DSM-5-TR Neurodevelopmental Disorders

Intellectual Developmental Disorder (Intellectual Disability)

Intellectual developmental disorder (intellectual disability) is a disorder with onset
during the developmental period that includes both intellectual and adaptive
functioning deficits in conceptual, social, and practical domains. The following three
criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving, planning,
abstract thinking, judgment, academic learning, and learning from experience,
confirmed by both clinical assessment and individualized, standardized
intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and
sociocultural standards for personal independence and social responsibility.
Without ongoing support, the adaptive deficits limit functioning in one or more
activities of daily life, such as communication, social participation, and
independent living, across multiple environments, such as home, school, work,
and community.
C. Onset of intellectual and adaptive deficits during the developmental period.
Specify severity (mild, moderate, severe, profound)

Global Developmental Delay

This diagnosis is reserved for individuals under the age of 5 years when the clinical
severity level cannot be reliably assessed during early childhood. This category is
diagnosed when an individual fails to meet expected developmental milestones in
several areas of intellectual functioning, and applies to individuals who are unable to
undergo systematic assessments of intellectual functioning, including children who
are too young to participate in standardized testing. This category requires
reassessment after a period of time.

Unspecified Intellectual Developmental Disorder (Intellectual Disability)

This category is reserved for individuals over the age of 5 years when assessment of
the degree of intellectual developmental disorder (intellectual disability) by means of locally available procedures is rendered difficult or impossible because of associated
sensory or physical impairments, as in blindness or prelingual deafness; locomotor
disability; or presence of severe problem behaviors or co-occurring mental disorder.
This category should only be used in exceptional circumstances and requires
reassessment after a period of time.

Language Disorder

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 production that include the following:
1. Reduced vocabulary (word knowledge and use).
2. Limited sentence structure (ability to put words and word endings together to
form sentences based on the rules of grammar and morphology).
3. Impairments in discourse (ability to use vocabulary and connect sentences to
explain or describe a topic or series of events or have a conversation).
B. Language abilities are substantially and quantifiably below those expected for
age, resulting in functional limitations in effective communication, social
participation, academic achievement, or occupational performance, individually
or in any combination.
C. Onset of symptoms is in the early developmental period.
D. The difficulties are not attributable to hearing or other sensory impairment, motor
dysfunction, or another medical or neurological condition and are not better
explained by intellectual developmental disorder (intellectual disability) or global
developmental delay.

Speech Sound Disorder

A. Persistent difficulty with speech sound production that interferes with speech
intelligibility or prevents verbal communication of messages.
B. The disturbance causes limitations in effective communication that interfere with
social participation, academic achievement, or occupational performance,
individually or in any combination.
C. Onset of symptoms is in the early developmental period.
D. The difficulties are not attributable to congenital or acquired conditions, such as
cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or
other medical or neurological conditions.

Childhood-Onset Fluency Disorder (Stuttering)

A. Disturbances in the normal fluency and time patterning of speech that are
inappropriate for the individual's age and language skills, persist over time, and
are characterized by frequent and marked occurrences of one (or more) of the
following:
1. Sound and syllable repetitions.
2. Sound prolongations of consonants as well as vowels.
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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., "I-I-I-I see him").
B. The disturbance causes anxiety about speaking or limitations in effective
communication, social participation, or academic or occupational performance,
individually or in any combination.
C. The onset of symptoms is in the early developmental period. (Note: Later-onset
cases are diagnosed as F98.5 adult-onset fluency disorder.)
D. The disturbance is not attributable to a speech-motor or sensory deficit,
dysfluency associated with neurological insult (e.g., stroke, tumor, trauma), or
another medical condition and is not better explained by another mental
disorder.

Social (Pragmatic) Communication Disorder

A. Persistent difficulties in the social use of verbal and nonverbal communication as
manifested by all of the following:
1. Deficits in using communication for social purposes, such as greeting and
sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the
needs of the listener, such as speaking differently in a classroom than on a
playground, talking differently to a child than to an adult, and avoiding use of
overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking
turns in conversation, rephrasing when misunderstood, and knowing how to
use verbal and nonverbal signals to regulate interaction.
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 effective communication, social
participation, social relationships, academic achievement, or occupational
performance, individually or in combination.
C. The onset of the symptoms is in the early developmental period (but deficits may
not become fully manifest until social communication demands exceed limited
capacities).
D. The symptoms are not attributable to another medical or neurological condition
or to low abilities in the domains of word structure and grammar, and are not
better explained by autism spectrum disorder, intellectual developmental
disorder (intellectual disability), global developmental delay, or another mental
disorder.

Unspecified Communication Disorder

This category applies to presentations in which symptoms characteristic of
communication disorder that cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning predominate but do not
meet the full criteria for communication disorder or for any of the disorders in the
neurodevelopmental disorders diagnostic class. The unspecified communication
disorder category is used in situations in which the clinician chooses not to specify
the reason that the criteria are not met for communication disorder or for a specific
neurodevelopmental disorder, and includes presentations in which there is
insufficient information to make a more specific diagnosis.

Autism Spectrum Disorder

A. Persistent deficits in social communication and social interaction across multiple
contexts, as manifested by all of the following, currently or by history (examples
are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal
social approach and failure of normal back-and-forth conversation; to reduced
sharing of interests, emotions, or affect; to failure to initiate or respond to
social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction,
ranging, for example, from poorly integrated verbal and nonverbal
communication; to abnormalities in eye contact and body language or deficits
in understanding and use of gestures; to a total lack of facial expressions and
nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging,
for example, from difficulties adjusting behavior to suit various social contexts;
to difficulties in sharing imaginative play or in making friends; to absence of
interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested
by at least two of the following, currently or by history (examples are illustrative,
not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g.,
simple motor stereotypies, lining up toys or flipping objects, echolalia,
idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized
patterns of verbal or nonverbal behavior (e.g., extreme distress at small
changes, difficulties with transitions, rigid thinking patterns, greeting rituals,
need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g.,
strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory
aspects of the environment (e.g., apparent indifference to pain/temperature,
adverse response to specific sounds or textures, excessive smelling or
touching of objects, visual fascination with lights or movement).
C. Symptoms must be present i

Attention-Deficit/Hyperactivity Disorder

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes
with functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted 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 solely a manifestation of oppositional behavior,
defiance, hostility, or failure to understand tasks or instructions. For older
adolescents and adults (age 17 and older), at least five symptoms are
required.
a. Often fails to give close attention to details or makes careless mistakes in
schoolwork, at work, or during other activities (e.g., overlooks or misses
details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has
difficulty remaining focused during lectures, conversations, or lengthy
reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems
elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (e.g., starts tasks but
quickly loses focus and is easily sidetracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing
sequential tasks; difficulty keeping materials and belongings in order;
messy, disorganized work; has poor time management; fails to meet
deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (e.g., schoolwork or homework; for older
adolescents and adults, preparing reports, completing forms, reviewing
lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school materials,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older adolescents and
adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running errands; for
older adolescents and adults, returning calls, paying bills, keeping
appointments).
2. Hyperactivity and impulsivity:

Other Specified Attention-Deficit/Hyperactivity Disorder

This category applies to presentations in which symptoms characteristic of attentiondeficit/
hyperactivity disorder that cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning predominate but do not
meet the full criteria for attention-deficit/hyperactivity disorder or any of the disorders
in the neurodevelopmental disorders diagnostic class. The other specified attentiondeficit/
hyperactivity disorder category is used in situations in which the clinician
chooses to communicate the specific reason that the presentation does not meet the
criteria for attention-deficit/hyperactivity disorder or any specific neurodevelopmental
disorder. This is done by recording "other specified attention-deficit/hyperactivity
disorder" followed by the specific reason (e.g., "with insufficient inattention
symptoms").

Unspecified Attention-Deficit/Hyperactivity Disorder

This category applies to presentations in which symptoms characteristic of attentiondeficit/
hyperactivity disorder that cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning predominate but do not
meet the full criteria for attention-deficit/hyperactivity disorder or any of the disorders
in the neurodevelopmental disorders diagnostic class. The unspecified attentiondeficit/
hyperactivity disorder category is used in situations in which the clinician
chooses not to specify the reason that the criteria are not met for attentiondeficit/
hyperactivity disorder or for a specific neurodevelopmental disorder, and
includes presentations in which there is insufficient information to make a more
specific diagnosis.

Specific Learning Disorder

A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months,
despite the provision of interventions that target those difficulties:
1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud
incorrectly or slowly and hesitantly, frequently guesses words, has difficulty
sounding out words).
2. Difficulty understanding the meaning of what is read (e.g., may read text
accurately but not understand the sequence, relationships, inferences, or
deeper meanings of what is read).
3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or
consonants).
4. Difficulties with written expression (e.g., makes multiple grammatical or
punctuation errors within sentences; employs poor paragraph organization;
written expression of ideas lacks clarity).
5. Difficulties mastering number sense, number facts, or calculation (e.g., has
poor understanding of numbers, their magnitude, and relationships; counts on
fingers to add single-digit numbers instead of recalling the math fact as peers
do; gets lost in the midst of arithmetic computation and may switch
procedures).
6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying
mathematical concepts, facts, or procedures to solve quantitative problems).
B. The affected academic skills are substantially and quantifiably below those
expected for the individual's chronological age, and cause significant
interference with academic or occupational performance, or with activities of
daily living, as confirmed by individually administered standardized achievement
measures and comprehensive clinical assessment. For individuals age 17 years
and older, a documented history of impairing learning difficulties may be
substituted for the standardized assessment.
C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the
individual's limited capacities (e.g., as in timed tests, reading or writing lengthy
complex reports for a tight deadline, excessively heavy academic loads).
D. The learning difficulties are not better accounted for by int

Developmental Coordination Disorder

A. The acquisition and execution of coordinated motor skills is substantially below that expected given the individual's chronological age and opportunity for skill
learning and use. Difficulties are manifested as clumsiness (e.g., dropping or
bumping into
objects) as well as slowness and inaccuracy of performance of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or
participating in sports).
B. The motor skills deficit in Criterion A significantly and persistently interferes with
activities of daily living appropriate to chronological age (e.g., self-care and selfmaintenance)
and impacts academic/school productivity, prevocational and
vocational activities, leisure, and play.
C. Onset of symptoms is in the early developmental period.
D. The motor skills deficits are not better explained by intellectual developmental
disorder (intellectual disability) or visual impairment and are not attributable to a
neurological condition affecting movement (e.g., cerebral palsy, muscular
dystrophy, degenerative disorder).

Stereotypic Movement Disorder

A. Repetitive, seemingly driven, and apparently purposeless motor behavior (e.g.,
hand shaking or waving, body rocking, head banging, self-biting, hitting own
body).
B. The repetitive motor behavior interferes with social, academic, or other activities
and may result in self-injury.
C. Onset is in the early developmental period.
D. The repetitive motor behavior is not attributable to the physiological effects of a
substance or neurological condition and is not better explained by another
neurodevelopmental or mental disorder (e.g., trichotillomania [hair-pulling
disorder], obsessive-compulsive disorder).
Specify if:
With self-injurious behavior (or behavior that would result in an injury if
preventive measures were not used)
Without self-injurious behavior
Specify if:
Associated with a known genetic or other medical condition,
neurodevelopmental disorder, or environmental factor (e.g., Lesch-Nyhan
syndrome, intellectual developmental disorder [intellectual disability], intrauterine
alcohol exposure)
Coding note: Use additional code to identify the associated genetic or other
medical condition, neurodevelopmental disorder, or environmental factor.
Specify current severity:
Mild: Symptoms are easily suppressed by sensory stimulus or distraction.
Moderate: Symptoms require explicit protective measures and behavioral
modification.
Severe: Continuous monitoring and protective measures are required to prevent
serious injury.

Tourette's Disorder

A. Both multiple motor and one or more vocal tics have been present at
some time during the illness, although not necessarily concurrently.
B. The tics may wax and wane in frequency but have persisted for more than 1 year
since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of a substance
(e.g., cocaine) or another medical condition (e.g., Huntington's disease, postviral
encephalitis).

Persistent (Chronic) Motor or Vocal Tic Disorder

A. Single or multiple motor or vocal tics have been present during the
illness, but not both motor and vocal.
B. The tics may wax and wane in frequency but have persisted for more than 1 year
since first tic onset.
F95.0
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of a substance
(e.g., cocaine) or another medical condition (e.g., Huntington's disease, postviral
encephalitis).
E. Criteria have never been met for Tourette's disorder.
Specify if:
With motor tics only
With vocal tics only

Provisional Tic Disorder

A. Single or multiple motor and/or vocal tics.
B. The tics have been present for less than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of a substance
(e.g., cocaine) or another medical condition (e.g., Huntington's disease, postviral
encephalitis).
E. Criteria have never been met for Tourette's disorder or persistent (chronic) motor
or vocal tic disorder.

Other Specified Tic Disorder

This category applies to presentations in which symptoms characteristic of a tic
disorder that cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning predominate but do not meet
the full criteria for a tic disorder or any of the disorders in the neurodevelopmental
disorders diagnostic class. The other specified tic disorder category is used in
situations in which the clinician chooses to communicate the specific reason that the
presentation does not meet the criteria for a tic disorder or any specific
neurodevelopmental disorder. This is done by recording "other specified tic disorder"
followed by the specific reason (e.g., "with onset after age 18 years").

Unspecified Tic Disorder

This category applies to presentations in which symptoms characteristic of a tic
disorder that cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning predominate but do not meet
the full criteria for a tic disorder or for any of the disorders in the neurodevelopmental
disorders diagnostic class. The unspecified tic disorder category is used in situations
in which the clinician chooses not to specify the reason that the criteria are not met
for a tic disorder or for a specific neurodevelopmental disorder and includes
presentations in which there is insufficient information to make a more specific
diagnosis.

Other Specified Neurodevelopmental Disorder

This category applies to presentations in which symptoms characteristic of a
neurodevelopmental disorder that cause impairment in social, occupational, or other
important areas of functioning predominate but do not meet the full criteria for any of
the disorders in the neurodevelopmental disorders diagnostic class. The other
specified neurodevelopmental disorder category is used in situations in which the
clinician chooses to communicate the specific reason that the presentation does not
meet the criteria for any specific neurodevelopmental disorder. This is done by
recording "other specified neurodevelopmental disorder" followed by the specific
reason (e.g., "neurodevelopmental disorder associated with prenatal alcohol
exposure").
An example of a presentation that can be specified using the "other specified"
designation is the following:
Neurodevelopmental disorder associated with prenatal alcohol exposure:
Neurodevelopmental disorder associated with prenatal alcohol exposure is
characterized by a range of developmental disabilities following exposure to
alcohol in utero.

Unspecified Neurodevelopmental Disorder

This category applies to presentations in which symptoms characteristic of a
neurodevelopmental disorder that cause impairment in social, occupational, or other
important areas of functioning predominate but do not meet the full criteria for any of
the disorders in the neurodevelopmental disorders diagnostic class. The unspecified
neurodevelopmental disorder category is used in situations in which the clinician
chooses not to specify the reason that the criteria are not met for a specific
neurodevelopmental disorder and includes presentations in which there is
insufficient information to make a more specific diagnosis (e.g., in emergency room settings).