or production
of vocabulary sentence structure or discourse.
 Usually affects vocabulary and grammar:
 i. First words and phrases are delayed;
 ii. Vocabulary size is smaller and less varied
 iii. Sentences are shorter and less complex

10. LANGUAGE DISORDER, CONTINUED
 Diagnosis is based on the synthesis of the
individual’s history, clinical observations in different
contexts, and scores from standardized tests of
language ability.
 Language disorders emerge during the early
developmental period. By age 4 individual
differences in language ability are more stable and
typically persist into adulthood.
 When the child meets criteria for an intellectual
disability, s separate diagnosis of Language
Disorder is not given unless the language deficits
are clearly in excess of the intellectual limitations.

11. SPEECH SOUND DISORDER:
 Difficulty with phonological knowledge of speech
sounds or the ability to coordinate movements for
speech in varying degrees.
 Diagnosed when speech sound production is not
what would be expected based on the child’s age
and developmental stage
 Not a result of physical, structural, neurological or
hearing impairment.
 Language disorder may co-occur with speech
sound disorder.
 The mastery of speech sound production should result
in mostly intelligible speech by age 3 years.

12. CHILDHOOD-ONSET FLUENCY DISORDER
(STUTTERING)
 Disturbances in the normal fluency and time
patterning of speech as well as anxiety about
speaking or limitations in effective communication
and socialization.
 Childhood fluency disorder occurs by age 6 for 80%
of affected individuals.
 The severity of fluency disorder at age 8 years predicts
recovery or persistence into adolescence and beyond.

13. SOCIAL COMMUNICATION DISORDER
 Designed to capture children who have severe
deficits in social communication and interaction but
who lack the restrictive and repetitive behavior
patterns necessary for ASD. These children have
typically been diagnosed with PDD-NOS.

14. SOCIAL (PRAGMATIC) COMMUNICATION
DISORDER
 Difficulty with following rules for social nuances in
communication such as following social rules for
discourse or inability to follow non-verbal cues.
 A differential diagnosis of Autism should be based
on the presence of restricted/repetitive patterns of
behavior, interests or activities.

15. AUTISTIC SPECTRUM DISORDERS
 The most debated and anticipated change is the
consolidation of DSM-IV criteria for Autism—
Asperger’s, childhood disintegrative disorder, and
pervasive developmental disorder-not otherwise
specific (PDD-NOS)—into one diagnostic category
called autism spectrum disorder (ASD).

16. NEW CRITERIA
 For ASD, the new criteria identify two major
categories of symptoms for the diagnosis of ASD,
rather than three from the DSM-IV.
a. deficits in social communication and
social interaction;
b. restrictive and repetitive behavior
patterns.

17. LEVELS OF SEVERITY
 Three levels of severity for both principal symptoms
indicate the level of supportive services required by
an individual patient. The three levels are:
 a. “requiring support,”
 b. “requiring substantial support,” and
 c. “requiring very substantial support.”

18. SPECIFIERS
 Specifiers include
 a. Severity
 b. With or without accompanying intellectual
impairment
 c. With or without accompanying language
impairment
 d. Associated with known medical or genetic
condition or environmental factors.

19. INCLUSIVE CATEGORY
 Autism spectrum disorder encompasses disorders
previously referred to as early infantile autism,
pervasive developmental disorder NOS, childhood
disintegrative disorder, and Asperger’s disorder.
 Impairments in communication and social
interaction are pervasive and sustained.

20. ASD & COMMUNICATION DEFICITS
 Language deficits range from complete lack of
speech through language delays, echoed speech,
or overly literal language.
 The use of language for reciprocal social
communication is impaired in ASD.
 Deficits in nonverbal communication include
absent, reduced, or atypical use of eye contact,
gestures, facial expressions, body orientation or
speech intonation.

21. INTERPERSONAL RELATIONSHIP DEFICITS
 Deficits in interpersonal relationships should be
judged against norms for age, gender, and culture.
 a. In young children there is often a lack of
shared social play and insistence on
playing by very fixed rules.
 b. Difficulties in understanding irony,
metaphors, and white lies.
 c. Sometimes a preference for relating to
people much older or much younger than
them.

22. STEREOTYPY
 Stereotyped or repetitive behaviors include simple
motor behaviors such as hand flapping or spinning
coins, and repetitive speech.
 Resistance to change and ritualized behavior.
 Many adults with ASD without intellectual or
language disabilities learn to suppress repetitive
behavior in public, and childhood history of such
may need to be evaluated.

23. DIAGNOSTIC INDICATORS OF ASD
 Symptoms are typically recognized during the
second year of life.
 a. Look for early developmental delays or any
losses of social or language skills.
 b. A “red flag” for ASD is the deterioration in
social behaviors or use of language during
the first 2 years of life for some individuals.
 c. First symptoms of ASD involve delayed
language development and/or lack of social
interest or unusual social interactions

24. DEVELOPMENTAL PROGRESSIONS
 ASD is not a degenerative disorder—
Developmental gains are typical in later childhood.
 Only a minority of individuals with ASD live and
work independently in adulthood, and those who do
tend to have superior language or intellectual
abilities.

25. DIFFERENTIAL DIAGNOSIS OF ASD
 ASD is 4x more prevalent in males than females
 When an individual shows impairment in social
communication but not restrictive and repetitive
behavior or interests, R/O social (pragmatic)
communication Disorder.
 Intellectual disability is the appropriate diagnosis
when there is no apparent discrepancy between the
level of social-communicative skills and other
intellectual skills.
 ADHD should be considered when ADHD
symptoms exceeds that typically seen in individuals
of comparable mental age

26. ATTENTION-DEFICIT/HYPERACTIVITY
DISORDER
 A persistent pattern of inattention and/or
hyperactivity-impulsivity
 Hyperactivity refers to excessive motor activity;
Impulsivity refers to actions that occur without
forethought and result in a high potential for harm.
Impulsive behaviors may manifest as social
intrusiveness.

27. DIAGNOSTIC CRITERIA & ASSOCIATED
FEATURES
 ADHD begins in childhood, and symptoms must be
present before age 12.
 Symptoms must be present in more than one
setting. Typically symptoms vary depending on
context within a given setting.
 Mild delays in language, motor, or social
development often co-occur with ADHD.
 Associated features may include low frustration
tolerance, irritability, or mood lability.

28. ADHD PREVALENCE
 ADHD occurs in most cultures in about 5% of
children and about 2.5% of adults.
 It is 2x more prevalent in males than females.
Females are more likely than males to present
primarily with inattentive features.

29. DEVELOPMENTAL PATTERNS
 Most often first identified in elementary age
children. The disorder is relatively stable through
adolescence, but some develop symptoms of
conduct disorder.
 In adulthood, along with inattention and
restlessness, impulsivity may remain problematic
even when hyperactivity has diminished.

30. DIFFERENTIAL DIAGNOSIS OF ADHD
 With Oppositional Defiant Disorder (ODD) can be
complicated, because some individuals with ADHD
develop secondary oppositional attitudes toward tasks
that are challenging and require attention and sustained
activity.
 Intermittent Explosive Disorder reflects serious
aggression toward others, which is not a feature of
ADHD.
 Children with ADHD may show significant changes in
mood within the same day; such lability is distinct from a
manic episode, which must last 4 or more days. Bipolar
disorder is rare in preadolescents, even when severe
irritability and anger are prominent.
 Children with ADHD may also be diagnosed with
Disruptive mood dysregulation disorder.

31. SPECIFIC LEARNING DISORDER
 The consolidation of separate learning disorders
that had appeared in DSM-IV—reading disorder,
mathematics disorder, and disorder of written
expression—into one diagnosis called specific
learning disorder

32. SPECIFIC LEARNING DISORDER
 Difficulties learning and using academic skills in
reading, writing, and mathematics. It can include
deficits in recognition, comprehension and fluency.
 Learning disorders cannot be better accounted for
by intellectual disability, visual or auditory deficits,
neurological impairments or inadequate educational
opportunities

33. SPECIFIERS
 Each academic area that is impaired should be
specified.
 Severity (Mild, Moderate, Severe) should also be
specified for each impaired domain.
 It is a neurodevelopmental disorder with a biological
origin that is the basis for abnormalities at a
cognitive level.

34. DIAGNOSTIC CONSIDERATIONS OF
SPECIFIC LEARNING DISORDERS
 It is not simply a consequence of the lack of opportunity
or inadequate instruction.
 The individual’s performance of the affected academic
skills is well below average for age. They are typically
readily apparent in the early school years.
 Specific learning disorder affects learning in individuals
who otherwise demonstrate normal levels of intellectual
functioning, and can occur in intellectually “gifted”
 The diagnosis is made on the basis of medical,
developmental, educational and family history.
 An uneven profile of academic abilities is common.

35. PREVALENCE & PROGNOSIS
 Learning disorders affect 5-15% of school-age
children; Prevalence in adults is 4%. It is more
common in males than in females (2:1-3:1).
 Specific learning disorder is lifelong.
 Comorbidity with ADHD is predictive of worse
mental health outcome than that associated without
ADHD.
 Individualized instruction may improve or
ameliorate the learning difficulties in some
individuals.

36. MOTOR DISORDERS
 Developmental Coordination Disorder
 Stereotypic Movement Disorder
 Tic Disorders

37. DEVELOPMENTAL COORDINATION DISORDER
 Impaired skills requiring motor coordination,
significantly interfering with performance of daily
activities (dressing, eating, use of specific tools,
sports, etc.); can affect both gross and fine motor
skills.
 Typically not diagnosed before the age of 5 years.

38. COMORBIDITIES
 If intellectual disability is present, the motor
difficulties are in excess of those expected for the
mental age.
 Both ADHD and ASD can be diagnosed with
Developmental Coordination Disorder if
coordination problems are not better attributable to
lack of attention or impulsiveness.

39. STEREOTYPIC MOVEMENT DISORDER
 Repetitive, seemingly driven, and purposeless
motor behavior.
 Specify with or without self-injurious behavior;
 Specify with a known medical condition,
neurodevelopmental disorder or environmental factor;
 Specify if mild, moderate, or severe.

40. DIFFERENTIAL DIAGNOSIS
 When ASD is present, stereotypic movement
disorder is diagnosed only when there is self-injury
or when the stereotypic behaviors are a focus of
treatment.
 Stereotypies have an earlier age of onset (before 3
years) than do tics, which have a mean age of 5-7
years).
 They are more consistent and fixed in their pattern
compared with tics.

41. TIC DISORDER
 a. Tourette’s Disorder
 b. Persistent (Chronic) Motor or Vocal Tic
Disorder
 c. Provisional Tic Disorder
 Diagnosis for any tic disorder is based on the
presence of motor and/or vocal tics.

42. DIFFERENTIAL DIAGNOSIS
 Tic symptoms cannot be attributable to the
physiological effects of a substance or another
medical condition.
 Having previously met diagnostic criteria for
Tourette’s disorder negates a possible diagnosis of
persistent tic or vocal tic disorder.
 Differentiating tics from OCD behaviors can be
difficult, but OCD often have cognitive-based drive
and require repeated behaviors equally on both
sides of the body. The behaviors appear more goal
directed and complex than tics.