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1. Neurodevelopmental Disorders
Intellectual Development Disorder (Intellectual Disability) ► (Frequently co-occur with Autism!!!)
o A disorder with onset during the developmental period that includes BOTH intellectual and adaptive
functioning deficits in conceptual, social, and practical domains. The following 3 criteria must be met:
Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking,
judgment, academic learning, and learning from experience, confirmed by both clinical
assessment and individualized, standardized intelligence testing.
Deficits in adaptive functioning that results in failure to meet developmental and sociocultural
standards for personal independence and social responsibility. Without ongoing support, the
adaptive deficits limit functioning in one or more activities of daily life, such as communication,
social participation, and independent living, across multiple environments, such as home, school,
work, and community.
Onset of intellectual and adaptive deficits during the developmental period.
o Specifiers:
Mild / Moderate / Severe / Profound
Global Developmental Delay
o For individuals under the age of 5 years when the clinical severity level cannot be reliably assessed
during early childhood.
Unspecified Intellectual Developmental Disorder (Intellectual Disability)
o For individuals over the age of 5 years when assessment of the degree of intellectual development
disorder by means of locally available procedures is rendered difficult or impossible …
Communication Disorders
Language Disorder
o Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign
language, or other) due to deficits in comprehension or production that include the following:
Reduced vocabulary (word knowledge and use).
Limited sentence structure (ability to put words and word endings together to form sentences
based on rules of grammar and morphology).
Impairments in discourse (ability to use vocabulary and connect sentences to explain or
describe a topic or series of events or have a conversation).
o 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.
o Onset of symptoms is in the early developmental period.
o 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
o Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal
communication of messages.
o The disturbance causes limitations in effective communication that interfere with social participation,
academic achievement, or occupational performance, individually or in any combination.
o Onset of symptoms is in the early developmental period.
o Not attributable 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)
o Disturbances in the normal fluency and time patterning 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 1
(or more) of the following:
Sound and syllable repetitions.
Sound prolongations of consonants as well as vowels.
Broken words (pauses within a word).
Audible or silent blocking (filled or unfilled pauses in speech).
Circumlocutions (words substitutions to avoid problematic words).
Words produces with an excess of physical tension.
Monosyllabic whole-word repetitions (“I-I-I-I see him”)
o Causes anxiety about speaking or limitations in effective communication, social participation, or academic
or occupational performance, individually or in any combination.
o Onset of symptoms is in the early developmental period.
o Not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult.
Social (Pragmatic) Communication Disorder)
o Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the
following:
Deficits in using communication for social purposes, such as greeting and sharing
information, in a manner that is appropriate for the social context.
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Impairment in 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.
Difficulties following rules for conversation and storytelling, such as taking turns in
conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal
signals to regulate interaction.
Difficulties understanding what is not explicitly stated (making inferences) and nonliteral
or ambiguous meanings of language (idioms, humor, metaphors, multiple meanings that
depend on the context for interpretation).
o The deficits result in functional limitations in effective communication, social participation, social
relationships, academic achievement, or occupational performance, individually or in combination.
o The onset of symptoms is in the early developmental period (but deficits may not become fully manifest
until social communication demands exceed limited capacities).
o The symptoms are not attributable to another medical or neurological condition or to low abilities in word
structure and grammar, and they are not better explained by autism spectrum disorder, intellectual disability,
global developmental delay, or another mental disorder.
Autism Spectrum Disorder ► (Deficits in social communication and interaction / Restricted, repetitive patterns)
!!! Comorbidity: ADHD / Anxiety / Language impairment / Intellectual disability (social communication
should be below expected for developmental level)
o Persistent deficits in social communication and social interaction across multiple contexts, as manifested by
all of the following, currently or by history:
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
affect; to failure to initiate or respond to social interactions.
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.
Deficits in developing, maintaining, and understanding relationships, ranging, 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.
o Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the
following, currently or by history:
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or
nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid
thinking patterns, greeting rituals, need to take same route or eat same food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong
attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative
interests).
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the
environment (e.g., apparent indifference to pain/temperature, adverse response to specific
sounds or textures, excessive smelling or touching of objects, visual fascination with lights or
movement).
o Symptoms must be present in the early developmental period (but may not become fully manifest until
social demands exceed limited capacities, or may be masked by learned strategies in later life).
o Symptoms cause clinically significant impairment in social, occupational, or other important areas of
current functioning.
o These disturbances are not better explained by intellectual disability (intellectual developmental disorder)
or global developmental delay. Intellectual disability and autism spectrum disorder
frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual
disability, social communication should be below that expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or
pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum
disorder. Individuals who have marked deficits in social communication, but whose symptoms do not
otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic)
communication disorder.
o Specifiers:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia
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TABLE 2 Severity levels for autism spectrum disorder
Severity
level Social communication Restricted, repetitive behaviors
Level 3 Severe deficits in verbal and nonverbal social communication skills cause Inflexibility of behavior, extreme difficulty coping
“Requiring severe impairments in functioning, very limited initiation of social with change, or other restricted/repetitive behaviors
very interactions, and minimal response to social overtures from others. For markedly interfere with functioning in all spheres.
substantial example, a person with few words of intelligible speech who rarely initiates Great distress/difficulty changing focus or action.
support” interaction and, when he or she does, makes unusual approaches to meet
needs only and responds to only very direct social approaches.
Level 2 Marked deficits in verbal and nonverbal social communication skills; social Inflexibility of behavior, difficulty coping with
“Requiring impairments apparent even with supports in place; limited initiation of social change, or other restricted/repetitive behaviors
substantial interactions; and reduced or abnormal responses to social overtures from appear frequently enough to be obvious to the
support” others. For example, a person who speaks simple sentences, whose casual observer and interfere with functioning in a
interaction is limited to narrow special interests, and who has markedly odd variety of contexts. Distress and/or difficulty
nonverbal communication. changing focus or action.
Level 1 Without supports in place, deficits in social communication cause Inflexibility of behavior causes significant
“Requiring noticeable impairments. Difficulty initiating social interactions, and clear interference with functioning in one or more
support” examples of atypical or unsuccessful responses to social overtures of contexts. Difficulty switching between activities.
others. May appear to have decreased interest in social interactions. For Problems of organization and planning hamper
example, a person who is able to speak in full sentences and engages in independence.
communication but whose to-and-fro conversation with others fails, and
whose attempts to make friends are odd and typically unsuccessful.
Attention-Deficit/Hyperactivity Disorder (ADHD) ► (Inattention and/or hyperactivity-impulsivity for at least 6 months)
!!! Comorbidity: Oppositional defiant disorder/Depressive Disorders/Anxiety disorders/ Substance
abuse disorders/ Sleep disorders
o A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or
development, as characterized by (1) and/or (2):
o 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:
Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to
understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five
symptoms are required.
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work,
or during other activities (e.g., overlooks or misses details, work is inaccurate).
Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining
focused during lectures, conversations, or lengthy reading).
Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the
absence of any obvious distraction).
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in
the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks;
difficulty keeping materials and belongings in order; messy, disorganized work; has poor time
management; fails to meet deadlines).
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
(e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing
forms, reviewing lengthy papers).
Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools,
wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include
unrelated thoughts).
Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents
and adults, returning calls, paying bills, keeping appointments).
o 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:
Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure
to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five
symptoms are required.
Often fidgets with or taps hands or feet or squirms in seat.
Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place
in the classroom, in the office or other workplace, or in other situations that require remaining in
place).
Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or
adults, may be limited to feeling restless.)
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Often unable to play or engage in leisure activities quietly.
Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable
being still for extended time, as in restaurants, meetings; may be experienced by others as being
restless or difficult to keep up with).
Often talks excessively.
Often blurts out an answer before a question has been completed (e.g., completes people’s
sentences; cannot wait for turn in conversation).
Often has difficulty waiting his or her turn (e.g., while waiting in line).
Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may
start using other people’s things without asking or receiving permission; for adolescents and
adults, may intrude into or take over what others are doing).
o Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
o Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at
home, school, or work; with friends or relatives; in other activities).
o There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or
occupational functioning.
o The symptoms do not occur exclusively during the course of schizophrenia or another psychotic
disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder,
dissociative disorder, personality disorder, substance intoxication or withdrawal).
o Specifiers:
Combined presentation (If both Criterion A1 and A2 are met for the past 6 months).
Predominantly inattentive presentation (If Criterion A1 is met but A2 is not met for the past 6
months).
Predominantly hyperactive/impulsive presentation (If Criterion A2 is met but A1 is not met for
the past 6 months).
In partial remission (Full criteria where previously met, fewer than the full criteria have been
met for the past 6 months and the symptoms still result in impairment in social, academic, or
occupational functioning).
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and
symptoms result in no more than minor impairments in social or occupational functioning
Moderate: Symptoms or functional impairment between “mild” and “severe” are present
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms
that are particularly severe, are present, or the symptoms result in marked impairment in social or
occupational functioning
Specific Learning Disorder ► (At least one of the symptoms for at least 6 months)
o Difficulties learning and using academic skills, as indicated by the presence of at least one of the following
symptoms that have persisted for at least 6 months, despite the provision of interventions that target
those difficulties:
Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or
slowly and hesitantly, frequently guesses words, has difficulty sounding out words).
Difficulty understanding the meaning of what is read (e.g., may read text accurately but not
understand the sequence, relationships, inferences, or deeper meanings of what is read).
Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants).
Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors
within sentences; employs poor paragraph organization; written expression of ideas lacks clarity).
Difficulties mastering number sense, number facts, or calculation (e.g., has poor
understanding of numbers, their magnitude, and relationships; counts on fingers to add single-
digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic
computation and may switch procedures).
Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical
concepts, facts, or procedures to solve quantitative problems).
o 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 individuals age 17 years and older, a documented history of
impairing learning difficulties may be substituted for the standardized assessment.
o 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 (e.g., as in timed tests,
reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads).
o The learning difficulties are not better accounted for by intellectual disabilities, 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.
Note: The four diagnostic criteria are to be met based on a clinical synthesis of the individual’s history
(developmental, medical, family, educational), school reports, and psychoeducational assessment.
o Specifiers:
With impairment in reading: Word reading accuracy/Reading rate or fluency/Reading
comprehension
