8 Neurodevelopmental Disorders

Question 1

A. A persistent pattern of inattention and/or hyperactivity-impulsivity 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. 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)
   b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
   c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
   d. 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).
   e. 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).
   f. 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).
   g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
   h. 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).
2. 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 uncomfortable 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 settings (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 whether:

314. 01 (F90.2) Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.
315. 00 (F90.0) Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.
316. 01 (F90.1) Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.

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.

Answer 1

Attention-Deficit/Hyperactivity Disorder

Question 2

Children with ADHD are first identified as different from their peers around age _____; their parents describe them as active, mischievous, slow to toilet train, and oppositional.

Answer 2

3 or 4

Question 3

_____ is a DSM-5 disorder that includes behaviors such as “often loses temper”, “argues with adults”, “often deliberately annoys people”, “touchy and easily annoyed by others”, and “often spiteful and vindictive”. The impulsivity and hyperactivity observed in children with ADHD can manifest themselves in some of these symptoms.

Answer 3

Oppositional Defiant Disorder (ODD)

Question 4

_____ disorder can be a precursor to antisocial personality disorder—is also observed in many children with ADHD.

Answer 4

Conduct

Question 5

_____ disorder, is one of the mood disorders—also overlaps significantly with ADHD. This overlap can complicate diagnosis in these children.

Answer 5

Bipolar

Question 6

ADHD is considered to be highly influenced by _____.

Answer 6

genetics

Question 7

Prenatal _____ seemed to interact with this genetic predisposition to increase the risk for hyperactive and impulsive behavior.

Other research is now pointing to additional environmental factors, such as maternal stress and alcohol use, and parental marital instability and discord, as involved in these gene–environment interactions.

Answer 7

smoking

Question 8

A. 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:

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 mathematical concepts, facts, or procedures to solve quantitative problems).

B. 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; 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.

Answer 8

Specific Learning Disorder

Question 9

_____ disorder, which is defined as a significant discrepancy between a person’s academic achievement and what would be expected for someone of the same age—referred to by some as “unexpected underachievement”.

Answer 9

Specific learning

Question 10

In addition, a diagnosis of specific learning disorder requires that the person’s disability not be caused by a sensory difficulty, such as trouble with _____, and should not be the result of poor or absent instruction.

Answer 10

sight or hearing

Question 11

Difficulties with _____ are the most common of the learning disorders and occur in some form in 4% to 10% of the general population.

Answer 11

reading

Question 12

Students with _____ disorders are more likely to drop out of school, more likely to be unemployed, and more likely to have suicidal thoughts and attempt suicide.

Answer 12

learning

Question 13

A different area in the left hemisphere—the intraparietal _____—seems to be critical for the development of a sense of numbers and is implicated in mathematics disorder.

Answer 13

sulcus

Question 14

_____ is a neurodevelopmental disorder that, at its core, affects how one perceives and socializes with others.

Answer 14

Autism spectrum disorder (ASD)

Question 15

DSM-5 combined most of the disorders previously included under the umbrella term “_____ developmental disorders” (e.g., autistic disorder, Asperger’s disorder, and childhood disintegrative disorder) and included them into this one category.

Answer 15

pervasive

Question 16

_____ disorder, a genetic condition that affects mostly females, is diagnosed as ASD with the qualifier “associated with _____ syndrome” or “associated with MeCP2 mutation” (the gene involved in Rett syndrome). And the designation “not otherwise specified” which was applied to other disorders prior to DSM-5, was deleted.

Answer 16

Rett

Question 17

A disorder new to DSM-5—_____ Communication Disorder—includes the difficulties in social communication seen in ASD, but without restricted, repetitive patterns of behavior.

These individuals do not easily learn the social rules when communicating with others (e.g., interrupting, talking too loud, not listening to others).

Answer 17

Social (Pragmatic)

Question 18

A. Persistent deficits in social communication and social interaction across multiple contexts, 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 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.

B. 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 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).

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior

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 _____ disorder frequently co-occur; to make comorbid diagnoses of _____ 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 _____ disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for _____ disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if;
With or without accompanying inteliectual impairment
With or without accompanying language impairment
Associated with a icnown medicai or genetic condition or environmental factor
(Coding note: Use additional code to identify the associated medical or genetic condition.)
Associated with another neurodevelopmental, mental, or behavioral disorder
(Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with _____ disorder to indicate the presence of the comorbid catatonia.)

Answer 18

Autism Spectrum Disorder

Question 19

Two major characteristics of _____ are expressed in DSM-5:

1) impairments in social communication and social interaction
2) restricted, repetitive patterns of behavior, interests, or activities

Answer 19

Autism Spectrum Disorder

Question 20

Individuals with the less severe form of ASD may also lack appropriate facial expressions or tone of voice (also known as _____) when speaking or just give the appearance of general nonverbal awkwardness.

Answer 20

prosody

Question 21

Instantaneously and accurately count hundreds of toothpicks falling to the floor. This type of ability—referred to as _____ skills—does not occur in all individuals with ASD. It is estimated that approximately one third of individuals with ASD have these unusual skills, although no persons with the more severe form of ASD appear to have savant abilities. These exceptional skills appear to be the result of possessing superior working memory and highly focused attention

Answer 21

savant

Question 22

One generally accepted conclusion is that _____ deficiencies are the primary distinguishing characteristic of people with ASD.

Answer 22

social

Question 23

One area that is receiving attention involves the genes responsible for the brain chemical _____. Because oxytocin is shown to have a role in how we bond with others and in our social memory

Answer 23

oxytocin

Question 24

There appears to be an increased risk of having a child with ASD among older parents. One group of researchers in Israel, for example, found that fathers 40 years old and up were more than five times more likely to have a child with ASD than fathers under the age of 30. The same correlation does seem to hold up for maternal age.

These findings suggest that mutations may occur in the sperm of fathers or the eggs of mothers (called de _____ mutations) that influence the development of ASD.

Answer 24

novo

Question 25

The damaged _____ may account for the different way people with ASD respond to social situations.

Answer 25

amygdala

Question 26

_____ is a disorder evident in childhood as significantly below-average intellectual and adaptive functioning

Answer 26

Intellectual disability (ID)

Question 27

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. 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
B. Deficits in adaptive functioning that result 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.
C. Onset of intellectual and adaptive deficits during the developmental period

Coding note: The ICD-9-CM code for intellectual disability (intellectual developmental disorder) is 319, which is assigned regardless of the severity specifier. The ICD-10-CM code depends on the severity specifier (see below).

Specify current severity (see Table 1 ):
(F70) Mild
(F71) Moderate
(F72) Severe
(F73) Profound

Answer 27

Intellectual Disability

Intellectual Developmental Disorder

Question 28

To be diagnosed with ID a person must have significantly subaverage intellectual functioning, a determination made with one of several IQ tests with a cutoff score set by DSM-5 of approximately 70.

The American Association on Intellectual and Developmental Disabilities (AAIDD), which has its own, similar definition of intellectual disability, has a cutoff score of approximately 70 to _____.

Answer 28

75

Question 29

The final criterion for ID is the age of onset. The characteristic below-average intellectual and adaptive abilities must be evident before the person is _____.

Answer 29

18

Question 30

Traditionally, classification systems have identified four levels of ID:

1. mild, which is identified by an IQ score between 50–55 and 70;
2. moderate, with a range of 35–40 to 50–55;
3. severe, ranging from 20–25 to 35–40;
4. ______, which includes people with IQ scores below 20–25.

Answer 30

profound

Question 31

Causes of ID
 Environmental: For example, deprivation, abuse, and neglect
 Prenatal: For instance, exposure to disease or drugs while still in the womb
 Perinatal: Such as difficulties during labor and delivery
 Postnatal: For example, infections and head injury
 Heavy use of alcohol among pregnant women can produce a disorder in their children called fetal _____ syndrome, a condition that can lead to severe learning disabilities.

Answer 31

alcohol

Question 32

The next time you drink a diet soda, notice the warning, “Phenylketonurics: Contains Phenylalanine.” This is a caution for people with the recessive disorder called _____ (PKU), which affects 1 of every 10,000 newborns and is characterized by an inability to break down a chemical in our diets called phenylalanine.

Answer 32

phenylketonuria

Question 33

Down syndrome, the most common chromosomal form of ID, was first identified by the British physician Langdon Down in _____.

Answer 33

1866

Question 34

_____ syndrome is a second common chromosomally related cause of ID

primarily affects males

Men with the disorder display moderate to severe levels of ID and have higher rates of hyperactivity, short attention spans, gaze avoidance, and perseverative speech (repeating the same words again and again).

Answer 34

Fragile X

Question 35

_____ treatment of ID is currently not a viable option.

Answer 35

Biological