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DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION DSM-5™ |
American Psychiatric Association Officers 2012-2013 PRESIDENT DILIP V. JESTE, M. D. PRESIDENT-ELECT JEFFREY A. LIEBERMAN, M. D. TREASURER DAVID FASSLER, M. D. SECRETARY ROGER PEELE, M. D. Assembly SPEAKER R. SCOTT BENSON, M. D. SPEAKER-ELECT MELINDA L. YOUNG, M. D. Board of Trustees JEFFREY AKAKA, M. D. CAROL A. BERNST... |
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION DSM-5™ New School Library \llll'IJL,111 Psvch iatric l'ublih Jng Washington, DC London, England |
Copyright© 2013 American Psychiatric Association DSM and DSM-5 are trademarks of the American Psychiatric Association. Use of these terms is prohibited without permission of the American Psychiatric Association. ALL RIGHTS RESERVED. Unless authorized in writing by the APA, no part of this book may be reproduced or used... |
Contents DSM-5 Classification................................... xiii Preface.............................. . ......... xl i Section I DSM-5 Basics Introduction............................................ 5 Use of the Manual................................... 19 Cautionary Statement for Forensic Use of DSM-5........ 25... |
Disruptive, Impulse-Control, and Conduct Disorders........ 461 Substance-Related and Addictive Disorders............... 481 Neurocognitive Disorders............................... 591 Personality Disorders.................................. 645 Paraphilic Disorders.................................. 685 Other Mental Diso... |
DSM-5 Task Force DAVID J. KUPFER, M. D. Task Force Chair DARREL A. REGIER, M. D., M. P. H. Task Force Vice-Chair William E. Narrow, M. D., M. P. H., Research Director Dan G. Blazer, M. D., Ph. D., M. P. H. Jack D. Burke Jr., M. D., M. P. H. William T. Carpenter Jr., M. D. F. Xavier Castellanos, M. D. Wilson M. Compton,... |
Editorial and Coding Consultants Michael B. First, M. D. Maria N. Ward, M. Ed., RHIT, CCS-P DSM-5 Work Groups ADHD and Disruptive Behavior Disorders DAVID SHAFFER, M. D. Chair F. XAVIER CASTELLANOS, M. D. Co-Chair Paul J. Frick, Ph. D., Text Coordinator Glorisa Canino, Ph. D. Terrie E. Moffitt, Ph. D. Joel T. Nigg, Ph.... |
Mood Disorders ]AN A. FAWCETI, M. D. Ellen Frank, Ph. D., Text Coordinator Jules Angst, M. D. (2007-2008) William H. Coryell, M. D. Lori L. Davis, M. D. Raymond J. De Paulo, M. D. Sir David Goldberg, M. D. James S. Jackson, Ph. D. Chair Kenneth S. Kendler, M. D., Ph. D. (2007-2010) Mario Maj, M. D., Ph. D. Husseini K. ... |
Psychotic Disorders WILLIAM T. CARPENTER JR., M. D. Deanna M. Barch, Ph. D., Text Coordinator Juan R. Bustillo, M. D. Wolfgang Gaebel, M. D. Raquel E. Gur, M. D., Ph. D. Stephan H. Heckers, M. D. Chair Dolores Malaspina, M. D., M. S. P. H. Michael J. Owen, M. D., Ph. D. Susan K. Schultz, M. D. Rajiv Tandon, M. D. Ming ... |
DSM-5 Study Groups Diagnostic Spectra and DSMIICD Harmonization STEVEN E. HYMAN, M. D. Chair (2007-2012) William T. Carpenter Jr., M. D. Wilson M. Compton, M. D., M. P. E. Jan A. Fawcett, M. D. Helena C. Kraemer, Ph. D. David J. Kupfer, M. D. William E. Narrow, M. D., M. P. H. Charles P. O'Brien, M. D., Ph. D. John M. ... |
Impairment and Disability JANE S. PAULSEN, PH. D. J. Gavin Andrews, M. D. Glorisa Canino, Ph. D. Lee Anna Clark, Ph. D. Diana E. Clarke, Ph. D., M. Sc. Michelle G. Craske, Ph. D. Chair Hans W. Hoek, M. D., Ph. D. Helena C. Kraemer, Ph. D. William E. Narrow, M. D., M. P. H. David Shaffer, M. D. Diagnostic Assessment Ins... |
DSM-5 Classification Before each disorder name, ICD-9-CM codes are provided, followed by ICD-10-CM codes in parentheses. Blank lines indicate that either the ICD-9-CM or the ICD-10-CM code is not applicable. For some disorders, the code can be indicated only according to the subtype or specifier. ICD-9-CM codes are to ... |
xiv DSM-5 Classification Autism Spectrum Disorder (50) 299. 00 (F84. 0) Autism Spectrum Disorder (50) Specify if: Associated with a known medical or genetic condition or envi ronmental factor; Associated with another neurodevelopmental, men tal, or behavioral disorder Specify current severity for Criterion A and Crit... |
DSM-5 Classification 307. 21 (F95. 0) Provisional Tic Disorder (81) 307. 20 (F95. 8), Other Specified Tic Disorder (85) 307. 20 (F95. 9) Unspecified Tic Disorder (85) Other Neurodevelopmental Disorders (86) 315. 8 (F88) Other Specified Neurodevelopmental Disorder (86) 315. 9 (F89) Unspecified Neurodevelopmental Disorde... |
xvi 293. 89 (F06. 1) 293. 89 (F06. 1) 293. 89 (F06. 1) 298. 8 (F28) 298. 9 (F29) DSM-5 Classification Catatonia Associated With Another Mental Disorder (Catatonia Specifier) (119) Catatonic Disorder Due to Another Medical Condition (120) Unspecified Catatonia (121) Note: Code first 781. 99 (R29. 818) other symptoms inv... |
DSM-5 Classification 301. 13 (F34. 0) Cyclothymic Disorder (139) Specify if: With anxious distress xvii -·-(_. _} Substance/Medication-Induced Bipolar and Related Disorder (142) Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding. Specify if: ... |
xviii 625. 4 (N94. 3) -·-(_. _} 293. 83 L_. _) 311 311 (F06. 31) (F06. 32) (F06. 34) (F32. 8) (F32. 9) 309. 21 (F93. 0) 312. 23 (F94. 0) 300. 29 L_. _) (F40. 218) (F40. 228) L_. _) (F40. 230) (F40. 231) (F40. 232) (F40. 233) (F40. 248) (F40. 298) 300. 23 (F40. 1 0) 300. 01 (F41. 0) -·-L_. _) 300. 22 (F40. 00) 300. 02 (... |
DSM-5 Classification 293. 84 (F06. 4) Anxiety Disorder Due to Another Medical Condition (230) 300. 09 (F41. 8), Other Specified Anxiety Disorder (233) 300. 00 (F41. 9) Unspecified Anxiety Disorder (233) Obsessive-Compulsive and Related Disorders (235) xix The following specifier applies to Obsessive-Compulsive and Rela... |
XX (_. _J 309. 0 (F43. 21) 309. 24 (F43. 22) 309. 28 (F43. 23) 309. 3 (F43. 24) 309. 4 (F43. 25) 309. 9 (F43. 20) 309. 89 (F43. 8) 309. 9 (F43. 9) Adjustment Disorders (286) Specify whether: With depressed mood With anxiety With mixed anxiety and depressed mood With disturbance of conduct DSM-5 Classification With mixe... |
DSM-5 Cl assification xxi 316 (F54) 300. 19 (F68. 1 0) 300. 89 (F45. 8) 300. 82 (F45. 9) Psychological Factors Affecting Other Medical Conditions (322) Specify current severity: Mild, Moderate, Severe, Extreme Factitious Disorder (includes Factitious Disorder Imposed on Self, Factitious Disorder Imposed on Another) (32... |
xxii DSM-5 Classification Sleep-Wa ke Dis order s (361) The following specifiers apply to Sleep-Wake Disorders where indicated: a specify if: Episodic, Persistent, Recurrent bspecify if: Acute, Subacute, Persistent cspecify current severity: Mild, Moderate, Severe 780. 52 (G47. 00) Insomnia Disordera (362) Specify if: ... |
DSM-5 Cla ssification xxiii 307. 45 (G47. 26) Shift work type (397) 307. 45 (G47. 2 ) Unspecified type Paraso mnias (399) -·-(_. _j 307. 46 (F51. 3) 307. 46 (F51. 4} 307. 47 (F51. 5) 327. 42 (G47. 52) 333. 94 (G25. 81) -·-L_. _j 780. 52 (G47. 09) 780. 52 (G47. 00) 780. 54 (G47. 19} 780. 54 (G47. 10} 780. 59 (G47. 8) 78... |
xxiv 302. 71 (F52. 0) 302. 75 (F52. 4) -·-(_. _j 302. 79 (F52. 8) 302. 70 (F52. 9) -·-L. _) 302. 6 (F64. 2) 302. 85 (F64. 1) 302. 6 (F64. 8) 302. 6 (F64. 9) DSM-5 Classification Male Hypoactive Sexual Desire Disordera, b, c (440) Premature (Early) Ejaculationa, b, c (443) Substance/Medication-Induced Sexual Dysfunction... |
DSM-5 Classification XXV Substa nce-Rel ated and Addic tive Dis order s (481) The following specifiers and note apply to Substance-Related and Addictive Disorders where indicated: a specify if: In early remission, In sustained remission bspecify if: In a controlled environment cspecify if: With perceptual disturbances ... |
xxvi 292. 89 (_. _} (F12. 129) (F12. 229) (F12. 929) (F12. 122) (F12. 222) (F12. 922) 292. 0 (F12. 288) --L_. _) Cannabis Intoxicationc (516) Without perceptual disturbances With use disorder, mild With use disorder, moderate or severe Without use disorder With perceptual disturbances With use disorder, mild With use d... |
DSM-5 Classification 304. 60 (F18. 20) Moderate 304. 60 (F18. 2 ) Severe 292. 89 (_. _) Inhalant Intoxication (538) -·-(F18. 129) With use disorder, mild (F18. 229) (F18. 929) (_. _) With use disorder, moderate or severe Without use disorder Other Inhalant-Induced Disorders (540) 292. 9 (F18. 99) Unspecified Inhalant-R... |
xxviii (_. _) DSM-5 Classification Other Sedative-, Hypnotic-, or Anxiolytic-Induced Disorders (560) 292. 9 (F13. 99) Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related Disorder (560) Stimulant-Related Disorders (561) (_. _) (_. _) 305. 70 (F15. 1 0) 305. 60 (F14. 1 0) 305. 70 (F15. 1 0) -·-(_. _) 304. 40 (F15. 20... |
DSM-5 Classification 292. 9 (_. _j Unspecified Stimulant-Related Disorder (570) (F15. 9) Amphetamine or other stimulant (F14. 99) Cocaine Tobacco-Related Disorders (571) -·-(_. _j 305. 1 (Z72. 0) 305. 1 (F17. 200) 305. 1 (F17. 200) 292. 0 (F17. 203) --(_. _) 292. 9 (F17. 209) Tobacco Use Disorder3 (571) Specify if: On ... |
XXX 293. 0 (F05) 780. 09 (R41. 0) 780. 09 (R41. 0) Delirium due to multiple etiologies Specify if: Acute, Persistent DSM-5 Classification Specify if: Hyperactive, Hypoactive, Mixed level of activity Other Specified Delirium (602) Unspecified Delirium (602) Major and Mild Neur ocognitive Disorder s (602) Specify whether... |
DSM-5 Classification xxxi 331. 9 (G31. 9) Possible Major Neurocognitive Disorder With Lewy Bodiesa, b 331. 83 (G31. 84} Mild Neurocognitive Disorder With Lewy Bodiesa Major or Mild Vascular Neurocognitive Disorder (621) -·-(_. _) 290. 40 (F01. 51) 290. 40 (F01. 50) 331. 9 (G31. 9) 331. 83 (G31. 84) Probable Major Vascu... |
xxxii DSM-5 Classification 331. 9 (G31. 9) Major Neurocognitive Disorder Possibly Due to Parkinson's Diseasea, b 331. 83 (G31. 84) Mild Neurocognitive Disorder Due to Parkinson's Diseasea Major or Mild Neurocognitive Disorder Due to Huntington's Disease (638) (_. _j 294. 11 (F02. 81) 294. 10 (F02. 80) 331. 83 (G31. 84)... |
DSM-5 Classification Clus ter C Personal ity Disor ders 301. 82 (F60. 6 Avoidant Personality Disorder (672) 301. 6 (F60. 7) Dependent Personality Disorder (675) 301. 4 (F60. 5) Obsessive-Compulsive Personality Disorder (678) Other Personality Disor ders xxxiii 310. 1 (F07. 0) Personality Change Due to Another Medical C... |
xxxiv DSM-5 Classification Med ication-Ind uced Move ment Dis order s and Other Adve rse Effects of Med ication (709) 332. 1 (G21. 11) 332. 1 (G21. 19) 333. 92 (G21. 0) 333. 72 (G24. 02) 333. 99 (G25. 71) 333. 85 (G24. 01) 333. 72 (G24. 09) 333. 99 (G25. 71) 333. 1 (G25. 1) 333. 99 (G25. 79) Neuroleptic-Induced Parkins... |
DSM-5 Classification Abuse and Negl ect (717) Child Maltreatment and Neglect Problems (717) Child Physical Abuse (717) Child Physical Abuse, Confirmed (717) 995. 54 (T74. 12XA) Initial encounter 995. 54 (T74. 12XD) Subsequent encounter Child Physical Abuse, Suspected (717) 995. 54 (T76. 12XA) Initial encounter 995. 54 ... |
xxxvi Child Neglect, Suspected (719) 995. 52 (T76. 02XA) Initial encounter 995. 52 (T76. 02XD) Subsequent encounter Other Circumstances Related to Child Neglect (719) DSM-5 Classification V61. 21 (Z69. 01 0) Encounter for mental health services for victim of child neglect V61. 21 (Z69. 020) V15. 42 (Z62. 812) V61. 22 (... |
DSM-5 Classification xxxvii V15. 41 (Z91. 410) Personal history (past history) of spouse or partner violence, physical V61. 12 (Z69. 12) Encounter for mental health services for perpetrator of spouse or partner violence, physical Spouse or Partner Violence, Sexual (720) Spouse or Partner Violence, Sexual, Confirmed (72... |
xxxvi ii DSM-5 Classification V15. 42 (Z91. 411) Personal history (past history) of spouse or partner psychological abuse V61. 12 (Z69. 12) Encounter for mental health services for perpetrator of spouse or partner psychological abuse Adult Abuse by Nonspouse or Nonpartner (722) Adult Physical Abuse by Nonspouse or Nonp... |
DSM-5 Classification V60. 89 (Z59. 2) Discord With Neighbor, Lodger, or Landlord (723) V60. 6 (Z59. 3k Problem Related to Living in a Residential Institution (724) Economic Problems (724) V60. 2 (Z59. 4) Lack of Adequate Food or Safe Drinking Water (724) V60. 2 (Z59. 5) V60. 2 (Z59. 6) V60. 2 (Z59. 7) V60. 9 (Z59. 9) E... |
xl DSM-5 Classification Other Circums tances of Personal History (726} V15. 49 (Z91. 49) Other Personal History of Psychological Trauma (726) V15. 59 (Z91. 5) Personal History of Self-Harm (726) V62. 22 (Z91. 82) V15. 89 (Z91. 89) V69. 9 (Z72. 9) Personal History of Military Deployment (726) Other Personal Risk Factors... |
Preface The American Psyc hiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders with associated criteria de signed to facilitate more reliable diagnoses of these disorders. With successive editions over the past 60 years, it has become a standard refe... |
xlii Preface Representation of developme ntal issues related to diagnosis. The change in chapter organization better reflects a lifespan approach, with disorders more frequently diag nosed in childhood (e. g., neurodevelopmental disorders) at the beginning of the man ual and disorders more applicable to older adultho... |
Preface xliii specific molecular genetic findings for rare variants of Alzheimer's disease and Hun tington's disease have greatly advanced clinical diagnoses, and these disorders and others have now been separated into specific subtypes. Transition in conceptualizing personality disor ders. Although the benefits of a ... |
xliv Preface bly review process. Special thanks go to Helena C. Kraemer, Ph. D., for her expert statistical consultation; Michael B. First, M. D., for his valuable input on the coding and review of cri teria; and Paul S. Appelbaum, M. D., for feedback on forensic issues. Maria N. Ward, M. Ed., RHIT, CCS-P, also helped... |
SECTION I DSM-5 Basics Introduction.................................................. 5 Use of the Manual........................................... 19 Cautionary Statemen t for Forensic Use of DSM-5.................. 25 |
This sec tion is a basic orientation to the purpose, structure, content, and use of DSM-5. It is not intended to provide an exhaustive account of the evo lution of DSM-5, but rather to give readers a succinct overview of its key ele ments. The introductory section describes the public, professional, and expert review... |
Introduction The crea tion of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was a massive undertaking that involved hundreds of people working toward a common goal over a 12-year process. Much thought and deliberation were involved in evaluating the diagnostic criteria, considering ... |
6 Introduction examination of the range of symptoms present, DSM can serve clinicians as a guide to identify the most prominent symptoms that should be assessed when diagnosing a disorder. Although some mental disorders may have well-defined boundaries around symptom clusters, scien tific evidence now places many, if ... |
Introduction 7 field. Thereafter, the task force of 28 members was approved in 2007, and appointments of more than 130 work group members were approved in 2008. More than 400 additional work group advisors with no voting authority were also approved to participate in the pro cess. A clear concept of the next evolution... |
8 Introduction variety of patient populations; the latter supplied valuable information about how proposed revisions performed in everyday clinical settings among a diverse sample of DSM users. It is anticipated that future clinical and basic research studies will focus on the validity of the re vised categorical diag... |
Introduction 9 Force to draft the diagnostic criteria and accompanying text. This effort was supported by a team of AP A J?ivision of Research staff and developed through a network of text coor dinators from each work group. The preparation of the text was coordinated by the text editor, working in close collaboration... |
10 Introduction body of the APA representing the district branches and wider membership that is com posed of psychiatrists from throughout the United States who provide geographic, prac tice size, and interest-based diversity. The Committee on DSM-5 is a committee made up of a diverse group of assembly leaders. Follo... |
Introduction 11 relationships within the classification are based on current research and may need to be modified as new evidence is gathered by future research both within and across the do mains of propos ed disorders. "Conditions for Further Study," described in Section III, are those for which we determined that t... |
12 Introduction may not fully capture the complexity and heterogeneity of mental disorders. The revised organization is coordinated with the mental and behavioral disorders chapter (Chapter V) of ICD-11, which will utilize an expanded numeric-alphanumeric coding system. How ever, the official coding system in use in t... |
Introduction 13 hance understanding of disease origins and pathophysiological commonalities between disorders and provide a base for future replication wherein data can be reanalyzed over time to continua )ly assess validity. Ongoing revisions of DSM-5 will make it a "living doc ument," adaptable to future discoveries... |
14 Introduction Cultural Issues Mental disorders are defined in relation to cultural, social, and familial norms and values. Culture provides interpretive frameworks that shape the experience and expression of the symptoms, signs, and behaviors that are criteria for diagnos is. Culture is transmitted, re vised, and re... |
Introduction 15 These three concepts (for which discussion and examples are provided in Section III and the Appenqix) suggest cultural ways of understanding and describing illness experi ences that can be elicited in the clinical encounter. They influence symptomatology, help seeking, clinical presentations, expectati... |
16 Introduction reason that the criteria are not met for a specific disorder, then "unspecified depressi ve disorder" would be diagnosed. Note that the differentiation between other specified and unspecified disorders is based on the clinician's decision, providing maximum flexibility for diagnos is. Clinicians do not ... |
Introduction 17 Onlin e Enhancemen ts It was challeng ing to determine what to include in the print version of DSM-5 to be most clinically relevant and useful and at the same time maintain a manageable size. For this reason, the inclusion of clinical rating scales and measures in the print edition is limited to those c... |
Use of the Man ual The introd uction contains much of the history and developmental process of the DSM-5 revision. This section is designed to provide a practical guide to using DSM-5, par ticularly in clinical practice. The primary purpose of DSM-5 is to assist trained clinicians in the diagnosis of their patients' m... |
20 Use of the Manual mania, depression, anxiety, substance intoxication, or neurocognitive symptoms-so that an "unspecified" disorder in that category is identified until a fuller differential diagnosis is possible. Definition of a Men tal Disorder Each disorder identified in Section II of the manual (excluding those i... |
Use of the Manual 21 Crit erion for Ciin ical Sign ificance There have beeh substantial efforts by the DSM-5 Task Force and the World Health Orga nization (WHO) to separate the concepts of mental disorder and disability (impairment in social, occupational, or other important areas of functioni ng). In the WHO system, ... |
22 Use of the Manual individuals with the disorder who share certain features (e. g., major depressive disorder, with mixed features) and to convey information that is relevant to the management of the individual's disorder, such as the "with other medical comorbidity" specifier in sleep wake disorders. Although a fif... |
Use of the Manual 23 be considered "principal" for an individual hospitalized with both schizophrenia and al cohol use disorer, because each condition may have contributed equally to the need for admission and treatment. The principal diagnosis is indicated by listing it first, and the re maining disorders are listed... |
24 Use of the Manual ment tools, a cultural formulation interview, and conditions for further study included in Section III are those for which we determined that the scientific evidence is not yet avail able to support widespread clinical use. These diagnostic aids and criteria are included to highlight the evolution... |
Cauti onary State men t for For ensi c Use of DS M-5 Although the DSM-5 diagnostic criteria and text are primarily designed to assist clinicians in conducting clinical assessment, case formulation, and treatment planning, DSM-5 is also used as a reference for the courts and attorneys in assessing the forensic con sequ... |
SECTION II Diagnostic Criteria and Codes Neur odevelo pmental Disorder s................................. 31 Sch izophr enia Spe ctrum and Other Psychotic Disor ders........... 87 Bipolar and Related Disor ders................................. 123 Depr essive Disor ders........................................ 155 Anxie... |
I his section contains the diagnostic criteria approved for routine clinical use along with the ICD-9-CM codes (ICD-1 0 codes are shown parentheti cally). For each mental disorder, the diagnostic criteria are followed by descriptive text to assist in diagnostic decision making. Where needed, specific recording procedur... |
Neurodevelo pmen tal Disorders The neur ode velopmen tal disorders are a group of conditions with onset in the developmental period. The disorders typically manifest early in development, often be fore the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, ... |
32 Neurodevelopmen tal Disorders be met based on historical information, although the current presentation must cause sig nificant impairment. Within the diagnosis of autism spectrum disorder, individual clinical characteristics are noted through the use of specifiers (with or without accompanying intellectual impair... |
Intellectual Disability (Intellectual Developmen tal Disorder) 33 cians an opportunity to document factors that may have played a role in the etiology of the disorder, as wll as those that might affect the clinical course. Examples include genetic disorders, such as fragile X syndrome, tuberous sclerosis, and Rett synd... |
TABLE 1 Severity levels for intellectu al disabi lity {intellectu al dev elopm ental disor der) Severity level Conceptual domain Social domain Practical domain Mild For preschool children, there Compared with typically developing age-The individual may function age-appropriately in may be no obvious conceptual mates, t... |
TABLE 1 Severity levels for intellectual disability (intellectual developmen tal disorder) (continued) Severity level Conceptual domain Social domain Practical domain Moderate All through development, the The individual shows marked differences from The individual can care for personal needs involving individual's conc... |
TABLE 1 Severity levels for intellectual disability (intellectual developmen tal disorder) (continued) Severity level Concep tual domain Severe Attainment of conceptual skills is limited. The individual gen-erally has little understanding of written language or of con-cepts involving numbers, quantity, time, and money.... |
Intellectual Disability (Intellectual Developmen tal Disorder) 37 Diagno stic Featu res The essential features of intellectual disability (intellectual developmental disorder) are deficits in general mental abilities (Criterion A) and impairment in everyday adaptive functioning, in comparison to an individual's age-, g... |
38 Neurodevelopmental Disorders factors (e. g., sensory impairment, severe problem behavior), the individual may be diag nosed with unspecif ied intellectual disabilit y. Adaptive functioning may be difficult to assess in a controlled setting (e. g., prisons, detention centers); if possible, corroborative in formatio... |
Intellectual Disabi lity (Intellectual Developmental Disorder) 39 others (e. g., San Phillippo syndrome) progressive worsening of intellectual function. After early childhood, the disorder is generally lifelong, although severity levels may change over time. The course may be influenced by underlying medical or genetic... |
40 Neurodevelopmental Disorders genetic or medical condition. A genetic syndrome linked to intellectual disability should be noted as a concurrent diagnosis with the intellectual disability. Major and mild neurocognitive disorders. Intellectual disability is categorized as a neu rodevelopmental disorder and is distinc... |
Global Developmental Delay 41 manual. The AAIDD's classification is multidimensional rather than categorical and is based on the disability construct. Rather than listing specifiers as is done in DSM-5, the AAIDD emphasizes a profile of supports based on severity. Glob al Developm ental Dela y 315. 8 (F88) This diagnos... |
42 Neurodevelopmental Disorders Language Disorder Dia gnostic Criteria 315. 39 (F80. 9) A. Persistent difficulties in the acquisition and use of language across modalities (i. e., spoken, written, sign language, or other) due to deficits in comprehension or produc tion that include the following: 1. Reduced vocabulary... |
Language Disorder 43 Assoc iated Featu res Supp orting Diagnosis A positive family history of language disorders is often present. Individuals, even chil dren, can be adept at accommodating to their limited language. They may appear to be shy or reticent to talk. Affected individuals may prefer to commun icate only wi... |
44 Neurodevelopmental Disorders Comor bidity Language disorder is strongly associated with other neurodevelop mental disorders in terms of specific learning disorder (literacy and numeracy), attention-defi cit/hyperactiv ity disorder, autism spectrum disorder, and developmental coordination disorder. It is also associ... |
Childhood-Onset Fluency Disorder (Stut tering) 45 developmental pattern, which is reflected in the age norms of standardized tests. It is not unusual for typcally developing children to use developmental processes for shortening words and syllables as they are learning to talk, but their progression in mastering speech... |
46 Neurodevelopmental Disorders 3. Broken words (e. g., pauses within a word). 4. Audible or silent blocking (filled or unfilled pauses in speech). 5. Circumlocutions (word substitutions to avoid problematic words). 6. Words produced with an excess of physical tension. 7. Monosyllabic whole-word repetitions (e. g., "1-... |
Social (Pragmatic) Commun ication Disorder 47 cover from the dysfluency, with severity of fluency disorder at age 8 years predicting re covery or persis,_tence into adolescence and beyond. Risk and Prognos tic Factors Genetic and physiologic al. The risk of stuttering among first-degree biological rela tives of indiv... |
48 Neurodevelopmental Disorders 4. Difficulties understanding what is not explicitly stated (e. g., making inferences) and nonliteral or ambiguous meanings of language (e. g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation). B. The deficits result in functional limitations in ... |
Unspecified Communication Disorder 49 Differ ential Diagnosis \ Autism spectrum disorder. Autism spectrum disorder is the primary diagnostic con-sideration for individuals presenting with social communication deficits. The two disor ders can be differentiated by the presence in autism spectrum disorder of restricted /... |
50 Neurodevelopmen tal Disorder s Autism Spectru m Disor der Autism Spectru m Disor der Dia gnos tic Criteria 299. 00 (F84. 0 ) A. Persistent deficits in social communication and social interaction across multiple con texts, as manifested by the following, currently or by history (examples are illustrative, not exhaus... |
Autism Spectrum Disorder 51 E. These disturbances are not better explained by intellectual disability (intellectual devel opmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spec trum disorder and intellectual... |
TABLE 2 Severity lev els for autism spectrum disorder Severity level Level3 "Requiring very substantial support" Level2 "Requiring substantial support" Levell "Requiring support" Social communication Severe deficits in verbal and nonverbal social com munication skills cause severe impairments in func tioning, very li... |
Autism Spectrum Disorder 53 To use the specifier "with or without accompanying language impairment," the cur rent level of verbal functioning should be assessed and described. Examples of the specific descriptions for'"with accompanying language impairment" might include no intelligible speech (nonverbal), single word... |
54 Neurodevelopmen tal Disorder s Deficits in nonverbal communicative behaviors used for social interaction are mani fested by absent, reduced, or atypical use of eye contact (relative to cultural norms), ges tures, facial expressions, body orientation, or speech intonation. An early feature of autism spectrum disord... |
Autism Spectrum Disorder 55 Criterion D requires that the features must cause clinically significant impairment in so cial, occupation!, or other important areas of current functioning. Criterion E specifies that the social communication deficits, although sometimes accompanied by intellectual disabil ity (intellectu... |
56 Neurodevelopmental Disorders second birthday (see also Rett syndrome in the section "Differential Diagnos is" for this disorder). First symptoms of autism spectrum disorder frequently involve delayed language de velopment, often accompanied by lack of social interest or unusual social interactions (e. g., pulling i... |
Autism Spectrum Disorder 57 Genetic and physiological. Heritability estimat es for autism spectrum disorder have ranged from 37°/ to higher than 90%, based on twin concordance rates. Currently, as many as 15% of cases of autism spectrum disorder appear to be associated with a known genetic mutation, with different de n... |
58 Neurodevelopmen tal Disorder s Language disorders and social (pragmatic) communication disorder. In some forms of language disorder, there may be problems of communication and some secondary so cial difficulties. However, specific language disorder is not usually associated with abnor mal nonverbal communication, ... |
Attention-Defici VHype ractivity Disorder 59 disorders, and other comorbid diagnoses. Among individuals who are nonverbal or have language deficits, observable signs such as changes in sleep or eating and increases in chal lenging behavior should trigger an evaluation for anxiety or depression. Specific learning dif ... |
60 Neurodevelopmental Disorders 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have per sisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solel... |
Attention-Deficit/H yperactivity Disorder 61 Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms tl)at are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning. Diagno stic Featu res The essential feature of attentio... |
62 Neurodevelopmental Disorders Dev elop ment and Cou rse Many parents first observe excessive motor activity when the child is a toddler, but symp toms are difficult to distinguish from highly variable normative behaviors before age 4 years. ADHD is most often identified during elementa ry school years, and inattenti... |
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