DSM-5-TR - Neurodevelopmental Disorders

Intellectual Disability

Diagnostic Criteria

A. Deficits in intellectual functions (reasoning, problem-solving, learning).

B. Deficits in adaptive functioning (conceptual, social, practical) across settings.

C. Onset during developmental period.

Severity (based on adaptive functioning)

Mild: Some academic/social difficulties; needs support for complex tasks.

Moderate: Elementary-level academics; limited judgment; support for work/life.

Severe: Minimal academic skills; limited speech; dependent for most ADLs.

Profound: Nonverbal/gestural communication; dependent for all care.

Other Key Facts

Prevalence: ~1% (higher in males).

Etiology: Genetic, prenatal, perinatal, postnatal, environmental.

Comorbidities: ADHD, mood/anxiety disorders, autism, epilepsy.

Differentials: Neurocognitive disorder, learning/communication disorders, autism.

Global Developmental Delay (GDD)

Age: Reserved for children under 5 years.

Use: When severity cannot yet be determined.

Features:

Failure to meet developmental milestones in multiple intellectual areas.

Too young/unable to complete standardized IQ testing.

Note: Requires reassessment over time.

Autism Spectrum Disorder

Criteria

A. Social communication deficits (all):

Reciprocity (poor back-and-forth, reduced sharing).

Nonverbal communication (eye contact, gestures, expression).

Relationships (difficulty with peers, play, friendships).

B. Restricted/repetitive behaviors (≥2):

Repetitive speech/movements.

Insistence on sameness, routines.

Fixated interests.

Sensory hyper/hyporeactivity.

C. Onset early (may show later when demands ↑).

D. Impairment.

E. Not explained by ID/global delay.

Severity

Level 3: Very substantial support.

Level 2: Substantial support.

Level 1: Support.

Specifiers

With/without ID.

With/without language impairment.

With genetic/medical/environmental factor.

With another mental/behavioral disorder.

With catatonia.

Course & Risks

Onset: 12-24 months; may regress.

Non-degenerative; variable outcomes.

Genetic: ~80% heritable; 15% linked to mutations.

Environmental: parental age, prematurity, teratogens.

Males 3-4× > females.

Differentials

ADHD: attention issues, no RRBs.

ID: deficits match cognition.

Language/pragmatic disorder: no RRBs.

OCD: compulsions anxiety-driven.

Schizophrenia: later onset, psychosis.

Comorbidity

ID, language disorder, learning disorder, ADHD, anxiety, depression.

Epilepsy, GI issues.

↑ suicide risk.

Attention-Deficit/Hyperactivity Disorder

Criteria

A. Persistent inattention and/or hyperactivity-impulsivity (≥6 sx, ≥5 if ≥17, ≥6 mo).

Inattention: careless mistakes, poor focus, disorganized, avoids effort, forgetful.

Hyperactivity/Impulsivity: fidgets, leaves seat, restless, talks too much, interrupts.

B. Onset <12 y/o.

C. Symptoms in ≥2 settings.

D. Impairment.

E. Not better explained by another disorder.

Types

Combined (F90.2)

Inattentive (F90.0)

Hyperactive/Impulsive (F90.1)

Specifiers

Partial remission

Severity: Mild / Moderate / Severe

Course

Onset preschool/early school.

Hyperactivity ↓ with age; inattention/impulsivity persist.

~7% children, 2.5% adults.

Risks

Genetic (~74%)

Environmental: prematurity, low birth weight, prenatal smoking/toxins.

M > F (2:1 kids; females often inattentive type).

Impact

Academic/work impairment, peer rejection, accidents, unstable jobs.

↑ risk: substance use, mood disorders, suicide.

Differentials

ODD: defiance vs. inattention.

ASD: social disengagement vs. impulsivity.

Anxiety/Depression: worry/mood vs. persistent sx.

Bipolar: episodic vs. chronic.

Learning disorder: task-specific.

Comorbidity

ODD, conduct, mood disorders.

Anxiety, depression, SUD.

ASD, ID, learning/tic/sleep disorders.