NEURODEVELOPMENTAL DISORDERS
INTELLECTUAL DISABILITIES
Intellectual disability (intellectual developmental disorder)
Global Developmental Delay
Unspecified Intellectual Disability
Intellectual disability (intellectual developmental disorder) is a
disorder with onset during the developmental period that includes
both intellectual and adaptive functioning deficits in conceptual,
social, and practical domains. The following three criteria must be
met:
A.
B.
C.
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 result in failure to meet
developmental and socio-cultural 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.



Because
of
sensory
or
physical
impairments
(blindness/deafness/locomotor disability, etc.)
Only be used in exceptional circumstances
requires reassessment
ETIOLOGY






Environmental: Deprivation, abuse, neglect
Prenatal: exposure to disease or drugs while in the womb
Perinatal: Difficulties during labor and delivery
Postnatal: Infections and head injury
Fetal alcohol syndrome from the heavy use of alcohol among
pregnant women
Lack of oxygen (anoxia) during birth and malnutrition and
head injuries during developmental period
COMMUNICATION DISORDERS
language disorder
Speech Sound Disorder
Childhood-onset Fluency Disorder (Stuttering)
Social (Pragmatic) Communication Disorder
Unspecified Communication Disorder
LANGUAGE DISORDER
EASY TO REMEMBER

Intellectual disability

Deficits in intellectual functioning and adaptive functioning
NOTE

Diagnostic term intellectual disability is the equivalent term
for the ICD-11 diagnosis of intellectual developmental
disorders

United States’ Public law Rosa’s Law replaces the term
mental retardation with intellectual disability

Used by lay public and advocacy groups
SPECIFY CURRENT SEVERITY

Mild

Moderate

Severe

Profound
SPECIFIERS

Levels of severity- defined on the basis of adaptive
functioning and not IQ scores

Adaptive functioning that determines the level of supports
required
GLOBAL DEVELOPMENTAL DELAY





Reserved for individuals under the age of 5 years
Clinical severity level cannot be reliably assessed
Diagnosed when an individual fails to meet expected
developmental milestones in intellectual functioning
Children who are too young to participate in standardized
testing
Required reassessment after a period of time
UNSPECIFIED INTELLECTUAL DISABILITY


Reserved for individuals over the age of 5 years
When assessment of the degree of disability by means of
locally available procedures is rendered difficult or
impossible
A.
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:
1.
2.
Reduced vocabulary (word knowledge and use).
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 ex plain 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 disability (intellectual developmental disorder)
or global developmental delay.
EASY TO REMEMBER

Trouble understanding language and communicating
ETIOLOGY




Can have many possible causes
Brain disorder such as autism, Brain injury/ brain tumour
Unfounded psychological explanation is that the children’s
parents may not speak to them enough.
Biological theory- Middle ear infection is a contributory
cause
TREATMENT







Speech Language Pathologist (SLP)
Start therapy early
Advised to do simple activities such as:
Reading and talking to your child
Listening and responding when your child talks
Encouraging your child to ask and answer questions
Pointing out words on signs
SPEECH SOUND DISORDER
A.
B.
C.
D.
Persistent difficulty with speech sound production that
interferes with speech intelligibility or prevents verbal
communication of messages.
The disturbance causes limitations in effective
communication that interfere with social participation,
academic achievement, or occupational performance,
individually or in any combination.
Onset of symptoms is in the early developmental period.
The difficulties are not attributable to congenital or acquired
conditions, such as cere bral palsy, cleft palate, deafness or
hearing loss, traumatic brain injury, or other medical or
neurological conditions.
EASY TO REMEMBER


Often has no known cause
Injury to the brain
Problems with hearing or hearing loss
Physical problems that affect speech- cleft palate or cleft lip
TREATMENT


Speech Language Pathologists
Refer to an ear, nose, throat healthcare provider or
orthodontist if needed
CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING)
A.
B.
D.
ETIOLOGY


Genetic influences may be a factor
Childhood-onset fluency disorder makes people socially
anxious
TREATMENT

Parents are counselled about how to talk their children

Regulated-breathing method- person is instructed to stop
speaking when a stuttering episode occurs and then take a
deep breath before proceeding
SOCIAL (PRAGMATIC) COMMUNICATION DISORDER
A.
Difficulty with speech sound production
Trouble saying sounds
ETIOLOGY




C.
academic or occupational performance, individually or in
any combination.
The onset of symptoms is in the early developmental period.
(Note: Later-onset cases are diagnosed as 307.0 [F98.5]
adult-onset fluency disorder.)
The disturbance is not attributable to a speech-motor or
sensory deficit, dysfluency as sociated with neurological
insult (e.g., stroke, tumor, trauma), or another medical
condition and is not better explained by another mental
disorder.
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 one (or more) of the
following:
1. Sound and syllable repetitions.
2. Sound prolongations of consonants as well as vowels.
3. Broken words (e.g., pauses within a word).
4. Audible or silent blocking (filled or unfilled pauses in
speech).
5. Circumlocutions (word substitutions to avoid
problematic words).
6. Words produced with an excess of physical tension.
7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see
him”).
The disturbance causes anxiety about speaking or limitations
in effective communication, social participation, or
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 conversation 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
(e.g., making inferences) and nonliteral or ambiguous
meanings of language (e.g., idioms, humor, metaphors,
multiple meanings that depend on the context for
interpretation).
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 developmental
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
word structure and grammar, and are not better explained by
autism spectrum disorder, intellectual disability (intellectual
developmental disorder), global developmental delay, or
another mental disorder.
EASY TO REMEMBER

Difficulty with social aspects of verbal or nonverbal
communication


Deficits in understanding and following social rules of
verbal and nonverbal communication
Changing language according to the needs of the listener or
situation
ETIOLOGY



Limited information
Genetic factors
Hearing loss
TREATMENT



Individualized social skills training
Eg. Modelling, role playing
Teaching important rule necessary for carrying on
conversations with other (what is too much or too little
information)
UNSPECIFIED COMMUNICATION DISORDER



Symptoms characteristic of communication disorder that
cause clinically significant distress or impairment
predominate but do not meet the full criteria for
communication disorder
clinician chooses not to specify the reason that the criteria
are not met for communication disorder
There is insufficient information to make a specific
diagnosis
AUTISM SPECTRUM DISORDER
A.
B.
Persistent deficits in social communication and social
interaction across multiple con texts, as manifested by the
following, currently or by history (examples are illustrative,
not exhaustive; see text):
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 affect; 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, ranging, for ex ample, 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.
Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by history (examples are illustrative, not
exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies,
lining up toys or flipping objects, echolalia,
idiosyncratic phrases).
2.
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).
3. 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).
4. Hyper- or hypereactivity to sensory input or unusual
interest in sensory aspects of the environment (e.g.,
apparent indifference to pain/temperature, adverse re
sponse to specific sounds or textures, excessive
smelling or touching of objects, visual fascination with
lights or movement).
C. 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).
D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.
E. 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.
EASY TO REMEMBER



Criterion A- Impairment in social communication and social
interaction
Criterion B- Restricted, repetitive patterns of behavior,
interests or activities
Criteria C or D - present early childhood and limit or impair
everyday functioning
ETIOLOGY








Does not appear to have a single cause
Biological contributions may combine with psychosocial
influences.
Genetic influences.
Families that have one child with ASD have about 20%
chance of having another child with the disorder
Genes responsible for the brain chemical oxytocin (role on
how e bond with others and in our social memory)
Increased risk of having a child with ASD among older
parents
Neurobiological influences.
Research on the amygdala (involved in emotions such as
anxiety and fear)





Young children with ASD have a larger amygdala - causing
excessive anxiety and fear
Those with ASD have fewer neurons in this structure
Oxytocin- influences bonding and found to increase trust and
reduce fear.
Children with ASD - Lower levels of oxytocin in their blood
The study of ASD is a relatively young field and still awaits
an integrative theory of how biological, psychological, and
social factors work together to put an individual at risk for
developing autism.
TREATMENT


Enhancing communication and daily living skills
Reducing problem behaviors such as tantrums and selfinjury
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A.
A persistent pattern of inattention and/or hyperactivityimpulsivity 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:
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.
a.
b.
c.
d.
e.
f.
g.
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, dis organized 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, pen cils, books, tools,
wallets, keys, paperwork, eyeglasses, mobile
telephones).
h.
2.
Is often easily distracted by extraneous stimuli (for
older adolescents and adults, may include unrelated
thoughts).
i.
Is often forgetful in daily activities (e.g., doing
chores, running errands; for older adolescents and
adults, returning calls, paying bills, keeping
appointments).
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.
a. Often fidgets with or taps hands or feet or squirms
in seat.
b. 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).
c. Often runs about or climbs in situations where it is
inappropriate. (Note: In adolescents or adults, may
be limited to feeling restless.)
d. Often unable to play or engage in leisure activities
quietly.
e. Is often “on the go,” acting as if “driven by a motor”
(e.g., is unable to be or un comfortable being still
for extended time, as in restaurants, meetings; may
be experienced by others as being restless or
difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has
been completed (e.g., completes people’s
sentences; cannot wait for turn in conversation).
h. Often has difficulty waiting his or her turn (e.g.,
while waiting in line).
i. 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).
B. Several inattentive or hyperactive-impulsive symptoms
were present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are
present in two or more set tings (e.g., at home, school, or
work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or
reduce the quality of, social, academic, or occupational
functioning.
E. 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).
SPECIFY IF:

in partial remission: When full criteria were 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.
SPECIFY CURRENT SEVERITY:

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.
EASY TO REMEMBER

ADHD

Inattention and/or hyperactivity
TREATMENT

Psychosocial intervention- improving social skills

Biological treatment- goal is to reduce the children’s
impulsivity and hyperactivity and improve their attention
skills

Use of stimulant medications for children with ADHD

Drugs such as methylphenidate (Ritalin or Adderall)

Stimulant medications reinforce the brain’s ability to focus
attention during problem-solving tasks
OTHER SPECIFIED ATTENTION-DEFICIT/HYPERACTIVITY
DISORDER

This category applies to presentations in which symptoms
characteristic of attention- deficit/hyperactivity 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 attentiondeficit/hyperactivity disorder

Clinician chooses to communicate the specific reason that
the presentation does not meet the criteria for ADHD

Other specified ADHD disorder followed by a specific
reason (eg. Insufficient in attention symptoms)
UNSPECIFIED ATTENTION-DEFICIT/HYPERACTIVITY
DISORDER

Symptoms characteristic of ADHD predominate but do not
meet the full criteria

Clinician chooses not to specify the reason that the criteria
are not met for ADHD

If there is insufficient formation 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 symptoms
B.
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 (e.g.,
reads single words aloud incorrectly or slowly and
hesitantly, frequently guesses words, has difficulty
sounding out words).
2. 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).
3. Difficulties with spelling (e.g., may add, omit, or
substitute vowels or consonants).
4. Difficulties with written expression (e.g., makes
multiple grammatical or punctuation errors within
sentences; employs poor paragraph organization;
written expression of ideas lacks clarity).
5. 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).
6. Difficulties with mathematical reasoning (e.g., has
severe difficulty applying math ematical concepts,
facts, or procedures to solve quantitative problems).
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.

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 (e.g., as in timed tests, reading or writing
lengthy complex reports for a tight deadline, excessively
heavy academic loads).

D. 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

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.

Coding note: Specify all academic domains and subskills
that are impaired. When more than one domain is impaired,
each one should be coded individually according to the
following specifiers.
Note: Dyslexia is an alternative term used to refer to a pattern
of learning difficulties characterized by problems with
accurate or fluent word recognition, poor decoding, and poor
spelling abilities. If dyslexia is used to specify this particular
pattern of difficulties, it is important also to specify any
additional difficulties that are present, such as difficulties
with reading comprehension or math reasoning.


Note: Dyscalculia is an alternative term used to refer to a
pattern of difficulties characterized by problems processing
numerical information, learning arithmetic facts, and
performing accurate or fluent calculations. If dyscalculia is
used to specify this particular pattern of mathematic
difficulties, it is important also to specify any additional
difficulties that are present, such as difficulties with math
reasoning or word reasoning accuracy.



SPECIFY CURRENT SEVERITY:

Specify current severity:

Mild: Some difficulties learning skills in one or two
academic domains, but of mild enough severity that the
individual may be able to compensate or function well when
provided with appropriate accommodations or support
services, especially during the school years.


Moderate: Marked difficulties learning skills in one or more
academic domains, so that the individual is unlikely to
become proficient without some intervals of intensive and
specialized teaching during the school years. Some
accommodations or supportive services at least part of the
day at school, in the workplace, or at home may be needed
to complete activities accurately and efficiently.
Severe: Severe difficulties learning skills, affecting several
academic domains, so that the individual is unlikely to learn
those skills without ongoing intensive individualized and
specialized teaching for most of the school years. Even with
an array of appropriate accommodations or services at home,
at school, or in the workplace, the individual may not be able
to complete all activities efficiently.
EASY TO REMEMBER

Difficulty learning and using academic skills

Academic skills are below those expected for individual’s
chronological age

Begin during school age
DIFFERENTIAL DIAGNOSIS

Normal variations in academic achievement.

Specific learning disorder is distinguished from normal
variations in academic attainment due to external factors (eg.
Lack of educational opportunity, consistently poor
instruction)

Intellectual disability.

Specific learning disabilities occur in the presence of normal
levels of intellectual functioning (IQ score of at least 70 +/5).
ETIOLOGY




Learning disorders run in families
Some develop problems (word recognition) primarily
through their genes
Environmental influences such as home reading habits of
families an affect out-comes
Reading to children at risk for reading disorders can lessen
the impact of the genetic influence

Neurological explanation
Three areas of the left hemisphere appear to be involved in
problems with dyslexia (word recognition):
Broca’s area- articulation and word analysis
the left parietotemporal area- word analysis
Area in the left occipitotemporal area - affects recognizing
word form
Area in the left hemisphere- intraparietal sulcus- critical for
the development of a sense of numbers and implicated in
mathematics disorder
TREATMENT



Direct instruction- This program includes several
components; among them are
Systematic instruction (using highly scripted lesson plans
that place students together in small groups based on their
progress) and
Teaching for mastery (teaching students until they
understand all concepts).
MOTOR DISORDERS
Developmental Coordination Disorder
Stereotypic Movement Disorder
Tic Disorders
Other specified Tic Disorder
Unspecified Tic Disorder
DEVELOPMENTAL COORDINATION DISORDER
A.
B.
C.
D.
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 (e.g., dropping or
bumping into objects) as well as slowness and inaccuracy of
performance of motor skills (e.g., catching an object, using
scissors or cutlery, handwriting, riding a bike, or
participating in sports).
The motor skills deficit in Criterion A significantly and
persistently interferes with activities of daily living
appropriate to chronological age (e.g., self-care and selfmaintenance) and impacts academic/school productivity,
prevocational and vocational activities, leisure, and play.
Onset of symptoms is in the early developmental period.
The motor skills deficits are not better explained by
intellectual disability (Intellectual developmental disorder)
or visual impairment and are not attributable to a
neurological condition affecting movement (e.g., cerebral
palsy, muscular dystrophy, degenerative disorder).
Other terms used to describe developmental coordination
disorder include childhood dyspraxia, specific developmental
disorder of motor function, and clumsy child syndrome.
EASY TO REMEMBER


Child performs less well than expected in daily activities for
their age
Appear to move clumsily
ETIOLOGY





Factors that include a child’s likelihood of developing DCD:
Being born prematurely
Being born with low birth weight
Having a family history of DCD
Mother drinking alcohol or taking illegal drugs while
pregnant
B.
C.
D.
Persistent (Chronic) Motor or Vocal Tic Disorder 307.22 (F95.1)
A.
TREATMENT

Therapy to help children manage their problems

Being taught ways of doing activities they find difficult

Adapting tasks to make them easier- using special grips on
pens and pencils
STEREOTYPIC MOVEMENT DISORDER
A.
B.
C.
D.
Repetitive, seemingly driven, and apparently purposeless
motor behavior (e.g., hand shaking or waving, body rocking,
head banging, self-biting, hitting own body).
The repetitive motor behavior interferes with social,
academic, or other activities and may result in self-injury.
Onset is in the early developmental period.
The repetitive motor behavior is not attributable to the
physiological effects of a sub stance or neurological
condition and is not better explained by another
neurodevelopmental
or
mental
disorder
(e.g.,
trichotillomania
[hair-pulling disorder],
obsessivecompulsive disorder).
EASY TO REMEMBER



Repetitive, purposeless motor behavior
Hand shaking or waving
Headbanging
ETIOLOGY




Cause is not clear.
Some children with SMD have family members who have
SMD
Genetic link
May be linked to neurological problems or brain injuries in
some children
TREATMENT

Behavioral therapy.

Cognitive behavioral therapy
TIC DISORDERS
The tics may wax and wane in frequency but have persisted
for more than 1 year since first tic onset.
Onset is before age 18 years.
The disturbance is not attributable to the physiological
effects of a substance (e.g., co caine) or another medical
condition (e.g., Huntington’s disease, postviral encephalitis).
B.
C.
D.
Single or multiple motor or vocal tics have been present
during the illness, but not both motor and vocal.
The tics may wax and wane in frequency but have persisted
for more than 1 year since first tic onset.
Onset is before age 18 years.
The disturbance is not attributable to the physiological
effects of a substance (e.g., co caine) or another medical
condition (e.g., Huntington’s disease, postviral encephalitis).
E. Criteria have never been met for Tourette’s disorder.
EASY TO REMEMBER

For Tourette's disorder, both motor and vocal tics must be
present,

For persistent (chronic) motor or vocal tic disorder, only
motor or only vocal tics are present.

For provisional tic disorder, motor and/or vocal tics may
be present. (Less than 1 year)
TICS CAN EITHER BE SIMPLE OR COMPLEX









Simple motor tics- short duration
Eye blinking, shoulder shrugging, extension of extremities
Complex motor tics- longer duration
Tic-like sexual or obscene gesture (copropraxia)
Tic like imitation of someone else’s movements
(echopraxia)
Complex vocal tics
Palilalia- repeating one’s own sounds or words
Echolalia- repeated the last-heard word or phrase
Coprolalia- Uttering socially unacceptable words like
obscenities or slurs
ETIOLOGY




Exact cause is unknown
Genes that influence the form and severity of tics
Having a family history of Tourette syndrome- the risk of
developing Tourette syndrome
Dopamine, serotonin, glutamate brain chemicals
TREATMENT

Psychological: Self-monitoring, relaxation training and habit
reversal
Tic- sudden, rapid, recurrent, non-rhythmic motor movement or
vocalization

Tourette’s Disorder 307.23 (F95.2)
Delusional disorder
A.
Both multiple motor and one or more vocal tics have been
present at some time during the illness, although not
necessarily concurrently.
Delusional disorder is a type of serious mental illness in which a person
cannot tell what is real from what is imagined.
A.
B.
If the duration of one or more delusions is 1 month or longer.
Criterion have never been met for Schizophrenia.
C.
D.
E.
Aside from the impact of the delusion(s) or its ramifications,
functioning is not significantly impaired, and behaviour is
not obviously bizarre or odd.
If manic or major depressive episodes occurred, they were
brief in comparison to the duration of the delusional periods.
The disturbance is not explained by another mental disorder
such as body dysmorphic disorder or obsessive-compulsive
disorder, and it is not caused by the physiological effects of
a substance or another medical condition.
Treatment



Specify whether:
Erotomaniac type: Another person is in love with an individual.

Grandiose type: Having important or great talent (unrecognized), or
made an important discovery.
Jealous type: His/her spouse or lover is disloyal.
Persecutory type: Individual believed that he or she is conspired (e.g,
cheated, spied on, followed, poisoned or drugged and etc.
Somatic type: Bodily function or sensation of an individual.
Mixed type: There is no main Delusion.
Schizophreniform Disorder
Schizophreniform disorder, like schizophrenia, is a psychotic disorder
that affects how you act, think, relate to others, express emotions and
perceive reality. Unlike schizophrenia, it lasts one to six months
instead of the rest of your life
A.
Unspecified type: Not describe in a specific type.
Specify if:
With bizarre content: clearly implausible, not understandable, and not
derived from ordinary life experiences.
Specify if:






First episode, currently in acute episode
First episode, currently in partial remission
First episode, currently in full remission
Multiple episodes, currently in acute episode
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
B.
C.
D.
Brief Psychotic Disorder
A quick, short-term exhibition of psychotic behavior, such as
hallucinations or delusions, that happens in response to a stressful
incident is known as brief psychotic disorder.
A.
Presence of one or more of the following symptoms,
especially 1, 2, and 3.
1. Delusions
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or
incoherence).
4. Grossly disorganized or catatonic behavior
Note: Do not include a symptom if it is a culturally
sanctioned response
B.
C.
The duration of episode at least 1 day but less than 1 month
and eventually will returned to premorbid functioning level.
The disturbance is not better explained by major depressive
or bipolar illness with psychotic symptoms, or another
psychotic disorder like schizophrenia or catatonia, and it is
not due to the physiological effects of a substance (e.g., a drug
of abuse or a medication) or another medical condition.
The first line of treatment includes atypical antipsychotics,
such as: risperidone (Risperdal), olanzapine (Zyprexa) and
etc.
Since people with brief psychotic disorder are at increased
risk of also having depression, medications that address that
symptom can be an important part of treatment. These
include serotonergic medication.
And, Other antidepressant medications used to treat the
depression that can be associated with brief psychotic
disorder.
Cognitive behavioral psychotherapy (CBT) has been found
to be helpful in helping the brief psychotic disorder sufferer
manage some of the symptoms of this illness.
Two (or more) of the following, each present for a
significant portion of time during a 1-month period (or less
if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or
incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional
expression or avolition)
The number 1,2 and 3 must be present.
The episode lasted for at least 1 month but less than 6
months and it will be qualified as "provisional" if the
diagnosis made without waiting for recovery.
Schizoaffective disorder and depressive or bipolar disorder
with psychotic features have been ruled out
There must no psychological effects of a substance. Such as,
drug abuse or any medication.
Specify if:


With good prognostic features
Without good prognostic features
ETIOLOGY/ CAUSES
Doctors don’t know what causes schizophreniform disorder. A mix of
factors may be involved, including:



Genetics: A tendency to develop schizophrenia and
schizophreniform disorder may pass from parents to their
children. However, this does not guarantee that the disorder
will be passed on.
Brain structure and function: People with schizophrenia and
schizophreniform disorder may have a disturbance in brain
circuits that manage thinking and perception.
Environment: Poor relationships or very stressful events may
trigger schizophreniform disorder in people who have
inherited a tendency to develop the illness.
TREATMENT




Medication: Antipsychotic drugs are the main medications
that doctors use to treat the psychotic symptoms of
schizophreniform
disorder,
such
as
delusions,
hallucinations, and disordered thinking.
Psychotherapy: The goal is to help the person recognize and
learn about the illness and its treatment, set goals, and
manage everyday problems related to the condition.
People with severe symptoms or who are at risk of hurting
themselves or others may need to be hospitalized to get their
condition under control.
Schizophrenia is a chronic, severe mental disorder that
affects the way a person thinks, acts, expresses emotions,
perceives reality, and relates to others.
Schizophrenia
Two (or more) of the following, each present for a significant
portion of time during a 1 -month period (or less if
successfully treated). At least one of these must be (1 ), (2),
or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or
incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional
expression or avolition).
B. level of functioning in one or more major areas affected (e.g.
work, interpersonal relations, or self-care)
C. Continuous signs of the disturbance persist for at least 6
months.
D. Before you can be diagnosed with Schizophrenia, the
schizoaffective disorder and depressive or bipolar disorder
must be ruled out. For you to be diagnosed as schizophrenic.
E. There must no psychological effects of a substance. Such as,
drug abuse or any medication.
F. Genetics or History of family.


Schizoaffective Disorder
A.
B.
A.
C.
D.


Genetic inheritance
A chemical imbalance in the brain - Schizophrenia appears
to develop when there is an imbalance of a neurotransmitter
called dopamine, and possibly also serotonin, in the brain.
Environmental factors that may increase the risk of
schizophrenia include: trauma during birth, malnutrition
before birth, viral infections, psychosocial factors, such as
trauma.
Certain drugs and medications - In 2017, scientists found
evidence to suggest that some substances in cannabis can
trigger schizophrenia in those who are susceptible to it.








Antipsychotic drugs - these can be for daily use or for less
frequent use if the person opts for injectable medications,
which can last up to 3 months between injections (depending
on the medication).
Counselling- this can help a person develop coping skills and
pursue their life goals.
Coordinated special care - this integrates medication, family
involvement, and education services in a holistic approach.
Medications: Antipsychotics, Mood-stabilizing medications,
and Antidepressants.
Psychotherapy: Individual therapy, and Family or group
therapy
Life skills training: Social skills training and Vocational
rehabilitation and supported employment.
Hospitalization - During crisis periods or times of severe
symptoms, hospitalization may be necessary to ensure
safety, proper nutrition, adequate sleep and basic personal
care.
Electroconvulsive therapy - For adults with schizoaffective
disorder who do not respond to psychotherapy or
medications, electroconvulsive therapy (ECT) may be
considered
Substance/MedicationInduced Psychotic Disorder TREATMENT
Medication Psychotherapy Alcohol-Induced Psychotic Disorder
Considerations In addition to seeking professional care, you may also:





TREATMENT
An uninterrupted period of illness during which there is a
major mood episode (major depressive or manic) concurrent
with Criterion A of schizophrenia.
Note: The major depressive episode must include Criterion
A1: Depressed mood.
Delusions or hallucinations for 2 or more weeks in the
absence of a major mood episode (depressive or manic)
during the lifetime duration of the illness.
Symptoms that meet criteria for a major mood episode are
present for the majority of the total duration of the active and
residual portions of the illness.
The disturbance is not attributable to the effects of a substance
(e.g., a drug of abuse, a medication) or another medical
condition
TREATMENT
ETIOLOGY/ CAUSES


Some common medications for schizophrenia: risperidone
(Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel),
ziprasidone (Geodon), clozapine (Clozaril), haloperidol
(Haldol).
It is essential for a person to continue with their treatment
plan, even if the symptoms improve. If a person stops taking
medication, the symptoms may return.
Begin practicing mindfulness to help reduce stress
Engage in breathing exercises to ground yourself
Look for signs of caregiver fatigue and take time for yourself
to decompress
Connect with trusted loved ones about what you are
experiencing
Read helpful literature about substance/medication-induced
psychosis
Psychotic Disorder Due to Another Medical Condition
▪ Psychotic disorder due to another medical condition: Hallucinations,
delusions, or other symptoms may happen because of another illness
that affects brain function, such as a head injury or brain tumour.
TREATMENT
Antipsychotic medications may be prescribed to help control delusions
and hallucinations and prevent reoccurrence of symptoms.
Catatonia - Catatonia is a group of symptoms that usually involve a
lack of movement and communication, and also can include agitation,
confusion, and restlessness. Until recently, it was thought of as a type
of schizophrenia.
TREATMENT
Doctors usually treat catatonia with a kind of sedative called a
benzodiazepine that's often used to ease anxiety. Another treatment
option is electroconvulsive therapy (ECT). It sends electrical impulses
to the person's brain through electrodes placed on their head.
Other Specified Schizophrenia Spectrum and Other Psychotic Disorder

This category applies to presentations in which symptoms
characteristic of a schizophrenia spectrum and other
psychotic 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 any of the disorders in the schizophrenia spectrum and
other psychotic disorders diagnostic class.
C.
D.
Examples of presentations that can be specified using the “other
specified” designation include the following:
1.
2.
3.
4.
Persistent auditory hallucinations
Delusions with significant overlapping mood episodes
Attenuated psychosis syndrome
Deiusional symptoms in partner of individual within
deiusionai disorder
The unspecified schizophrenia spectrum and other psychotic
disorder category is used in situations in which the clinician
chooses not to specify the reason that the criteria are not met for
a specific schizophrenia spectrum and other psychotic disorder,
and includes presentations in which there is insufficient
information to make a more specific diagnosis
Bipolar and Related Disorders
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Bipolar I Disorder
For a diagnosis of bipolar I disorder, it is necessary to meet the
following criteria for a manic episode. The manic episode may have
been preceded by and may be followed by hypomanic or major
depressive episode.
Manic Episode
A.
B.
A distinct period of abnormally and persistently elevated,
expansive, or irritable mood and abnormally and persistently
increased goal-directed activity or energy, lasting at least 1 week
and present most of the day, nearly every day (or any duration if
hospitalization is necessary).
During the period of mood disturbance and increased energy or
activity, three (or more) of the following symptoms (four if the
mood is only irritable) are present to a significant degree and
represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3
hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are
racing.
5. Distractibility (i.e., attention too easily drawn to
unimportant or irrelevant external stimuli), as reported or
observed.
6. Increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation (i.e.,
purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high
potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or foolish
business investments).
The mood disturbance is sufficiently severe to cause marked
impairment in social or occupational functioning or to necessitate
hospitalization to prevent harm to self or others, or there are
psychotic features.
The episode is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication, other treatment) or
to another medical condition.
Note: A full manic episode that emerges during antidepressant
treatment (e.g., medication, electroconvulsive therapy) but
persists at a fully syndromal level beyond the physiological effect
of that treatment is sufficient evidence for a manic episode and,
therefore, a bipolar I diagnosis.
Note: Criteria A-D constitute a manic episode. At least one lifetime
manic episode is required for the diagnosis of bipolar I disorder.
Hypomanic Episode
A.
A distinct period of abnormally and persistently elevated,
expansive, or irritable mood and abnormally and persistently
increased activity or energy, lasting at least 4 consecutive days
and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and
activity, three (or more) of the following symptoms (four if the
mood is only irritable) have persisted, represent a noticeable
change from usual behavior, and have been present to a
significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours
of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are
racing.
5. Distractibility (i.e., attention too easily drawn to unimportant
or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation.
7. Excessive involvement in activities that have a high potential
for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business
investments).
C. The episode is associated with an unequivocal change in
functioning that is uncharacteristic of the individual when not
symptomatic.
D. The disturbance in mood and the change in functioning are
observable by others.
E.
F.
The episode is not severe enough to cause marked impairment in
social or occupational functioning or to necessitate
hospitalization. If there are psychotic features, the episode is, by
definition, manic.
The episode is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication, other treatment).
Note: A full hypomanic episode that emerges during
antidepressant treatment (e.g., medication, electroconvulsive
therapy) but persists at a fully syndromal level beyond the
physiological effect of that treatment is sufficient evidence for a
hypomanic episode diagnosis. However, caution is indicated so
that one or two symptoms (particularly increased irritability,
edginess, or agitation following antidepressant use) are not taken
as sufficient for diagnosis of a hypomanic episode, nor
necessarily indicative of a bipolar diathesis.
Note: Criteria A-'F constitute a hypomanic episode. Hypomanic
episodes are common in bipolar I disorder but are not required for the
diagnosis of bipolar I disorder.
Major Depressive Episode
A.
Five (or more) of the following symptoms have been present
during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to
another medical condition.
1. Depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feels sad, empty, or
hopeless) or observation made by others (e.g., appears
tearful). (Note: In children and adolescents, can be irritable
mood.)
2. Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by
either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g.,
a change of more than 5% of body weight in a month), or
decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
(observable by others; not merely subjective feelings of
restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely selfreproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed
by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt
or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a
substance or another medical condition.
Note: Criteria A-C constitute a major depressive episode. Major
depressive episodes are common in bipolar I disorder but are not
required for the diagnosis of bipolar I disorder.
Note: Responses to a significant loss (e.g., bereavement, financial ruin,
losses from a natural disaster, a serious medical illness or disability)
may include the feelings of intense sadness, rumination about the loss,
insomnia, poor appetite, and weight loss noted in Criterion A, which
may resemble a depressive episode. Although such symptoms may be
understandable or considered appropriate to the loss, the presence of a
major depressive episode in addition to the normal response to a
significant loss should also be carefully considered. This decision
inevitably requires the exercise of clinical judgment based on the
individual’s history and the cultural norms for the expression of
distress in the context of loss.
Bipolar I Disorder
A. Criteria have been met for at least one manic episode (Criteria AD under “Manic Episode” above).
B. The occurrence of the manic and major depressive episode(s) is
not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified
or unspecified schizophrenia spectrum and other psychotic
disorder.
Bipolar II Disorder
For a diagnosis of bipolar II disorder, it is necessary to meet the
following criteria for a current or past hypomanic episode and the
following criteria for a current or past major depressive episode:
Hypomanic Episode
A.
A distinct period of abnormally and persistently elevated,
expansive, or irritable mood and abnormally and persistently
increased activity or energy, lasting at least 4 consecutive days
and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and
activity, three (or more) of the following symptoms have persisted
(four if the mood is only irritable), represent a noticeable change
from usual behavior, and have been present to a significant
degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours
of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are
racing.
5. Distractibility (i.e., attention too easily drawn to unimportant
or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation.
7. Excessive involvement in activities that have a high potential
for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business
investments).
C. The episode is associated with an unequivocal change in
functioning that is uncharacteristic of the individual when not
symptomatic.
D. The disturbance in mood and the change in functioning are
observable by others.
E. The episode is not severe enough to cause marked impairment in
social or occupational functioning or to necessitate
hospitalization. If there are psychotic features, the episode is, by
definition, manic.
F. The episode is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication or other treatment).
Note: A full hypomanic episode that emerges during
antidepressant treatment (e.g., medication, electroconvulsive
therapy) but persists at a fully syndromal level beyond the
physiological effect of that treatment is sufficient evidence for a
hypomanic episode diagnosis. However, caution is indicated so
that one or two symptoms (particularly increased irritability,
edginess, or agitation following antidepressant use) are not taken
as sufficient for diagnosis of a hypomanic episode, nor
necessarily indicative of a bipolar diathesis.
C.
D.
Major Depressive Episode
A.
Five (or more) of the following symptoms have been present
during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to a
medical condition.
1. Depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feels sad, empty, or
hopeless) or observation made by others (e.g., appears
tearful). (Note: In children and adolescents, can be irritable
mood.)
2. Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by
either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g.,
a change of more than 5% of body weight in a month), or
decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
(observable by others; not merely subjective feelings of
restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely selfreproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed
by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, a suicide attempt, or
a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a
substance or another medical condition.
Note: Criteria A-C above constitute a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin,
losses from a natural disaster, a serious medical illness or disability)
may include the feelings of intense sadness, rumination about the loss,
insomnia, poor appetite, and weight loss noted in Criterion A, which
may resemble a depressive episode. Although such symptoms may be
understandable or considered appropriate to the loss, the presence of a
major depressive episode in addition to the normal response to a
significant loss should be carefully considered. This decision
inevitably requires the exercise of clinical judgment based on the
individual’s history and the cultural norms for the expression of
distress in the context of loss.
Bipolar II Disorder
A. Criteria have been met for at least one hypomanic episode
(Criteria A-F under “Hypomanic Episode” above) and at
least one major depressive episode (Criteria A-C under
“Major Depressive Episode” above).
B. There has never been a manic episode.
The occurrence of the hypomanic episode(s) and major
depressive episode(s) is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform
disorder, delusional disorder, or other specified or
unspecified schizophrenia spectrum and other psychotic
disorder.
The symptoms of depression or the unpredictability caused
by frequent alternation between periods of depression and
hypomania causes clinically significant distress or
impairment in social, occupational, or other important areas
of functioning
Cyclothymic Disorder
A.
B.
C.
D.
E.
F.
For at least 2 years (at least 1 year in children and adolescents)
there have been numerous periods with hypomanic symptoms that
do not meet criteria for a hypomanic episode and numerous
periods with depressive symptoms that do not meet criteria for a
major depressive episode.
During the above 2-year period (1 year in children and
adolescents), the hypomanic and depressive periods have been
present for at least half the time and the individual has not been
without the symptoms for more than 2 months at a time.
Criteria for a major depressive, manic, or hypomanic episode
have never been met.
The symptoms in Criterion A are not better explained by
schizoaffective disorder, schizophrenia, schizophreniform
disorder, delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder.
The symptoms are not attributable to the physiological effects of
a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism).
The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
Depressive Disorders
Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder
A.
B.
C.
D.
E.
F.
G.
Severe recurrent temper outbursts manifested verbally (e.g.,
verbal rages) and/or behaviorally (e.g., physical aggression
toward people or property) that are grossly out of proportion in
intensity or duration to the situation or provocation.
The temper outbursts are inconsistent with developmental level.
The temper outbursts occur, on average, three or more times per
week.
The mood between temper outbursts is persistently irritable or
angry most of the day, nearly every day, and is observable by
others (e.g., parents, teachers, peers).
Criteria A-D have been present for 12 or more months.
Throughout that time, the individual has not had a period lasting
3 or more consecutive months without all of the symptoms in
Criteria A-D.
Criteria A and D are present in at least two of three settings (i.e.,
at home, at school, with peers) and are severe in at least one of
these.
The diagnosis should not be made for the first time before age 6
years or after age 18 years.
H.
I.
J.
K.
By history or observation, the age at onset of Criteria A-E is
before 10 years.
There has never been a distinct period lasting more than 1 day
during which the full symptom criteria, except duration, for a
manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as
occurs in the context of a highly positive event or its anticipation,
should not be considered as a symptom of mania or hypomania.
The behaviors do not occur exclusively during an episode of
major depressive disorder and are not better explained by another
mental disorder (e.g., autism spectrum disorder, posttraumatic
stress disorder, separation anxiety disorder, persistent depressive
disorder [dysthymia]).
Note: This diagnosis cannot coexist with oppositional defiant
disorder, intermittent explosive disorder, or bipolar disorder,
though it can coexist with others, including major depressive
disorder, attention-deficit/hyperactivity disorder, conduct
disorder, and substance use disorders. Individuals whose
symptoms meet criteria for both disruptive mood dysregulation
disorder and oppositional defiant disorder should only be given
the diagnosis of disruptive mood dysregulation disorder. If an
individual has ever experienced a manic or hypomanic episode,
the diagnosis of disruptive mood dysregulation disorder should
not be assigned.
The symptoms are not attributable to the physiological effects of
a substance or to another medical or neurological condition.
C.
The episode is not attributable to the physiological effects of a
substance or to another medical condition.
Note: Criteria A-C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin,
losses from a natural disaster, a serious medical illness or disability)
may include the feelings of intense sadness, rumination about the loss,
insomnia, poor appetite, and weight loss noted in Criterion A, which
may resemble a depressive episode. Although such symptoms may be
understandable or considered appropriate to the loss, the presence of a
major depressive episode in addition to the normal response to a
significant loss should also be carefully considered. This decision
inevitably requires the exercise of clinical judgment based on the
individual’s history and the cultural norms for the expression of
distress in the context of loss.
D. The occurrence of the major depressive episode is not better
explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified
and unspecified schizophrenia spectrum and other psychotic
disorders.
E. There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or
hypomanic-like episodes are substance-induced or are
attributable to the physiological effects of another medical
condition.
Persistent Depressive Disorder (Dysthymia)
Major Depressive Disorder
A.
Five (or more) of the following symptoms have been present
during the same 2-week period and represent a change from
previous functioning: at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to
another medical condition.
1. Depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feels sad, empty,
hopeless) or observation made by others (e.g., appears
tearful). (Note: In children and adolescents, can be irritable
mood.)
2. Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by
either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g.,
a change of more than 5% of body weight in a month), or
decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feelings of
restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely selfreproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed
by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt
or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
This disorder represents a consolidation of DSM-lV-defined chronic
major depressive disorder and dysthymic disorder.
A.
Depressed mood for most of the day, for more days than not, as
indicated by either subjective account or observation by others,
for at least 2 years. Note: In children and adolescents, mood can
be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of
the disturbance, the individual has never been without the
symptoms in Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously
present for 2 years.
E. There has never been a manic episode or a hypomanic episode,
and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent
schizoaffective disorder, schizophrenia, delusional disorder, or
other specified or unspecified schizophrenia spectrum and other
psychotic disorder.
G. The symptoms are not attributable to the physiological effects of
a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g. hypothyroidism).
H. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
Note: Because the criteria for a major depressive episode include four
symptoms that are absent from the symptom list for persistent
depressive disorder (dysthymia), a very limited number of individuals
will have depressive symptoms that have persisted longer than 2 years
but will not mee| criteria for persistent depressive disorder. If full
criteria for a major depressive episode have been met at some point
during the current episode of illness, they should be given a diagnosis
of major depressive disorder. Otherwise, a diagnosis of other specified
depressive disorder or unspecified depressive disorder is warranted.
Premenstrual Dysphoric Disorder
A.
B.
C.
D.
E.
F.
G.
In the majority of menstrual cycles, at least five symptoms must
be present in the final week before the onset of menses, start to
improve within a few days after the onset of menses, and become
minimal or absent in the week postmenses.
One (or more) of the following symptoms must be present: 1.
Marked affective lability (e.g., mood swings: feeling suddenly sad
or tearful, or increased sensitivity to rejection). 2. Marked
irritability or anger or increased interpersonal conflicts. 3. Marked
depressed mood, feelings of hopelessness, or self-deprecating
thoughts. 4. Marked anxiety, tension, and/or feelings of being
keyed up or on edge.
One (or more) of the following symptoms must additionally be
present, to reach a total of five symptoms when combined with
symptoms from Criterion B above. 1. Decreased interest in usual
activities (e.g., work, school, friends, hobbies). 2. Subjective
difficulty in concentration. 3. Lethargy, easy fatigability, or
marked lack of energy. 4. Marked change in appetite; overeating;
or specific food cravings. 5. Hypersomnia or insomnia. A sense
of being over whelmed or out of control. 7. Physical symptoms
such as breast tenderness or swelling, joint or muscle pain, a
sensation of “bloating,” or weight gain. Note: The symptoms in
Criteria A-C must have been met for most menstrual cycles that
occurred in the preceding year.
The symptoms are associated with clinically significant distress
or interference with work, school, usual social activities, or
relationships with others (e.g., avoidance of social activities;
decreased productivity and efficiency at work, school, or home).
The disturbance is not merely an exacerbation of the symptoms
of another disorder, such as major depressive disorder, panic
disorder, persistent depressive disorder (dysthymia), or a
personality disorder (although it may co-occur with any of these
disorders).
Criterion A should be confirmed by prospective daily ratings
during at least two symptomatic cycles. (Note: The diagnosis may
be made provisionally prior to this confirmation.)
The symptoms are not attributable to the physiological effects of
a substance (e.g., a drug of abuse, a medication, other treatment)
or another medical condition (e.g., hyperthyroidism).