DSM-5-TR Neurodevelopmental Disorders

What are neurodevelopmental disorders

Conditions beginning during the developmental period that involve developmental deficits or differences in brain processes and impair personal / social / academic / occupational functioning

When do neurodevelopmental disorders typically appear

Early in development / often before the child enters school

What 2 things are required to diagnose a neurodevelopmental disorder

Symptoms / impaired functioning

Do neurodevelopmental disorders commonly co-occur

Yes / they frequently co-occur with one another and with other mental or behavioral disorders

What areas can neurodevelopmental deficits affect

Learning / executive functioning / communication / social skills / intellectual ability / motor functioning

What is intellectual developmental disorder

A developmental disorder involving deficits in both intellectual functioning and adaptive functioning

What 3 criteria are required for intellectual developmental disorder

Deficits in intellectual functions / deficits in adaptive functioning / onset during developmental period

What intellectual functions may be impaired in intellectual developmental disorder

Reasoning / problem solving / planning / abstract thinking / judgment / academic learning / learning from experience

How must intellectual deficits be confirmed

Clinical assessment plus individualized standardized intelligence testing

What is adaptive functioning

Ability to meet developmental and sociocultural standards for personal independence and social responsibility

What areas of life can adaptive deficits limit

Communication / social participation / independent living / school / work / community functioning

What are the 3 adaptive functioning domains

Conceptual / social / practical

What is the conceptual adaptive domain

Memory / language / reading / writing / math reasoning / practical knowledge / problem solving / judgment in new situations

What is the social adaptive domain

Awareness of others / empathy / interpersonal communication / friendships / social judgment

What is the practical adaptive domain

Personal care / job responsibilities / money management / recreation / behavior management / organization of school and work tasks

When must intellectual and adaptive deficits begin for intellectual developmental disorder

During the developmental period

What are the 4 severity levels of intellectual developmental disorder

Mild / moderate / severe / profound

What determines intellectual developmental disorder severity

Adaptive functioning rather than IQ score

Why is intellectual developmental disorder severity based on adaptive functioning

Adaptive functioning determines the amount of support the person requires

Is IQ alone sufficient to diagnose intellectual developmental disorder

No / clinical judgment and adaptive functioning are essential

What IQ range is commonly associated with intellectual developmental disorder

Approximately 70 plus or minus 5 / but IQ alone does not establish diagnosis

Why must IQ tests be interpreted cautiously

Measurement error / cultural and language differences / outdated norms / communication problems / sensory or motor problems can affect scores

What is the Flynn effect

IQ scores may appear artificially high when outdated test norms are used

Why should intellectual testing be culturally appropriate

Language and sociocultural differences can affect performance and invalidate comparisons

What is more useful than relying on one IQ score

A profile of cognitive strengths and weaknesses combined with adaptive functioning

Can someone with an IQ somewhat above 70 still meet criteria for intellectual developmental disorder

Yes / substantial adaptive functioning deficits may support diagnosis

How is adaptive functioning assessed

Clinical evaluation / standardized measures / knowledgeable informants / developmental educational medical and mental health information

What sources can provide information about adaptive functioning

Individual / parents / family / teachers / counselors / care providers / school and medical records

When is Criterion B for intellectual developmental disorder met

At least one adaptive domain is impaired enough that ongoing support is required across important environments

What important risks may occur with intellectual developmental disorder

Gullibility / exploitation / victimization / accidental injury / fraud / false confessions / abuse

Why can gullibility be clinically important in intellectual developmental disorder

Reduced social judgment may make the person easier to manipulate or exploit

What is approximate prevalence of intellectual developmental disorder

About 10 per 1000 people

When may severe intellectual developmental disorder first become apparent

Within first 2 years through delayed motor / language / social milestones

When may mild intellectual developmental disorder first become apparent

School age when academic difficulties become noticeable

Is intellectual developmental disorder usually lifelong

Yes / although severity and adaptive functioning can change over time

Can intellectual developmental disorder improve with intervention

Yes / early and ongoing intervention may substantially improve adaptive and sometimes intellectual functioning

Can intellectual developmental disorder ever cease to be an appropriate diagnosis

Yes / if stable generalized gains result in functioning that no longer meets criteria

Can intellectual developmental disorder and a neurocognitive disorder be diagnosed together

Yes / when developmental intellectual disability exists and later cognitive decline also develops

What prenatal causes can contribute to intellectual developmental disorder

Genetic syndromes / chromosomal disorders / metabolic disorders / brain malformations / maternal disease / alcohol / drugs / toxins / teratogens

What perinatal causes can contribute to intellectual developmental disorder

Events during labor or delivery that cause neonatal brain dysfunction

What postnatal causes can contribute to intellectual developmental disorder

Brain hypoxia / traumatic brain injury / infection / seizure disorders / severe deprivation / toxic exposure

Why must culture be considered when assessing intellectual developmental disorder

Adaptive functioning must be judged relative to the person's cultural / linguistic / socioeconomic / community context

Can people with intellectual developmental disorder be suicidal

Yes / especially with comorbid mental disorders / higher adaptive ability / recent stressors

Why can mental disorders be missed in people with intellectual developmental disorder

Symptoms may present atypically and some individuals have difficulty communicating internal experiences

What behavioral change in intellectual developmental disorder may indicate another mental or medical problem

New irritability / aggression / sleep change / eating change / mood change / self-injury

What disorders commonly co-occur with intellectual developmental disorder

ADHD / autism / depression / bipolar disorders / anxiety / stereotypic movement disorder / impulse-control disorders / neurocognitive disorders

What medical conditions are disproportionately common with intellectual developmental disorder

Epilepsy / cerebral palsy / obesity / other health problems

What is global developmental delay

Failure to meet expected developmental milestones in several areas of intellectual functioning in a young child who cannot yet be reliably assessed

What age group is global developmental delay intended for

Children younger than 5 years

When is global developmental delay used

When developmental deficits are present but standardized intellectual assessment cannot yet reliably determine severity

Does global developmental delay require reassessment

Yes / reassessment is required after a period of time

What is unspecified intellectual developmental disorder

A diagnosis used when intellectual disability is suspected but severity cannot be reliably assessed because standard assessment is difficult or impossible

When is unspecified intellectual developmental disorder generally used

In individuals older than 5 when sensory / physical / behavioral / mental health problems prevent adequate assessment

Should unspecified intellectual developmental disorder be routinely used

No / it is reserved for exceptional situations and requires reassessment

What are communication disorders

Neurodevelopmental disorders involving deficits in language / speech / social communication / fluency

What is speech

Expressive production of sounds including articulation / fluency / voice / resonance

What is language

A rule-governed system of spoken / signed / written / symbolic communication

What is communication

Verbal or nonverbal behavior capable of influencing another person's behavior / ideas / attitudes

What communication disorders are included in DSM-5-TR

Language disorder / speech sound disorder / childhood-onset fluency disorder / social pragmatic communication disorder / unspecified communication disorder

Why must culture and language be considered when assessing communication disorders

Normal language and communication vary across cultures and bilingual environments

Do communication disorders commonly co-occur with other disorders

Yes / especially other neurodevelopmental disorders / anxiety / seizure disorders / genetic conditions

What is language disorder

Persistent difficulty acquiring and using language because of deficits in comprehension or production

What modalities can language disorder affect

Spoken language / written language / sign language / other language systems

What are the 3 main language deficits required under Criterion A

Reduced vocabulary / limited sentence structure / impaired discourse

What does reduced vocabulary mean in language disorder

Limited word knowledge and word use

What does limited sentence structure mean in language disorder

Difficulty combining words and word endings according to grammar and morphology

What is impaired discourse

Difficulty connecting sentences and vocabulary to explain topics / describe events / tell stories / converse

How impaired must language ability be for language disorder

Substantially below age expectations with meaningful functional limitations

What areas can language disorder impair

Communication / social participation / academic achievement / occupational performance

When does language disorder begin

Early developmental period

What conditions must be excluded before diagnosing language disorder

Hearing or sensory impairment / motor dysfunction / neurological or medical causes / intellectual developmental disorder / global developmental delay

What is receptive language

Ability to receive and understand language

What is expressive language

Ability to produce vocal / gestural / verbal language

Why should receptive and expressive language be assessed separately

Severity may differ between the two

What common language features occur in language disorder

Delayed first words / smaller vocabulary / shorter sentences / grammatical errors / poor comprehension / word-finding problems

Can language comprehension deficits be underestimated

Yes / children may use context to infer meaning and appear to understand more language than they actually do

What memory-related problems may occur with language disorder

Difficulty remembering new words / long instructions / verbal information / novel sound sequences

What discourse problems may occur with language disorder

Difficulty giving necessary information or telling a coherent story

Can people with language disorder appear shy

Yes / they may avoid speaking or communicate mostly with familiar people as compensation

At what age does language disorder become more stable and predictive

Around age 4

Can language disorder persist into adulthood

Yes / particularly when diagnosed at age 4 or older

Which language deficit has a poorer prognosis

Receptive language impairment

Does bilingualism cause language disorder

No

How should language disorder appear in a bilingual child

True language disorder should affect both languages

What should be assessed when evaluating a bilingual child for language disorder

Both languages rather than only the dominant or school language

Is language disorder heritable

Yes / substantial familial and genetic influence is reported

What normal variation must be considered when diagnosing language disorder

Developmental variation / dialect / cultural / ethnic / regional language differences

What sensory problem must be excluded when evaluating language disorder

Hearing impairment

How does language disorder differ from intellectual developmental disorder

Language disorder involves specific language impairment rather than broad intellectual and adaptive deficits

Does language disorder require a large discrepancy between verbal and nonverbal IQ

No

How can autism differ from language disorder

Autism also involves social interaction differences / restricted repetitive behavior / rigid routines / unusual social communication patterns

Why is language regression clinically important

Loss of previously acquired language requires assessment for neurological disorders / epilepsy / autism and other causes

What neurological syndrome can cause acquired language loss in children

Landau-Kleffner syndrome

What commonly co-occurs with language disorder

Specific learning disorder / intellectual developmental disorder / ADHD / autism / developmental coordination disorder / social pragmatic communication disorder

What is speech sound disorder

Persistent difficulty producing speech sounds that reduces intelligibility or prevents effective verbal communication

What functional impairment is required for speech sound disorder

Communication difficulty that interferes with social / academic / occupational functioning

When does speech sound disorder begin

Early developmental period

What must be excluded before diagnosing speech sound disorder

Cerebral palsy / cleft palate / hearing loss / traumatic brain injury / neurological or other medical conditions

What is a phoneme

An individual speech sound used to construct spoken words

What abilities are required for speech sound production

Knowledge of speech sounds plus coordination of jaw / tongue / lips / breathing / vocalization