Post on 05-Jun-2018
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Dr.LeePui IConsultantPediatrician
PediatricandNeonatologydepartmentCHCSJ,Macau2/11/2014
Diagnosticcriteriaforcommondevelopmentalproblemof
children DSM5
DSM5 TheDiagnosticandStatisticalManualofMentalDisordersDSM
HistoryofDSM DSMI1952,60
DSMII1968, DSMIII1980 DSMIIIR1987 DSMIV1994297
DSMIVDSMIVTR2000
2013518DSMV
DSM5 (DSM5)1999(SteveHyman(StevenM.MirinDavidJ.Kupfer (NIMH)
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RevisionofDiseaseRelativetoChildren 20072
20082
5CharacteristicsofDSM5 5DSM52013518(APA)
:
DSM5(Spectrum)
DSM5Mainchangesofthediagnosiscriteria DSM5ABCDEbereavementgamblingdisorder
DSM5 Neurodevelopmental Disorders IntellectualDisabilities
IntellectualDisability(IntellectualDevelopmentalDisorder)
GlobalDevelopmentalDelay UnspecifiedIntellectualDisability
(IntellectualDevelopmentalDisorder)
CommunicationDisorders LanguageDisorder SpeechSoundDisorder(previously
PhonologicalDisorder) ChildhoodOnsetFluencyDisorder
(Stuttering) Social(Pragmatic)Communication
Disorder UnspecifiedCommunicationDisorder
AutismSpectrumDisorder AutismSpectrumDisorder
AttentionDeficit/HyperactivityDisorder AttentionDeficit/HyperactivityDisorder OtherSpecifiedAttention
Deficit/HyperactivityDisorder UnspecifiedAttention
Deficit/HyperactivityDisorder
SpecificLearningDisorder SpecificLearningDisorder
MotorDisorders DevelopmentalCoordinationDisorder StereotypicMovementDisorder TicDisorders Tourettes Disorder Persistent(Chronic)MotororVocalTic
Disorder ProvisionalTicDisorder OtherSpecifiedTicDisorder UnspecifiedTicDisorder
OtherNeurodevelopmental Disorders OtherSpecifiedNeurodevelopmental
Disorder UnspecifiedNeurodevelopmental
Disorder
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IntellectualDisabilities IntellectualDisability(IntellectualDevelopmentalDisorder) GlobalDevelopmentalDelay UnspecifiedIntellectualDisability(IntellectualDevelopmentalDisorder)
CommunicationDisorders LanguageDisorder SpeechSoundDisorder(previouslyPhonologicalDisorder))
ChildhoodOnsetFluencyDisorder(Stuttering)
Social(Pragmatic)CommunicationDisorder
UnspecifiedCommunicationDisorde
DSM5 AutismSpectrumDisorder
AutismSpectrumDisorder AttentionDeficit/HyperactivityDisorder/ AttentionDeficit/HyperactivityDisorder/
OtherSpecifiedAttentionDeficit/HyperactivityDisorder/
UnspecifiedAttentionDeficit/HyperactivityDisorder/
SpecificLearningDisorder SpecificLearningDisorder
DSM5 MotorDisorders
DevelopmentalCoordinationDisorder StereotypicMovementDisorder TicDisorders Tourettes Disorder Persistent(Chronic)MotororVocalTicDisorder
ProvisionalTicDisorder OtherSpecifiedTicDisorder
OtherNeurodevelopmental Disorders OtherSpecifiedNeurodevelopmental Disorder UnspecifiedNeurodevelopmental Disorder
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DifferentfromDSM5toDSMIV Neurodevelopmental Disorders MentalRetardationintellectualdisabilityintellectualdevelopmentaldisorder
PhonologicaldisordercommunicationdisordersspeechsounddisorderchildhoodonsetfluencydisorderSocialcommunicationdisorder
Neurodevelopmental Disorders Onsetearlyindevelopment,oftenbeforethechildentersgradeschool
characterization: developmentaldeficits:impairmentsofpersonal,social,academic,oroccupationalfunctioning.
Mentalretardation=intellectualdevelopmentaldisorder =
Neurodevelopmental Disorders IntellectualDisabilities
IntellectualDisability(IntellectualDevelopmentalDisorder) A.Deficitsinintellectualfunctions, B.Deficitsinadaptivefunctioningthatresultinfailuretomeet
developmentalandsociocultural standardsforpersonalindependenceandsocialresponsibility
GlobalDevelopmentalDelay undertheageof5years
UnspecifiedIntellectualDisability(IntellectualDevelopmentalDisorder) overtheageof5yearswhenassessmentofthedegreeofintellectual
disability requiresreassessmentafteraperiodoftime
DiagnosticFeatures A.deficitsingeneralmentalabilities B.impairmentineverydayadaptivefunctioning,incomparisontoanindividualsage,gender,andsocioculturally matchedpeers
C.Onsetisduringthedevelopmentalperiod
Thediagnosisofintellectualdisabilityisbasedonbothclinicalassessmentandstandardizedtestingofintellectualandadaptivefunctions.
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Prevalence Intellectualdisabilityhasanoverallgeneralpopulationprevalenceofapproximately1%,andprevalenceratesvarybyage.
Prevalenceforsevereintellectualdisabilityisapproximately6per1,000
Overall,malesaremorelikelythanfemalestobediagnosedwithbothmild(averagemale:female ratio1.6:1)andsevere(averagemale:female ratio1.2:1)formsofintellectualdisability
Thecommunicationdisorders languagedisorder speechsounddisorder)
childhoodonsetfluencydisorder(stuttering)()
social(pragmatic)communicationdisorder()
Thefirstthreedisordersarecharacterizedbydeficitsinthedevelopmentanduseoflanguage,speech,andsocialcommunication,respectively.
LanguageDisorder Thelanguagedeficitsareevidentinspoken Communication,writtencommunication,orsignlanguage
affectsvocabulary andgrammar
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Diagnosisoflanguagedisorder basedonthesynthesisoftheindividualshistory directclinicalobservationindifferentcontexts(home,school,orwork),
andscoresfromstandardizedtestsoflanguageabilitythatcanbeusedtoguideestimatesofseverity.
CauseofLanguagedisorder Geneticandphysiological Languagedisordersarehighlyheritable,andfamilymembersaremorelikelytohaveahistoryoflanguageimpairment.
Speechsounddisorder DiagnosticCriteria
A.Persistentdifficultywithspeechsoundproductionthatinterfereswithspeechintelligibilityorpreventsverbalcommunicationofmessages.
B.Thedisturbancecauseslimitationsineffectivecommunicationthatinterferewithsocialparticipation,academicachievement,oroccupationalperformance,individuallyorinanycombination.
C.Onsetofsymptomsisintheearlydevelopmentalperiod. D.Thedifficultiesarenotattributabletocongenitaloracquiredconditions,suchascerebralpalsy,cleftpalate,deafnessorhearingloss,traumaticbraininjury,orothermedicalorneurologicalconditions.
Childhoodonsetfluencydisorder A.Disturbancesinthenormalfluencyandtimepatterningofspeech
1.Soundandsyllablerepetitions. 2.Soundprolongationsofconsonantsaswellasvowels. 3.Brokenwords(e.g.,pauseswithinaword). 4.Audibleorsilentblocking(filledorunfilledpausesinspeech). 5.Circumlocutions(wordsubstitutionstoavoidproblematicwords).
6.Wordsproducedwithanexcessofphysicaltension. 7.Monosyllabicwholewordrepetitions(e.g.,IIIIseehim).
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Childhoodonsetfluencydisorder B.Thedisturbancecausesanxietyaboutspeakingorlimitationsineffectivecommunication,socialparticipation,oracademicoroccupationalperformance,individuallyorinanycombination.
C.Theonsetofsymptomsisintheearly D.Thedisturbanceisnotattributabletoaspeechmotororsensorydeficit,dysfluency associatedwithneurologicalinsult
Social(pragmatic)communicationdisorder() Persistentdifficultiesinthesocialuseofverbalandnonverbalcommunication
Social(pragmatic)communicationdisorderischaracterizedbyaprimarydifficultywithpragmatics,orthesocialuseoflanguageandcommunication,asmanifestedbydeficitsinunderstandingandfollowingsocialrulesofverbalandnonverbalcommunicationinnaturalisticcontexts,changinglanguageaccordingtotheneedsofthelistenerorsituation,andfollowingrulesforconversationsandstorytelling.
ASDDifferentinDSM5 (Pervasivedevelopmentaldisorder) (Autismspectrumdisorder,ASD)
(subtype) Asperger's disorder PDD,NOS
DSM5ASDdimensional,FragileXsyndromeRett's disordertuberoussclerosisASDsyndromic ASD
Rett's disorder ChildhoodDisintegrativedisorder
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DiagnosticCriteriaofASD Twocoredomain(From3to2symptomdomains)
DSMIV
A. B. C.
restrictedrepetitivebehavior,interestandactivities()
DiagnosticCriteriaofASD
DSMIV
DSMIV
DSMIV
DiagnosticCriteriaofASD
DSMIV
DSM5ASDASDDSMIV
ASD LevelofASDASD
:
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ASDPrevalence
91 (Kogan MD,etal.,2009;BradstreetJJ,et al.,2010) 41 58ASD
(IntellectualImpairment) 70%70 (LanguageImpairment) 5
X (FragileXSyndrome) (TuberousSclerosis)
Problemafterchange Aspergers syndromePDD
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ADHD impairment,clearevidencethatthesymptomsinterferewith,orreducethequalityof
threshold 175 Onset12(DSMIV:7) ASD
ADHD
ADHDDiagnosticCriteriaDSM5 (1) Inattention 1.
2.
3.
4. ()
5. )
6.
7.
8.
9.
If>17yrs,
ADHDDiagnosticCriteriaDSM5 (2) Hyperactivityandimpulsivity
1.fidgets with or taps hands or feet 2. 3.(adolescentsoradultsmaybelimitedtofeelingrestless)
4. 5. 6.
1. 2. 3.
If >17 yrs,
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ADHDDiagnosticCriteriaDSM5
A.ADHD(1) (2)
B.12C.ADHD()
D.
E.()
ADHDMainchangedinDSM5
(maladaptive)changedto(impactdirectlyon...) (clinicallysignificantimpairment)changedto(interferewithorreducethequalityof...)
Age (1)>17years5ormoreof(inattention)or(hyperactivityandimpulsivity)
(2)12 (subtype)(presentation)
ADHDPrevalence 1798 ():510%2.5% 1025
37ADHD
ADHD ADHDprevalence ADHD
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SpecificLearningDisorder ReadingDisorder,dyslexia MathematicsDisorder,dyscalculia DisorderofWrittenExpression
Change:substantiallybelowexpectednotconsistentwith
SpecificLearningDisorder A.Difficultieslearningandusingacademicskills,asindicatedbythepresenceofatleastoneofthefollowingsymptomsthathavepersistedforatleast6months,despitetheprovisionofinterventionsthattargetthosedifficulties: 1.Inaccurateorslowandeffortfulwordreading 2.Difficultyunderstandingthemeaningofwhatisread 3.Difficultieswithspelling 4.Difficultieswithwrittenexpression 5.Difficultiesmasteringnumbersense,numberfacts,orcalculation 6.Difficultieswithmathematicalreasoning
B.Theaffectedacademicskillsaresubstantiallyandquantifiablybelowthoseexpectedfortheindividualschronologicalage
Withimpairmentinreading Wordreadingaccuracy Readingrateorfluency Readingcomprehension
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Impairmentinwrittenexpression Spellingaccuracy Grammarandpunctuationaccuracy
Clarityororganizationofwrittenexpression
Withimpairmentinmathematics Numbersense Memorizationofarithmeticfacts Accurateorfluentcalculation Accuratemathreasoning
DiagnosticFeatures Specificlearningdisorderisaneurodevelopmentaldisorder withabiologicaloriginthatisthebasisforabnormalitiesatacognitivelevelthatareassociatedwiththebehavioralsignsofthedisorder.
ReasonforSLD Environmental
Prematurityorverylowbirthweightincreasestheriskforspecificlearningdisorder
Geneticandphysiological SLDappearstoaggregateinfamilies 48timesand510times
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DDofSLD Intellectualdisability Learningdifficultiesduetoneurologicalorsensorydisorders
Neurocognitive disorders Attentiondeficit/hyperactivitydisorder Psychoticdisorders
MotorDisorders DevelopmentalCoordinationDisorder StereotypicMovementDisorder TicDisorders
Tourettes Disorder Persistent(Chronic)MotororVocalTicDisorder Withmotorticsonly Withvocalticsonly
ProvisionalTicDisorder otherspecifiedandunspecifiedtic
DevelopmentalCoordinationDisorder DiagnosticCriteria
A.Theacquisitionandexecutionofcoordinatedmotorskillsissubstantiallybelowthatexpectedgiventheindividualschronologicalageandopportunityforskilllearninganduse
B.ThemotorskillsdeficitinCriterionAsignificantlyandpersistentlyinterfereswithactivitiesofdailylivingappropriatetochronologicalage
C.Onsetofsymptomsisintheearlydevelopmentalperiod.
D.Themotorskillsdeficitsarenotbetterexplainedbyintellectualdisability
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DevelopmentalCoordinationDisorder Themanifestationofimpairedskillsrequiringmotorcoordination(CriterionA)varieswithage
Developmentalcoordinationdisorderisdiagnosedonlyiftheimpairmentinmotorskillssignificantlyinterfereswiththeperformanceof,orparticipationin,dailyactivitiesinfamily,social,school,orcommunitylife
DCDprevalence Theprevalenceofdevelopmentalcoordinationdisorderinchildrenages511yearsis5%6%(inchildrenage7years,1.8%arediagnosedwithseveredevelopmentalcoordinationdisorderand3%withprobabledevelopmentalcoordinationdisorder)
M;F2:1and7:1.
Comorbidity Disordersthatcommonlycooccurwithdevelopmentalcoordinationdisorderincludespeechandlanguagedisorder;specific
learningdisorder(especiallyreadingandwriting);problemsofinattention(Kadesj andGillberg 1999),includingADHD(the
mostfrequentcoexistingcondition,withabout50%cooccurrence);autismspectrumdisorder(Lingametal.2010);disruptive
andemotionalbehaviorproblems(Cairney etal.2010);andjointhypermobility syndrome.
DiagnosticCriteria A.Theacquisitionandexecutionofcoordinatedmotorskillsissubstantiallybelowthatexpectedgiventheindividualschronological ageandopportunityforskilllearninganduse.
B.ThemotorskillsdeficitinCriterionAsignificantlyandpersistentlyinterfereswithactivitiesofdailylivingappropriatetochronological age
C.Onsetofsymptomsisintheearlydevelopmentalperiod.
D.Themotorskillsdeficitsarenotbetterexplainedbyintellectualdisability
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StereotypicMovementsPrevalence Simplestereotypicmovements(e.g.,rocking)arecommoninyoungtypicallydevelopingchildren.Complexstereotypic
movementsaremuchlesscommon(occurringinapproximately3%4%).Between4%and16%ofindividualswithintellectual
disability(intellectualdevelopmentaldisorder)engageinstereotypyandselfinjury
StereotypicMovementsPrevalence Simplestereotypicmovementsarecommonininfancyandearlychildhood.Rockingmayoccurinthetransitionfromsleepto
awake,abehaviorthatusuallyresolveswithage.Complexstereotypies arelesscommonintypicallydevelopingchildrenand
canusuallybesuppressedbydistractionorsensorystimulation.Theindividualsdailyroutineisrarelyaffected,andthe
movementsgenerallydonotcausethechilddistress.Thediagnosiswouldnotbeappropriateinthesecircumstances.
TicsDisorders Aticisasudden,rapid,recurrent,nonrhythmic motormovementorvocalization.
TicDisorders Tourettes Disorder Persistent(Chronic)MotororVocalTicDisorder Withmotorticsonly Withvocalticsonly
ProvisionalTicDisorder otherspecifiedandunspecifiedtic
Prevalence Ticsarecommoninchildhoodbuttransientinmostcases.TheestimatedprevalenceofTourettes disorderrangesfrom3to8
per1,000inschoolagechildren.Malesaremorecommonlyaffectedthanfemales,withtheratiovaryingfrom2:1to4:1
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OtherSpecifiedNeurodevelopmentalDisorder Thiscategoryappliestopresentationsinwhichsymptomscharacteristicofaneurodevelopmentaldisorderthatcauseimpairmentinsocial,occupational,orotherimportantareasoffunctioningpredominatebutdonotmeetthefullcriteriaforanyofthedisordersintheneurodevelopmental disordersdiagnosticclass.
Couldbeassociatedwith
UnspecifiedNeurodevelopmentalDisorder Thiscategoryappliestopresentationsinwhichsymptoms
characteristicofaneurodevelopmental disorderthatcauseimpairmentinsocial,occupational,orotherimportantareasoffunctioningpredominatebutdonotmeetthefullcriteriaforanyofthedisordersintheneurodevelopmental disordersdiagnosticclass.
Theunspecifiedneurodevelopmental disordercategoryisusedinsituationsinwhichtheclinicianchoosesnottospecifythereasonthatthecriteriaarenotmetforaspecificneurodevelopmental disorder,andincludespresentationsinwhichthereisinsufficientinformationtomakeamorespecificdiagnosis
QuestionsWhatisthepurposeofchangeinthenewedition?Isthediagnosiscomplete?Afterdiagnosis,howshallwedo?
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