Neurodevelopmental disorders

Diagnostic and Statistical Manual of Mental Disorders

DSM (Full meaning)

American Psychological Association

DSM 1V-TR was published by?

Axis I - Clinical Syndrome

top-level diagnosis that usually represents the acute symptoms that needs treatment

Axis II - Developmental Disorders and Personality Disorders

assessment of personality disorders and intellectual disabilities

Axis II - Developmental Disorders and Personality Disorders

disorders from this axis are usually life-long problems that first arise in childhood

Axis II - Developmental Disorders and Personality Disorders

disorders on this axis are accompanied by considerable social stigma because they are suffered by people who often fail to adapt well to society

Axis III - General Medical Conditions

this axis describes physical problems that may be relevant for diagnosing and treating mental disorders

Axis IV - Global Assessment Functioning Scale

this axis is a reflection of the evaluating clinician’s judgement of a patient’s ability to function in daily life

100 - 91

Superior Functioning in a wide range of activities; life problems never seem to get out of hand; sought out by others because of his/her many positive qualities; no symptoms

90 - 81

Absent minimal symptoms; good functioning in all areas; interested and involved in a wide range of activities; socially effective; generally satisfied with life; no more than everyday problems or concerns

80 - 71

If symptoms are present, they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in functioning

70 - 61

Some mild symptoms or some difficulty in social, occupational, or school functioning

60 - 51

Moderate symptoms or moderate difficulty in functioning

50 - 41

serious symptoms or serious impairment in functioning

40 - 31

some impairment in reality testing or communication or major impairment in several areas; (depressed)

30 - 21

Behavior is considerably influenced by hallucinations or delusions; inability to function in almost all areas

20 - 11

some danger of hurting self or others; gross impairment in communication (largely incoherent or mute; occasionally fails to maintain personal hygiene

10 - 1

persistent danger of severely hurting themselves or others’ persistent inability to maintain minimal personal hygiene; serious suicidal act with clear expectation of death

DSM 5

Published in 2015 by APA

DSM 5

It is intended to assist researchers, healthcare providers, insurance providers, regulatory institutions, and other parties in the medical field in guiding treatment of mental health issues.

Disruptive Mood Dysregulation Disorder

previously childhood bipolar disorder in DSM 1V

Neurocognitive Disorder.

dementia and the category of memory/learning have been subsumed into a new category

Externalizing disorders

classified by outward-directed behaviors

Externalizing disorders

non-compliance, aggressiveness, overactivity, impulsiveness

Externalizing disorders

includes attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder

Externalizing disorders

more common in boys

Internalizing disorders

characterized by inward-focused behaviors

Internalizing disorders

eg: anxiety, social withdrawal, depression

Internalizing disorders

includes chilhood anxiety and mood disorders; most common in girls

Intellectual Disability or Intellectual Developmental Disorder

previously called mental retardation which is not preferred due to stigma

Intellectual Disability or Intellectual Developmental Disorder

characterized by significant, below average intelligence and adaptive functioning

Intellectual Disability or Intellectual Developmental Disorder

classified as mild (50-55 to 70), moderate (35-40 to 50-55), severe (20-25 to 35-40), pr profound (below 20-25) based on the overall functioning

Global developmental delay

children younger than 5 years with severe defects exceeding those above

Borderline intellectual functioning

condition that may be the focus of clinical attention, but no criteria are given.

Down syndrome

Etiology: Neurological factors - chromosomal trisomy 21 (extra copy of chromosome 21) so 47 instead of 46

Fragile-X syndrome

Etiology: Neurological factors - mutation in the fMRI gene on the X chromosome

Recessive - gene disease

Etiology: Neurological factors - phenylketonuria (PKU)

Maternal Infectious Disease (first trimester)

Etiology: Neurological factors - cytomegalovirus, toxoplasmosis, rubella, herpes simplex, HIV, sy

Language Disorder

Communication disorder - developmental impairment in vocabulary resulting in difficulty producing age-appropriate sentences

speech sound disorder

Communication disorder - (phonological disorder) difficulty in articulation

childhood-onset fluency disorder or stuttering

Communication disorder - characterized by difficulty in fluency, rate, and rhythm of speech

social or pragmatic communication disorder

Communication disorder - difficulty in communication and interaction with peers

Autism Spectrum Disorder

characterized by severe difficulties in multiple developmental areas (social relatedness, communication, and range of activity and repetitive and stereotypical patterns of behavior

Level I ASD

Autism Spectrum Disorder - characterized by the ability to speak with reduced social interactions

Level II ASD

Autism Spectrum Disorder - minimal speech and minimal social interaction (Rett’s Disorder. DSM 4)

Level III ASD

total lack of speech and no social interaction

Autism Spectrum Disorder

rarely approach others

Autism Spectrum Disorder

problems in joint attention

Autism Spectrum Disorder

pay attention to different parts of faces than do people without autism, they focus on the mouth, neglecting the eye region (this neglect contributes to difficulties in perceiving emotions in other people

Autism Spectrum Disorder

Theory of Mind - understanding that other people have different desires, beliefs, intentions, and emotions

Autism Spectrum Disorder

Theory of Mind - crucial for understanding and successfully engaging in social interactions

Autism Spectrum Disorder

Theory of Mind - typically develops between 2 ½ and 5 years of age

Autism Spectrum Disorder

Theory of Mind - children with this disorder seem not to achieve this developmental milestone

Autism Spectrum Disorder

Communication Deficits - children with this disorder evidence early language disturbances

Echolalia

immediate or delayed repetition of what was heard

Autism Spectrum Disorder

Communication deficits - pronoun reversal and literal use of words

Autism Spectrum Disorder

Repetitive and Ritualistic Acts - becomes extremely upset when routine is altered

Autism Spectrum Disorder

Repetitive and Ritualistic Acts - engage in obsessional play and ritualistic body movements

Autism Spectrum Disorder

Repetitive and Ritualistic Acts - they become attached to inanimate objects

Autism Spectrum Disorder

Comorbidity - 1Q Less than 70 is common. they score poorly on all parts of IQ test and subtests related to language (abstract though. symbolism, sequential logic)

Autism Spectrum Disorder

Prevalence - 1 out of 100 children. Found in all SES, ethnic, and racial groups

Autism Spectrum Disorder

Prognosis - children with higher IQ who learn to speak before age of 6 have the best outcomes

Autism Spectrum Disorder

Genetic factors - estimates of around 80; 47 to 90% concordance rates of mz (identical) twins; deletion of chromosome 16

Autism Spectrum Disorder

Neurobiological Factors - brains of autistic adults and children are larger than normal

Autism Spectrum Disorder

Neurobiological factors - overgrown areas include frontal, temporal, and cerebellar, which have been linked with language, social, and emotional functions

Autism Spectrum Disorder

Neurobiological factors - abnormally sized amygdala predicted more difficulties in social behavior and communication

ADHD

one of the most frequently discussed psychiatric disorders in the lay media because of the sometimes unclear line between age-appropriate normal and disordered behavior and because of the concern that children without the disorder are being misdiagnosed and treated with medication

ADHD

the central features of the disorder are persistent inattention, hyperactivity and impulsivity or both that cause clinically significant impairment in functioning

ADHD - A

sic or more manifestation of inattention present for at least 6 months to a maladaptive degree and greater than what would be expected given a person’s developmental level (careless mistakes, not listening well, not following instructions, easily distracted, forgetful in daily activities

ADHD - B

six or more manifestations of hyperactivity - impulsivity present for atleast 6 months to a maladaptive degree and greater than what would be expected given a person’s developmental level (fidgeting, running about inappropriately, restlessness, acting as if driven by a motor, interrupting or intruding, incessant talking)

ADHD

present before age of 12

ADHD

present in two or more settings: home, work, school

ADHD

significant impairment in social, academic, or occupational functioning

ADHD

for people age 17 and older, only five signs of inattention and/or five signs of hyperactivity - impulsivity are required to meet the diagnosis

Predominantly inattentive type

THREE SPECIFIERS IN DSM-5 TO INDICATE WHICH SYMPTOMS PREDOMINATE IN ADHD, 1

Predominantly hyperactive-impulsive type

THREE SPECIFIERS IN DSM-5 TO INDICATE WHICH SYMPTOMS PREDOMINATE IN ADHD, 2

Combined Type

THREE SPECIFIERS IN DSM-5 TO INDICATE WHICH SYMPTOMS PREDOMINATE IN ADHD, 3

ADHD

often comorbid with anxiety and depression

ADHD

prevalence estimates 8 to 11% worldwide

ADHD

most common in boys, maybe because their behaviors are more likely to be aggressive

ADHD

symptoms persist beyond childhood and numerous longitudinal studies show 65 - 80% still exhibit symptoms. Also, 60% of adults continue to meet criteria for ADHD in remission

ADHD IN GIRLS

combined type had more disruptive behaviors than inattentive type

ADHD IN GIRLS

anxious and depressed: exhibit neurological deficits (poor planning, problem-solving); have symptoms of eating disorder and substance abuse

ADHD

Genetic factors - heritability estimates as high as 70 - 80% in adoption and twin studies

DRD4

two dopamine genes implicated

DAT1

Dopamine transporter gene

ADHD

Etiology - dopaminergic areas smaller in children with this disorder (frontal lobe, caudate nucleus, globus pallidus); poor performance on tests of frontal lobe function

ADHD

Perinatal and pre-natal factors - low birth weight: maternal tobacco and alcohol use

ADHD

Environmental toxins - nicotine from maternal smoking "(exposure to tobacco in utero is associated with symptoms and it may damage dopaminergic system, resulting in behavior disinhibition

Learning disability

evidence of inadequate development in a specific area of academic, language, speech, or motor skills

Learning Disability

not due to mental retardation, autism, physical disorder, or lack of educational opportunity

Learning Disability

usually of average or above average intelligence; often identified and treated in school

Learning Disability

reading disorder is more common than boys

Impairment in Reading

Dyslexia: difficulty in acquiring skills in reading

Impairment in Mathematics

difficulty in mathematics

Speech sound disorder

(phonological disorder) correct comprehension and sufficient vocabulary, but unclear speech and improper articulation. (Blue becomes bu, rabbit becomes wabbit) With speech therapy, complete recovery occurs in all cases, and milder ones may recover spontaneously by age of 8

Childhood-onset fluency disorder

disturbance in verbal fluency that is characterized by one or more ot the following speech patterns: frequent repetitions or prolongation of sounds, long pauses between words, substituting easy words for those that are difficult to articulate. Dsm 4 TR estimates that u[ to 80% of people with this disorder recover, most without prefessional intervention, before the age of 16

Tourette’s disorder

one or more vocal and multiple motor tics (rapid movements or sudden vocalizations) before the age of 18

Developmental coordination disorder

(motor skills disorder) marked impairment in the development of motor coordination that is not explainable by intellectual disability or a disorder such as cerebral palsy

Stereotypic movement disorder

involves seemingly purposeless movements repeated over and over that interfere with functioning and could even cause self injury