Neurodevelopmental Disorders - Dsm 5

Front 1

General Characteristics

Back 1

1. Identified early in development

2. Characterized by developmental deficits that produce impairments in functioning

3. Range of deficits varies

4. High co-occurrence of neurodevelopmental disorders

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Intellectual Disabilities

Back 2

1. Deficits in intellectual functioning - confirmed by clinical assessment AND standardized testing 2 SD below mean

2. Deficits in adaptive functioning - results in failure to meet developmental and sociocultural standards

3. Onset in developmental period

4. Passive & dependent or aggressive and impulsive, gullible with lack of awareness of risk

5.1% of general population

6. Higher risk of suicide if other mental disorder present

7. Generally lifelong and non-progressive

8. Must have adaptive impairment

Specify if mild, moderate, severe

Severity is dependent on social, practical, and conceptual domains

Front 3

Mild ID

Back 3

1. 85% of cases

2. Diff in learning and social interaction appear during school-age

3. By late teens academic skills at approx. 6th grade level

4. Not distinguishable from non ID in preschool

5. Can usually live independently

Front 4

Moderate ID

Back 4

1. 10% of cases

2. Unlikely to progress past 2nd grade level

3. Diff recognizing social convention, interferes in peer relationships

4. Usually able to perform unskilled or semi-skilled work under supervision

Front 5

Severe ID

Back 5

1. 3-4% of cases

2. Can be trained in elementary self-help skills

3. During adulthood able to perform simple tasks with close supervision

4. Can adapt to community group homes or with families

Front 6

Profound ID

Back 6

1. 1-2% of cases

2. Most have identifiable neurological condition

3. Display considerable impairments

4. Benefit from highly structured environment with constant aid

Front 7

ID Etiology, Gender

Back 7

1. Multiple causes

2. Mostly males

Front 8

ID Differential Diagnosis

Back 8

1. Neurocognitive Disorders - check for loss of impairment after normal developmental period

2. Communication and Specific Learning Disorders - no deficits in intellectual and adaptive functioning

3. ASD - may or may not include intellectual and adaptive functioning deficits

Front 9

ID Comorbitity

Back 9

ADHD, depressive/bipolar disorders, anxiety disorders, ASD, stereotypical-movement disorder, impulse-control disorders neurocognitive disorders

Front 10

Global Developmental Delay

Back 10

1.Under age of 5 when level of severity cannot be assessed

2. Needs reassessment

Front 11

Unspecified Intellectual Disability

Back 11

1. Over age 5 when level of severity cannot be assessed because of sensory or physical impairments, severe behavioral problems, other mental disorders

2. Should be used only in exceptional circumstances and needs reassessment

Front 12

Language Disorder

Back 12

1. Persistent difficulties with the acquisition and use of language - reduced vocab, limited sentence structure, impairments in discourse

2. Abilities substantially and quantifiably below those expected for age

3. Onset in developmental period

4. Not attributable to hearing or other sensory impairment

5. May be receptive or expressive or both - receptive has poorer prognosis

6. Likely to persist in adulthood if diagnosis is at age 4 or older

7. Likely heritable

Front 13

Language Disorder Problems/Symptoms

Back 13

1. Started talking late

2. Hard time following/giving directions

3. Understanding questions, jokes, social skills difficult

4. Simpler spoken language, vocabulary, grammar than peers

5. Difficulty remember words, uses non-specific words, breaking language into parts, phonological awareness

6. Shy and less talkative, tangential, or inappropriate

Front 14

Language Disorder Differential Diagnosis

Back 14

1. Normal variations in language - diff before age 4

2. Hearing or Sensory Impairment

3. Intellectual Disability - ID supercedes LD, LD may occur in contect of ID

4. Neurological Disorders

5. Language Regression

Front 15

Language Disorder Comorbidity

Back 15

Specific Learning Disorder, ADHD, ASD, Social (pragmatic) Communication Disorder, Developmental Coordination Disorder

Front 16

Speech Sound Disorder

Back 16

1. Persistent difficulty with speech sound production

2. Disturbance causes limitations in effective communication that interferes with social/academic performance

3. Onset in early developmental period

4. Not attributable to congenital or acquired conditions

5. History of delay in facial musculature

6. Heritable

7. Responds to treatement but poorer prognosis if with LD

Front 17

Speech Sound Disorder Differential Diagnoses

Back 17

1. Normal variations in speech

2. Hearing or other sensory impairment

3. Structural Deficits

4. Motor Disorders

5. Selective Mutism

Front 18

Childhood-onset Fluency Disorder (Stuttering)

Back 18

1. Disturbance in fluency and time patterning of speech marked by one of:

a. Sound and syllable repetitions b. Sound prolongations of consonants and verbs c. Broken words d. Audible or silent blocking e. Words produced with excess of physical tension f. Circumlocutions (substitutions) g. Monosyllabic whole-word repetitions

2. Disturbance causes anxiety about speaking

3. Onset in early developmental period

4. Not attributable to speech-motor or sensory deficit, med condition, or mental disorder

5. Heritable, onset 2-7 years

Front 19

Childhood-onset Fluency Disorder (Stuttering)

Associated Features

Back 19

Can/May be:

1. Accompanied by motor movements, eye blinks, tremors of lips

2. Dysfluency absent when reading, singing, or talking to pets and inanimate objects

3. Stress and anxiety exacerbates symptoms, symptoms cause anxiety

4. Avoid certain words, speaking on phone

5. Can be assoc with LD, limits occupational choices or advancement

Front 20

Childhood-onset Fluency Disorder (Stuttering)

Differential Diagnosis

Back 20

1. Normal Speech Dysfluency

2. Hearing or other sensory impairments

3. Medication side effects

4. Adult-onset fluency disorder

5. Tourette's disorder

Front 21

Social (Pragmatic) Communication Disorder

Back 21

1. Need ALL of the following:

a. Deficits in using communication for social purposes

b. Impairment of ability to change communication to match context

c. Difficulties in following rules for convo and storytelling

d. Difficulty understanding what is not explicitly stated

2. Deficits result in functional limitation in effective communication, social participation, relationships, academics

3. Onset in early developmental period

4. Difficulties not attributable to another medical or neurological condition

5. Heritable, rarely diagnosed before 4, course is variable

Front 22

Social (Pragmatic) Communication Disorder

Differential Diagnosis

Back 22

ASD, ADHD, Social anxiety disorder, Intellectual Disability (ID supercedes)

Front 23

Unspecified Social (Pragmatic) Communication Disorder

Back 23

Symptom presentation causes clinically significant distress but does not meet criteria for specific comm disorder or any other disorder in the neurodevelopment class

Front 24

Autism Spectrum Disorder (ASD)

Back 24

A. Persistent deficits in social communication and interaction must have ALL of:

a. deficits in social-emotional reciprocity

b. deficits in non-verbal communication behaviors for social interaction

c. Deficits in developing, maintaining, understanding relationships

B. Restrictive repetitive behaviors, interests, abilities must have TWO of following:

a. Stereotyped or repetitive motor movements

b. insistence on sameness

c. highly restricted fixated interests

d. hyper- or hypo-reactivity to sensory input

C. Onset in early developmental period

D. Causes clinically significant impairment in social, occupational functioning

E. Specify with or without:

intellectual impairment ID , language impairment LD, can be associated with medical condition (MD), ND

environmental factor

F. 1% of population, no single cause, more males

Front 25

Autism Spectrum Disorder (ASD)

Levels

Back 25

Level 1 - requiring support

Level 2 - requiring substantial support

Level 3 - Requiring very substantial support

Front 26

Autism Spectrum Disorder (ASD)

Associated Features

Back 26

1. language deficits often present but can vary

2. use of language for reciprocal communication is impaired

3. limited use of gestures and facial expressions, exaggerated body language, odd uncoordinated movements, motor deficits, self-injurious behavior

4. large gap between intellectual abilities and adaptive functioning skills

5. Anxiety and depression in teens and adults

6. Catatonia

Front 27

Autism Spectrum Disorder (ASD)

Course

Back 27

1. Recognized between 12-24 months

2. some kids experience plateaus or regression

3. core features evident early on but functional impairment varies

4. learning and compensation throughout life

5. High intellectual ability may live and work independently, but with social impairment and anxiety and depression

Front 28

Autism Spectrum Disorder (ASD)

Comorbidity

Back 28

Language disorder, ADHD,Developmental coordination disorder, anxiety and depressive disorders, sleep disorders, avoidant-restrictive food intake

Front 29

Autism Spectrum Disorder (ASD)

Differential Diagnosis

Back 29

1. Rhett syndrome - females between 1-4, progressive loss of language, motor and social skills

2. Selective mutism

3. Language disorders

4. Intellectual Disability without Autism

5. Stereotypic movement disorder

6. ADHD

7. Schizophrenia

Front 30

Attention-Deficit / Hyperactivity Disorder

314.01 (F90.2) Combined presentation

314.00 (F90.0) predominantly inattentive presentation

314.01 (F90.1) Predominantly Hyperactive/Impulsive presentation

Back 30

A. Either (1) or (2)

1. SIX or more of the following symptoms of inattention for SIX months that is inconsistent with developmental level and negatively impacts social, academic, occupational activities

a. fails to give close attention to details

b. difficulty sustaining attention

c. does not seem to listen

d. does not follow through on instructions, homework, chores

e. difficulty organizing

f. reluctant to engage in tasks that require sustained mental effort

g. often loses things

h. easily distracted

i. forgetful

(2) SIX or more symptoms of hyperactivity/impulsive for at least SIX months that is inconsistent with developmental level and negatively impacts social, academic, occupational activities

a. fidgets - hands, feet, squirming

b. leaves seat

c. runs about or climbs excessively

d. difficulty playing or engaging in leisure activities quietly

e. talks excessively

f. on the go, driven by a motor

g. blurts out answers before question complete

h. difficulty waiting in line

i. interrupts or intrudes on others

B. Symptoms present before age 12

C. Several inattentive or hyperactive-impulsive symptoms present in two or more settings

D. Clear evidence that symptoms interfere with or reduce quality of social, academic, occupational functioning

E. Symptoms do not occur excessively during the course of schizophrenia or another psychotic disorder

Specify if Mild, Moderate, severe, in Partial Remission

No single cause identified: genetics, temperament, low birth weight, fetal alcohol syndrome, neurotoxin exposure, infections

Front 31

Attention-Deficit / Hyperactivity Disorder

Associated Features

Back 31

1. Mild delays in language, motor, social development

2. low frustration tolerance irritability, mood instability

3. impaired academic and work performance even in absence of learning disabilities

4. increased risk of suicide with mood, conduct, and substance abuse disorders

5. 5% in children, 2.5% in adults

6. First signs in toddler-hood

7. diff to diagnose before age 4

8. diagnosis typically made after formal schooling

9. symptoms stable thorough early adolescence

10. Sometimes symptoms worsen, most cases hyperactivity decreases with age, but inattention, restlessness, poor planning, impulsivity remain

11. Hyperactive more common among males, inattentive type in females

12. SES and cultural variations

Front 32

Attention-Deficit / Hyperactivity Disorder

Comorbidities

Back 32

1. Oppositional Defiant Disorder and Conduct Disorder

2. Specific Learning Disorders

3. Anxiety and Depressive Disorders

4. Intermittent Explosive Disorder

5. ASD and Tic Disorders

6. Personality Disorder - antisocial, obsessive-compulsive

Front 33

Attention-Deficit / Hyperactivity Disorder

Differential Diagnosis

Back 33

1. Oppositional Defiant Disorder (more about negativity, hostility than impulsive/hyperactive)

2. Intermittent Explosive Disorder (more about aggressiveness than impulsive/hyperactive)

3. Other Neurodevelopmental Disorders

4. Specific Learning Disorder

5. Intellectual Disability

6. Reactive Attachment Disorder (more about social disinhibition and lack of secure attachments than impulsive/hyperactive)

7. Anxiety and Depressive Disorders - inattention due to worry, preoccupations and rumination instead of attraction to external stimuli

8. Bipolar Disorder - impulsive and inattention episodic

9. Disruptive Mood Dysregulation Disorder - can be combined but more about pervasive irritability and intolerance of frustration than impulsive/hyperactive

10. Substance Use Disorders

11. Personality Disorders- impulsive/hyperactive d/t negative emotional states

12. Psychotic disorders - symptoms only during psychotic episodes

13. Medication - induced

14. Neurocognitive Disorders - late symptom onset

Front 34

Other Specified Attention-Deficit / Hyperactivity Disorder

Back 34

Symptoms characteristic of ADHD cause distress or impairment in functioning but do not meet full criteria for ADHD

Clinician wants to communicate reason why symptoms do not meet criteria

Front 35

Unspecified Attention-Deficit / Hyperactivity Disorder

Back 35

Symptoms characteristic of ADHD cause distress or impairment in functioning but do not meet full criteria for ADHD

Clinician does not want to communicate why symptoms do not meet full criteria

Front 36

Specific Learning Disorder

315.00 (F81.0) with impairment in reading

315.2 (F81.81) with impairment in written expression

315.1 (F81.2) with impairment in mathematics

Mild, moderate, severe

Back 36

A. Difficulty learning and using academic skills. Presence of at least one of the following for at least 6 months, despite interventions:

1. Inaccurate or slow and effortful word reading

2. Difficulty understanding the meaning of what is read

3. Difficulty with spelling

4. Difficulty with written expression

5. Difficulty mastering number sense, facts or calculations

6. Difficulty with numerical reasoning

B. The academic skills are substantially and quantifiably below expected as confirmed by individually administered standardized achievement measure and comprehensive clinical assessment

C. Learning difficulties begin during school-age years but may not fully manifest until skill demands excess capacities

D. Learning difficulties are not better accounted for by ID, visual/auditory acuity, mental, neurological disorders, psychosocial adversity, lack of proficiency in language, inadequate instruction

Examples: 315.00 (F81.0) Specific Learning Disorder with impairment in reading, with impairment in reading rate or fluency, and impairment in reading comprehension

315.2 (F81.2) Specific Learning Disorder with impairment with impairment in mathematics, with impairment in number sense and accurate math reasoning

Front 37

Specific Learning Disorder

Associated features

Back 37

1. demoralization, low self-esteem, deficits in social skills

2. school drop out 40%

3. with ADHD, ODD, Conduct Disorder, MDD, Dysthymic Disorder + SLD

4. Associated with genetic disposition, embryonic alterations, perinatal problems, environmental influences, other mental disorders and general medical conditions in childhood

5. standardized testing should take cultural factors into account

6. SLD must be distinguished from variations in academic achievement d/t lack of opportunity and poor teaching

7. Impaired vision and hearing is possible explanation

8. limited English fluency complicates assessment

9. prevalence 2-10%

Front 38

Developmental Coordination Disorder

Back 38

A. Acquisition and execution of coordinated motor skills substantially below expected given age and opportunity for skill learning and use. Difficulties are clumsiness, slowness, inaccuracy of performing motor skills

B. The motor skill deficits significantly and persistently interferes with ADL appropriate to chronological age

C. Onset in early developmental period

D. Motor skill deficits are not better explained by ID or visual impairment and not attributable to neurological condition affecting movement

Front 39

Stereotypic Movement Disorder

315.4 (F82) Severe, with self-injurious behavior, associated with intellectual disability

Back 39

A. Repetitive, seemingly driven, and apparently purposeless motor behavior like rocking, head banging, self-biting

B. Interferes with social, academic, or other ADL and may result in self-injury

c. Onset in early developmental period

D. Repetitive motor behavior not attributable to physiological effects of substance or neurological condition

Specify mild, moderate, severe, with self-injurious, without self-injurious behavior, associated with a known medical or genetic condition, neurodevelopmental disorder or environmental factor

ie:

315.4 (F82) Stereotypic Movement Disorder Severe, with self-injurious behavior, associated with intellectual disability

Front 40

Tourette's Disorder

307.23

Back 40

1. Multiple motor AND one or more vocal tic

2. Wax and wane but persist for more than 1 year

3. Onset before 18 years

4. Not attributable to substance use or other medical condition

Front 41

Persistent (Chronic) Motor or Vocal Tic Disorder

307.22 (F95.1)

Back 41

1. Multiple motor OR one or more vocal tic

2. Wax and wane but persist for more than 1 year

3. Onset before 18 years

4. Not attributable to substance use or other medical condition

5. Criteria never met for Tourette's

Front 42

Provisional Tic Disorder

307.21 (F95.0)

Back 42

1. Single motor AND/OR one or more vocal tic

2. Present for less than 1 year

3. Onset before 18 years

4. Not attributable to substance use or other medical condition

5. Criteria never met for Tourette's or PCMVTD

Front 43

Other Specified Tic Disorder

Back 43

Symptoms characteristic of a tic disorder that cause distress or impairment in functioning but do not meet criteria for one of 3 main tic disorders or some other neurodevelopmental disorder

clinician wants to communicate reason why symptoms do not meet criteria

Front 44

Unspecified Tic Disorder

Back 44

Symptoms characteristic of a tic disorder that cause distress or impairment in functioning but do not meet criteria for one of 3 main tic disorders or some other neurodevelopmental disorder

clinician does not want to communicate reason why symptoms do not meet criteria

Front 45

Other Specified Neurodevelopmental Disorder

Back 45

Symptoms characteristic of a neurodevelopmental disorder that cause distress or impairment in functioning but do not meet criteria for one of 3 main tic disorders or some other neurodevelopmental disorder

clinician wants to communicate reason why symptoms do not meet criteria

Front 46

Unspecified Neurodevelopmental Disorder

Back 46

Symptoms characteristic of an ND disorder that cause distress or impairment in functioning but do not meet criteria for one of 3 main tic disorders or some other neurodevelopmental disorder

clinician does not want to communicate reason why symptoms do not meet criteria or has insufficient info to make more specific diagnosis