DSM-5-TR - NeuroDev Disorders

Question 1

ID

Answer 1

• Onset during developmental period
• Refer to assessment(s) for ID - HOWEVER, IQ may also be above 70 if there are significant adaptive deficits
• Severity - based on adaptive fxn (4 types)
• Adaptive fxn (3 areas) - conceptual/academic domain, social, practical
  *Determined by 1) clinical assessment 2) standardized intell testing
• Etologies:
  —prenatal (75%), perinatal (10-15%), postnatal (10-15%)
  —genetics (5%) [like Down Syndrome)
  —environmental factors (most of)
• Prevalence (1%) [population]
• Prevalence (85% of) mild severity
• Comorbidity (3-4x gen pop)
• M:F - 1.5:1

Question 2

Global Developmental Delay

Answer 2

• under 5 years
• fails to meet developmental milestones
• reassess over time (too young for standardized tests)

Question 3

Communication Disorders

Answer 3

Language Disorder
* Acquiring + using language DUE TO deficits in comprehension/production
* Onset MUST in early years
* Dx at age 4+
* Likely stable/persist into adulthood

Speech Sound Disorder
* phonology + articulation INTERFERES w/ intelligibility/prevents VERBAL comm
* most respond well to treatment, improve over time, may not be lifelong

Childhood-onset Fluency Disorder (stuttering)
* Disturbed fluency, sound/syll repition, interjections
* Dx at or after 2
* Recovery at (65-85%)

Social (pragmatic) Communication Disorder
* difficulties/deficits reading social CUES

Question 4

Autism Spectrum Disorder

Answer 4

Social Comm/Interaction - across multiple contexts
* at least 3 in areas of: reciprocity, nonverbal, understanding of relationships

Restricted/Repetitive
* at least 2 of: motor movements/speech, inflexibility; highly restricted, fixated interests; hyper/hyporeactivity to sensory input

Specifications of:
* with or without intellectual impariment
* with or without language impairment

Evident/Onset
* 2nd year of life

Question 5

Autism Spectrum Disorder
Continued

Answer 5

Frequency
* 1%-2% [gen population]
* M:F - 3:1

Heritability!!!
* 35% - 90% | TWIN studies
* [tbd for the rest]
* 15% [genetic mutation]

Savant ~
* Striking abilities OR
* Severe deficits in cog fxn/social

ASD X Rett Syndrome
* excusively females
* normal until 5m
* 5m-4yrs, deceleration of head growth, stereotyped hand/poorly coordinated movements, loss of social engagement

Question 6

ASD Intervention/Treatment(s)

Question 7

ADHD

Answer 7

Must Haves
* Patterns of inattention and/or hyperactivity
* For AT LEAST 6 months
* In AT LEAST 2 settings
* Present BEFORE 12yrs old

Criteria for INATTENTION
* Met when 6+ symptoms
* For Adolescents + Adults AT LEAST 5 required

Criteria for HYPERACTIVITY
* Met when 6+ symptoms
* For Adolescents + Adults AT LEAST 5 required

coded as predominantly [], combined; severity at mild - severe

Question 8

ADHD
Continued

Answer 8

Dx of ADHD
* difficult pre 4 yrs - normative vs. adhd
* tends to be stable thorugh adolescence
* adolescence/adulthood - motor hyper decrease
* rest of remains (inc. impulsivity)
* 1/3 children w/ ADHD remain “impaired”

Associated Features
* Low frustration tolerance, irritability, mood liability, as well as social rejection + interpersonal conflict
* Academic achievement and/or work performance often impaired

Comorbidity
* ODD (50% of time), CD (25% of time)
* Early adulthood - increased SI risk | ESP when comorbid w/ mood, conduct, substance

Question 9

ADHD
Intervention/Treatment(s)

Answer 9

Numbers
* 7% children, 2.5% adults
* M:F - 2:1
* Heritability at 75% [tbd for more]

Medications
* Stimulants - Ritalin (methylphenidate), Concerta (methylphenidate), Adderall (amphetamine), Dexedrine (dextroamphetamine), Vyvanse (lisdexamfetamine)
* Non-Stim - Strattera (atomoxetine)

Interventions for Children
* Behavior therapy
* Social skills training
* Parenting education
* Neurofeedback [EEG]

Interventions for Adults
* CBT

Question 10

Specific Learning Disorder

Answer 10

Copied over from Assessment Deck:
* ‘sub below’ = at least 1.5 SD below (7% percentile) mean for age — ruled out intellectual disabilities

Dx of Specific Learning Disorder
* Presence of AT LEAST 1 of Sx*
* For AT LEAST 6 months
* Academic domain should be coded
* Specifiers include: w/ impairment in reading or written expression or mathematics

Numbers
* Prevalence 5%-15% [gen population]
* M:F - 2|3:1
* Heritability — 1st degree relatives signficantly (5-10x) higher [tbd on more]
* Comorbids include neuro and other.

Question 11

Motor Disorders

Part 1

Answer 11

Developmental Coordination Disorder
* coordinated motor skills significantly below age expected
* Onset MUST be during dev period

Stereotypic Movement Disorder
* repetitive/nonfunctional
* interferes w/ normal activities or self-inflicted bodily injury

Question 12

Motor Disorders |
Tic Disorders

Answer 12

Onset for ALL before age 18

Tourette’s
* multiple motor, 1 or more vocal
* MUST have been present for more than 1 year since onset of 1st tic.
* 5/1000 children
* M:F - 2|4:1
* Prevalence of Comorbid ADHD and OCD — 50%+

Persistent motor or vocal | not both
* either 1+ motor tics OR 1+ vocal
* MUST have been present for more than 1 year since onset of 1st tic.

Provisional tic disorder | less than 1 yr since onset

Question 13

Motor Disorders |
Tic Disorders 2

Answer 13

Additional Facts
* can be voluntarily suppressed for limited time
* increase under stress, decrease during absorbing activities
* motor | eye blink, neck jerk, shoulder shrug, facial grimacing, etc.
* vocal | throat clearing, grunting, sniffing, barking, coprolalia (swearing), echolalia

Medications
* Catapres (clonidine) [anti-hypertensive]
* Haldol (haloperidol), Abilify (aripiprazole) [antipsychotics]
* Prozac (fluoxetine) [SSRIs] WHEN co-occurring anxiety/OCD

Interventions
* CBIT [comp behavioral inter for tics]