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A User-Friendly Guide to DSM-5 Part II Jeanne Bereiter , M.D. Avi Kriechman, M.D. UNM Departmentof Psychiatryand Behavioral Sciences Division of Community Behavioral Health Neurodevelopmental Disorders Intellectual developmental disorder


  1. A User-Friendly Guide to DSM-5 Part II Jeanne Bereiter , M.D. Avi Kriechman, M.D. UNM Departmentof Psychiatryand Behavioral Sciences Division of Community Behavioral Health

  2. Neurodevelopmental Disorders Intellectual developmental disorder (previously termed mental retardation) Communicationdisorders Autism spectrum disorder Attention-deficit/hyperactivitydisorder (ADHD) Specific learning disorder Motordisorders (e.g., T ourette’sdisorder)

  3. Intellectual Disability (Intellectual Developmental Disorder)  Previously known as mental retardation  Namechanged due to negative connotations of “retardation”  Diagnosis based upon having both:  deficits in cognitive functioning beginning in the developmental period  deficits in adaptive functioning  Diagnosis made through standardized intelligence testing (IQ) plus test of adaptive functioning (e.g., Vineland Adaptive Behavior Scales)  Problems usually noticed before thechild begins elementary school

  4. Intellectual Disability (Intellectual Developmental Disorder)  Severitydetermined by degree of deficits in adaptive functioning not IQ becauseadaptive functioning determines level of supports needed  Adaptive functioning=ability tocommunicate, have appropriatesocial interactions, perform ADLs (activitiesof daily living such as dressing self, self care)  The greater thedegree of intellectual disability , thegreater thechance of mental healthor behavioral problems

  5. Mild Intellectual Disability  Problems may not be identified until elementary school  Difficulties learning academic skills (reading, writing, math)  As adults, problems with abstract thinking, planning ahead, money management  Immature in social interactions, acts younger than age  Usuallycan perform ADLs as well as same age peers, but may have problems with more complex tasks (e.g. how to plan and cook a meal)  As an adult will requiresome support in employment, healthcare decisions, legal decisions

  6. Moderate Intellectual Disability  At preschool age hasslower language and pre-academic skill development  Developmentof reading, writing, math, understanding of timeand money much slower than peers  Academicskill development typicallyatan elementary level  Will need ongoing supportasan adult in managing employment, relationships, money  Can learn all ADLs butwill take more time todo so

  7. Severe Intellectual Disability  Usually identified by toddler age  Limited language e.g. single words or phrases, supplemented bygesturing  Little understanding of written language or math  Requires full support forall ADLs including meals, dressing self  Cannot make responsibledecisions regarding self/others  Requiresongoing support in adulthood forwork, housechores  Significant minority have problems with maladaptive behavior

  8. Profound Intellectual Disability  Usually identified in infancy  Often hasco-occurring physical and sensory problems  Limited language development though can understand simple language  Expresses needs nonverbally  Usuallyenjoys relationships with known family/familiar others  Dependent upon others forall aspects of care

  9. Global Developmental Delay  Used forchildren under theage of 5  Used when theclinical severitycannot be reliably assessed  Child fails to meet expected developmental milestones in several areasof intellectual functioning

  10. Communication Disorders  language disorder  Combinesexpressived/o and receptive-expressived/o  speech sound disorder  Previously phonological disorder  childhood-onset f luencydisorder  Previously called stuttering  social (pragmatic) communication disorder (new)  impaired social verbal and nonverbal communication  Cannot be used in someonewith ASD  Some previouslydx’d with PDD NOS may have this dx

  11. Language Disorder  Difficultyacquiring and/or using language due to problems understanding or producing speech  Reduced vocabulary  Problems with sentence structure  Impairments in verbal conversation  Deficitsare evident in spoken communication, written communication, orsign language  May have problems understanding language (receptive) and/or producing language (expressive)  Often co-occurs with other neurodevelopmental disorders

  12. Speech Sound Disorder  Difficultyproducing intelligible speech due to problems with speech sounds e.g., l,r , s, z, th, ch, dzh, zh  Atage 2, 50% of speech should be intelligible  Atage 4, overall speech should be intellibible  Most speech sounds should be produced clearly by age 7  When treated with speech therapy , most children respond well and problem resolves

  13. Childhood-Onset Fluency Disorder  Previouslycalled stuttering  Onsetage 2-7  65-85% of children recover

  14. Social (Pragmatic) Communication Disorder  Difficulty in social use of verbal and nonverbal communication  Problems greeting people, sharing information  Problems changing speech to match the needs of the situationor listener  Problems following the rules forconversation orstorytelling e.g. taking turns  Problems understanding non-literal useof language e.g. humor , sarcasm, things implied  Previously , individuals might have been diagnosed with autisticdisorderor PDD NOS ratherthan SCD but SCD is to be used if individual doesn’t have restricted range of interests

  15. Autism Spectrum Disorders  Characterized by BOTH:  deficits in social communication and social interaction  restricted repetitive behaviors, interests, and activities  Previously children were diagnosed with autisticdisorder , Asperger’s disorder , CDD, PDD NOS  DSM 5 states that theseare all varying degrees of severity of the samecondition  May beassociated with intellectual disability (more likely the more severe theautism)  May beassociated with language impairment (more likely the more severe theautism)

  16. Severity of Autism Spectrum Disorders  Level I “Requiring Support”  Problems initiating social interactions, making friends  Difficultyswitching between activities, inf lexible behavior  Level 2 “Requiring Substantial Support”  Marked deficits in verbal and nonverbal social communication  Social deficitseven with supports  Restricted/repetitive behaviors interferewith functioning  Difficultycoping with change

  17. Severity of Autism Spectrum Disorders- Level 3  Level 3 “Requiring very substantial support”  May have limited language  Rarely initiatesor responds tosocial interaction  Extremedifficultycoping with change  Extremely restricted/repetitive behaviors interferewith functioning in all areas

  18. ADHD Overview  The most common neurodevelopmental disorder  Occurs in approximately 5% of children, 2.5% of adults  Persistent pattern of problems in 3 domains:  Inattention (314.00 predominantly inattentive presentation)  Or: Hyperactivity & Impulsivity (314.01 predominantly hyperactive/impulsivesubtype)  Or: inattentiveand hyperactive/impulsive (314.01, combined presentation)  Several of these symptomswere present before theage of 12  Symptoms present in more than one domain (home, school, work)

  19. Inattentive Symptoms  Careless mistakes  Problems sustaining attention in tasksorplay  Doesn’tseem to listenwhen spoken to  Doesn’t follow through/fails to finish things  Difficultyorganizing tasksand activities  Dislikes tasks that require sustained mental effort  Loses things necessary for tasksoractivities  Easilydistracted  Forgetful in dailyactivities

  20. Hyperactive & Impulsive Symptoms  Fidgets or taps  Leaves seat in situations where remaining seated is expected  Runs orclimbs in situationswhere this is inappropriate  Unable to playorengage in leisureactivitiesquietly  “on the go” “driven by a motor”  Talks excessively  Blurts outanswers  Difficultywaiting hisor her turn  Interrupts or intrudeson others

  21. ADHD-Diagnosis  Foradults age 17+, cutoff forADHD is 5 symptoms  Forchildren <17, 6 symptoms required  Patientswith diagnosis of autism spectrum disorder may be diagnosed with ADHD as well

  22. Specific Learning Disorder  Persistentd ifficulties learning and using academic skills, below what is expected forage, IQ  Replaces previousdiagnoses of reading disorder , mathematicsdisorder , disorderof written expression  Learning disorders often occur together , soare given as specifiers rather than separatediagnoses  e.g. 315.0 Specific Learning Disorderwith impairment in reading

  23. Developmental Coordination Disorder  Motorskillsare below thatexpected forchronological or mental age  May seeclumsiness, slownessor inaccuracy  Shows in areas such as handwriting, using scissors, riding a bicycleordoing sports  Usually notdiagnosed before age 5 butonset is during theearlydevelopmental period

  24. Stereotypic Movement Disorder  Hand shaking orwaving, body rocking, head banging, self-biting, hitting self  Onsetduring theearly developmental period  Simplestereotypic movementsare normal in young children  Can beassociated with self injury  Morecommon in peoplewith intellectual disability

  25. Tic Disorders  T ourette’s  V ocal and motor tics for more than ayear  Persistent motororvocal ticdisorder  Haseither motororvocal tics  Provisional ticdisorder  Present for less than ayear

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