Neurodevelopmental Disorders

Intellectual Developmental Disorder

A. Deficits in intellectual functions (such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, learning from experience), confirmed by both clinical assessment and individualized, standard intelligence testing
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility
C. Onset of intellectual and adaptive deficits occur during the developmental period
Mild
Moderate
Severe
Profound

Global Developmental Delay

- Diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood
- 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

Unspecified Intellectual Developmental Disorder (Intellectual Disorder)

- This category is reserved for individuals over the age of 5 years when assessment of the degree of intellectual developmental disorder 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
- 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, write, 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 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 attributed 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 pattering 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
3. Broken words
4. Audible or silent blocking
5. Circumlocutions (word substitutions to avoid problematic words)
6. Word produced with an excess of physical tension
7. Monosyllabic whole-word repetitions
B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individuality or in any combination
C. The onset of symptoms is in the early developmental period
D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult, or another medical condition that 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 conversations 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 (making references) and nonliteral ambiguous meaning of language (idioms, humor, metaphors, etc.)
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 development 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 work structure and grammar, and are not better explained by ASD, IDD, GDD, 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
- 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:
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 affects; 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, running, 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 behaviors, interests, or activities, as manifested by at least two of the following, currently or by history
1 . Stereotyped or repetitive motor movements, use of objects, or speech
2. Instances of sameness, inflexible adherence to routines, or ritualized patterns of nonverbal behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper- or hyporeactivity to sensory input to unusual interest in sensory aspects of the environment
C. Symptoms must be present in the early developmental period
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
E. These disturbances are not better explained by IDD or GDD
- Specify if:
Requiring very substantial support - level 3
Requiring substantial support

Requiring Support

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 (For over the age of 17, at least 5 must occur):
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities
b. Often has difficulty sustaining attention in tasks or play activities
c. Often does not seem to listen when spoken to directly
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
e. Often has difficulty organizing tasks and activities
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
g. Often loses things necessary for tasks or activities
h. Is often easily distracted by extraneous stimuli
i. Is often forgetful in daily activities
2. Hyperactivity and impulsivity: 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 (For over the age of 17, at least 5 must occur):
a. Often fidgets with or taps hands or feet or squirms in seat
b. Often leaves seat in situations when remaining seated is expected
c. Often turns about or climbs in situations where it is inappropriate
d. Often unable to play or engage in leisure activities quietly
e. Is often "on the go," acting as if "driven by a motor"
f. Often talks excessively
g. Often blurts out an answer before a question has been completed
h. Often has difficulty waiting turn

i. Often interrupts or intrudes on others

B. Several symptoms present prior to age 12

C. Several symptoms are present in two or more settings

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

Other Specified Attention-Deficit/Hyperactivity Disorder

- This category applies to presentations in which symptoms characteristic of ADHD 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 ADHD or any disorders in the neurodevelopmental disorders diagnostic class
- Used when the clinician chooses to communicate the specific reason the presentation does not meet the criteria for ADHD or neurodevelopmental disorder

Unspecified Attention-Deficit/Hyperactivity Disorder

- This category applies to presentations in which symptoms characteristic of ADHD 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 ADHD or any disorders in the neurodevelopmental disorders diagnostic class
- Used when the clinician chooses not to specify the reason that the criteria is not met for ADHD or 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 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
2. Difficulty understanding the meaning of what is read
3. Difficulties with spelling
4. Difficulties with written expression
5. Difficulties mastering number sense, number facts, or calculation
6. Difficulties with mathematical reasoning
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 17 years of age 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
D. The learning difficulties are not better accounted for by IDs, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction
(The four criteria are meant to be based on a clinical synthesis of the individual's history, school reports, and psychoeducational assessment)
- Specify if:
With impairment in reading:
Word reading accuracy
Reading rate or fluency
Reading comprehension
With impairment in written expression:
Spelling accuracy
Grammar and punctuation accuracy
Clarity or organization of written expression

With impairment in math:

Number sense

Memorization of arithmetic facts

Accurate or fluent calculation

Accurate math reasoning

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, slowness, and inaccuracy of performance of motor skills
B. The motor skills deficit in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age and impacts academic/school productivity, revocation 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 or visual impairment and are not attributable to a neurological condition affecting movement

Stereotypic Movement Disorder

A. Repetitive, seemingly driven, and apparently purposeless motor behavior
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 attributed to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder
- Specify if:
With self-injurious behavior
Without self-injurious behavior
- Specify if:
Associated with a known genetic or other medical condition, neurodevelopmental disorder, or environmental factor
- Specify current severity:
Mild
Moderate
Severe

What is a tic?

A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization

Tourette's Disorder

A. Both multiple motor and one or more vocal tics have been present at some time during multiple 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 or another medical condition

Persistent (Chronic) Motor or Vocal Tic Disorder

A. Single or multiple motor or vocal tics have been present during 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
C. Onset is before age 18 years
D. The disturbance is not attributable to the physiological effects of a substance or another medical condition
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 or another medical condition
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 neurodevelopmental disorder
- Used when the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for a tic disorder or neurodevelopmental disorder
This is done by recording "other specified tic disorder" followed by the specific reason

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 neurodevelopmental disorder
- Used when the clinician does not choose to specify the reason that the presentation does not meet the criteria for a tic disorder or neurodevelopmental disorder and includes presentations in which there is insufficient information to make a specific diagnosis

Other Specified Neurodevelopmental Disorders

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