Oklahoma Psychological Association DSM-5 Panel November 8-9, 2013 Jennifer L. Morris, Ph.D. DSM-5 continues developmental progression, starting with disorders that are observed in early life. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence now termed Neurodevelopmental Disorders Other disorders are now categorized with disorders with similar symptoms Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. 1
Include disorders with onset during the early developmental period Include specifiers to improve the clinical picture Specifiers for severity, age of onset, associated medical/genetic condition or environmental factor Name change reflects terms used in medical and educational settings, change in name from federal statute (Public Law 111-256, Rosa s Law). Focus on intellectual functioning and adaptive functioning. New criteria allows consideration of variety of intellectual functions, including problem-solving, reasoning, judgment, learning, abstract thinking. 2
Continue to have severity modifiers but now they are based on adaptive functioning (conceptual, social, and practical domains see pages 34-36 for examples) Mild Moderate Severe Profound Global Developmental Delay For children under age 5, who are exhibiting delays in meeting developmental milestones in a number of areas True functioning cannot be assessed with standardized tests Unspecified Intellectual Disability Individuals >5yo exhibiting deficits but skills cannot be measured because of physical, sensory, motor, or behavioral problems 3
Language Disorder Consolidates Expressive & Mixed Receptive-Expressive Language Disorders Considers deficits in comprehension OR production Speech Sound Disorder Phonological/Articulation Disorder Childhood-onset Fluency Disorder (Stuttering) Social (Pragmatic) Communication Disorder New disorder that identifies children with deficits in social communication and conversation skills Autism Spectrum Disorder has been term used in research and clinical practice for a number of years represents spectrum of symptom presentation Autism Spectrum Disorder combines four diagnoses from previous DSM - Autistic Disorder, Childhood Disintegrative Disorder, Asperger s Disorder, and Pervasive Developmental Disorder NOS 4
Criteria changes From 3 areas of deficit (reciprocal social interaction, communication, restricted interests/repetitive behaviors) Now 2 areas of deficit (social communication and interaction, and restricted, repetitive patterns of behavior, interests, activities) New restricted/repetitive criteria include sensory sensitivities Levels of severity for each area of deficit Level 1 requiring support Level 2 requiring substantial support Level 3 requiring very substantial support Allows clinician to identify areas of impairment With/without intellectual impairment With/without structural language impairment Associated with known medical/genetic or environmental/acquired condition Associated with another neurodevelopmental, mental, or behavioral disorder Specifiers Age of first concern With/without loss of skills Severity 5
No longer combined with the Disruptive Behavior Disorders those are now identified with other impulse-control and behavioral disorders Attention-Deficit/Hyperactivity Disorder 6 Inattentive and/or 6 Hyperactive-Impulsive symptoms for 6 months Symptoms present before 12 years of age Fewer symptoms (5) needed in each area for individuals over age 17 years Combined presentation Predominantly Inattentive presentation Predominantly Hyperactive/Impulsive presentation Allows for in partial remission specifier Clinician rates severity - Mild, moderate, severe based on number of symptoms, impairment in functioning 6
Academic skill and learning deficits (1 out of 6 areas) Significantly below age expectations on standardized tests Specify all areas of impairment Reading - word reading, fluency, comprehension Mathematics numbers, fluency, math reasoning Written Expression spelling, fluency, grammar/writing Severity Mild (1-2 academic domains, some compensation) Moderate (1 or more, need for specialized instruction to gain skills) Severe (several academic domains, ongoing intensive individualized and specialized teaching for most of the school years Developmental Coordination Disorder Stereotypic Movement Disorder Specifier for with/without self-injury Tic Disorders Tourette s Disorder Persistent (Chronic) Motor or Vocal Tic Disorder Provisional Tic Disorder For motor/vocal tics present less than 1 year 7
Anxiety Disorders Separation Anxiety Disorder Selective Mutism Feeding/Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Disruptive, Impulse-control, and Conduct Disorders Oppositional Defiant Disorder Conduct Disorder Trauma and Stress-Related Disorders Reactive Attachment Disorder of Infancy or Early Childhood 8