Introduction To Developmental Psychopathology: 1. Assessment

Introduction to Developmental Psychopathology
1. Assessment
Assessment Component Description
Conduct a comprehensive interview with the child/adolescent and caregivers to

Clinical Interview gather developmental history, family dynamics, and presenting problems.
Directly observe the child's behavior in various settings to assess functioning, social
Behavioral Observation interactions, and behavioral patterns.
Administer standardized tests to assess cognitive, emotional, and behavioral

functioning, including intelligence, academic achievement, and personality
Psychological Testing assessments.
Collect information from parents, teachers, and caregivers through structured

Parent and Teacher Reports questionnaires or interviews to gain additional perspectives on the child's behavior.
Conduct a thorough medical evaluation to rule out underlying medical conditions or

Medical Evaluation neurological disorders contributing to symptoms.
Neuropsychological Assess specific cognitive abilities, such as attention, memory, and executive
Assessment functioning, to identify any brain-related issues.
Review developmental milestones and history to identify delays or deviations from

Developmental History typical developmental trajectories.
Understand family dynamics, parenting styles, and stressors to assess their impact on
Family Assessment the child's development and psychopathology.
Consider the cultural background and context of the child and family to ensure
Cultural Considerations assessments are culturally sensitive and appropriate.
Collaborate with other professionals, such as pediatricians, psychiatrists, and

therapists, to obtain a comprehensive understanding and develop appropriate
Collaboration treatment plans.
Continuous Monitoring and Continuously monitor and periodically reassess the child's progress to track changes
Reassessment in symptoms and adjust interventions as needed.
Assessing developmental psychopathology involves a comprehensive approach that considers

various factors contributing to atypical development in children and adolescents. Here's an
overview of the assessment process:
1. Clinical Interview: A thorough clinical interview with the child/adolescent and their
caregivers is typically the first step. This helps gather information about the child's
developmental history, family dynamics, medical history, academic performance, social
interactions, and any presenting problems.
2. Behavioral Observation: Direct observation of the child's behavior in different
settings (e.g., home, school, clinic) provides valuable insights into their functioning,
social interactions, and behavioral patterns.
3. Psychological Testing: Standardized psychological tests are administered to assess
various aspects of the child's cognitive, emotional, and behavioral functioning. These
tests may include intelligence tests, academic achievement tests, personality
assessments, and measures of specific symptoms or disorders.
4. Parent and Teacher Reports: Gathering information from parents, teachers, and other
caregivers through structured questionnaires or interviews provides additional
perspectives on the child's behavior and functioning across different settings.
5. Medical Evaluation: A thorough medical evaluation is essential to rule out any
underlying medical conditions or neurological disorders that may be contributing to the
child's symptoms.
6. Neuropsychological Assessment: In cases where there are concerns about cognitive
functioning or brain-related issues, a neuropsychological assessment may be conducted
to evaluate specific cognitive abilities, such as attention, memory, executive
functioning, and processing speed.
7. Developmental History: Reviewing the child's developmental milestones and history
can help identify any delays or deviations from typical developmental trajectories.
8. Family Assessment: Understanding family dynamics, parenting styles, and family
stressors is crucial as family factors can significantly impact a child's development and
psychopathology.
9. Cultural Considerations: Assessors must consider the cultural background and
context of the child and their family to ensure that assessments are culturally sensitive
and appropriate.
10. Collaboration with Other Professionals: Collaboration with other professionals, such
as pediatricians, psychiatrists, speech-language pathologists, and occupational
therapists, may be necessary to obtain a comprehensive understanding of the child's
needs and to develop an appropriate treatment plan.
11. Continuous Monitoring and Reassessment: Developmental psychopathology is
dynamic, and symptoms may change over time. Therefore, continuous monitoring and
periodic reassessment are essential to track the child's progress and adjust interventions
as needed.
2. Diagnosis
Diagnostic Step Description
Conduct a thorough clinical interview with the child/adolescent and caregivers to gather
information about developmental history, family dynamics, and presenting concerns. Explore
Clinical symptoms, behaviors, emotions, and their impact on daily functioning across different settings
Interview (home, school, social contexts).
Observe the child's behavior directly in various settings to assess for symptoms, social
Behavioral interactions, and behavioral patterns. Note any abnormalities, such as hyperactivity, aggression,
Observation withdrawal, or repetitive behaviors, that may indicate the presence of a developmental disorder.
Administer standardized psychological tests and measures to assess cognitive abilities, emotional
functioning, and behavioral symptoms. Utilize validated tools such as intelligence tests, rating
Psychological scales for specific disorders (e.g., ADHD, autism spectrum disorder), and assessments of
Assessment executive functioning, language skills, and social communication.
Compare presenting symptoms and behaviors with criteria outlined in diagnostic manuals such
as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International
Diagnostic Classification of Diseases (ICD-11). Determine whether the child meets criteria for specific
Criteria disorders or conditions based on the presence, duration, and severity of symptoms.
Rule out other potential explanations for the observed symptoms, including medical conditions,
neurological disorders, environmental stressors, or cultural factors. Consider comorbidities and
Differential overlapping symptoms between different disorders to accurately identify the primary diagnosis
Diagnosis and tailor interventions accordingly.
Review the child's developmental milestones, medical history, family history of mental health
Developmental issues, and previous assessments or interventions. Identify any significant events, trauma, or
History disruptions in early development that may contribute to current symptoms or psychopathology.
Collaborate with other professionals involved in the child's care, including pediatricians,
psychiatrists, school psychologists, and therapists. Share assessment findings, observations, and
diagnostic impressions to obtain a comprehensive understanding and ensure coordinated
Collaboration treatment planning.
Consider the cultural background, beliefs, and values of the child and family when interpreting
symptoms and making diagnostic decisions. Recognize cultural variations in expression,
perception, and help-seeking behaviors related to mental health issues. Adapt assessment
Cultural methods and interventions to be culturally sensitive and relevant to the individual's cultural
Considerations context.
Integrate information from multiple sources (interviews, observations, test results) to formulate a
comprehensive diagnostic impression. Provide a clear and accurate description of the primary
diagnosis, specifying any relevant specifiers (e.g., severity, comorbidities) and differential
Formulating a considerations. Communicate the diagnosis sensitively and collaboratively with the child and
Diagnosis family, emphasizing understanding, support, and treatment options.
Establish a plan for ongoing monitoring and follow-up to track the child's progress, response to
interventions, and any changes in symptoms or functioning over time. Schedule regular
Monitoring and appointments to reassess symptoms, adjust treatment strategies as needed, and provide support
Follow-Up and guidance to the child and family throughout the diagnostic and treatment process.
3. Treatment strategies
Psychotherapy Strategies Table:
Psychotherapy Strategy Description
Cognitive-Behavioral Helps children and adolescents identify and change negative thought patterns and
Therapy (CBT) behaviors. Effective for anxiety, depression, and behavioral disorders.
Uses play as a means of communication and expression, facilitating emotional

Play Therapy processing and coping skills development.
Involves the entire family in therapy sessions to improve communication, resolve

Family Therapy conflicts, and address family dynamics contributing to the child's difficulties.
Parent-Child Interaction Teaches parents positive reinforcement techniques and effective discipline strategies to
Therapy (PCIT) improve parent-child relationships and manage challenging behaviors.
Medication Strategies Table:
Medication
Strategy Description
Psychotropic Prescribed by psychiatrists or pediatricians to alleviate symptoms of specific mental health

Medications disorders, such as ADHD, depression, anxiety, or bipolar disorder.
Regular monitoring by healthcare providers to assess medication effectiveness, monitor side

Careful Monitoring effects, and adjust dosage as needed.
Behavioral Interventions Table:
Behavioral
Intervention Description
Applied Behavior Utilizes principles of learning and reinforcement to modify behaviors and teach new skills.
Analysis (ABA) Effective for children with ASD and developmental delays.
Teaches interpersonal and communication skills, problem-solving strategies, and

Social Skills Training appropriate social behaviors to improve peer relationships and social interactions.
Educational Support Strategies Table:
Educational Support Description
Individualized Education Plan Provides accommodations and modifications in the school setting to support
(IEP) or 504 Plan academic success and address behavioral or learning challenges.
Offers specialized instruction, therapies, and support services tailored to the child's
Special Education Services needs, such as speech therapy, occupational therapy, or resource room support.
Collaborative Strategies Table:

Collaborative Strategy Description
Coordination among healthcare providers, educators, therapists, and other professionals

Collaboration with Other involved in the child's care to ensure a comprehensive and integrated approach to
Professionals treatment.
Assistance in navigating the healthcare system, accessing services, and coordinating care
Case Management across different providers and agencies.
Long-Term Support and Monitoring Strategies Table:
Long-Term Support and

Monitoring Description
Regular check-ins with healthcare providers to monitor progress, address new

Continued Follow-Up challenges, and adjust treatment strategies as needed.
Assistance in transitioning to adulthood, including vocational support, independent

Transition Planning living skills training, and accessing adult mental health services.
1. Psychotherapy:
• Cognitive-Behavioral Therapy (CBT): Helps children and adolescents
identify and change negative thought patterns and behaviors. It is effective for
a wide range of conditions, including anxiety disorders, depression, and
disruptive behavior disorders.
• Play Therapy: Utilizes play as a means of communication and expression for
children, facilitating emotional processing and coping skills development.
• Family Therapy: Involves the entire family in therapy sessions to improve
communication, resolve conflicts, and address family dynamics that contribute
to the child's difficulties.
• Parent-Child Interaction Therapy (PCIT): Teaches parents positive
reinforcement techniques and effective discipline strategies to improve parent-
child relationships and manage challenging behaviors.
2. Medication:
• Psychotropic Medications: Prescribed by a psychiatrist or pediatrician to
alleviate symptoms of specific mental health disorders, such as attention-
deficit/hyperactivity disorder (ADHD), depression, anxiety, or bipolar
disorder. Common medications include stimulants, antidepressants, mood
stabilizers, and antipsychotics.
• Careful Monitoring: Regular monitoring by healthcare providers to assess
medication effectiveness, monitor side effects, and adjust dosage as needed.
3. Behavioral Interventions:
• Applied Behavior Analysis (ABA): Utilizes principles of learning and
reinforcement to modify behaviors and teach new skills. It is particularly
effective for children with autism spectrum disorder (ASD) and developmental
delays.
• Social Skills Training: Teaches children and adolescents interpersonal and
communication skills, problem-solving strategies, and appropriate social
behaviors to improve peer relationships and social interactions.
4. Educational Support:
• Individualized Education Plan (IEP) or 504 Plan: Provides
accommodations and modifications in the school setting to support academic
success and address behavioral or learning challenges.
• Special Education Services: Offers specialized instruction, therapies, and
support services tailored to the child's needs, such as speech therapy,
occupational therapy, or resource room support.
5. Parent Training and Support:
• Parent Education Programs: Offer guidance and support to parents in
managing their child's behavior, implementing effective discipline strategies,
and promoting positive parent-child interactions.
• Support Groups: Provide opportunities for parents to connect with others
facing similar challenges, share experiences, and receive emotional support
and practical advice.
6. Multidisciplinary Approach:
• Collaboration: Coordination among healthcare providers, educators,
therapists, and other professionals involved in the child's care to ensure a
comprehensive and integrated approach to treatment.
• Case Management: Assistance in navigating the healthcare system, accessing
services, and coordinating care across different providers and agencies.
7. Early Intervention Programs:
• Early Childhood Intervention (ECI): Provides services and support for
infants and toddlers with developmental delays or disabilities to promote
optimal development and address areas of need as early as possible.
8. Holistic Approaches:
• Mindfulness and Relaxation Techniques: Teaches children and adolescents
techniques to manage stress, regulate emotions, and improve self-awareness
and coping skills.
• Physical Activity and Nutrition: Encourages regular exercise and healthy
eating habits, which can positively impact mood, behavior, and overall well-
being.
9. Community Resources and Support Services:
• Community Mental Health Centers: Offer a range of mental health services,
including therapy, medication management, and case management.
• Supportive Services: Access to community-based programs, respite care,
recreational activities, and other resources that support the child's and family's
needs.
10. Long-Term Support and Monitoring:
• Continued Follow-Up: Regular check-ins with healthcare providers to
monitor progress, address new challenges, and adjust treatment strategies as
needed.
• Transition Planning: Assistance in transitioning to adulthood, including
vocational support, independent living skills training, and accessing adult
mental health services.
4. Research on child Psychopathology

Research Areas in Child Psychopathology Table:
Research Area Description
Epidemiology and Studies examining the prevalence rates of mental health disorders in children and
Prevalence adolescents, including demographic patterns, regional variations, and trends over time.
Research exploring biological, psychological, social, and environmental factors

Risk and Protective contributing to the development of psychopathology in children, as well as factors
Factors promoting resilience and positive mental health outcomes.
Investigations into the genetic and neurobiological underpinnings of childhood mental

Genetics and health disorders, including genetic risk factors, brain structure and function,
Neurobiology neurotransmitter systems, and neurodevelopmental processes.
Studies focusing on understanding early developmental trajectories of children at risk for

Early Childhood or experiencing mental health problems, including the impact of early experiences,
Development attachment relationships, and developmental milestones.
Research developing and validating assessment tools and diagnostic criteria for childhood
Assessment and mental health disorders, including standardized measures, diagnostic interviews, and
Diagnosis observational techniques.
Evaluations of the efficacy and effectiveness of psychosocial interventions, psychotherapy

Intervention and approaches, pharmacological treatments, and integrated treatment models for addressing
Treatment various childhood mental health disorders.
Prevention and Early

Investigations into preventive interventions aiming to reduce the risk of mental health
Intervention
problems in children and promote healthy development, as well as early intervention
Research Area Description
programs targeting at-risk populations to prevent or mitigate the onset or progression of

psychopathology.
Studies exploring cultural variations in the expression, experience, and perception of

Cultural and Diversity mental health symptoms and disorders among children from diverse cultural backgrounds,
Considerations as well as culturally sensitive assessment and treatment approaches.
Comorbidity and Research examining the co-occurrence of multiple mental health disorders, longitudinal
Developmental trajectories of psychopathology from childhood to adolescence and adulthood, and factors
Trajectories influencing stability or change in symptoms over time.
Assessments of the impact of mental health disorders on various domains of children's

Impact on Functioning functioning and well-being, including academic achievement, social relationships, family
and Well-being functioning, physical health, and quality of life.
Implementation Studies focusing on the implementation of evidence-based practices in real-world settings,

Science and dissemination of research findings to practitioners and policymakers, and strategies for
Dissemination improving access to quality mental health care for children and families.
Epidemiology and Prevalence:

Studies in this area involve systematic investigations into the prevalence rates of various mental
health disorders in children and adolescents. Researchers examine trends over time,
demographic patterns, and regional variations to better understand the distribution of mental
health conditions within populations. Epidemiological studies utilize rigorous methodologies,
such as large-scale surveys or longitudinal cohort studies, to gather data on the occurrence and
distribution of specific disorders, including their frequency, severity, and associated risk
factors. This research provides critical insights into the burden of mental health disorders on
child and adolescent populations and informs public health policies and interventions aimed at
prevention and early intervention.
Risk and Protective Factors:
Research in this area focuses on identifying the complex interplay of biological, psychological,
social, and environmental factors that contribute to the development of psychopathology in
children. Studies investigate risk factors that increase vulnerability to mental health problems,
such as genetic predispositions, adverse childhood experiences, family dysfunction, socio-
economic stressors, and exposure to trauma or violence. Conversely, researchers also explore
protective factors that promote resilience and positive mental health outcomes, such as
supportive family relationships, access to quality education and healthcare, social support
networks, and effective coping strategies. Understanding these factors can inform targeted
interventions and preventive efforts to mitigate risk and enhance protective factors to promote
healthy development and well-being in children and adolescents.
Genetics and Neurobiology:
Studies in this area aim to unravel the genetic and neurobiological underpinnings of childhood
mental health disorders. Researchers investigate genetic risk factors, including gene variants
and heritability estimates, associated with susceptibility to specific disorders. Additionally,
neurobiological research explores brain structure and function abnormalities, neurotransmitter
systems dysregulation, and neurodevelopmental processes implicated in the etiology and
pathophysiology of mental health conditions in children. Advances in genetics and
neurobiology provide insights into the biological mechanisms underlying psychiatric disorders,
informing the development of targeted interventions, pharmacological treatments, and
personalized approaches to care.
Early Childhood Development:
Research in early childhood development focuses on understanding the critical periods of
growth and development in infancy and early childhood and their implications for mental
health outcomes. Investigators examine the impact of early experiences, such as prenatal
factors, attachment relationships, parental caregiving, and environmental influences, on
children's socio-emotional, cognitive, and behavioral development. Longitudinal studies track
developmental trajectories and identify early markers of risk or resilience for later mental
health problems. This research underscores the importance of early intervention and preventive
efforts to support healthy development and mitigate the impact of early adversities on long-
term mental health outcomes.
Assessment and Diagnosis:
Studies in this area involve the development, validation, and refinement of assessment tools
and diagnostic criteria for childhood mental health disorders. Researchers collaborate to create
standardized measures, diagnostic interviews, and observational techniques that are reliable,
valid, and culturally sensitive. These instruments enable clinicians and researchers to
systematically evaluate symptoms, functional impairments, and diagnostic criteria across
different developmental stages and cultural contexts. Valid and reliable assessment tools are
essential for accurate diagnosis, treatment planning, and monitoring of treatment outcomes in
children and adolescents with mental health concerns.
Intervention and Treatment:
Research in intervention and treatment focuses on evaluating the efficacy, effectiveness, and
safety of psychosocial interventions, psychotherapy approaches, pharmacological treatments,
and integrated treatment models for addressing various childhood mental health disorders.
Randomized controlled trials (RCTs), systematic reviews, and meta-analyses are conducted to
assess the impact of interventions on symptom reduction, functional improvement, and quality
of life outcomes. Researchers investigate the mechanisms of action underlying therapeutic
interventions and identify moderators and mediators of treatment response. This research
informs evidence-based practice guidelines and clinical decision-making to optimize treatment
outcomes and enhance the well-being of children and adolescents with mental health needs.
Prevention and Early Intervention:
Studies in this area examine preventive interventions aimed at reducing the risk of mental
health problems in children and promoting healthy development, as well as early intervention
programs targeting at-risk populations to prevent the onset or progression of psychopathology.
Researchers evaluate the effectiveness of universal, selective, and indicated prevention
strategies implemented in various settings, including schools, communities, and healthcare
settings. Early intervention programs target vulnerable populations, such as children exposed
to trauma, abuse, or neglect, and provide targeted support and services to mitigate risk factors
and enhance protective factors. Preventive efforts aim to promote resilience, strengthen coping
skills, and foster positive mental health outcomes in children and adolescents.
Cultural and Diversity Considerations:
Research in this area explores cultural variations in the expression, experience, and perception
of mental health symptoms and disorders among children from diverse cultural backgrounds.
Investigators examine cultural norms, values, beliefs, and practices related to mental health and
help-seeking behaviors. Culturally sensitive assessment tools and treatment approaches are
developed to address the unique needs and preferences of diverse populations. Researchers
collaborate with communities to promote culturally competent care, reduce disparities in access
to mental health services, and enhance cultural responsiveness in clinical practice.
Comorbidity and Developmental Trajectories:
Studies in this area investigate the co-occurrence of multiple mental health disorders
(comorbidity), longitudinal trajectories of psychopathology from childhood to adolescence and
adulthood, and factors influencing stability or change in symptoms over time. Researchers
examine patterns of symptomatology, diagnostic overlap, and risk factors associated with
comorbid conditions. Longitudinal studies track individuals over time to identify
developmental pathways, transitions between diagnostic categories, and predictors of
outcomes across different developmental stages. Understanding comorbidity and
developmental trajectories informs personalized treatment planning and interventions tailored
to the evolving needs of children and adolescents with complex mental health profiles.
Impact on Functioning and Well-being:
Research in this area assesses the impact of mental health disorders on various domains of
children's functioning and well-being, including academic achievement, social relationships,
family functioning, physical health, and quality of life. Investigators employ multidimensional
measures to evaluate functional impairments, adaptive functioning, and subjective well-being
in children and adolescents with mental health concerns. Longitudinal and cross-sectional
studies examine the bi-directional relationships between mental health and functioning
outcomes, as well as moderators and mediators of these associations. Findings highlight the
importance of addressing mental health needs holistically and promoting positive outcomes
across multiple domains of functioning.
Implementation Science and Dissemination:
Studies in this area focus on the implementation of evidence-based practices in real-world
settings, dissemination of research findings to practitioners and policymakers, and strategies
for improving access to quality mental health care for children and families. Implementation
science examines the adoption, implementation, and sustainment of interventions in routine
practice settings, identifying barriers and facilitators to implementation and scaling-up
effective interventions. Dissemination efforts utilize various dissemination strategies, such as
training, consultation, and knowledge translation activities, to promote the uptake of research
findings and best practices by stakeholders. Researchers collaborate with policymakers,
healthcare organizations, and community partners to promote the integration of evidence-based
mental health services into healthcare systems and improve the delivery of care to children and
families in need.
5. ICD classification of child psychopathology

ICD-
11
Main Heading Classification Explanation Code
Neurodevelopmental Disorders
(6A00-6A9Z)
Autism spectrum disorders are characterized by

persistent deficits in social communication and
Autism Spectrum interaction, as well as restricted, repetitive
Disorders (6A00) patterns of behavior, interests, or activities. 6A00
Intellectual developmental disorders involve

deficits in intellectual functioning (e.g.,
Intellectual reasoning, problem-solving) and adaptive
Developmental Disorders functioning (e.g., daily living skills), typically
(6A01) diagnosed in childhood. 6A01
Attention-Deficit ADHD is characterized by persistent patterns of

Hyperactivity Disorder inattention, hyperactivity, and impulsivity that
(ADHD) (6A02) interfere with functioning or development. 6A02
Specific learning disorders involve difficulties in

acquiring and using academic skills, such as
reading, writing, or mathematics, that are not
Specific Learning solely attributable to intellectual disabilities or
Disorders (6A03) other factors. 6A03
Communication disorders encompass deficits in

language, speech, and communication skills,
including expressive and receptive language
Communication disorders, speech sound disorders, and social
Disorders (6A04) communication disorder. 6A04
Emotional Disorders (6A10-6A1Z)
Depressive disorders involve persistent feelings

of sadness, hopelessness, and loss of interest or
Depressive Disorders pleasure in activities, accompanied by changes in
(6A10) mood, behavior, and cognitive functioning. 6A10
Anxiety disorders are characterized by excessive

fear or worry, along with associated symptoms
Anxiety Disorders such as restlessness, fatigue, muscle tension, and
(6A11) difficulty concentrating. 6A11
Obsessive-Compulsive
Disorder (6A12) Obsessive-compulsive disorder involves 6A12
recurrent, intrusive thoughts (obsessions) and
ICD-
11
repetitive behaviors or mental acts (compulsions)

aimed at reducing anxiety or distress.
PTSD occurs in response to exposure to traumatic

events, characterized by intrusive memories,
avoidance of trauma-related stimuli, negative
Post-Traumatic Stress alterations in mood or cognition, and heightened
Disorder (6A13) arousal or reactivity. 6A13
Behavioral Syndromes Associated

with Physiological Disturbances and
Physical Factors (6A20-6A2Z)
Oppositional defiant disorder involves a pattern

of angry/irritable mood, argumentative/defiant
Oppositional Defiant behavior, and vindictiveness lasting at least six
Disorder (6A20) months, often directed toward authority figures. 6A20
Conduct disorder is characterized by a repetitive

and persistent pattern of behavior that violates the
rights of others or societal norms, including
aggression toward people or animals, destruction
Conduct Disorder (6A21) of property, deceitfulness, or theft. 6A21
Disorders Specifically Associated

with Stress (6A30-6A3Z)
Adjustment disorder involves the development of

emotional or behavioral symptoms in response to
identifiable stressors, such as significant life
Adjustment Disorder changes or adverse events, that exceed normal
(6A30) adaptive responses. 6A30
Reactive attachment disorder is characterized by

markedly disturbed and developmentally
inappropriate social relatedness, typically
Reactive Attachment resulting from inadequate caregiving experiences
Disorder (6A31) during early childhood. 6A31
Psychotic Disorders (6A40-6A4Z)
Schizophrenia is a severe mental disorder

characterized by disturbances in thought,
perception, emotion, and behavior, often
involving hallucinations, delusions, disorganized
Schizophrenia (6A40) thinking, and impaired social functioning. 6A40
Schizoaffective Disorder Schizoaffective disorder involves a combination

(6A41) of mood symptoms (e.g., depressive or manic 6A41
episodes) and psychotic symptoms (e.g.,
ICD-
11
hallucinations or delusions) that meet criteria for

both schizophrenia and mood disorders.
Disruptive, Impulse-Control, and

Conduct Disorders (6A50-6A5Z)
Oppositional defiant disorder involves a pattern

of angry/irritable mood, argumentative/defiant
Oppositional Defiant behavior, and vindictiveness lasting at least six
Disorder (6A50) months, often directed toward authority figures. 6A50
Conduct disorder is characterized by a repetitive

and persistent pattern of behavior that violates the
rights of others or societal norms, including
aggression toward people or animals, destruction
Conduct Disorder (6A51) of property, deceitfulness, or theft. 6A51
Anxiety Disorders (6A60-6A6Z)
Separation anxiety disorder involves excessive

fear or anxiety about separation from attachment
figures, leading to significant distress or
Separation Anxiety impairment in social, academic, or occupational
Disorder (6A60) functioning. 6A60
Specific phobia is characterized by marked and

persistent fear or anxiety about a specific object
Specific Phobia (6A61) or situation, leading to avoidance or distress. 6A61
Obsessive-Compulsive and Related

Disorders (6A70-6A7Z)
Obsessive-compulsive disorder involves

recurrent, intrusive thoughts (obsessions) and
Obsessive-Compulsive repetitive behaviors or mental acts (compulsions)
Disorder (6A70) aimed at reducing anxiety or distress. 6A70
Body dysmorphic disorder involves

preoccupation with perceived defects or flaws in
physical appearance, leading to repetitive
Body Dysmorphic behaviors or mental acts in response to
Disorder (6A71) appearance concerns. 6A71
Trauma- and Stressor-Related

Disorders (6A80-6A8Z)
PTSD occurs in response to exposure to traumatic

events, characterized by intrusive memories,
avoidance of trauma-related stimuli, negative
Post-Traumatic Stress alterations in mood or cognition, and heightened
Disorder (6A80) arousal or reactivity. 6A80
ICD-
11
Acute stress disorder involves the development of

severe anxiety, dissociation, or other symptoms
Acute Stress Disorder within one month of exposure to a traumatic
(6A81) event, causing significant distress or impairment. 6A81
Feeding and Eating Disorders

(6A90-6A9Z)
Avoidant/restrictive food intake disorder involves

persistent avoidance or restriction of food intake,
Avoidant/Restrictive leading to significant weight loss, nutritional
Food Intake Disorder deficiencies, or interference with psychosocial
(6A90) functioning. 6A90
Anorexia nervosa is characterized by persistent

restriction of energy intake, intense fear of
gaining weight or becoming fat, and distorted
Anorexia Nervosa body image, leading to significantly low body
(6A91) weight. 6A91
Elimination Disorders (6AA0-6AAZ)
Enuresis involves repeated involuntary urination

during the day or night, typically occurring after
Enuresis (6AA0) the age at which bladder control is expected. 6AA0
Encopresis involves repeated passage of feces

into inappropriate places (e.g., clothing or floor)
in children who have reached the age at which
Encopresis (6AA1) bowel control is expected. 6AA1
1. Neurodevelopmental Disorders (6A00-6A9Z):

1. Autism Spectrum Disorders (6A00):
• Explanation: Autism spectrum disorders are characterized by persistent deficits in
social communication and interaction, as well as restricted, repetitive patterns of
behavior, interests, or activities.
• ICD-11 Code: 6A00
2. Intellectual Developmental Disorders (6A01):
• Explanation: Intellectual developmental disorders involve deficits in intellectual
functioning (e.g., reasoning, problem-solving) and adaptive functioning (e.g., daily
living skills), typically diagnosed in childhood.
3. Attention-Deficit Hyperactivity Disorder (ADHD) (6A02):
• Explanation: ADHD is characterized by persistent patterns of inattention,
hyperactivity, and impulsivity that interfere with functioning or development.
4. Specific Learning Disorders (6A03):
• Explanation: Specific learning disorders involve difficulties in acquiring and using
academic skills, such as reading, writing, or mathematics, that are not solely
attributable to intellectual disabilities or other factors.
5. Communication Disorders (6A04):
• Explanation: Communication disorders encompass deficits in language, speech, and
communication skills, including expressive and receptive language disorders, speech
sound disorders, and social communication disorder.
2. Emotional Disorders (6A10-6A1Z):
1. Depressive Disorders (6A10):
• Explanation: Depressive disorders involve persistent feelings of sadness,
hopelessness, and loss of interest or pleasure in activities, accompanied by changes in
mood, behavior, and cognitive functioning.
2. Anxiety Disorders (6A11):
• Explanation: Anxiety disorders are characterized by excessive fear or worry, along
with associated symptoms such as restlessness, fatigue, muscle tension, and difficulty
concentrating.
3. Obsessive-Compulsive Disorder (6A12):
• Explanation: Obsessive-compulsive disorder involves recurrent, intrusive thoughts
(obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing
anxiety or distress.
4. Post-Traumatic Stress Disorder (6A13):
• Explanation: PTSD occurs in response to exposure to traumatic events, characterized
by intrusive memories, avoidance of trauma-related stimuli, negative alterations in
mood or cognition, and heightened arousal or reactivity.
3. Behavioral Syndromes Associated with Physiological Disturbances and Physical Factors
(6A20-6A2Z):
1. Oppositional Defiant Disorder (6A20):
• Explanation: Oppositional defiant disorder involves a pattern of angry/irritable
mood, argumentative/defiant behavior, and vindictiveness lasting at least six months,
often directed toward authority figures.
2. Conduct Disorder (6A21):
• Explanation: Conduct disorder is characterized by a repetitive and persistent pattern
of behavior that violates the rights of others or societal norms, including aggression
toward people or animals, destruction of property, deceitfulness, or theft.
4. Disorders Specifically Associated with Stress (6A30-6A3Z):
1. Adjustment Disorder (6A30):
• Explanation: Adjustment disorder involves the development of emotional or
behavioral symptoms in response to identifiable stressors, such as significant life
changes or adverse events, that exceed normal adaptive responses.
2. Reactive Attachment Disorder (6A31):
• Explanation: Reactive attachment disorder is characterized by markedly disturbed
and developmentally inappropriate social relatedness, typically resulting from
inadequate caregiving experiences during early childhood.
5. Psychotic Disorders (6A40-6A4Z):
1. Schizophrenia (6A40):
• Explanation: Schizophrenia is a severe mental disorder characterized by disturbances
in thought, perception, emotion, and behavior, often involving hallucinations,
delusions, disorganized thinking, and impaired social functioning.
2. Schizoaffective Disorder (6A41):
• Explanation: Schizoaffective disorder involves a combination of mood symptoms
(e.g., depressive or manic episodes) and psychotic symptoms (e.g., hallucinations or
delusions) that meet criteria for both schizophrenia and mood disorders.
6. Disruptive, Impulse-Control, and Conduct Disorders (6A50-6A5Z):
1. Oppositional Defiant Disorder (6A50):
• Explanation: Oppositional defiant disorder involves a pattern of angry/irritable
mood, argumentative/defiant behavior, and vindictiveness lasting at least six months,
often directed toward authority figures.
2. Conduct Disorder (6A51):
• Explanation: Conduct disorder is characterized by a repetitive and persistent pattern
of behavior that violates the rights of others or societal norms, including aggression
toward people or animals, destruction of property, deceitfulness, or theft.
7. Anxiety Disorders (6A60-6A6Z):
1. Separation Anxiety Disorder (6A60):
• Explanation: Separation anxiety disorder involves excessive fear or anxiety about
separation from attachment figures, leading to significant distress or impairment in
social, academic, or occupational functioning.
2. Specific Phobia (6A61):
• Explanation: Specific phobia is characterized by marked and persistent fear or
anxiety about a specific object or situation, leading to avoidance or distress.
8. Obsessive-Compulsive and Related Disorders (6A70-6A7Z):
1. Obsessive-Compulsive Disorder (6A70):
• Explanation: Obsessive-compulsive disorder involves recurrent, intrusive thoughts
(obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing
anxiety or distress.
2. Body Dysmorphic Disorder (6A71):
• Explanation: Body dysmorphic disorder involves preoccupation with perceived
defects or flaws in physical appearance, leading to repetitive behaviors or mental acts
in response to appearance concerns.
9. Trauma- and Stressor-Related Disorders (6A80-6A8Z):
1. Post-Traumatic Stress Disorder (6A80):
• Explanation: PTSD occurs in response to exposure to traumatic events, characterized
by intrusive memories, avoidance of trauma-related stimuli, negative alterations in
mood or cognition, and heightened arousal or reactivity.
2. Acute Stress Disorder (6A81):
• Explanation: Acute stress disorder involves the development of severe anxiety,
dissociation, or other symptoms within one month of exposure to a traumatic event,
causing significant distress or impairment.
10. Feeding and Eating Disorders (6A90-6A9Z):
1. Avoidant/Restrictive Food Intake Disorder (6A90):
• Explanation: Avoidant/restrictive food intake disorder involves persistent avoidance
or restriction of food intake, leading to significant weight loss, nutritional
deficiencies, or interference with psychosocial functioning.
2. Anorexia Nervosa (6A91):
• Explanation: Anorexia nervosa is characterized by persistent restriction of energy
intake, intense fear of gaining weight or becoming fat, and distorted body image,
leading to significantly low body weight.
11. Elimination Disorders (6AA0-6AAZ):
1. Enuresis (6AA0):
• Explanation: Enuresis involves repeated involuntary urination during the day or
night, typically occurring after the age at which bladder control is expected.
• ICD-11 Code: 6AA0
2. Encopresis (6AA1):
• Explanation: Encopresis involves repeated passage of feces into inappropriate places
(e.g., clothing or floor) in children who have reached the age at which bowel control
is expected.
• ICD-11 Code: 6AA1
6. Clinical features and diagnostic criteria for mental retardation

Mental retardation, also known as intellectual disability, is characterized by significant limitations in
intellectual functioning and adaptive behavior, with onset during the developmental period. The
diagnosis of mental retardation is based on clinical assessment and the fulfillment of specific
diagnostic criteria. Below are the clinical features and diagnostic criteria for mental retardation:
Clinical Features:
1. Intellectual Functioning:
• Individuals with mental retardation typically have an intellectual functioning level
(IQ) significantly below average, typically measured by standardized intelligence
tests.
• Intellectual functioning is assessed across various domains, including reasoning,
problem-solving, abstract thinking, learning ability, and academic skills.
2. Adaptive Behavior:
• Adaptive behavior refers to the practical skills necessary for daily life functioning,
including communication, self-care, social skills, and community living.
• Individuals with mental retardation often demonstrate limitations in adaptive behavior
compared to their peers, which can affect their ability to independently navigate daily
tasks and social interactions.
3. Age of Onset:
• Mental retardation is evident during the developmental period, usually manifesting
before adulthood.
• Symptoms and impairments in intellectual functioning and adaptive behavior are
observed early in life, often becoming more pronounced as the individual grows older
and encounters greater demands and expectations.
4. Severity:
• Mental retardation can vary widely in severity, ranging from mild to profound levels
of impairment.
• Severity is often classified based on the individual's level of intellectual functioning
and adaptive behavior, with more severe cases presenting greater challenges in daily
functioning and requiring more intensive support and assistance.
5. Co-occurring Conditions:
• Individuals with mental retardation may have co-occurring medical, neurological, or
psychiatric conditions, which can further impact their overall functioning and quality
of life.
• Common co-occurring conditions include epilepsy, sensory impairments (e.g., vision
or hearing loss), motor coordination difficulties, and behavioral or emotional
disorders.
Diagnostic Criteria (Based on DSM-5):
To meet the diagnostic criteria for intellectual disability according to the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5), the following criteria must be satisfied:
1. Deficits in Intellectual Functioning:
• Significantly below-average intellectual functioning, typically indicated by an IQ
score approximately two standard deviations or more below the population mean
(usually an IQ of 70 or below).
• Intellectual deficits are assessed using standardized intelligence tests and take into
account factors such as cultural and linguistic diversity.
2. Deficits in Adaptive Behavior:
• Significant limitations in adaptive behavior, impacting an individual's ability to meet
the standards of personal independence and social responsibility expected for their
age and cultural group.
• Adaptive behavior deficits are assessed across multiple domains, including
conceptual, social, and practical skills, through clinical observation, caregiver reports,
and standardized assessments.
3. Onset During the Developmental Period:
• Onset of intellectual and adaptive deficits occurs during the developmental period,
typically before 18 years of age.
• Symptoms may be evident in early childhood, although diagnosis and assessment
may occur later, particularly as the individual's abilities and challenges become more
apparent in various life domains.
4. Severity Specifiers:
• Severity of intellectual disability is specified based on the individual's level of
intellectual functioning and adaptive behavior:
• Mild: IQ level 50-55 to approximately 70, with minimal support needed in
daily functioning.
• Moderate: IQ level 35-40 to 50-55, with moderate support needed in daily
functioning.
• Severe: IQ level 20-25 to 35-40, with extensive support needed in daily
functioning.
• Profound: IQ level below 20-25, with pervasive support needed in all areas of
daily functioning.
Mental retardation, also known as intellectual disability, encompasses various types characterized by
different levels of severity and underlying causes. Below are some common types of mental
retardation, along with their clinical features, diagnostic criteria, and corresponding codes based on
the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):
1. Mild Intellectual Disability (F70)
• Clinical Features:
• Individuals typically have an IQ score between 50-55 to approximately 70.
• Mild deficits in intellectual functioning may be present, impacting problem-solving,
reasoning, and academic skills.
• Adaptive behavior may demonstrate some limitations, particularly in more complex
or novel situations.
• Diagnostic Criteria:
• IQ level approximately two standard deviations below the population mean (typically
an IQ of 70 or below).
• Significant limitations in adaptive behavior, impacting independence and social
responsibility.
• Onset during the developmental period.
2. Moderate Intellectual Disability (F71)
• Individuals typically have an IQ score between 35-40 to 50-55.
• Moderate deficits in intellectual functioning are evident, affecting learning,
communication, and daily living skills.
• Adaptive behavior shows more pronounced limitations, requiring moderate support in
various life domains.
• IQ level approximately three to four standard deviations below the population mean.
• Moderate limitations in adaptive behavior, necessitating support for independence
and social functioning.
3. Severe Intellectual Disability (F72)
• Individuals typically have an IQ score between 20-25 to 35-40.
• Severe deficits in intellectual functioning impact overall cognitive abilities,
communication, and self-care skills.
• Adaptive behavior is significantly impaired, requiring extensive support and
supervision in daily activities.
• IQ level approximately four to five standard deviations below the population mean.
• Severe limitations in adaptive behavior, necessitating substantial support for daily
functioning and safety.
4. Profound Intellectual Disability (F73)
• Individuals typically have an IQ score below 20-25.
• Profound deficits in intellectual functioning severely limit cognitive abilities,
communication, and self-care.
• Adaptive behavior is profoundly impaired, requiring constant supervision and
assistance in all aspects of daily life.
• IQ level significantly below the population mean.
• Profound limitations in adaptive behavior, necessitating pervasive support for all
aspects of daily functioning.
Additional Notes:
• Diagnosis of intellectual disability involves comprehensive assessment of intellectual
functioning, adaptive behavior, and onset during the developmental period.
• Codes provided are based on the International Classification of Diseases (ICD-10) coding
system for intellectual disabilities.
Clinical
Features Diagnostic Criteria
Intellectual Deficits in intellectual functioning, typically indicated by an IQ score approximately two

Functioning standard deviations or more below the population mean (usually an IQ of 70 or below).
Intellectual deficits are assessed using standardized intelligence tests and take into
account factors such as cultural and linguistic diversity.
Significant limitations in adaptive behavior, impacting an individual's ability to meet the

Adaptive standards of personal independence and social responsibility expected for their age and
Behavior cultural group.
Adaptive behavior deficits are assessed across multiple domains, including conceptual,
social, and practical skills, through clinical observation, caregiver reports, and
standardized assessments.
Onset of intellectual and adaptive deficits occurs during the developmental period,
typically before 18 years of age. Symptoms may be evident in early childhood, although
diagnosis and assessment may occur later, particularly as the individual's abilities and
Age of Onset challenges become more apparent in various life domains.
Severity of intellectual disability is specified based on the individual's level of intellectual

Severity functioning and adaptive behavior.
- Mild: IQ level 50-55 to approximately 70, with minimal support needed in daily
functioning.
- Moderate: IQ level 35-40 to 50-55, with moderate support needed in daily functioning.
- Severe: IQ level 20-25 to 35-40, with extensive support needed in daily functioning.
- Profound: IQ level below 20-25, with pervasive support needed in all areas of daily
functioning.
Individuals with mental retardation may have co-occurring medical, neurological, or

Co-occurring psychiatric conditions, which can further impact their overall functioning and quality of
Conditions life.
Common co-occurring conditions include epilepsy, sensory impairments (e.g., vision or

hearing loss), motor coordination difficulties, and behavioral or emotional disorders.
ICD-
10
Type Clinical Features Diagnostic Criteria Code
Mild Intellectual - IQ score between 50-55 to - IQ level approximately two standard deviations
Disability (F70) approximately 70. below the population mean. F70
- Mild deficits in - Significant limitations in adaptive behavior,

intellectual functioning. impacting independence and social responsibility.
- Some limitations in
adaptive behavior. - Onset during the developmental period.
Moderate
Intellectual - IQ score between 35-40 to - IQ level approximately three to four standard
Disability (F71) 50-55. deviations below the population mean. F71
- Moderate limitations in adaptive behavior,

- Moderate deficits in necessitating support for independence and social
intellectual functioning. functioning.
- More pronounced
limitations in adaptive
behavior. - Onset during the developmental period.
Severe Intellectual - IQ score between 20-25 to - IQ level approximately four to five standard
Disability (F72) 35-40. deviations below the population mean. F72
- Severe limitations in adaptive behavior,

- Severe deficits in necessitating substantial support for daily
intellectual functioning. functioning and safety.
- Significantly impaired
Profound
Intellectual - IQ level significantly below the population
Disability (F73) - IQ score below 20-25. mean. F73
- Profound limitations in adaptive behavior,

- Profound deficits in necessitating pervasive support for all aspects of
intellectual functioning. daily functioning.
- Profoundly impaired
Unit -2: Clinical features and diagnostic criteria for Mental retardation and
disorders of Psychological development
Mental retardation- Manuals

1. DSM
1. Diagnostic and Statistical Manual of Mental Disorders (DSM):
Introduction: The DSM is a widely-used classification system developed by the American
Psychiatric Association (APA) for diagnosing mental disorders. It provides clinicians with
standardized criteria and guidelines for identifying and categorizing various psychological
conditions.
History:
• DSM-I (1952): The first edition of the DSM introduced standardized diagnostic criteria
for mental disorders, although it was heavily influenced by psychoanalytic theory.
• DSM-II (1968): This edition expanded the number of disorders and included more
detailed descriptions but remained rooted in psychoanalytic principles.
• DSM-III (1980): Considered a significant milestone, DSM-III introduced a more
systematic approach based on empirical research and adopted a multiaxial system for
diagnosis.
• DSM-IV (1994): DSM-IV refined diagnostic criteria and added new disorders, further
improving reliability and validity.
• DSM-5 (2013): The latest edition, DSM-5, represented a major overhaul, integrating
advances in neuroscience and removing the multiaxial system for a simpler diagnostic
framework.
Axis System: The DSM formerly used a multiaxial system for diagnosis:
1. Axis I: Clinical Syndromes (e.g., mood disorders, anxiety disorders)
2. Axis II: Personality Disorders and Mental Retardation
3. Axis III: General Medical Conditions
4. Axis IV: Psychosocial and Environmental Problems
5. Axis V: Global Assessment of Functioning (GAF)
Brief Definitions of Disorders:
• Neurodevelopmental Disorders: Conditions affecting brain development, such as
autism spectrum disorder and attention-deficit/hyperactivity disorder (ADHD).
• Schizophrenia Spectrum and Other Psychotic Disorders: Disorders characterized
by distortions in thinking, perception, and emotions, including schizophrenia and
schizoaffective disorder.
• Bipolar and Related Disorders: Mood disorders involving episodes of mania or
hypomania, such as bipolar I disorder and bipolar II disorder.
• Depressive Disorders: Disorders characterized by persistent feelings of sadness or loss
of interest, including major depressive disorder and persistent depressive disorder.
• Anxiety Disorders: Disorders involving excessive fear or worry, such as generalized
anxiety disorder, panic disorder, and social anxiety disorder.
• Obsessive-Compulsive and Related Disorders: Conditions characterized by intrusive
thoughts (obsessions) and repetitive behaviors (compulsions), including obsessive-
compulsive disorder (OCD) and hoarding disorder.
• Trauma- and Stressor-Related Disorders: Disorders resulting from exposure to
traumatic or stressful events, such as post-traumatic stress disorder (PTSD) and acute
stress disorder.
• Dissociative Disorders: Conditions involving disruptions in memory, identity, or
consciousness, such as dissociative identity disorder and dissociative amnesia.
• Somatic Symptom and Related Disorders: Disorders characterized by excessive
focus on physical symptoms, such as somatic symptom disorder and illness anxiety
disorder.
• Feeding and Eating Disorders: Disorders involving abnormal eating behaviors and
attitudes toward food and body weight, including anorexia nervosa, bulimia nervosa,
and binge-eating disorder.
• Sleep-Wake Disorders: Conditions affecting sleep patterns and quality, such as
insomnia disorder and narcolepsy.
• Sexual Dysfunctions: Disorders involving problems with sexual response or
functioning, such as erectile disorder and female orgasmic disorder.
• Gender Dysphoria: Distress caused by a incongruence between an individual's
assigned gender and their gender identity.
• Disruptive, Impulse-Control, and Conduct Disorders: Disorders characterized by
problems with self-control and behavior, such as oppositional defiant disorder and
conduct disorder.
• Substance-Related and Addictive Disorders: Disorders involving problematic use of
substances, including alcohol use disorder, opioid use disorder, and gambling disorder.
• Neurocognitive Disorders: Disorders involving cognitive decline due to underlying
medical conditions, such as Alzheimer's disease and vascular dementia.
• Personality Disorders: Disorders characterized by enduring patterns of behavior and
inner experience that deviate from cultural expectations, including borderline
personality disorder and narcissistic personality disorder.
• Paraphilic Disorders: Disorders involving atypical sexual interests or behaviors, such
as exhibitionism and pedophilic disorder.
2. (ICD):
International Classification of Diseases (ICD):
Introduction: The International Classification of Diseases (ICD) is a globally recognized
classification system for diseases and health conditions, including mental disorders. It is
developed and maintained by the World Health Organization (WHO) and serves as a standard
diagnostic tool used for epidemiology, health management, and clinical purposes worldwide.
History:
• The ICD has a long history, dating back to the late 19th century, with the first edition
published in 1893.
• Since then, the ICD has undergone multiple revisions to reflect advances in medical
knowledge, changes in disease patterns, and updates in diagnostic criteria.
• The latest version, ICD-11, was released in 2018 after extensive consultation with
experts and stakeholders from around the world.
Axis System: The ICD does not utilize a formal axis system like the DSM. Instead, disorders
are classified into chapters and subchapters based on their nature and etiology.
• Neurodevelopmental Disorders: Conditions affecting brain development and
function, such as intellectual disabilities and specific learning disorders.
• Schizophrenia and Other Primary Psychotic Disorders: Disorders characterized by
disruptions in thought processes, perception, and behavior, including schizophrenia and
schizoaffective disorder.
• Bipolar Disorders: Mood disorders involving episodes of mania, hypomania, and
depression, such as bipolar I disorder and bipolar II disorder.
• Depressive Disorders: Disorders characterized by persistent feelings of sadness,
hopelessness, and loss of interest or pleasure, including major depressive disorder and
persistent depressive disorder.
• Anxiety and Fear-Related Disorders: Disorders involving excessive fear, worry, or
anxiety, such as generalized anxiety disorder, panic disorder, and phobias.
• Obsessive-Compulsive and Related Disorders: Conditions characterized by
obsessions (intrusive thoughts) and compulsions (repetitive behaviors), including
obsessive-compulsive disorder (OCD) and body dysmorphic disorder.
• Disorders Specifically Associated with Stress: Disorders resulting from exposure to
traumatic or stressful events, such as post-traumatic stress disorder (PTSD) and
adjustment disorders.
• Dissociative Disorders: Conditions involving disruptions in memory, consciousness,
identity, or perception, such as dissociative identity disorder and dissociative amnesia.
• Somatic Symptom Disorders: Disorders characterized by excessive focus on physical
symptoms or health concerns, despite no identifiable medical cause, such as somatic
symptom disorder and illness anxiety disorder.
• Eating Disorders: Disorders involving abnormal eating behaviors and attitudes
towards food and body weight, including anorexia nervosa, bulimia nervosa, and binge-
eating disorder.
• Sleep-Wake Disorders: Conditions affecting sleep patterns and quality, such as
insomnia disorder, sleep apnea, and restless legs syndrome.
• Sexual Dysfunctions: Disorders involving problems with sexual response or
functioning, such as erectile disorder, female sexual interest/arousal disorder, and
premature ejaculation.
• Gender Incongruence: Distress caused by a discrepancy between an individual's
experienced or expressed gender and their assigned gender at birth.
• Disorders of Adult Personality and Behavior: Disorders characterized by enduring
patterns of inner experience and behavior that deviate from cultural norms, including
personality disorders and impulse-control disorders.
• Neurocognitive Disorders: Disorders involving cognitive decline or impairment due
to underlying medical conditions, such as Alzheimer's disease, vascular dementia, and
traumatic brain injury.
• Paraphilic Disorders: Disorders involving atypical sexual interests or behaviors, such
as exhibitionism, voyeurism, and pedophilia.
3. Chinese Classification of Mental Disorders and Psycho Dynamic

Diagnostic Manual 2nd Edition (PDM-2)
1. Chinese Classification of Mental Disorders:
Introduction: The Chinese Classification of Mental Disorders (CCMD) is a diagnostic
classification system used in China for categorizing mental health conditions. It was developed
by the Chinese Society of Psychiatry and is widely utilized by mental health professionals in
China.
History:
• The CCMD was first published in 1985 and has undergone several revisions since then
to reflect changes in diagnostic criteria and advancements in psychiatric research.
• The latest version, CCMD-3, was released in 2001, with subsequent updates and
revisions to improve diagnostic accuracy and clinical utility.
Axis System: Similar to the DSM, the CCMD does not utilize a formal axis system for
diagnosis. Instead, disorders are categorized based on their clinical presentation and
symptomatology.
• The CCMD classifies disorders into various categories, including mood disorders,
psychotic disorders, anxiety disorders, personality disorders, and developmental
disorders.
• Each category includes specific diagnostic criteria for disorders such as major
depressive disorder, schizophrenia, generalized anxiety disorder, and borderline
personality disorder, among others.
• The CCMD also includes culturally specific disorders and syndromes that may be more
prevalent or recognized within the Chinese population.
2. Psycho Dynamic Diagnostic Manual 2nd Edition (PDM-2):
Introduction: The Psycho Dynamic Diagnostic Manual 2nd Edition (PDM-2) is a diagnostic
manual developed by the Alliance of Psychoanalytic Organizations. It provides a framework
for understanding and diagnosing mental health conditions from a psychodynamic perspective.
History:
• The PDM-2 is the second edition of the manual, building upon the principles and
concepts established in the original PDM.
• It was published in 2017 and represents a collaborative effort by leading psychoanalytic
organizations to update and refine diagnostic criteria based on contemporary clinical
practice and research.
Axis System: Unlike the DSM, the PDM-2 does not use a formal axis system for diagnosis.
Instead, it emphasizes a holistic understanding of the individual's psychological functioning
and interpersonal dynamics.
• The PDM-2 provides a comprehensive framework for diagnosing a wide range of
mental health conditions, including mood disorders, anxiety disorders, personality
disorders, and trauma-related disorders.
• Each disorder is described in terms of its underlying psychodynamic processes,
interpersonal dynamics, and developmental origins.
• The PDM-2 emphasizes the importance of exploring unconscious conflicts, defensive
mechanisms, and relational patterns in understanding and treating mental illness.
• It also integrates contemporary research findings and clinical insights to provide a
nuanced understanding of complex psychological phenomena.
TABLES
Aspect Diagnostic and Statistical Manual of Mental Disorders (DSM)
The DSM is a widely-used classification system developed by the American Psychiatric

Association (APA) for diagnosing mental disorders. It provides clinicians with standardized
Introduction criteria and guidelines for identifying various psychological conditions.
- DSM-I (1952): Introduced standardized diagnostic criteria influenced by psychoanalytic

theory. - DSM-II (1968): Expanded the number of disorders. - DSM-III (1980): Introduced a
more systematic approach and a multiaxial system for diagnosis. - DSM-IV (1994): Refined
criteria and added new disorders. - DSM-5 (2013): Integrated advances in neuroscience and
History removed the multiaxial system.
The DSM formerly used a multiaxial system for diagnosis: 1. Axis I: Clinical Syndromes 2.
Axis II: Personality Disorders and Mental Retardation 3. Axis III: General Medical
Conditions 4. Axis IV: Psychosocial and Environmental Problems 5. Axis V: Global
Axis System Assessment of Functioning (GAF)
- Neurodevelopmental Disorders: Autism spectrum disorder, attention-deficit/hyperactivity

disorder (ADHD), intellectual disability. - Schizophrenia Spectrum and Other Psychotic
Disorders: Schizophrenia, schizoaffective disorder. - Bipolar and Related Disorders: Bipolar
I disorder, bipolar II disorder. - Depressive Disorders: Major depressive disorder, persistent
depressive disorder. - Anxiety Disorders: Generalized anxiety disorder, panic disorder, social
anxiety disorder. - Obsessive-Compulsive and Related Disorders: Obsessive-compulsive
disorder (OCD), hoarding disorder. - Trauma- and Stressor-Related Disorders: Post-traumatic
stress disorder (PTSD), acute stress disorder. - Dissociative Disorders: Dissociative identity
disorder, dissociative amnesia. - Somatic Symptom and Related Disorders: Somatic symptom
disorder, illness anxiety disorder. - Feeding and Eating Disorders: Anorexia nervosa, bulimia
nervosa, binge-eating disorder. - Sleep-Wake Disorders: Insomnia disorder, narcolepsy. -
Sexual Dysfunctions: Erectile disorder, female orgasmic disorder. - Gender Dysphoria:
Gender incongruence. - Disruptive, Impulse-Control, and Conduct Disorders: Oppositional
defiant disorder, conduct disorder. - Substance-Related and Addictive Disorders: Alcohol use
disorder, opioid use disorder, gambling disorder. - Neurocognitive Disorders: Alzheimer's
disease, vascular dementia. - Personality Disorders: Borderline personality disorder,
Disorders narcissistic personality disorder. - Paraphilic Disorders: Exhibitionism, pedophilic disorder.
Aspect International Classification of Diseases (ICD)
The International Classification of Diseases (ICD) is a globally recognized classification

system for diseases and health conditions, including mental disorders. It is developed and
Introduction maintained by the World Health Organization (WHO).
- The ICD has a long history, dating back to the late 19th century, with the first edition
published in 1893. - The latest version, ICD-11, was released in 2018 after extensive
History consultation with experts and stakeholders from around the world.
The ICD does not utilize a formal axis system like the DSM. Instead, disorders are classified
Axis System into chapters and subchapters based on their nature and etiology.
Aspect International Classification of Diseases (ICD)
- Neurodevelopmental Disorders: Autism spectrum disorder, attention-deficit/hyperactivity

disorder (ADHD), intellectual disabilities. - Schizophrenia and Other Primary Psychotic
Disorders: Schizophrenia, schizoaffective disorder. - Bipolar Disorders: Bipolar I disorder,
bipolar II disorder. - Depressive Disorders: Major depressive disorder, persistent depressive
disorder. - Anxiety and Fear-Related Disorders: Generalized anxiety disorder, panic disorder,
phobias. - Obsessive-Compulsive and Related Disorders: Obsessive-compulsive disorder
(OCD), body dysmorphic disorder. - Disorders Specifically Associated with Stress: Post-
traumatic stress disorder (PTSD), adjustment disorders. - Dissociative Disorders:
Dissociative identity disorder, dissociative amnesia. - Somatic Symptom Disorders: Somatic
symptom disorder, illness anxiety disorder. - Eating Disorders: Anorexia nervosa, bulimia
nervosa, binge-eating disorder. - Sleep-Wake Disorders: Insomnia disorder, sleep apnea. -
Sexual Dysfunctions: Erectile disorder, female sexual interest/arousal disorder. - Gender
Incongruence: Gender dysphoria. - Disorders of Adult Personality and Behavior: Borderline
personality disorder, antisocial personality disorder. - Neurocognitive Disorders: Alzheimer's
Disorders disease, vascular dementia. - Paraphilic Disorders: Exhibitionism, voyeurism.
Psycho Dynamic Diagnostic Manual

Aspect Chinese Classification of Mental Disorders 2nd Edition (PDM-2)
The Psycho Dynamic Diagnostic Manual

The Chinese Classification of Mental Disorders 2nd Edition (PDM-2) is a diagnostic
(CCMD) is a diagnostic classification system manual developed by the Alliance of
used in China for categorizing mental health Psychoanalytic Organizations. It provides
conditions. It was developed by the Chinese a framework for understanding and
Society of Psychiatry and is widely utilized in diagnosing mental health conditions from
Introduction China. a psychodynamic perspective.
- The CCMD was first published in 1985 and has

undergone several revisions since then to reflect - The PDM-2 is the second edition of the
changes in diagnostic criteria and advancements manual, building upon the principles and
in psychiatric research. - The latest version, concepts established in the original PDM.
History CCMD-3, was released in 2001. - It was published in 2017.
The PDM-2 does not use a formal axis

system for diagnosis. It emphasizes a
The CCMD does not utilize a formal axis system holistic understanding of the individual's
for diagnosis. Disorders are categorized based on psychological functioning and
Axis System their clinical presentation and symptomatology. interpersonal dynamics.
- Mood Disorders - Anxiety Disorders -

Trauma- and Stressor-Related Disorders -
Personality Disorders - Psychosomatic
- Mood Disorders - Psychotic Disorders - Anxiety Disorders - Disorders of Sexuality and
Disorders - Personality Disorders - Gender Identity - Substance-Related and
Disorders Developmental Disorders Addictive Disorders
4. Difference between DSM and (ICD)
Diagnostic and Statistical Manual of International Classification of
Aspect Mental Disorders (DSM) Diseases (ICD)
Developed by the American Psychiatric Developed by the World Health

Development Association (APA). Organization (WHO).
Covers a broader range of diseases

Primarily focuses on mental health disorders and health conditions, including
Purpose and their diagnosis. mental disorders.
Predominantly used in North America, Globally recognized and used in

Usage although it is recognized internationally. many countries around the world.
Currently on ICD-11, with

Currently on DSM-5, with previous editions previous editions including ICD-
Editions including DSM-IV, DSM-III, etc. 10, ICD-9, etc.
Offers a more concise

Provides detailed descriptions and diagnostic classification system with codes for
Format criteria for each disorder. diseases and health conditions.
Organizes disorders into distinct categories Classifies disorders into chapters

based on symptomatology and clinical and subchapters based on nature,
Categorization presentation. etiology, and body systems.
Formerly used a multiaxial system for

diagnosis, including axes for clinical Does not utilize a formal axis
syndromes, personality disorders, and general system, disorders are categorized
Axis System medical conditions. within chapters and subchapters.
Focuses solely on mental disorders, providing Covers a wide range of diseases

in-depth descriptions and criteria for and health conditions, including
Scope diagnosis. mental disorders.
Developed by the World Health

Organization (WHO) with inputs
Developed by the American Psychiatric from international experts,
Association (APA) with contributions from healthcare professionals, and
Developmental mental health professionals, researchers, and stakeholders from various
Process experts in the field. countries.
Provides standardized diagnostic

codes and descriptions for diseases
Emphasizes detailed diagnostic criteria, and conditions, facilitating
descriptions, and clinical features specific to uniformity in data collection,
Diagnostic each mental disorder, aiding in precise research, and epidemiological
Criteria diagnosis and treatment planning. studies.
Diagnostic and Statistical Manual of International Classification of
Aspect Mental Disorders (DSM) Diseases (ICD)
Follows a hierarchical, multiaxial,

and systematic approach,
categorizing diseases and
Utilizes a categorical approach, wherein conditions into chapters, blocks,
disorders are classified into distinct categories and codes according to etiology,
Approach to based on symptomatology and clinical affected body systems, and related
Diagnosis presentation. factors.
Subject to regular revisions and

updates to reflect evolving medical
science, technological
Undergoes periodic updates and revisions to advancements, changes in disease
incorporate advances in psychiatric research, patterns, and updates in diagnostic
Updates and changes in diagnostic criteria, and emerging terminology, with the latest version
Revisions clinical knowledge. being ICD-11.
Adopted by countries worldwide as

the standard classification system
for diseases and health conditions,
Primarily used in North America and other with translations available in
Geographical English-speaking countries, although it is multiple languages, making it
Usage recognized and referenced internationally. accessible to diverse populations.
Designed for healthcare

professionals across various
disciplines, including physicians,
Targeted towards mental health professionals, nurses, epidemiologists, health
including psychiatrists, psychologists, social informaticians, and policymakers,
workers, and psychiatric nurses, involved in engaged in clinical practice, public
Primary the assessment, diagnosis, and treatment of health, research, and healthcare
Audience mental disorders. management.
Developed and maintained by the

World Health Organization (WHO)
as a public health tool, with the
Owned and copyrighted by the American latest version, ICD-11, freely
Psychiatric Association (APA), with access accessible online and distributed as
Intellectual primarily available through purchase or open-source software, promoting
Property subscription. widespread dissemination and use.
5. Mental Retardation
Introduction: Intellectual disability, previously termed mental retardation, is a
neurodevelopmental disorder characterized by limitations in intellectual functioning and
adaptive behavior. Intellectual functioning refers to a person's ability to learn, reason, solve
problems, and understand complex concepts. Adaptive behavior encompasses the skills needed
to live independently and function effectively in daily life, including communication, self-care,
social interaction, and independent living skills.
Intellectual disability is typically diagnosed in childhood and can have a significant impact on
an individual's ability to learn, communicate, and participate in daily activities. The severity of
intellectual disability varies widely among individuals, ranging from mild to profound. While
some individuals with intellectual disability may require minimal support and can live
independently, others may require significant assistance with daily tasks and may have
challenges in communication, socialization, and independent living.
History:
1. Ancient Societies: In ancient civilizations like Greece and Rome, individuals with
intellectual disabilities were often abandoned or left to perish due to societal beliefs
about their inferiority or lack of value. They were considered burdens on society and
were sometimes subjected to infanticide or abandonment.
2. Middle Ages: During the Middle Ages, people with intellectual disabilities were often
marginalized and viewed as possessed by evil spirits or punished for sins. They were
often hidden away from society and subjected to neglect, abuse, and exploitation.
3. Enlightenment Era: The modern understanding of intellectual disability began to
emerge during the Enlightenment era in the 18th century. Enlightenment thinkers
advocated for the education and support of individuals with cognitive impairments,
challenging prevailing beliefs about their inherent worthlessness.
4. Institutionalization: In the 19th and early 20th centuries, institutions were established
to care for individuals with intellectual disabilities. While these institutions provided
shelter and care, they often subjected residents to overcrowding, neglect, and inhumane
treatment.
5. Deinstitutionalization: In the mid-20th century, there was a movement towards
deinstitutionalization and community-based care for individuals with intellectual
disabilities. Legislation such as the Americans with Disabilities Act (ADA) aimed to
protect the rights of individuals with disabilities and promote their inclusion in society.
6. Advancements in Education: Efforts to provide education and training for individuals
with intellectual disabilities gained momentum in the 20th century. Special education
programs and services were developed to meet the unique needs of students with
cognitive impairments, promoting their integration into mainstream educational
settings.
7. Shift in Attitudes: Over time, there has been a gradual shift in societal attitudes towards
intellectual disability, from one of exclusion and segregation to one of inclusion and
acceptance. Advocacy efforts and awareness campaigns have played a crucial role in
challenging stereotypes and promoting the rights of individuals with intellectual
disabilities.
Classification: Intellectual disability is classified based on the severity of limitations in

intellectual functioning and adaptive behavior. The American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines three levels of
severity:
1. Mild Intellectual Disability: Individuals with mild intellectual disability typically
have IQ scores ranging from 50 to 70. They may experience delays in academic and
social skills but can often function independently with appropriate support.
2. Moderate Intellectual Disability: Those with moderate intellectual disability have IQ
scores between 35 and 49. They may require more support with daily living activities
and benefit from structured environments and assistance from caregivers.
3. Severe or Profound Intellectual Disability: Individuals with severe or profound
intellectual disability have IQ scores below 35. They often require intensive support for
basic self-care tasks and may have significant impairments in communication and
mobility.
Examples of Stigma:
1. Derogatory Language: Individuals with intellectual disabilities are often subjected to
derogatory language and slurs, such as "retard" or "mentally challenged," which
reinforce negative stereotypes and perpetuate stigma.
2. Bullying and Harassment: People with intellectual disabilities are more vulnerable to
bullying and harassment due to their perceived differences. They may be targeted for
ridicule, teasing, or exclusion by their peers, leading to social isolation and low self-
esteem.
3. Discrimination in Employment: Despite legal protections against discrimination,
individuals with intellectual disabilities often face barriers to employment due to stigma
and misconceptions about their capabilities. They may be overlooked for job
opportunities or paid less than their non-disabled peers.
4. Social Exclusion: Stigma surrounding intellectual disability can lead to social
exclusion and isolation, as individuals with cognitive impairments may be seen as
"different" or "less than" their neurotypical counterparts. They may struggle to form
meaningful relationships or participate in community activities.
5. Institutional Bias: Institutions and organizations may perpetuate stigma through
policies and practices that marginalize individuals with intellectual disabilities. For
example, segregated educational settings or inaccessible public spaces can reinforce the
idea that people with cognitive impairments are separate and inferior.
6. Media Portrayals: Negative portrayals of intellectual disability in the media can
reinforce stereotypes and perpetuate stigma. Characters with intellectual disabilities are
often depicted as helpless, pitiful, or comic relief, rather than as complex individuals
with strengths and abilities.
Aspect Explanation
Intellectual disability, previously termed mental retardation, is a neurodevelopmental

disorder characterized by limitations in intellectual functioning and adaptive behavior.
Individuals with intellectual disabilities may have difficulties with reasoning, problem-
Introduction solving, communication, and social skills.
- Ancient Societies: Individuals with intellectual disabilities were often abandoned or left
to perish due to societal beliefs about their inferiority or lack of value. - Middle Ages:
People with intellectual disabilities were marginalized and viewed as possessed by evil
spirits or punished for sins. - Enlightenment Era: Advocacy for education and support
for individuals with cognitive impairments began to emerge. - Institutionalization:
Institutions were established to care for individuals with intellectual disabilities, but they
often subjected residents to neglect and inhumane treatment. - Deinstitutionalization:
Movement towards community-based care and the closure of large institutions. -
Advancements in Education: Special education programs and services were developed
to meet the unique needs of individuals with intellectual disabilities. - Shift in Attitudes:
Over time, there has been a gradual shift towards inclusion and acceptance of individuals
History with intellectual disabilities, driven by advocacy efforts and awareness campaigns.
- Mild Intellectual Disability: Individuals with mild intellectual disability typically have
IQ scores ranging from 50 to 70. They may experience delays in academic and social skills
but can often function independently with appropriate support. - Moderate Intellectual
Disability: Those with moderate intellectual disability have IQ scores between 35 and 49.
They may require more support with daily living activities and benefit from structured
environments and assistance from caregivers. - Severe or Profound Intellectual
Disability: Individuals with severe or profound intellectual disability have IQ scores
below 35. They often require intensive support for basic self-care tasks and may have
Classification significant impairments in communication and mobility.
- Derogatory Language: Individuals with intellectual disabilities are often subjected to

derogatory language and slurs, such as "retard" or "mentally challenged," which reinforce
negative stereotypes and perpetuate stigma. - Bullying and Harassment: People with
intellectual disabilities are more vulnerable to bullying and harassment due to their
perceived differences, leading to social isolation and low self-esteem. - Discrimination
in Employment: Despite legal protections, individuals with intellectual disabilities often
face barriers to employment due to stigma and misconceptions about their capabilities. -
Social Exclusion: Stigma can lead to social exclusion and isolation, making it difficult
for individuals with intellectual disabilities to form meaningful relationships and
participate in community activities. - Institutional Bias: Institutions and organizations
may perpetuate stigma through policies and practices that marginalize individuals with
intellectual disabilities, such as segregated educational settings or inaccessible public
spaces. - Media Portrayals: Negative depictions of intellectual disability in the media
Examples of reinforce stereotypes and perpetuate stigma, portraying individuals as helpless or pitiful
Stigma rather than highlighting their strengths and abilities.
6. Specific developmental disorders of speech and language

6A01.0 Developmental speech sound disorder
1. Developmental Speech Sound Disorder (6A01.0):

• Description: This disorder involves difficulties in producing speech sounds correctly. Children
with this disorder may have trouble articulating certain sounds or pronouncing words
accurately.
• Persistent difficulty in producing speech sounds appropriately for their age.
• The difficulty is not better explained by developmental delays, structural abnormalities,
or neurological disorders.
• The impairment significantly impacts communication abilities and may affect social
interactions and educational progress.
• Examples: Substitutions (e.g., "wabbit" instead of "rabbit"), distortions, or omissions of speech
sounds.
2. Developmental Speech Fluency Disorder (6A01.1):
• Description: This disorder involves disruptions in the rhythm or flow of speech, often referred
to as stuttering. Individuals with this disorder may experience repetitions, prolongations, or
blocks of sounds or syllables during speech.
• Persistent difficulty in achieving fluent speech.
• The difficulty is not due to sensory impairments, structural abnormalities, or other
neurological disorders.
• The impairment leads to significant distress or functional impairment.
• Examples: Repetitions (e.g., "I-I-I want that"), prolongations (e.g., "sssssnake"), or blocks (a
pause in speech where no sound is produced).
3. Developmental Language Disorder (6A01.2):
• Description: This disorder involves difficulties in understanding and/or using language
effectively for communication purposes. It encompasses various aspects of language including
vocabulary, grammar, comprehension, and pragmatics (social use of language).
• Persistent difficulties in language comprehension and/or expression.
• The difficulties significantly impact communication and may interfere with academic
or social interactions.
• The impairment is not solely due to intellectual disabilities, neurological conditions, or
sensory deficits.
• Examples: Limited vocabulary, grammatical errors, difficulty following instructions,
challenges in engaging in conversations appropriately.
4. Other Specified Developmental Speech or Language Disorders (6A01.Y):
• Description: This category encompasses speech or language difficulties that do not fit precisely
into the previous three categories but still significantly impact communication and functioning.
• Persistent speech or language difficulties not meeting criteria for the specific disorders
outlined above.
• The difficulties are not better explained by other developmental disorders or structural
abnormalities.
• The impairment results in significant functional limitations or distress.
• Examples: Unusual speech patterns, difficulty with narrative skills, idiosyncratic language use.
Disorder Category Description Diagnostic Criteria Examples
-
- Persistent difficulty in producing Substitutions:
speech sounds appropriate for age. - Not "wabbit" for
better explained by other developmental "rabbit" -
Developmental Difficulty in delays or neurological conditions. - Distortions,
Speech Sound producing speech Significant impact on communication omissions of
Disorder (6A01.0) sounds accurately and function. sounds
- Repetitions:
"I-I-I want
that" -
- Persistent difficulty in achieving fluent Prolongations:
speech. - Not attributed to sensory "sssssnake" -
Developmental Disruptions in the impairments or neurological conditions. Blocks:
Speech Fluency flow of speech - Causes distress or functional pauses in
Disorder (6A01.1) (Stuttering) impairment. speech
- Limited
vocabulary -
- Persistent difficulties in language Grammatical
Difficulty in comprehension and/or expression. - Not errors -
Developmental language solely due to intellectual disabilities or Difficulty
Language Disorder comprehension and neurological conditions. - Significant following
(6A01.2) expression impact on communication. instructions
- Unusual
speech
patterns -
- Persistent difficulties not meeting Difficulty
Other Specified Speech or language criteria for specific disorders. - Not better with narrative
Developmental difficulties not explained by other developmental skills -
Speech or Language fitting specific disorders. - Results in functional Idiosyncratic
Disorders (6A01.Y) criteria limitations or distress. language use
6A01.0 Developmental speech sound disorder
Description
Developmental speech sound disorder is characterised by difficulties in the acquisition, production and
perception of speech that result in errors of pronunciation, either in number or types of speech errors
made or the overall quality of speech production, that are outside the limits of normal variation expected
for age and level of intellectual functioning and result in reduced intelligibility and significantly affect
communication. The errors in pronunciation arise during the early developmental period and cannot be
explained by social, cultural, and other environmental variations (e.g., regional dialects). The speech
errors are not fully explained by a hearing impairment or a structural or neurological abnormality.
Diagnostic Requirements:
Essential Features Additional Clinical Features
- Persistent errors of pronunciation, - Delays in the acquisition, production, and perception of

articulation, or phonology. spoken language.
- Errors manifest as developmentally typical - Phonological errors may be consistent or inconsistent,

or atypical speech sound errors. involving classes of sounds, changes in syllable structure, etc.
- Familiar listeners may accommodate and decode speech

- Onset of speech sound difficulties occurs errors, but increased rate of speech may hinder
during the early developmental period. comprehension.
- Imprecision and inconsistency of oral movements (childhood

- Speech errors result in significant apraxia/dyspraxia of speech) may be associated, affecting
limitations in communication due to reduced production of speech sounds, consonants and vowels, and
intelligibility. prosody.
- Not better accounted for by diseases of the - Associated oral-motor dysfunction may affect early feeding,
nervous system, sensory impairments, sucking, chewing, blowing, and imitating oral movements and
structural abnormalities, etc. speech sounds.
- Common co-occurrence with other neurodevelopmental

disorders like ADHD, Developmental Speech Fluency
Disorder, and Developmental Language Disorder.
Course Features:
Sex- and/or Gender-

Characteristics Prevalence Rates Related Features
- Many children experience - More common in boys,

remission by school-age. - Prevalence decreases with age: especially at younger ages.
- Early speech difficulties in

- Up to 50 – 70% may exhibit girls more likely to resolve
academic difficulties. - 16% at age 3-4 by school age.
Sex- and/or Gender-
Characteristics Prevalence Rates Related Features
- Co-occurring developmental - Gender differences decline

disorders increase risks. - Approximately 4% at age 6 with age.
- Boys more likely to have

co-occurring language
- 3.6% by age 8 impairments.
- Many pre-school children exhibit typical

speech sound development upon entering
school.
Boundaries with Other Disorders and Conditions (Differential Diagnosis):
Boundary with Developmental Speech

Boundary with Disorders of Fluency Disorder and Developmental Boundary with Selective
Intellectual Development Language Disorder Mutism
- Consistent speaking
- Speech difficulties without selectivity, typically
significant intellectual - Reduced intelligibility affecting predictable across
limitations. communication. settings.
- Can co-occur with

- Distinct disorders characterized by specific Developmental Speech
difficulties in fluency or language. Sound Disorder.
- Speech sound errors in Developmental Speech

Sound Disorder are distinct from fluency or
language errors.
Boundary with Secondary

Boundary with Dysphonia Boundary with Dysarthria Speech or Language Syndrome
- Distortion or substitution of - Motor difficulties with vocal tract - Speech difficulties without
speech sounds, not abnormal movements, affecting eating, drinking, primary nervous system, sensory,
voice quality. etc. or structural impairment.
- Speech difficulties secondary to

- Includes imprecision and underlying conditions, distinct
inconsistency of oral - Speech difficulties due to neurological from primary speech sound
movements. or structural impairments. disorder.
- Diagnosis of Secondary Speech

- Dysphonia may result from - Dysarthria involves difficulty with or Language Syndrome when
voice strain, structural range, rate, force, coordination of vocal speech difficulties are secondary
anomalies, or nervous diseases. tract movements. to other conditions.
- Unlike dysphonia, - Dysarthria may cause difficulties in - Distinct from Developmental

Developmental Speech Sound eating, drinking, swallowing, etc., not Speech Sound Disorder, which is
Boundary with Secondary
Boundary with Dysphonia Boundary with Dysarthria Speech or Language Syndrome
Disorder primarily affects typical in Developmental Speech Sound characterized by errors in

speech sounds. Disorder. pronunciation, articulation, or
phonology.
Boundary with Normality (Threshold):
Aspect Description
Children exhibit a wide range of speech sound acquisition sequences and ages. It's
normal for children to make speech sound errors during development, even up to
Typical Variation the age of 4 years.
Children with Developmental Speech Sound Disorder have persistent and

Developmental Speech significant problems with speech sound production. These difficulties cause notable
Sound Disorder limitations in communication due to reduced intelligibility.
6A01.1 Developmental speech fluency disorder

Description
Aspect Description
Developmental speech fluency disorder is characterized by frequent or pervasive disruption of the

normal rhythmic flow and rate of speech. This includes repetitions, prolongations in sounds,
Description syllables, words, and phrases, blocking, word avoidance, or substitutions.
Exclusions Tic disorders are excluded from this diagnosis.
Diagnostic Requirements
Aspect Description
Diagnostic - Frequent or pervasive disruption of speech flow characterized by repetitions,

Requirements prolongations, blocking, and word avoidance.
- Persistent dysfluency from early developmental period, significantly below expected

fluency for age.
- Dysfluency causing significant impairment in social communication or other important

areas of functioning.
- Not better explained by other disorders like intellectual development disorder, nervous
system diseases, sensory impairments, or structural abnormalities.
Additional Clinical Features

Aspect Description
Additional Clinical - May include cluttering, physical tension in speech muscles, struggle behaviors,
Features secondary mannerisms, and anxiety related to speaking.
- Dysfluency may vary across situations and be more severe under pressure.
- About 60% of children with this disorder have co-occurring developmental speech and
language disorders.
Course Features
Aspect Description
Course
Features - Many children experience remission without intervention before puberty.
- Impact can be evident by age 3, with more persistent cases associated with male gender, family
history, older age at onset, longer duration, and co-occurring language disorder.
Boundary with Normality (Threshold)
Aspect Description
Boundary with Normality

(Threshold) - Minor dysfluencies are common in typically developing preschool children.
- Children with developmental speech fluency disorder exhibit persistent

dysfluencies that significantly impair communication.
- Many typically developing children show minor dysfluencies during the preschool
years, but these do not cause significant communication impairments.
Sex- and/or Gender-Related Features
Aspect Description
Sex- and/or Gender- - Developmental speech fluency disorder is more common in boys, with a ratio of
Related Features about 1.5:1 in preschool age.
- Females are more likely to remit, while males continue to outnumber females
into adulthood, with an estimated ratio of 4:1.
Developmental Presentations
Aspect Description
Developmental - Typically emerges between ages 2.5 and 4 years, with a lifetime incidence estimated
Presentations at 5% and population prevalence around 1%.
- More common in boys, with a ratio of about 1.5:1 in preschool age, but males
continue to outnumber females into adulthood.
Boundaries with Other Disorders
Aspect Description
Boundaries with Other - Differentiated from developmental speech sound disorder and language disorder
Disorders by distinct fluency disruptions.
- Distinguished from primary tic disorders by absence of complex tics involving

speech dysfluency.
- Diseases of the nervous system may cause dysfluency but are distinguished by
neurological signs.
6A01.2 Developmental language disorder

Additional Clinical Features
Aspect Description
- Deficits in various components of language skills may be present with relative weaknesses in
some areas and relative strengths in others. - Possible discrepancy between verbal and
Additional nonverbal ability. - Frequently co-occurs with other neurodevelopmental disorders. -
Clinical Associated with difficulties in peer relationships, emotional disturbance, and disruptive
Features behaviors. - Family history of developmental language disorder is common.
Boundary with Normality (Threshold)
Aspect Description
- Children vary widely in the age at which they first acquire language, but very early delays
or persistent impairments in language acquisition may indicate developmental language
Boundary with disorder. - Language deficits are significantly below what would be expected for the
Normality individual's age. - Pronunciation and language use may vary within cultural contexts, but
(Threshold) developmental language disorder is characterized by significant deficits relative to peers.
Course Features
Aspect Description
Course
- Course may vary depending on severity and type of symptoms. - Language strengths and deficits
Features
may change over time. - More likely to persist into adulthood compared to developmental speech
Aspect Description
sound and speech fluency disorders. - Impact continues into early adulthood with social and
communication problems.
Developmental Presentations
Aspect Description
- Emerges early in development, typically before age four. - Diagnosis from age four
onwards yields a more stable symptom presentation. - Estimated prevalence ranges from
Developmental 6% to 15% among children. - More common among children with co-occurring
Presentations neurodevelopmental disorders.
Sex- and/or Gender-Related Features
Aspect Description
Sex- and/or - Appears to affect more boys than girls, with varying gender ratios reported across
Gender-Related clinical and population-based samples. - Boys more likely to experience co-occurring
Features developmental language and speech sound disorders.
Boundaries with Other Disorders and Conditions (Differential Diagnosis)
Aspect Description
- Developmental language disorder can co-occur with disorders of intellectual

Boundary with Disorders development but may be distinguished by the extent of language impairment
of Intellectual relative to overall intellectual functioning. - Both diagnoses may be assigned if
Development criteria for both are met.
Specifiers for areas of language impairment
Aspect Description
- Four specifiers are available based on the main areas of language impairment:
receptive and expressive language, mainly expressive language, mainly pragmatic
Specifiers for areas of language, and other specified language impairment. - Used to characterize the specific
language impairment deficits in language skills.
Specifiers for Areas of Language Impairment:
Specifier Description
6A01.20 Developmental Language

Disorder - Impairment of both receptive and expressive language skills.
- Markedly below expected level for age.

Disorder - Impairment of mainly expressive language skills.
- Markedly below expected level for age, while receptive language

skills are relatively intact.

Disorder - Impairment of mainly pragmatic language skills.
- Difficulties in understanding and using language in social contexts.
- Markedly below expected level for age, interfering with functional

communication.
6A01.23 Developmental Language - Other specified language impairment not fitting into the above
Disorder categories.
Aspect Description
Intellectual
Development Disorders - Language deficits may occur with varying levels of intellectual ability.
- If language abilities are significantly below expected level based on intellectual

functioning, both diagnoses may be assigned.
- Differentiated by the nature of language difficulties: pronunciation and fluency

Developmental Speech issues for speech sound and fluency disorders, persistent deficits in language
Sound & Fluency acquisition, understanding, production, or use for language disorders.
Autism Spectrum - Language difficulties may be present but are characterized by additional
Disorder impairments in social reciprocity and restricted, repetitive behaviors.
- Pragmatic language impairment is a characteristic feature of ASD.
- Both diagnoses may be assigned if specific impairments in semantic, syntactic, and

phonological development are present.
Developmental
Learning Disorder - Language deficits may lead to academic learning difficulties, especially in literacy.
- Both diagnoses may be assigned if all diagnostic requirements are met.
Selective Mutism - Language difficulties apparent in all settings, unlike selective mutism.
- Both diagnoses may be assigned if warranted.
Diseases of the Nervous - Language impairment may result from brain damage but should be diagnosed as a
System secondary syndrome if language difficulties are a specific focus of clinical attention.
Aspect Description
- Language delay may be better accounted for by hearing impairment, but

Developmental Language Disorder can still be diagnosed if language problems are
Hearing Impairment disproportionate to severity of hearing loss.
Additional Clinical Features:
Feature Description
Correlation of - Typically developing children exhibit tight correlation between understanding and
Language Components production of different language components.
- Developmental Language Disorder may present with out-of-step developmental

relationships between various language skills.
- Often co-occurs with other neurodevelopmental disorders such as developmental

Co-occurrence with speech sound disorder, developmental learning disorder, ADHD, ASD, and
Other Disorders developmental motor coordination disorder.
- Associated with difficulties in peer relationships, emotional disturbance, and

disruptive behaviors, particularly in school-age children.
Family History - Developmental Language Disorder often runs in families.
Chromosomal - Can be a presenting feature in individuals with specific chromosomal anomalies,

Anomalies including sex chromosome anomalies.
Regression of - Not a feature of Developmental Language Disorder; regression may indicate ASD or
Language Skills neurological conditions.
Essential (Required) Features:
Feature Description
- Deficits in acquisition, understanding, production, or use of language persist

Persistent Language Deficits over time.
- Markedly below expected level for age.
Onset During Developmental

Period - Onset of language difficulties occurs during early childhood.
Significant Impact on - Language deficits cause significant limitations in communication, impacting

Communication daily life at home, school, or work.
No Better Accounted For by - Language deficits are not better explained by other neurodevelopmental
Other Conditions disorders, sensory impairments, or diseases of the nervous system.
7. Specific developmental disorders of scholastic skills

Features Description
Significant and persistent Persistent and significant challenges in reading, writing, or

difficulties mathematics.
Below expected levels for age, Skills significantly below what is typically expected for an
schooling, intelligence individual's age and intelligence.
Interference with academic Impairments interfere significantly with academic achievement or

achievement or daily life activities requiring these skills.
Difficulties not better explained by intellectual disabilities,

uncorrected sensory impairments, or inadequate educational
Exclusion Criteria opportunities.
Manifestation Across Specific difficulties may manifest differently across individuals, impacting
Domains reading, writing, or mathematics skills.
Difficulties with organization, attention, memory, and executive functions

Associated Features may further impact academic performance.
Disorders/Conditions Distinctions
Specific developmental disorders of scholastic skills are limited to

Intellectual Developmental academic areas, unlike global impairments seen in intellectual
Disorders developmental disorders.
These disorders, such as autism spectrum disorder and ADHD, may co-
Neurodevelopmental occur with specific developmental disorders of scholastic skills but have
Disorders broader symptom profiles.
While similar, learning disorders encompass a broader range of

difficulties beyond scholastic skills, including motor, language, and
Learning Disorders social skills.
Scholastic difficulties should not solely result from medical conditions

like brain injury, sensory impairments, or neurological disorders, which
Other Medical Conditions would require separate diagnosis.
Course Features:
Specific developmental disorders of scholastic skills typically persist into

Persistence adolescence and adulthood, although interventions can mitigate impact.
Changes Over Severity and manifestations may change over time, influenced by interventions,
Time cognitive development, and coping strategies.
Developmental Presentations:
Manifestations emerge during early school years when academic

Onset demands increase.
Early Identification and Early identification and intervention can lead to improved outcomes, but
Intervention difficulties may persist without support.
Sex- and/or Gender-Related Features:
Disorders may occur more frequently in males than females, although

Gender Distribution prevalence rates vary.
Gender Differences in Gender differences in presentation and response to interventions may

Presentation exist but require further research.
8. Specific developmental disorders of motor functions

Features Detailed Explanation
This refers to a noticeable delay in developing both gross (like walking or jumping)
Delay in acquisition of and fine (like writing or buttoning a shirt) motor skills compared to other children of
motor skills the same age.
Below-expected level It means that the person's motor skills are significantly behind what is typically
for age expected for someone their age.
Onset during This indicates that the problems with coordination started during early childhood,
developmental period usually before the age of 5.
Persistent limitations in These difficulties continue over time and significantly affect everyday activities like
functioning getting dressed, playing sports, or writing.
It's important to note that these difficulties aren't due to other medical conditions like
Exclusion criteria nervous system diseases or sensory impairments.
Delayed motor Some children might be slow to reach certain motor milestones like sitting up,
milestones crawling, or walking.
This can include trouble with activities such as climbing stairs, tying shoelaces, or
Specific skill difficulties using utensils.
Pervasiveness of motor These challenges might affect both big movements (like running or jumping) and
difficulties small movements (like picking up small objects or writing).
Manifestations in These issues with coordination often continue into adulthood, making activities like
adulthood driving, sports, or writing challenging.
Co-occurrence with other Often, developmental coordination disorder is found alongside other conditions like
disorders ADHD or learning disorders. This can complicate diagnosis and treatment.
Variability in motor Children develop motor skills at different rates, making it difficult to diagnose
development before age 5 when motor skills become more stable.
Diagnosis typically after age Because of this variability, doctors usually wait until after age 5 to diagnose
5 developmental coordination disorder.
Importance of standardized To accurately diagnose, doctors use standardized tests and evaluate how the
assessments difficulties impact daily life at home, school, and elsewhere.
Course Features:
These coordination difficulties often persist into teenage years and adulthood,
Chronic persistence affecting various aspects of life.
Impact of co-occurring If other disorders are present alongside developmental coordination disorder, it can
disorders make the condition more severe and harder to manage.
Prevalence in school-aged It's estimated that around 5-6% of school-aged children have developmental
children coordination disorder, though severity varies.
Manifestation across The symptoms can change as a child grows, affecting different activities as
developmental stages they move from preschool to adulthood.
Male Boys are more likely to be diagnosed with developmental coordination disorder than girls,
predominance though the reasons for this aren't entirely clear.
Disorders/Conditions Detailed Explanation
Developmental coordination disorder focuses specifically on motor

skills, unlike intellectual developmental disorders which affect overall
Intellectual Developmental Disorders intellectual functioning.
While individuals with autism might avoid activities needing

coordination, developmental coordination disorder is about difficulties
Autism Spectrum Disorder performing these activities.
Attention Deficit Hyperactivity While these conditions can overlap, careful evaluation is needed to
Disorder differentiate between motor clumsiness and symptoms of ADHD.
Diseases of the Nervous System, Developmental coordination disorder is diagnosed when motor
Musculoskeletal System difficulties aren't solely due to these medical conditions.
Treatment Strategies:
Treatment Strategy Detailed Explanation
Occupational therapists work with individuals to improve motor skills through

Occupational Therapy exercises, activities, and adaptive equipment.
Physical therapists focus on improving strength, coordination, and mobility through

Physical Therapy exercises and specialized techniques.
Sensory Integration This therapy helps individuals better process and respond to sensory information,
Therapy which can improve coordination and motor skills.
Counseling or therapy can help individuals cope with the emotional and psychological
Psychotherapy challenges associated with developmental coordination disorder.
Treatment Strategy Detailed Explanation
Teachers and educational specialists can provide accommodations and modifications

Educational Support to help individuals succeed in school despite motor difficulties.
Parent and Caregiver Educating parents and caregivers about the condition and how to support their child's
Education development can be crucial for long-term success.
Devices such as pencil grips, weighted utensils, or adaptive keyboards can help
Assistive Devices individuals overcome specific motor challenges.
9. Mixed specific developmental disorders

Feature Explanation
Movements are under the individual's control and can be initiated or

Voluntary stopped at will.
Repetitive Movements occur repeatedly in a similar manner over time.
Movements lack a clear goal or function and seem unnecessary or

Apparently Purposeless aimless.
Not Caused by Substances or Movements are not a result of drug effects, including withdrawal
Medications symptoms.
Significant Interference or Self- Movements disrupt normal activities or cause harm to oneself,
Inflicted Injury requiring protective measures to prevent injury.
Feature Explanation
Co-occurrence with Intellectual Stereotyped movement disorder often co-occurs with

Development Disorders intellectual development disorders.
Feature Explanation
Stereotyped movement disorder involves movements that significantly

Differentiation from interfere with daily activities or result in self-inflicted injury, unlike typical
Typical Behaviors childhood behaviors.
Course Features:
Feature Explanation
Progression Over Stereotyped movement disorder may change over time, especially in individuals
Time with intellectual development disorders.
Feature Explanation
Onset and Stereotyped movement disorder typically emerges in early childhood, with
Prevalence prevalence varying across different developmental stages.
Feature Explanation
Gender Research has not systematically described differences across male and female
Differences presentations of stereotyped movement disorder.
Feature Explanation
Stereotyped movement disorder is distinguished from autism

Differentiation from Autism spectrum disorder by additional limitations in social interactions
Spectrum Disorder and communication.
Stereotyped movement disorder differs from obsessive-

Differentiation from Obsessive- compulsive disorder in the complexity and purpose of repetitive
Compulsive Disorder behaviors.
Stereotyped movement disorder is distinguished from body-

Differentiation from Body-Focused focused repetitive behavior disorders by the nature of repetitive
Repetitive Behaviour Disorders behaviors and their onset.
Stereotyped movement disorder differs from tic disorders in the

pattern and predictability of movements and their association
Differentiation from Tic Disorders with age of onset.
Stereotyped movement disorder is differentiated from diseases

Differentiation from Diseases of the of the nervous system by specific signs and symptoms indicative
Nervous System of such diseases.
10. Pervasive developmental disorders

Pervasive Developmental Disorders (PDD) based on ICD-10:
Childhood Autism (F84.0):
Feature Explanation
Abnormal or Impaired
Development Manifests before age three years.
Abnormal functioning in reciprocal social interaction, communication,

Psychopathology and restricted, stereotyped, repetitive behavior.
Common nonspecific issues include phobias, sleeping and eating

Additional Problems disturbances, temper tantrums, and self-directed aggression.
Atypical Autism (F84.1):
Feature Explanation
Age of Onset Abnormal and impaired development is present only after age three years.
Diagnostic Criteria Does not fulfill all three sets of diagnostic criteria for childhood autism.
Common Characteristic abnormalities may be observed in reciprocal social interactions,

Manifestations communication, or restricted, stereotyped, repetitive behavior.
Rett Syndrome (F84.2):
Feature Explanation
Gender Specificity Found only in girls.
Developmental Apparently normal early development followed by partial or complete loss of

Regression speech, locomotion, and hand skills.
Clinical Deceleration in head growth, hand-wringing stereotypies, hyperventilation,

Characteristics trunk ataxia, apraxia, and choreoathetoid movements.
Other Childhood Disintegrative Disorder (F84.3):
Feature Explanation
Period of Onset Preceded by a period of entirely normal development.
Definite loss of previously acquired skills in several areas of development over a few
Loss of Skills months.
Additional General loss of interest in the environment, stereotyped motor mannerisms, and
Features autistic-like abnormalities in social interaction and communication.
Overactive Disorder Associated with Mental Retardation and Stereotyped Movements

(F84.4):
Feature Explanation
Clinical Ill-defined disorder in children with severe mental retardation (IQ below 35)
Description exhibiting hyperactivity, attention problems, and stereotyped behaviors.
Response to Does not benefit from stimulant drugs; may exhibit dysphoric reaction or
Stimulants psychomotor retardation when given stimulants.
Developmental
Delays Often associated with various developmental delays, specific or global.
Asperger Syndrome (F84.5):
Feature Explanation
Social Interaction Qualitative abnormalities in reciprocal social interaction similar to

Abnormalities autism.
Language and Cognitive No general delay or retardation observed in language or cognitive

Development development.
Marked clumsiness, tendency for abnormalities to persist into

Associated Characteristics adolescence and adulthood, occasional psychotic episodes.
Other Pervasive Developmental Disorders (F84.8):

This category encompasses other less common pervasive developmental disorders not
specifically categorized.
Pervasive Developmental Disorder, Unspecified (F84.9):
This category is used when the specific pervasive developmental disorder cannot be precisely
identified or does not fit into any of the defined categories.
Other Disorders of Psychological Development (F88):
This category includes developmental agnosia and other disorders of psychological
development not otherwise classified.
Unspecified Disorder of Psychological Development (F89):
This category is used when the specific disorder of psychological development cannot be
precisely identified or does not fit into any of the defined categories.
Pervasive Developmental Disorders (PDD) based on ICD-11

Feature Explanation
Individuals with autism spectrum disorder (ASD) exhibit persistent difficulties in

initiating and sustaining reciprocal social interactions. This includes challenges in
Deficits in Social understanding social cues, sharing interests, and engaging in back-and-forth
Interaction communication.
ASD is characterized by deficits in social communication, including challenges in

understanding and using verbal and non-verbal cues appropriately. This may manifest
Deficits in Social as difficulty maintaining conversations, using gestures, or understanding the emotions
Communication of others.
ASD involves a range of restricted, repetitive, and inflexible behaviors, interests, or

activities that are atypical or excessive for the individual's age and context. These
Restricted, Repetitive behaviors may include repetitive movements (e.g., hand flapping), adherence to
Patterns of Behavior routines, and intense fixation on specific interests.
Symptoms of ASD typically emerge in early childhood, although they may not become
fully evident until later in life, particularly when social demands exceed limited
Onset during capacities. Early signs may include delays in language development, lack of social
Developmental Period responsiveness, and unusual play behaviors.
Feature Explanation
Many children with ASD exhibit delays in language and motor coordination, which may
Developmental be a cause for parental concern. These delays may manifest as late onset of speech,
Delays difficulties with motor skills, or delays in reaching developmental milestones.
Anxiety and Anxiety, social anxiety disorder, and depressive disorders are common in individuals
Depressive with ASD, particularly in middle childhood and adolescence. These symptoms may
Symptoms arise due to challenges in social interaction, communication, and coping with change.
Feature Explanation
Diagnosis of ASD requires marked and persistent deviation from typical social
interaction, communication, and behavior, considering the individual's age and
Differentiation from context. This involves assessing whether the individual's behaviors significantly
Typical Development impair their ability to function in daily life compared to peers.
Limited social interactions and early language delay alone are not indicative of ASD
unless accompanied by impaired social communication behaviors. It's important to
Social Interaction and consider whether the individual's communication difficulties extend beyond typical
Communication Skills developmental variations.
Repetitive behaviors and focused interests are common in children but are not
Repetitive Behaviors
necessarily indicative of ASD without impaired social interaction and communication.
Feature Explanation
It's essential to evaluate whether these behaviors significantly interfere with daily
functioning and social relationships.
Course Features:
Feature Explanation
ASD is a lifelong condition, with manifestations and impacts that vary across age,
intellectual abilities, co-occurring conditions, and environmental contexts. While
symptoms may change over time, ASD remains present throughout an individual's lifespan
Lifelong Disorder and requires ongoing support and intervention.
Persistence of Repetitive behaviors, particularly sensorimotor behaviors, persist over time, although their
Repetitive intensity and frequency may lessen during adolescence. These behaviors may serve as
Behaviors coping mechanisms or sources of comfort for individuals with ASD.
Developmental
Stage Characteristics
Symptoms may emerge during infancy, although they may only be recognized as indicative
of ASD in retrospect. Early signs may include delays in reaching developmental milestones,
Infancy lack of responsiveness to social cues, and unusual motor behaviors.
Indicators in preschool children may include avoidance of eye contact, language delays, and
sensory sensitivities. Diagnosis during this stage often involves assessing social interaction
Preschool skills, communication abilities, and engagement in play activities.
Social adjustment difficulties may arise in school-aged children, with resistance to

Middle unfamiliar experiences and marked reactions to changes in routine. Additionally, symptoms
Childhood of anxiety and social withdrawal may become more apparent during this stage.
By adolescence, the capacity to cope with increasing social complexity may be

overwhelmed, leading to depressive symptoms and social isolation. Diagnosis during this
stage often involves assessing changes in behavior, emotional regulation, and social
Adolescence functioning.
Challenges with social relationships may become increasingly evident in adulthood, with
compensation strategies often inadequate in social groups. Diagnosis during this stage may
Adulthood be prompted by difficulties in maintaining relationships or managing daily responsibilities.
Culture-Related Features:
Feature Explanation
Norms of social communication and behavior vary across cultures, leading to differences in the
Cultural recognition of impairment in functioning. Clinicians must consider cultural context when
Variation assessing symptoms and determining diagnostic criteria for ASD.
Feature Explanation
Males are more likely to be diagnosed with ASD than females, with gender differences in
Gender presentation and co-occurring disorders affecting functioning. Understanding these differences
Differences is essential for accurate diagnosis and intervention planning.
Feature Explanation
This gender disparity in diagnosis indicates that ASD may present

Males are four times more likely than differently or be underdiagnosed in females, possibly due to varied
females to be diagnosed with Autism symptom expression or differences in help-seeking behavior
Spectrum Disorder. between genders.
Females diagnosed with Autism

Spectrum Disorder are more frequently This suggests that less severe presentations of ASD in females may
diagnosed with co-occurring Disorders of go undetected compared to males, possibly due to differences in
Intellectual Development. symptom manifestation or diagnostic criteria.
Females tend to demonstrate fewer Gender differences in symptom expression may contribute to varied
restricted, repetitive interests and diagnostic patterns, with females potentially exhibiting less overt or
behaviors than males. stereotypical ASD traits compared to males.
Boys may exhibit reactive aggression or other behavioral symptoms

when challenged or frustrated, while girls may withdraw socially
During middle-childhood, gender and experience emotional changes in response to social adjustment
differences in presentation differentially difficulties. Understanding these differences is crucial for tailored
affect functioning. intervention strategies.
Boundary with Other Disorders and Conditions (Differential Diagnosis):
Boundary Condition Explanation
ASD diagnosis is possible in individuals with Disorders of Intellectual

Development if social communication deficits exceed what would be
expected based on intellectual functioning. Both diagnoses may be
assigned, emphasizing social deficits in ASD over adaptive behavior.
Boundary with Disorders of Assessment focuses on social reciprocity and communication rather than
Intellectual Development solely on intellectual skills.
Developmental Language Disorder differs from ASD by its emphasis on

pragmatic language impairment, with affected individuals still able to
initiate social interactions appropriately. ASD diagnosis is not based solely
Boundary with Developmental on pragmatic language deficits, avoiding additional diagnoses unless
Language Disorder language abilities are significantly below age expectations.
Boundary with Developmental

Reluctance in ASD individuals to participate in activities requiring
Motor Coordination Disorder
complex motor coordination stems from lack of interest rather than specific
motor deficits. Both diagnoses may coexist if warranted, although each

condition's distinct features should guide assessment and intervention.
While attention abnormalities are common in ASD, core symptoms differ,

with ASD characterized by social communication deficits and restricted
behaviors. Co-occurrence is possible but requires meeting diagnostic
Boundary with Attention Deficit criteria for both conditions. ADHD symptoms may sometimes overshadow
Hyperactivity Disorder ASD symptoms but don't negate ASD diagnosis.
Severe stereotypies in ASD may warrant additional clinical attention,

leading to a co-occurring diagnosis if necessary. However, ASD diagnosis
primarily focuses on social communication deficits and restricted
Boundary with Stereotyped behaviors, with stereotypies considered within this context rather than as a
Movement Disorder separate disorder.
Schizophrenia onset typically occurs in adolescence or early adulthood,

distinct from ASD's early childhood onset. Schizophrenia includes
psychotic symptoms and lacks ASD's characteristic restricted behaviors.
Differential diagnosis considers age of onset, symptomatology, and
Boundary with Schizophrenia presence of social deficits.
Both disorders involve interpersonal difficulties, but ASD additionally

features restricted behaviors. Clear differentiation requires assessing the
Boundary with Schizotypal presence of repetitive behaviors and adherence to routines characteristic of
Disorder ASD but absent in Schizotypal Disorder.
Social Anxiety Disorder primarily involves fear of negative evaluation,

differing from ASD's pervasive deficits in social communication and
Boundary with Social Anxiety interaction. While social anxiety may coexist with ASD, the latter presents
Disorder with broader social impairments and repetitive behaviors.
Selective Mutism is characterized by situational communication

difficulties, unlike ASD's pervasive deficits across contexts. Differential
diagnosis focuses on the consistency of social communication
impairments, with ASD diagnosis not solely based on reluctance to
Boundary with Selective Mutism communicate.
Both disorders involve repetitive behaviors, but OCD's focus on anxiety-

driven rituals contrasts with ASD's broader social communication deficits
Boundary with Obsessive- and restricted behaviors. Assessment considers the presence of social
Compulsive Disorder impairments distinct from OCD's primary symptomatology.
RAD stems from severe neglect or maltreatment, with symptoms less

focused on social communication deficits and restricted behaviors seen in
Boundary with Reactive ASD. Clear differentiation involves assessing the history of caregiver
Attachment Disorder interactions and the impact on social understanding.
Boundary with Disinhibited Social

Similar social approaches may occur in ASD and DSED, but ASD features
Engagement Disorder
include restricted behaviors, absent in DSED. Assessment considers the
history of social deprivation and the presence of broader repetitive

behaviors to distinguish between the two disorders.
ARFID involves food aversions but lacks the pervasive social

communication deficits and restricted behaviors defining ASD. Clear
Boundary with Avoidant- diagnosis requires assessing the impact of food restrictions on overall
Restrictive Food Intake Disorder functioning and considering the presence of broader ASD symptoms.
ODD involves noncompliant behavior but lacks ASD's core social

communication deficits and restricted behaviors. While oppositional
Boundary with Oppositional behavior may occur in ASD, clear diagnosis requires distinguishing
Defiant Disorder between typical ASD symptoms and distinct features of ODD.
Personality Disorder involves maladaptive patterns of cognition and

behavior distinct from ASD's social communication deficits and restricted
behaviors. Diagnosis considers the stability of patterns over time and their
Boundary with Personality impact on psychosocial functioning to differentiate between the two
Disorder disorders.
Primary tics lack the persistent social communication deficits and

Boundary with Primary Tics or Tic restricted behaviors seen in ASD. Clear differentiation involves assessing
Disorders including Tourette tic characteristics, age of onset, and the presence of broader ASD
Syndrome symptoms to determine the appropriate diagnosis.
Diseases involving regression may resemble ASD, but differential

diagnosis considers early social and language development and
Boundary with Diseases of the neurological features. Clear differentiation relies on comprehensive
Nervous System and other medical evaluation of symptomatology, developmental history, and neurological
conditions classified elsewhere findings.
Secondary Neurodevelopmental Syndrome may mimic ASD symptoms

but stems from acquired medical conditions. Differential diagnosis focuses
on identifying the underlying medical cause and assessing whether
Boundary with Secondary symptoms represent exacerbation of pre-existing ASD or a distinct
Neurodevelopmental Syndrome syndrome.
Variation specifiers
Code Fully Specified Name Description
All definitional requirements for autism spectrum disorder are

met, intellectual functioning and adaptive behaviour are found
Autism spectrum disorder to be at least within the average range (approximately greater
without disorder of intellectual than the 2.3rd percentile), and there is only mild or no
development and without impairment in the individual's capacity to use functional
impairment of functional language (spoken or signed) for instrumental purposes, such as
6A02.0 language to express personal needs and desires.
Code Fully Specified Name Description
Autism spectrum disorder All definitional requirements for both autism spectrum disorder
with disorder of intellectual and disorder of intellectual development are met and there is
development and without only mild or no impairment in the individual's capacity to use
impairment of functional functional language (spoken or signed) for instrumental
6A02.1 language purposes, such as to express personal needs and desires.
All definitional requirements for autism spectrum disorder are

met, intellectual functioning and adaptive behaviour are found
to be at least within the average range (approximately greater
than the 2.3rd percentile), and there is marked impairment in
Autism spectrum disorder functional language (spoken or signed) relative to the
without disorder of intellectual individual’s age, with the individual not able to use more than
development and with single words or simple phrases for instrumental purposes, such
6A02.2 impaired functional language as to express personal needs and desires.
All definitional requirements for both autism spectrum disorder

and disorder of intellectual development are met and there is
Autism spectrum disorder marked impairment in functional language (spoken or signed)
with disorder of intellectual relative to the individual’s age, with the individual not able to
development and with use more than single words or simple phrases for instrumental
6A02.3 impaired functional language purposes, such as to express personal needs and desires.
All definitional requirements for both autism spectrum disorder

and disorder of intellectual development are met and there is
Autism spectrum disorder complete, or almost complete, absence of ability relative to the
with disorder of intellectual individual’s age to use functional language (spoken or signed)
development and with absence for instrumental purposes, such as to express personal needs and
6A02.5 of functional language desires.
Treatment
Treatment Approach Description
Behavioral interventions such as Applied Behavior Analysis (ABA), Early

Intensive Behavioral Intervention (EIBI), and Positive Behavior Support (PBS)
are used to teach social, communication, and adaptive skills, as well as to reduce
Behavioral Therapies problematic behaviors.
Speech-language pathologists work with individuals with ASD to improve

Speech and Language communication skills, including speech, language, and social communication
Therapy abilities.
Occupational therapists help individuals with ASD develop fine motor skills,
sensory integration, and daily living skills necessary for independence and
Occupational Therapy functioning in daily activities.
Treatment Approach Description
Group therapy or individual sessions focused on social skills development help

individuals with ASD learn and practice appropriate social interactions,
Social Skills Training nonverbal communication, and understanding social cues.
Medications may be prescribed to manage co-occurring conditions such as

anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), or
Medication aggression. Commonly prescribed medications include selective serotonin
Management reuptake inhibitors (SSRIs), antipsychotics, stimulants, and mood stabilizers.
Parents and caregivers often participate in training programs to learn strategies

Parent Training and for managing behaviors, facilitating communication, and supporting their
Education child's development.
Individualized education plans (IEPs) or special education services in school

Educational settings provide academic support, accommodations, and behavioral
Interventions interventions to help children with ASD succeed in the classroom.
Access to support groups, counseling, respite care, and community resources can
Support Services provide valuable support to individuals with ASD and their families.
Some individuals with ASD may benefit from alternative or complementary

Alternative and therapies such as music therapy, art therapy, animal-assisted therapy, or dietary
Complementary interventions. However, it's essential to consult with healthcare professionals
Therapies before trying these approaches.
As individuals with ASD transition into adulthood, support services and

programs focused on vocational training, independent living skills, and
Transition Planning community integration become increasingly important.
11. Other disorders of psychological development
ICD-
10
Disorder Code Description
Developmental agnosia refers to a condition where a child has difficulty

Developmental recognizing or making sense of information from the senses. It can affect one
Agnosia F89.0 or more sensory modalities, such as visual, auditory, or tactile perception.
This category encompasses a range of developmental disorders that do not

fit specific diagnostic criteria but still present with significant impairments
in psychological development. It is used when the symptoms do not match
Unspecified Disorder any other specific disorder within the classification. Examples include
of Psychological developmental disorder not otherwise specified (NOS) and other unspecified
Development F89.9 conditions affecting psychological development.
Unit 3: Clinical features and diagnostic criteria for behavioural and
emotional disorders with onset usually occurring in childhood and
adolescence- I
1. Hyperkinetic disorders
ICD-
10
A group of disorders characterized by an early onset, lack of persistence in

activities requiring cognitive involvement, and excessive activity.
Hyperkinetic children may also exhibit recklessness, impulsivity, and
Hyperkinetic Disorders F90 difficulty in social relationships. Cognitive impairments are common.
Hyperkinetic conduct disorder refers to hyperkinetic behavior associated

with conduct disorder, where children exhibit both hyperactivity and
conduct problems such as aggression, defiance, and rule-breaking
Hyperkinetic Conduct behaviors. These individuals may have difficulty controlling impulses and
Disorder F90.0 regulating behavior.
This category includes hyperkinetic disorders that do not fit the criteria for
hyperkinetic conduct disorder. It encompasses a range of conditions
Other Hyperkinetic characterized by hyperactivity, impulsivity, and difficulty sustaining
Disorders F90.8 attention, without the presence of conduct disorder.
This code is used when the specific type of hyperkinetic disorder is not
specified or does not fit the criteria for any other hyperkinetic disorder
Hyperkinetic Disorder, subtype. It is used for cases where there is evidence of hyperkinetic
Unspecified F90.9 behavior but does not meet the criteria for a more specific diagnosis.
This term is used to describe hyperkinetic behavior that does not meet the
Hyperkinetic Reaction criteria for a specific disorder but is observed in childhood or adolescence.
of Childhood or It is a non-specific term used when there are symptoms of hyperactivity,
Adolescence NOS - impulsivity, or attention difficulties without a formal diagnosis.
Similar to hyperkinetic reaction of childhood or adolescence NOS, this term

is used when hyperkinetic symptoms are present but do not meet the criteria
Hyperkinetic Syndrome for a specific diagnosis. It implies the presence of hyperactivity,
NOS - impulsivity, or attention difficulties without a specific underlying cause.
ICD-
10
A group of disorders characterized by an early onset, lack of persistence in

activities requiring cognitive involvement, excessive activity, impulsivity, and
disorganization. Hyperkinetic children often display recklessness, impulsivity,
Hyperkinetic difficulty in social relationships, and cognitive impairments. They may also
Disorders F90 experience delays in motor and language development.
Panic Disorder Characterized by recurrent episodes of severe anxiety (panic) that are
(Episodic unpredictable and not restricted to any particular situation. Symptoms include
Paroxysmal palpitations, chest pain, choking sensations, dizziness, and feelings of unreality.
Anxiety) F41.0 Secondary fear of dying, losing control, or going mad may also be present.
Involves generalized and persistent anxiety not restricted to specific

environmental circumstances. Symptoms include persistent nervousness,
Generalized trembling, muscular tensions, sweating, palpitations, dizziness, and fears of
Anxiety Disorder F41.1 illness or accidents.
This category is used when symptoms of anxiety and depression coexist, but
Mixed Anxiety and neither is predominant to warrant a separate diagnosis. When both anxiety and
Depressive depressive symptoms are severe, individual diagnoses of both disorders should
Disorder F41.2 be recorded instead of using this category.
Includes symptoms of anxiety mixed with features of other disorders in the F42-
Other Mixed F48 range, but neither symptom type is severe enough to warrant a separate
Anxiety Disorders F41.3 diagnosis.
Other Specified Includes anxiety disorders that do not fit into specific categories. Examples
Anxiety Disorders F41.8 include anxiety hysteria.
Anxiety Disorder, Used when the anxiety disorder does not fit into any specific category or when
Unspecified F41.9 there is not enough information to make a more specific diagnosis.
ICD-
10
A single episode characterized by an abnormally elevated mood, increased energy,

and other symptoms such as overactivity, pressure of speech, decreased need for
Manic Episode F30 sleep, distractibility, inflated self-esteem, and reckless behavior.
Bipolar disorder characterized by a single manic episode without any depressive

Bipolar Disorder, episodes. It involves persistent mild elevation of mood, increased energy and
Single Manic activity, marked feelings of well-being, talkativeness, over-familiarity, and decreased
Episode F30.0 need for sleep, among other symptoms.
A disorder characterized by a persistent mild elevation of mood, increased energy

Hypomania F30.1
and activity, and usually marked feelings of well-being. While similar to mania,
ICD-
10
hypomania does not lead to severe disruption of work or social rejection. Symptoms
may include increased sociability, talkativeness, irritability, and decreased need for
sleep, among others.
Mania without Mania characterized by an elevated mood, increased energy, overactivity, pressure
Psychotic of speech, decreased need for sleep, distractibility, inflated self-esteem, and reckless
Symptoms F30.1 behavior. However, there are no hallucinations or delusions present.
Mania accompanied by delusions (usually grandiose) or hallucinations (usually of

Mania with voices speaking directly to the patient), or extreme excitement, excessive motor
Psychotic activity, and flight of ideas to the extent that communication becomes
Symptoms F30.2 incomprehensible or inaccessible.
Other Manic
Episodes F30.8 Other specified manic episodes not falling into the previous categories.
Manic Episode,
Unspecified F30.9 Manic episode where the specifics of symptoms are unspecified.
ICD-
10
Characterized by abnormal or impaired development before the age of

three, with qualitative abnormalities in reciprocal social interactions,
communication, and restricted, stereotyped, repetitive behavior. Other
common problems may include phobias, sleeping and eating
Childhood Autism F84.0 disturbances, temper tantrums, and aggression.
Differs from childhood autism either in age of onset or in failing to

fulfill all three diagnostic criteria. May occur after age three with
characteristic abnormalities in one or two areas of psychopathology,
despite not meeting criteria for autism. Often seen in profoundly
Atypical Autism F84.1 retarded individuals or those with specific developmental disorders.
Typically found only in girls, characterized by partial or complete loss

of speech and skills in locomotion and use of hands, along with
deceleration in head growth. Other features include loss of purposive
hand movements, hand-wringing stereotypies, hyperventilation, trunk
ataxia, apraxia, and choreoathetoid movements. Severe mental
Rett Syndrome F84.2 retardation is common.
Defined by a period of normal development followed by a loss of

Other Childhood
previously acquired skills in several areas over a few months.
Disintegrative Disorder F84.3
Symptoms include loss of interest in the environment, stereotyped
ICD-
10
motor mannerisms, and autistic-like abnormalities in social interaction

and communication. May be associated with encephalopathy.
An ill-defined disorder including children with severe mental

retardation and major problems in hyperactivity, attention, and
Overactive Disorder stereotyped behaviors. Often not responsive to stimulant drugs, and
Associated with Mental may exhibit dysphoric reactions to stimulants. Associated with
Retardation and Stereotyped developmental delays and may have unknown etiology related to IQ or
Movements F84.4 organic brain damage.
Characterized by qualitative abnormalities in reciprocal social

interaction and a restricted, stereotyped, repetitive repertoire of
interests and activities. Differs from autism in that there is no general
delay or retardation in language or cognitive development. May persist
into adolescence and adulthood and is often associated with marked
Asperger Syndrome F84.5 clumsiness.
Other Pervasive Other specified pervasive developmental disorders not falling into the
Developmental Disorders F84.8 previous categories.
Pervasive Developmental
Disorder, Unspecified F84.9 Pervasive developmental disorder with unspecified characteristics.
ICD-
10
Characterized by stable, often paranoid delusions accompanied by hallucinations,

Paranoid particularly auditory. Other symptoms such as affective, volitional, speech
Schizophrenia F20.0 disturbances, and catatonic symptoms are either absent or less prominent.
Prominent affective changes, fleeting delusions and hallucinations, unpredictable

behavior, incoherent speech, and social isolation. Rapid development of "negative"
Hebephrenic symptoms like flattening of affect and loss of volition. Typically diagnosed in
Schizophrenia F20.1 adolescents or young adults.
Dominated by prominent psychomotor disturbances including extremes such as

hyperkinesis and stupor, automatic obedience, negativism, catalepsy, and flexibilitas
Catatonic cerea. Episodes of violent excitement may occur, along with dream-like states and
Schizophrenia F20.2 vivid scenic hallucinations.
Psychotic conditions meeting general diagnostic criteria for schizophrenia but not
Undifferentiated conforming to any specific subtype or exhibiting features of more than one subtype
Schizophrenia F20.3 without clear predominance. Also referred to as atypical schizophrenia.
ICD-
10
Depressive episode occurring after a schizophrenic illness. Some residual

schizophrenic symptoms must still be present, but depression dominates the clinical
Post-Schizophrenic picture. Associated with an increased risk of suicide. If no schizophrenic symptoms
Depression F20.4 remain, diagnosis should be depressive episode (F32.-).
Chronic stage characterized by long-term "negative" symptoms such as psychomotor

slowing, blunting of affect, passivity, poor speech and nonverbal communication, and
Residual social performance decline. Represents progression from earlier stages of
Schizophrenia F20.5 schizophrenia, but symptoms may not be irreversible.
Insidious development of oddities of conduct, inability to meet societal demands, and

Simple decline in total performance without preceding overt psychotic symptoms. Negative
Schizophrenia F20.6 features like blunting of affect and loss of volition are prominent.
Includes various subtypes and manifestations of schizophrenia not falling into specific
categories mentioned above, such as cenesthopathic schizophrenia, schizophreniform
Other Schizophrenia F20.8 disorder not otherwise specified, and psychosis not otherwise specified.
Schizophrenia,
Unspecified F20.9 Schizophrenia with unspecified characteristics.
Hyperkinetic Hyperkinetic disorder associated with conduct disorder, characterized by symptoms of

Conduct Disorder F90.1 hyperactivity and impulsivity along with conduct problems.
Includes hyperkinetic disorders other than hyperkinetic conduct disorder, such as

Other Hyperkinetic attention deficit disorder with hyperactivity, hyperkinetic syndrome not otherwise
Disorders F90.8 specified, and disturbances of activity and attention.
Hyperkinetic
Disorder,
Unspecified F90.9 Hyperkinetic disorder with unspecified characteristics.
2. Conduct disorders
CONDUCT DSORDER HAS TWO TYPES- ODD AND CONDUCT DSSOCAL DSORDER
Oppositional Defiant Disorder (ODD): A Comprehensive Explanation with Tables

Essential Features and Diagnostic Criteria:
ODD is characterized by a persistent pattern of negative and defiant behavior that significantly impacts
daily life. To be diagnosed with ODD, an individual must exhibit several of the following features for
at least 6 months and to a degree that is greater than expected for their age and developmental level:
Table 1: Essential Features of ODD
Feature Description Example
This includes frequently arguing

Markedly A child argues with their
with authority figures, refusing to
noncompliant, teacher about classroom rules
comply with requests or rules,
defiant, and and refuses to complete their
and deliberately doing things to
disobedient behavior assigned work.
annoy others.
This includes deliberately trying A teenager spreads rumors

Provocative, spiteful,
to upset or anger others, often about a classmate online to
or vindictive
through teasing, name-calling, or get revenge for a perceived
behavior
social media attacks. slight.
This includes being easily A child throws a tantrum and

Extreme irritability annoyed, losing one's temper yells at their parent because
or anger frequently, and having angry they are not allowed to have
outbursts. dessert before dinner.
The oppositional behavior must A child's constant arguing

cause significant problems in at with their teachers and
Impairment in
least one important area of life, classmates leads to them
functioning
such as school, home, or social being isolated and struggling
relationships. academically.
Specifiers:
In addition to the essential features, there are several specifiers that can be used to further describe the
presentation of ODD:
Table 2: Specifiers for ODD
Specifier Description Example
A child becomes easily

This specifier indicates that the
With chronic frustrated and throws frequent
individual experiences frequent and
irritability- tantrums, often accompanied
intense anger or irritability in addition
anger by yelling and aggressive
to the other features of ODD.
behavior.
Without This specifier indicates that the A teenager occasionally argues

chronic individual experiences anger and with their parents but does not
irritability- irritability less frequently and severely experience frequent outbursts
anger than those with the "with chronic of anger.
irritability-anger" specifier.

A child bullies another child
With limited individual has difficulty understanding
and shows no empathy or
prosocial or responding to the emotions of others
concern for the other child's
emotions and shows little remorse or guilt for
feelings.
their behavior.

With typical A teenager argues with their
individual does not experience
prosocial parent but later apologizes for
significant difficulties with empathy or
emotions their behavior.
remorse.

While not part of the diagnostic criteria, ODD often presents with several additional features that can
impact the individual's life:
Table 3: Additional Clinical Features of ODD
A child's constant arguing

ODD can lead to difficulties with
with their parents leads to
Negative impact peers, family members, and other
frequent conflict and strained
on relationships individuals due to the negative and
relationships within the
oppositional behavior.
family.
A teenager deliberately
Individuals with ODD may often
Provocative ignores their teacher's
initiate confrontations and be seen as
quality instructions and disrupts the
excessively rude and uncooperative.
classroom environment.
Decreased Younger children may exhibit

A preschooler frequently
frequency of oppositional behaviors more
argues with their parents about
behaviors with frequently as they receive more direct
bedtime routines, but this
age demands from adults. However, the
behavior becomes less
diagnosis is still valid if the behavior is
atypical for the individual's age and frequent as they enter
development. elementary school.
An adult with ODD struggles

Adults with ODD may continue to
to maintain friendships and
Impact on experience difficulties in relationships
employment due to their
adulthood and at work due to their persistent
frequent arguments and
negative behavior patterns.
confrontational behavior.
ODD can occur alongside other mental

A child with ODD also
health disorders, such as Attention
Co-occurring exhibits symptoms of ADHD,
Deficit Hyperactivity Disorder
disorders such as hyperactivity and
(ADHD), Conduct Disorder, and
impulsivity.
depression.
Detailed Explanation of ODD: Additional Information

Table 1: Boundary with Normality
Occasional noncompliance,
Transient defiance, and disobedience, A child occasionally argues with a parent
behaviors including irritability or anger, about bedtime but ultimately complies.
can be normal.
These behaviors can be part of

A child throws a tantrum when they are
Typical typical development,
separated from their parents for the first
development especially during challenging
time at daycare.
situations or transitions.
Anxiety in specific situations A child becomes argumentative and

Normative
can lead to temporary refuses to go on stage during a school play
anxiety
oppositional behavior. due to stage fright.
ODD diagnosis requires
a persistent
A child argues with their parents and
pattern of markedly
teachers frequently and intensely,
Diagnosis of noncompliant, defiant, and
deliberately disobeys rules, and shows this
ODD disobedient behavior that
behavior consistently across different
is atypical for the individual's
settings.
age, gender, and cultural
context.
Table 2: Course Features
Feature Description Prognostic Implication
The specific presentation can

Heterogeneity of ODD can vary in severity and
influence the potential course
presentations presentation.
of the disorder.
ODD, especially with severe Early intervention for ODD

Precursor to defiance or spitefulness, can may help prevent the
Conduct Disorder increase the risk of developing development of Conduct
Conduct Disorder. Disorder.
Addressing co-occurring
Comorbidity with ODD can co-occur with other
disorders is important for
other disorders mental health conditions.
comprehensive treatment.
Table 3: Developmental Presentations
Feature Description
Typical age of onset Middle childhood (preschool age)
Symptoms emerge Rarely after early adolescence
Prevalence rates 3.3% among children and adolescents (aged 6-18)
Sex differences Higher rates observed among school-aged boys (ratio of 1.4:1)
Possible decrease in Some evidence suggests a decrease beginning in adolescence and
prevalence young adulthood
Disrupted caregiving relationships, harsh or inconsistent

Risk factors
parenting practices
Can lead to peer rejection, interpersonal conflict, and other

Impact on development
difficulties
Table 4: Culture-Related Features
Feature Description Implication
Cultural norms influence

Variation in
Across cultures perception of noncompliant
prevalence
behavior.
Behaviors should be
A diagnosis shouldn't solely rely on
Cultural context evaluated within the
comparing behavior to a different
evaluation individual's cultural
cultural standard.
framework.
Possible
Family structure, disciplinary These factors can influence the
explanations for
practices, and cultural values prevalence of ODD across cultures.
differences
Table 5: Sex- and/or Gender-Related Features
Feature Description
Prevalence Higher among school-aged boys
Gender difference at other No significant difference in prevalence at other points in the

points lifespan
Conduct-Dissocial Disorder (ICD-11): Detailed Explanation with Tables

Table 1: Essential Features
A child repeatedly
Repetitive and A consistent pattern of violating the basic rights
bullies classmates,
persistent of others or major age-appropriate societal
steals from their peers,
pattern of norms, rules, or laws. This behavior is not
and destroys school
behavior simply occasional or situational.
property.
Multiple
The individual exhibits at least one or more of
behaviors
the following types of behaviors:
involved
* Aggression towards people or

animals: This can include threatening,
intimidating, or bullying others; initiating A teenager threatens
physical fights; using weapons that can cause classmates with a knife
serious harm; inflicting physical cruelty on and steals their
people or animals; aggressive forms of stealing belongings.
(e.g., mugging, extortion); or forcing someone
into sexual activity.
* Destruction of property: This includes

deliberately setting fires with the intention of A child repeatedly sets
causing serious damage or deliberately fires in their
destroying the property of others (e.g., breaking neighborhood, causing
windows, slashing tires, vandalizing damage to property.
buildings).
* Deceitfulness or theft: This includes An adolescent lies to

stealing items of value (e.g., shoplifting, car their parents about their
theft), lying to obtain goods or favors or to whereabouts and steals
avoid obligations (e.g., "conning" others), or money from their
breaking into someone's house, building, or car. family to buy drugs.
* Serious violations of rules: This includes A child consistently

repeated defiance of parental rules (e.g., stays out past curfew,
staying out all night despite prohibitions), runs away from home
repeatedly running away from home, or often multiple times, and
skipping school or work without permission. skips school frequently.
The pattern of behavior must be persistent and The individual exhibits
Persistence recurrent, including multiple incidents of the these behaviors
and types described above over an extended period consistently for a year
recurrence of time (typically at least 1 year). Isolated acts or more, not just
of delinquency are not sufficient for diagnosis. occasionally.
The individual's behavior pattern results in

significant impairment in at least one important
The individual's
area of their life, such as personal functioning
behavior negatively
(e.g., difficulty managing emotions), family
Significant impacts their ability to
relationships (e.g., constant conflict with
impairment function effectively in
parents), social relationships (e.g., rejection by
various aspects of their
peers), educational functioning (e.g., failing
life.
grades), or occupational functioning (e.g., job
loss).
Table 2: Specifiers for Age of Onset
Meets all diagnostic criteria for Conduct-Dissocial Disorder and one

6C91.0 Conduct-
or more features of the disorder have clearly been present and
Dissocial Disorder,
persistent during childhood prior to adolescence (e.g., before 10
childhood onset
years of age).
6C91.1 Conduct- Meets all diagnostic criteria for Conduct-Dissocial Disorder, but
Dissocial Disorder, none of the features of the disorder were present prior to adolescence
adolescent onset (e.g., before 10 years of age).
6C91.Z Conduct-
Dissocial Disorder, Insufficient information is available to determine the age of onset.
unspecified
Table 3: Specifiers for Prosocial Emotions
Specifier Description Example
6C91.y0 with This is a less common and more severe An individual with this specifier
limited presentation of Conduct-Dissocial may show little empathy or
prosocial Disorder. It is characterized by a concern for others' feelings, lack
emotions pattern of limited prosocial emotions, remorse or guilt for their actions,
sometimes referred to as "callous and and display a shallow or insincere
unemotional traits." expression of emotions.
This is the more common presentation An individual with this specifier

6C91.y1 with of Conduct-Dissocial Disorder. These may show occasional lack of
typical individuals may exhibit occasional concern for others or struggle
prosocial limited concern, remorse, or emotional with expressing emotions, but
emotions expression, but these are not persistent these behaviors are not a
or pervasive features. consistent pattern.
Additional Clinical Features of Conduct-Dissocial Disorder (ICD-11)

Table 1: Delinquent Peer Groups
Individuals with Conduct- A teenager with Conduct-Dissocial

Association with Dissocial Disorder may be part Disorder joins a group of friends
delinquent peers of groups engaging in who steal from local stores and
delinquent activities. vandalize property.
Teenagers with Conduct-Dissocial

Particularly This association is more Disorder who did not exhibit
common in frequent when the disorder problems earlier in childhood are
adolescent onset starts in adolescence. more likely to be part of such
groups.
Table 2: Relationship with Oppositional Defiant Disorder (ODD)
A child with ODD who argues

ODD was previously excessively with parents and teachers
Historically viewed
considered a precursor may develop Conduct-Dissocial
as hierarchical and
to Conduct-Dissocial Disorder if their behavior escalates to
developmental
Disorder. more severe rule-breaking and
aggression.
Both disorders can be
An adolescent diagnosed with Conduct-
diagnosed together,
Can co-occur with Dissocial Disorder may also meet criteria
especially with
ODD for ODD due to their ongoing defiance
persistent behavior
and disobedience.
problems.
Table 3: Risk Factors for Long-Term Antisocial Behavior
A child diagnosed with Conduct-

Childhood onset
Individuals with this Dissocial Disorder before adolescence
and limited
combination are at higher risk and exhibiting limited empathy and
prosocial
for persistent problems. remorse is at greater risk for future
emotions
antisocial behavior.
Distinction These are separate An individual with Conduct-Dissocial

between characteristics, and childhood Disorder starting in childhood may
subtypes and onset does not guarantee still display typical prosocial
specifiers limited prosocial emotions. emotions.
Table 4: Comorbidity with Other Disorders
An individual with Conduct-Dissocial

Conduct-Dissocial
Frequent co- Disorder may also struggle with ADHD,
Disorder often occurs
occurrence with learning difficulties, anxiety disorders,
alongside other mental
other disorders mood disorders, or substance use
health conditions.
disorders.
Table 5: Boundary with Normality
A teenager participating in a
Political protest not
Engaging in peaceful protests peaceful protest against
indicative of
should not be misconstrued as a environmental injustice does not
Conduct-Dissocial
symptom of the disorder. necessarily meet criteria for
Disorder
Conduct-Dissocial Disorder.
The disorder involves behaviors An isolated act of theft due to
Criminal offenses that may have legal peer pressure or impulsive
and legal consequences, but not all decision-making wouldn't
repercussions criminal acts are indicative of necessarily qualify for the
Conduct-Dissocial Disorder. diagnosis.
Diagnosis should consider the A single criminal act should not

Focus on broader individual's overall behavior solely determine the diagnosis; a
pattern of behavior pattern, not just isolated persistent and pervasive pattern
incidents. of antisocial behavior is crucial.
Table 6: Course Features
A child who develops Conduct-

Individuals with earlier
Earlier onset Dissocial Disorder at a young age and
onset and more severe
and worse exhibits severe aggression may be at
symptoms tend to have
prognosis higher risk for future criminal behavior
poorer outcomes.
and co-occurring disorders in adulthood.
The disorder's course can

An individual diagnosed with Conduct-
Variable course vary significantly, with some
Dissocial Disorder in adolescence may
with potential individuals experiencing
show improvement and no longer meet
remission complete remission by
the criteria for the disorder in adulthood.
adulthood.
A child who initially exhibits occasional

Symptoms may start mild lying may escalate to more serious
Progression of
(e.g., lying) and worsen over behavior like stealing or physical
symptoms
time (e.g., assault). aggression if the underlying issues are
not addressed.
Table 7: Developmental Presentations
Typical age While possible in early childhood, the typical onset Onset after the age of
of onset is during early to middle adolescence. 16 is uncommon.
Individuals exhibiting Conduct-Dissocial Disorder
Rare onset
symptoms for the first time after 16 are unlikely to
after age 16
meet diagnostic criteria.
Table 8: Culture-Related Features
Assessment should consider cultural In some cultures,

Consideration of
norms and expectations to avoid children may be
cultural context
misdiagnosis. absent
Sex- and/or Gender-Related Features of Conduct-Dissocial Disorder (ICD-11)
Conduct-Dissocial Disorder Males are diagnosed with Conduct-

Prevalence is more common among Dissocial Disorder more frequently than
males. females.
Males are more likely to exhibit behaviors

like stealing, vandalism, fighting, and
Symptom Males and females exhibit school discipline problems, while females
presentation different symptom patterns. are more likely to exhibit lying, truancy,
substance abuse, absconding, and
prostitution.
Males tend to display both Males with Conduct-Dissocial Disorder

physical and relational may engage in physical violence like
Type of
aggression, while females hitting and pushing, while females may
aggression
are more likely to exhibit use social tactics like spreading rumors or
relational aggression only. excluding others.
Boundaries with Other Disorders and Conditions (ICD-11)

Table 1: Boundary with Oppositional Defiant Disorder (ODD)

A child with ODD may argue with
Conduct-Dissocial Disorder
parents and refuse to follow rules, but
Severity and involves severe and dissocial
wouldn't violate major rules like
nature of behavior violating major rules
stealing or harming others, which are
behavior and rights, exceeding ODD's
characteristic of Conduct-Dissocial
noncompliance and defiance.
Disorder.
An adolescent with Conduct-Dissocial

Disorder engaging in aggressive
ODD and Conduct-Dissocial
behavior and property destruction
Comorbidity Disorder can co-occur and be
might also meet criteria for ODD if
and diagnosis diagnosed together if both
they exhibit persistent defiance and
criteria are met.
disobedience towards authority
figures.
Table 3: Boundary with Mood Disorders
When behavior problems A teenager experiencing a manic

occur solely within the episode may act impulsively and
Context of context of a mood episode aggressively, but if these behaviors
behavior (e.g., depression, mania), a resolve when the mood episode
problems separate diagnosis of subsides, a separate diagnosis of
Conduct-Dissocial Disorder Conduct-Dissocial Disorder wouldn't
is usually not needed. be warranted.
A teenager with depression might be

Mood disorders may present
irritable and argumentative, but
with irritability, but Conduct-
wouldn't necessarily exhibit persistent
Distinguishing Dissocial Disorder involves a
and intentional rule-breaking,
symptoms broader pattern of antisocial
aggression, or disregard for others'
behavior beyond mood-
rights, which are key features of
related irritability.
Conduct-Dissocial Disorder.
Table 4: Boundary with Intermittent Explosive Disorder (IED)
IED involves impulsive An individual with IED may experience

Nature of outbursts, not a broader sudden and intense anger episodes leading
aggression pattern of antisocial to aggressive outbursts, but these wouldn't
behavior. involve a consistent pattern of rule-
breaking, lying, and violating others'
rights, as seen in Conduct-Dissocial
Disorder.
An individual with Conduct-Dissocial

Conduct-Dissocial
Disorder might plan and steal something
Disorder aggression is
Premeditation for personal gain, while an individual with
often premeditated and
and intent IED might have an impulsive outburst of
instrumental, while IED
anger leading to property damage without
aggression is impulsive.
a specific goal.
Table 5: Boundary with Personality Disorder
Conduct-Dissocial Disorder An individual with Conduct-Dissocial

focuses on recurrent behavior Disorder may exhibit antisocial
patterns, while Personality behavior for several years, but it's not
Duration and
Disorder is characterized by necessarily a deeply ingrained part of
pervasiveness
enduring and pervasive their personality across different areas
disturbances in personality of life, as seen in a Personality
traits. Disorder diagnosis.
Treatment Approaches for Conduct-Dissocial Disorder (ICD-11)

Table 1: Evidence-Based Interventions
Intervention Description Target population Evidence
CBT helps individuals Strong evidence for

identify and modify Adolescents and effectiveness in
Individual
unhelpful thinking young adults reducing antisocial
Cognitive
patterns and behaviors with Conduct- behavior, improving
Behavioral
associated with their Dissocial social skills, and
Therapy (CBT)
Conduct-Dissocial Disorder. reducing emotional
Disorder. distress.
Parent PMT equips parents Parents of Moderate to strong

Management with skills to manage children and evidence for
Training (PMT) their child's behavior adolescents with effectiveness in
effectively and build Conduct- reducing behavioral
positive parent-child Dissocial problems and
relationships. Disorder. improving parent-
child communication.
MST is an intensive
family and community- Moderate evidence
Youths with
based intervention that for effectiveness in
Conduct-
Multisystemic addresses the various reducing antisocial
Dissocial
Therapy (MST) factors contributing to behavior,
Disorder and
the child's behavior delinquency, and
their families.
problems in different substance use.
settings.
Social skills training

Adolescents and
helps individuals
young adults
develop skills for Moderate evidence
with Conduct-
building and for effectiveness in
Social Skills Dissocial
maintaining healthy improving social
Training Disorder who
relationships, resolving skills and reducing
struggle with
conflicts constructively, aggressive behavior.
social
and expressing
interactions.
emotions appropriately.
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Table 2: Additional Considerations
An adolescent with mild Conduct-

Treatment approaches are
Dissocial Disorder might benefit from
Severity and tailored to the individual's
individual CBT, while a youth with a
individual specific needs and the severity
more severe case might require a
needs of their Conduct-Dissocial
combination of interventions like MST
Disorder.
and social skills training.
An adolescent with Conduct-Dissocial

If the individual has co-
Disorder and ADHD might benefit
occurring mental health
from a combination of CBT for
Comorbidity conditions like ADHD or
Conduct-Dissocial Disorder and
depression, treatment should
medication or behavioral interventions
address both disorders.
for ADHD.
Family involvement is crucial
Parental participation in therapy
for successful treatment.
Family sessions and implementation of learned
Interventions like PMT can
involvement strategies at home can significantly
equip parents with skills to
impact treatment outcomes.
support their child's progress.
Conduct-Dissocial Disorder
Regular check-ins with a therapist or
can be a chronic condition.
counselor can help the individual
Long-term Long-term follow-up and
identify potential triggers and develop
follow-up support are essential to
coping mechanisms to avoid future
maintain progress and prevent
behavioral problems.
relapse.
Utilizing community resources

Connecting with others who understand
like support groups, mentoring
Community- the challenges of Conduct-Dissocial
programs, and educational
based Disorder can provide a sense of
interventions can complement
resources community and belonging for both the
therapy and provide additional
individual and their family.
support.
Conduct-Dissocial Disorder Subtypes: Childhood Onset vs. Adolescent Onset (ICD-11)
Feature Childhood Onset (6C91.0) Adolescent Onset (6C91.1)
No symptoms present before

Symptoms appear before the age of 10
Age of Onset adolescence (typically after 10
years.
years of age).
Repetitive and persistent violation of

Same behavior pattern as
others' rights, societal norms, rules, and
childhood onset, but
Description laws, including aggression, property
symptoms first appear during
destruction, deceitfulness, theft, and
adolescence.
serious rule violations.
Features must be present for at

Features must be present for at least 12
Diagnostic least 12 months. Isolated
months. Isolated dissocial acts don't
Criteria dissocial acts don't warrant
warrant diagnosis.
diagnosis.
A teenager begins engaging in
A child exhibits aggressive behavior,
fights, vandalizes property,
Example destroys others' property, and frequently
and steals money in their mid-
lies from a young age (before 10).
teens (after 10).
Adolescent onset may be

Early onset may indicate a greater risk for
influenced by various factors
Explanation long-term problems with antisocial
like peer pressure or
behavior.
environmental changes.
3. Mixed disorders of conduct and emotions
Mixed Disorders of Conduct and Emotions (ICD-10): A Breakdown
Subcategory Additional
Description Emotional Disturbance Examples
(ICD-10 Code) Information
- Symptoms
last for at least
a year and
Requires both conduct cause
disorder (F91.-) - Depression: Sadness or significant
and persistent, irritability, loss of interest or distress or
F92.0 -
marked pleasure in activities, feelings impairment in
Depressive
depression (F32.-). of worthlessness or guilt, daily life. -
Conduct
Individuals experience hopelessness or thoughts of Individuals
Disorder
significant depressive death, sleep or appetite may also
symptoms alongside disturbances exhibit other
conduct problems. symptoms of
depression
not listed
here.
Requires conduct - Anxiety - Examples

F92.8 - disorder (F91.-) Disorders: Generalized listed are not
Other with other significant anxiety, panic disorder, social exhaustive.
Mixed emotional anxiety disorder, etc. Other
Disorders disturbances not - Obsessive-compulsive emotional
of Conduct meeting criteria for disorder disturbances
depressive conduct (OCD) - Phobias: Specific may also co-
and disorder. This category phobias, social phobia, etc. occur with
Emotions covers a wider range of - Dissociative conduct
emotional problems disorders: Depersonalization, disorder in
co-occurring with derealization this category.
conduct disorder. - Hypochondriasis: Excessive - Symptoms
health concerns last for at least
a year and
cause
significant
distress or
impairment in
daily life.
- This
category is
used when the
Used when conduct
emotional
problems co-occur
disturbance
with unspecified
doesn't
F92.9 - emotional
- Combination of emotional clearly fall
Mixed disturbances not
symptoms not fitting a under any of
Disorder of meeting criteria for
specific diagnosis, such as the other
Conduct other subcategories.
anger outbursts, mood swings, subcategories.
and This category
irritability, or emotional - Symptoms
Emotions, acknowledges the
dysregulation. last for at least
Unspecified complexity of co-
a year and
occurring problems
cause
without a specific
significant
emotional diagnosis.
distress or
impairment in
daily life.
Important Points:
• Both conduct problems and emotional symptoms must be persistent and
significant (lasting for at least a year) for a diagnosis.
• The severity and specific types of conduct problems and emotional disturbances can
vary greatly between individuals.
• This classification system is not used in the newer ICD-11 (released in 2019).
Additional Notes:
• This table provides a general overview. Professional diagnosis requires a
comprehensive evaluation by a mental health professional.
• If you suspect yourself or someone you know might be struggling with mixed disorders
of conduct and emotions, seeking professional help is crucial.
4. Emotional disorders with onset specific to childhood

Separation Anxiety Disorder of Childhood
Description: Separation anxiety disorder (SAD) is characterized by excessive fear or anxiety
concerning separation from attachment figures, leading to significant distress and functional
impairment. It typically manifests in children when they are separated from their primary
caregivers or familiar environments.
Symptoms:
• Excessive distress, worry, or fear when separation is anticipated or occurs
• Persistent reluctance or refusal to go to school or other places away from home
• Fear of harm befalling loved ones when separated
• Physical symptoms such as headaches, stomachaches, or nausea when separation is
imminent
• Nightmares about separation or being alone
• Clinging behavior or excessive need for reassurance
Causes:
• Genetic predisposition, with family history of anxiety disorders
• Environmental factors such as stressful life events or family disruptions
• Overprotective parenting styles or early traumatic experiences related to separation
Impact:
• Impairment in social relationships, academic performance, and overall quality of life
• Interference with normal developmental tasks, such as gaining independence and
autonomy
• Increased risk of developing other anxiety disorders later in life
Prevalence:
• Estimated prevalence of 4-5% in children aged 7-11 years
Tips for Parents:
• Establish predictable routines and rituals to provide a sense of security
• Encourage gradual exposure to separation situations, starting with short separations and
gradually increasing duration
• Teach coping strategies such as deep breathing, positive self-talk, or visualization
techniques
• Seek professional help if symptoms persist or significantly interfere with daily
functioning
Treatment:
• Cognitive-behavioral therapy (CBT) focusing on gradual exposure, cognitive
restructuring, and relaxation techniques
• Parent-child interaction therapy to improve attachment relationships and
communication skills
• Medications such as selective serotonin reuptake inhibitors (SSRIs) in severe cases,
under the guidance of a qualified healthcare provider
Parental Care:
• Offer reassurance and support during separation situations, while also encouraging
independence and self-reliance
• Communicate openly with the child about their fears and concerns, validating their
feelings without reinforcing excessive dependence
• Collaborate with teachers and other caregivers to create a supportive environment for
the child's transition and adjustment
Phobic Anxiety Disorder of Childhood
Description: Phobic anxiety disorder involves irrational fears or anxieties about specific
objects or situations that are common in childhood but are experienced with an intensity or
persistence that is statistically unusual. These fears typically lead to avoidance behavior and
significant distress.
Symptoms:
• Persistent and excessive fear or anxiety about a specific object or situation, such as
animals, storms, or medical procedures
• Avoidance of the phobic stimulus or enduring it with intense distress
• Physical symptoms such as rapid heartbeat, sweating, trembling, or nausea when
exposed to the phobia
• Recognition that the fear is excessive or unreasonable but feeling unable to control it
Causes:
• Traumatic experiences or conditioning related to the phobic stimulus
• Learned behavior through observation or modeling, such as witnessing a parent's fear
reaction
Impact:
• Disruption of daily activities, social relationships, and academic performance
• Avoidance behavior may lead to missed opportunities for learning and growth
• Increased risk of developing other anxiety disorders or depression later in life
Prevalence:
• Prevalence rates vary depending on the specific phobia but may range from 3% to 8%
in children and adolescents
Tips for Parents:
• Provide a supportive and non-judgmental environment for the child to express their
fears and concerns
• Gradually expose the child to the phobic stimulus in a controlled and supportive
manner, starting with less intense exposures
• Model calm and confident behavior when dealing with anxiety-provoking situations,
while also acknowledging the child's bravery
Treatment:
• Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive
restructuring, and relaxation techniques
• Systematic desensitization to gradually confront the phobic stimulus in a hierarchical
manner
• Medications such as beta-blockers or benzodiazepines in severe cases, under the
guidance of a qualified healthcare provider
Parental Care:
• Validate the child's feelings and provide encouragement during exposure exercises,
while avoiding excessive reassurance or accommodation of avoidance behavior
• Reinforce brave behavior and efforts to confront fears, while also acknowledging and
praising small steps of progress
• Collaborate with mental health professionals to develop a comprehensive treatment
plan tailored to the child's needs and preferences
Social Anxiety Disorder of Childhood
Description: Social anxiety disorder involves an intense fear or anxiety about social situations,
including interacting with unfamiliar people, being observed, or performing in front of others.
These fears significantly interfere with social functioning and may lead to avoidance behavior.
Symptoms:
• Fear of embarrassment, humiliation, or rejection in social situations
• Avoidance of social interactions, particularly with unfamiliar people or in performance
situations
• Physical symptoms such as blushing, sweating, trembling, or gastrointestinal distress
• Excessive self-consciousness or worry about being judged negatively by others
• Difficulty initiating or maintaining conversations, making eye contact, or speaking in
public
Causes:
• Negative experiences or traumas related to social interactions, such as bullying or
rejection
• Overprotective parenting styles or high levels of criticism and scrutiny
Impact:
• Impairment in social relationships, academic performance, and overall quality of life
• Increased risk of depression, substance abuse, or academic underachievement in
adolescence and adulthood
• Interference with developmental tasks such as forming friendships, dating, or pursuing
educational and career goals
Prevalence:
• Estimated prevalence of 2-4% in children and adolescents
Tips for Parents:
• Encourage participation in social activities that match the child's interests and abilities,
while respecting their comfort level
• Role-play social situations at home to practice social skills and build confidence
• Provide positive reinforcement for brave behavior and efforts to overcome anxiety,
while also acknowledging the challenges and providing support
Treatment:
• Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive
restructuring, and social skills training
• Group therapy to provide opportunities for social interaction and peer support
• Medications such as selective serotonin reuptake inhibitors (SSRIs) or selective
serotonin-norepinephrine reuptake inhibitors (SNRIs) in severe cases, under the
guidance of a qualified healthcare provider
Parental Care:
• Foster a supportive and accepting home environment where the child feels valued and
understood, while also setting appropriate boundaries and expectations
• Avoid pushing the child into social situations before they are ready, but gently
encourage gradual exposure and participation
• Model confident and assertive behavior in social interactions to serve as a positive role
model, while also acknowledging and validating the child's feelings
Sibling Rivalry Disorder
Description: Sibling rivalry disorder refers to emotional disturbances following the birth of a
younger sibling, characterized by jealousy, attention-seeking behavior, or aggression. While
some degree of rivalry is common among siblings, sibling rivalry disorder is diagnosed when
the degree or persistence of the disturbance is statistically unusual and associated with
abnormal social interaction.
Symptoms:
• Jealousy or resentment toward the younger sibling, expressed through verbal or
physical aggression
• Attention-seeking behavior to regain parental attention or affection, such as acting out
or exaggerated emotions
• Competitiveness or comparison with the sibling in various domains, such as
achievements, talents, or parental favoritism
• Disruption of family harmony or cohesion, leading to tension, conflict, or emotional
distress among family members
Causes:
• Competition for parental attention, resources, or affection
• Changes in family dynamics and routines due to the new sibling, including changes in
parental availability or attention
• Individual temperament and coping styles, such as sensitivity to perceived injustice or
unfairness
Impact:
• Disruption of sibling relationships and family dynamics, leading to long-term effects
on social development and emotional well-being
• Increased risk of behavioral problems, emotional difficulties, or adjustment difficulties
in childhood and adolescence
• Interference with parental bonding and attachment relationships, affecting parental
mental health and family functioning
Prevalence:
• Sibling rivalry is common in families with multiple children, with varying degrees of
severity depending on factors such as age spacing, temperament, and parental
responsiveness
Tips for Parents:
• Acknowledge and validate each child's feelings and needs, while also setting clear
expectations for behavior and conflict resolution
• Provide opportunities for individual attention and bonding with each child, reinforcing
their unique strengths and qualities
• Foster cooperative rather than competitive interactions between siblings, emphasizing
teamwork, collaboration, and mutual respect
Treatment:
• Family therapy to address underlying family dynamics, communication patterns, and
conflict resolution strategies
• Parent-child interaction therapy to improve parent-child relationships and enhance
parental sensitivity and responsiveness
• Individual therapy for children to express and process their feelings in a safe and
supportive environment, learning coping skills and emotion regulation strategies
Parental Care:
• Spend quality one-on-one time with each child to reinforce their sense of importance
and value, promoting positive sibling relationships and emotional security
• Establish and enforce clear boundaries and consequences for aggressive or
inappropriate behavior, while also teaching conflict resolution and problem-solving
skills
• Model healthy communication, empathy, and cooperation in family interactions,
demonstrating positive ways of resolving disputes and managing emotions
Other Childhood Emotional Disorders
Description: This category includes various emotional disorders not fitting into specific
subtypes, such as identity disorder or overanxious disorder. Each disorder may have unique
presentations requiring individualized assessment and treatment.
Symptoms:
• Symptoms vary depending on the specific disorder but may include disturbances in
mood, behavior, or self-perception
• Impairment in social, academic, or familial functioning
• Examples include identity disorder characterized by confusion or instability in one's
sense of self, or overanxious disorder marked by excessive worry and anxiety about
everyday events or activities
Causes:
• Causes vary depending on the specific disorder but may involve genetic, environmental,
or psychosocial factors
• Examples include genetic predisposition, early trauma or adversity, or maladaptive
coping strategies
Impact:
• Impairment in multiple domains of functioning, including emotional regulation,
interpersonal relationships, and academic achievement
• Increased risk of comorbid psychiatric disorders or psychosocial difficulties, affecting
long-term outcomes and quality of life
• Examples include disruption of identity formation, interpersonal conflicts, or academic
underachievement
Prevalence:
• Prevalence rates vary depending on the specific disorder and population studied, with
some disorders being relatively rare or understudied
• Examples include identity disorder, which may be less common but can have significant
impact on individual well-being and functioning
Tips for Parents:
• Seek professional evaluation and assessment to determine the specific nature and
treatment needs of the child's emotional disorder, collaborating closely with mental
health professionals to develop a comprehensive treatment plan
• Provide unconditional love and support while setting appropriate boundaries and
expectations, promoting resilience and adaptive coping skills
• Educate yourself about the child's disorder and available resources for support and
treatment, advocating for the child's needs within educational and community settings
Treatment:
• Individualized treatment plans tailored to the specific needs and symptoms of the child,
incorporating evidence-based interventions and therapeutic modalities
• Examples include cognitive-behavioral therapy (CBT), dialectical behavior therapy
(DBT), play therapy, or family therapy, depending on the nature and severity of the
disorder
• Medications may be considered for certain disorders or symptoms, under the guidance
of a qualified healthcare provider, with careful monitoring of benefits and side effects
Parental Care:
• Collaborate closely with mental health professionals to implement treatment strategies
and monitor progress, actively participating in therapy sessions and treatment planning
• Create a supportive and nurturing home environment that promotes emotional
expression and growth, fostering open communication and validation of feelings
• Advocate for the child's needs within educational and community settings, seeking
accommodations and support services as needed to optimize functioning and well-being
Separation Anxiety Disorder of Childhood
Aspect Description
- Excessive distress, worry, or fear when separation is anticipated or occurs -

Persistent reluctance or refusal to go to school or other places away from home
- Fear of harm befalling loved ones when separated - Physical symptoms such
as headaches, stomachaches, or nausea when separation is imminent -
Nightmares about separation or being alone - Clinging behavior or excessive
Symptoms need for reassurance
- Genetic predisposition, with family history of anxiety disorders -

Environmental factors such as stressful life events or family disruptions -
Overprotective parenting styles or early traumatic experiences related to
Causes separation
- Impairment in social relationships, academic performance, and overall quality

of life - Interference with normal developmental tasks, such as gaining
independence and autonomy - Increased risk of developing other anxiety
Impact disorders later in life
Prevalence - Estimated prevalence of 4-5% in children aged 7-11 years
- Establish predictable routines and rituals to provide a sense of security -

Encourage gradual exposure to separation situations, starting with short
separations and gradually increasing duration - Teach coping strategies such as
deep breathing, positive self-talk, or visualization techniques - Seek
Tips for professional help if symptoms persist or significantly interfere with daily
Parents functioning
- Cognitive-behavioral therapy (CBT) focusing on gradual exposure, cognitive

restructuring, and relaxation techniques - Parent-child interaction therapy to
improve attachment relationships and communication skills - Medications such
as selective serotonin reuptake inhibitors (SSRIs) in severe cases, under the
Treatment guidance of a qualified healthcare provider
Phobic Anxiety Disorder of Childhood
Aspect Description
- Persistent and excessive fear or anxiety about a specific object or situation,

Symptoms
such as animals, storms, or medical procedures - Avoidance of the phobic
Aspect Description
stimulus or enduring it with intense distress - Physical symptoms such as rapid

heartbeat, sweating, trembling, or nausea when exposed to the phobia -
Recognition that the fear is excessive or unreasonable but feeling unable to
control it
- Genetic predisposition, with family history of anxiety disorders - Traumatic

experiences or conditioning related to the phobic stimulus - Learned behavior
Causes through observation or modeling, such as witnessing a parent's fear reaction
- Disruption of daily activities, social relationships, and academic

performance - Avoidance behavior may lead to missed opportunities for
learning and growth - Increased risk of developing other anxiety disorders or
Impact depression later in life
- Prevalence rates vary depending on the specific phobia but may range from
Prevalence 3% to 8% in children and adolescents
- Provide a supportive and non-judgmental environment for the child to

express their fears and concerns - Gradually expose the child to the phobic
stimulus in a controlled and supportive manner, starting with less intense
exposures - Model calm and confident behavior when dealing with anxiety-
provoking situations, while also acknowledging the child's bravery - Seek
Tips for professional help if symptoms persist or significantly interfere with daily
Parents functioning
- Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive

restructuring, and relaxation techniques - Systematic desensitization to
gradually confront the phobic stimulus in a hierarchical manner - Medications
such as beta-blockers or benzodiazepines in severe cases, under the guidance
Treatment of a qualified healthcare provider
Social Anxiety Disorder of Childhood
Aspect Description
- Fear of embarrassment, humiliation, or rejection in social situations - Avoidance

of social interactions, particularly with unfamiliar people or in performance
situations - Physical symptoms such as blushing, sweating, trembling, or
gastrointestinal distress - Excessive self-consciousness or worry about being judged
negatively by others - Difficulty initiating or maintaining conversations, making eye
Symptoms contact, or speaking in public
- Genetic predisposition, with family history of anxiety disorders - Negative

experiences or traumas related to social interactions, such as bullying or rejection -
Causes Overprotective parenting styles or high levels of criticism and scrutiny
Aspect Description
- Impairment in social relationships, academic performance, and overall quality of

life - Increased risk of depression, substance abuse, or academic underachievement
in adolescence and adulthood - Interference with developmental tasks such as
Impact forming friendships, dating, or pursuing educational and career goals
Prevalence - Estimated prevalence of 2-4% in children and adolescents
- Encourage participation in social activities that match the child's interests and
abilities, while respecting their comfort level - Role-play social situations at home
to practice social skills and build confidence - Provide positive reinforcement for
brave behavior and efforts to overcome anxiety, while also acknowledging the
Tips for challenges and providing support - Seek professional help if symptoms persist or
Parents significantly interfere with daily functioning
- Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive

restructuring, and social skills training - Group therapy to provide opportunities for
social interaction and peer support - Medications such as selective serotonin
reuptake inhibitors (SSRIs) or selective serotonin-norepinephrine reuptake
inhibitors (SNRIs) in severe cases, under the guidance of a qualified healthcare
Treatment provider
Sibling Rivalry Disorder
Aspect Description
- Jealousy or resentment toward the younger sibling - Attention-seeking behavior to regain

Symptoms parental attention - Aggression toward the sibling, such as hitting or teasing
- Competition for parental attention or resources - Changes in family dynamics and

Causes routines due to the new sibling - Individual temperament and coping styles
- Disruption of family harmony and cohesion - Long-term effects on sibling relationships

Impact and self-esteem
- Sibling rivalry is common in families with multiple children, with varying degrees of
Prevalence severity
- Acknowledge and validate each child's feelings and needs - Encourage positive sibling
Tips for interactions through shared activities and cooperative play - Set clear boundaries and
Parents consequences for aggressive or inappropriate behavior
- Family therapy to address underlying family dynamics and improve communication -

Treatment Individual therapy for children to express and process their feelings in a safe environment
Unit 4 Clinical features and diagnostic criteria for behavioural and
emotional disorders with onset usually occurring in childhood and
adolescence- II
1. Disorders of social functioning with onset specific to childhood and

adolescence
Elective Mutism (F94.0)
Description: Elective mutism is a selective mutism characterized by a marked, emotionally
determined selectivity in speaking. Children with this disorder demonstrate language
competence in some situations but fail to speak in others due to social anxiety, withdrawal,
sensitivity, or resistance.
Symptoms:
• Refusal to speak in specific social situations, such as school or public places.
• Demonstrating language competence in familiar environments or with certain people.
• Exhibiting signs of social anxiety, withdrawal, or sensitivity in situations where speech
is expected.
Causes:
• Social anxiety or phobia related to specific situations or people.
• Environmental factors such as family stress, trauma, or overprotective parenting.
• Temperamental factors such as shyness or introversion.
• Genetic predisposition or family history of anxiety disorders.
Impact:
• Interferes with academic, social, and emotional development.
• Can lead to social isolation, peer rejection, and academic difficulties.
• May contribute to low self-esteem, anxiety, and depression.
Prevalence: Estimated prevalence varies, but it is believed to affect approximately 0.5% to 1%
of children.
Tips for Parents:
• Create a supportive and nonjudgmental environment at home.
• Encourage gradual exposure to anxiety-provoking situations.
• Seek professional evaluation and therapy, such as cognitive-behavioral therapy (CBT)
or speech therapy.
Treatment:
• Cognitive-behavioral therapy (CBT) to address underlying anxiety and promote
gradual exposure.
• Speech therapy to improve communication skills and confidence in speaking.
• Parental involvement in therapy sessions to learn strategies for supporting the child.
What Parents Can Do:
• Encourage open communication and validate the child's feelings.
• Avoid pressuring or criticizing the child for not speaking.
• Collaborate with educators and mental health professionals to develop a comprehensive
treatment plan.
• Provide opportunities for socialization and practice speaking in a supportive
environment.
Reactive Attachment Disorder of Childhood (F94.1)
Description: Reactive attachment disorder (RAD) of childhood is characterized by persistent
abnormalities in a child's pattern of social relationships, typically starting in the first five years
of life. These abnormalities are associated with emotional disturbance and react to changes in
environmental circumstances.
Symptoms:
• Avoidance of or resistance to physical or emotional closeness with caregivers.
• Difficulty forming and maintaining stable relationships.
• Expressions of fearfulness, hypervigilance, or aggression in response to changes in
caregivers or living situations.
Causes:
• Severe parental neglect, abuse, or inconsistent caregiving during infancy and early
childhood.
• Multiple changes in caregivers or placements, such as foster care or institutionalization.
• Lack of opportunity for secure attachment bonding during critical developmental
periods.
Impact:
• Impairs the child's ability to trust and form healthy attachments.
• Increases the risk of developmental delays, emotional disorders, and behavior
problems.
• Can lead to difficulties in school, peer relationships, and later functioning in adulthood.
Prevalence: The prevalence of reactive attachment disorder is estimated to be less than 1% in
the general population but may be higher in populations with high rates of abuse, neglect, or
institutionalization.
Tips for Parents:
• Seek early intervention and professional evaluation if concerns arise about attachment
and social development.
• Provide consistent, nurturing, and responsive caregiving to promote secure attachment.
• Participate in attachment-focused therapy and parenting support groups.
Treatment:
• Attachment-focused therapy, including interventions aimed at repairing attachment
disruptions and promoting secure attachment.
• Family therapy to address underlying family dynamics and improve parent-child
relationships.
• Trauma-focused therapy to address any underlying trauma or adverse experiences.
What Parents Can Do:
• Focus on building trust and emotional connection with the child through consistent and
responsive caregiving.
• Engage in activities that promote bonding and attachment, such as play, affection, and
shared routines.
• Seek support from mental health professionals, support groups, and community
resources for parenting guidance and coping strategies.
Elective Mutism (F94.0)
Symptom Prevalenc Tips for Treatmen Parental

Aspect Description s Causes Impact e Parents t Care
Elective
mutism is
characterize
d by a
marked,
emotionally
determined
selectivity Selective Encourage
in speaking. silence, gradual Cognitive Provide
Children reluctance Social exposure to - reassurance,
with this to speak anxiety, Impaired feared behaviora create
disorder in certain extreme social situations, l therapy, supportive
demonstrate situations shyness, interaction Estimated praise effort, speech environmen
language despite past s, prevalenc avoid therapy, t, avoid
competence ability, traumatic academic e varies, pressure or medicatio pressure to
in some anxiety experience difficulties, but it's negative n in speak,
Descriptio situations around s, family low self- relatively reinforceme severe model calm
n but fail to speaking stressors esteem rare nt cases behavior
speak in
Symptom Prevalenc Tips for Treatmen Parental
Aspect Description s Causes Impact e Parents t Care
others due
to social
anxiety,
withdrawal,
sensitivity,
or
resistance.
Reactive Attachment Disorder of Childhood (F94.1)
Tips for Parental

Aspect Description Symptoms Causes Impact Prevalence Parents Treatment Care
Reactive
attachment
disorder (RAD)
involves
persistent
abnormalities in a
child's pattern of
social
relationships,
typically starting
in the first five
years of life. Provide
Symptoms consistent Establish
include emotional care, routines,
disturbance, establish Attachment- provide
fearfulness, Impaired routines, focused consistent
hypervigilance, Fearfulness, social Estimated seek therapy, care, seek
poor social hypervigilance, Severe development, prevalence professional trauma- professional
interaction, poor social parental emotional is around help for focused help for
aggression, and interaction, neglect, difficulties, 1% to 2% in trauma- therapy, trauma-
growth failure in aggression, abuse, or academic the general focused family focused
Description severe cases. growth failure mishandling challenges population therapy therapy therapy
Disinhibited Attachment Disorder of Childhood (F94.2)

Tips for Parental
Disinhibited
attachment
disorder
involves
abnormal
social
functioning
that emerges
during the first
five years of
life and
persists
despite
changes in
environmental
circumstances.
Symptoms
include
diffuse,
nonselectively
focused
attachment Provide Provide
behavior, consistent consistent
attention- Indiscriminate Prevalence care, Attachment- care,
seeking, friendliness, Impaired is higher in establish focused establish
indiscriminate attention- social children boundaries, therapy, boundaries,
friendliness, seeking, functioning, who seek trauma- seek
and poorly poorly difficulty experienced professional focused professional
modulated modulated forming institutional help for therapy, help for
peer peer Severe neglect or healthy care or attachment family attachment
Description interactions. interactions institutionalization relationships neglect issues therapy issues
Other Childhood Disorders of Social Functioning (F94.8)

Tips for Parental
This category
encompasses
various other
childhood
disorders
involving
abnormalities
in social
functioning
that do not fit
into the
above
categories.
Examples
include
social Seek
anxiety professional Provide
disorder, Prevalence evaluation support and
specific varies and Treatment guidance,
phobias, and Varies Varies Varies widely guidance varies seek
other depending depending depending depending for specific depending professional
anxiety- on the on the on the on the symptoms on the help for
related specific specific specific specific and specific specific
Description disorders. disorder disorder disorder disorder concerns disorder concerns
Childhood Disorder of Social Functioning, Unspecified (F94.9)
Tips for Parental

Used when a
childhood
disorder
involving
social
Seek
functioning
professional Provide
does not fit
Prevalence is evaluation support and
into any
difficult to and Treatment guidance,
specific
Varies Varies Varies estimate due guidance varies seek
category. It
depending depending depending to the for specific depending professional
may include
on the on the on the heterogeneity symptoms on the help for
presentations
specific specific specific of and specific specific
with atypical
Description presentation presentation presentation presentations concerns presentation concerns
symptoms or
Tips for Parental
unique
combinations
of symptoms
not covered
by other
diagnoses.
2. Tic Disorders
Category Information
Code 8A05
Disorders characterized by brief, sudden, repetitive movements (motor tics) or

utterances (phonic or vocal tics) that are temporarily suppressible and are usually
preceded by a strong urge to perform the tic. The most common cause of childhood-
Description onset tics is Tourette Syndrome.
Symptoms - Brief, sudden, repetitive movements or sounds (motor or vocal tics)
- Strong urge to perform the tic
Causes - Genetic factors
- Neurobiological factors
- Environmental factors
Impact - Interference with daily activities and social interactions
- Psychological distress
Prevalence Variable, depending on the specific disorder within the tic spectrum
Tips for Parents - Educate yourself about tic disorders and their management
- Provide support and understanding to your child
- Encourage open communication
Treatment - Behavioral therapies

- Medications in severe cases
Parental Care - Be patient and supportive
- Help your child manage stress and anxiety
- Advocate for your child's needs in educational and social settings
Primary Tics or Tic Disorders
Code 8A05.0
Primary tics or tic disorders are characterized by the presence of chronic motor and/or vocal
(phonic) tics. Motor and vocal tics are defined as sudden, rapid, non-rhythmic, and recurrent
movements or vocalizations, respectively. In order to be diagnosed, tics must have been
Description present for at least one year, although they may not manifest consistently.
Types - Tourette syndrome
- Chronic motor tic disorder
- Transient motor tics
- Other specific tic disorders
- Primary tic disorder unspecified
Symptoms - Chronic motor and/or vocal tics
Causes Similar to tic disorders in general
Impact Similar to tic disorders in general
Prevalence Similar to tic disorders in general
Tips for
Parents Similar to tic disorders in general
Treatment Similar to tic disorders in general
Parental
Care Similar to tic disorders in general
Primary types
Tourette Syndrome:
Gilles de la Tourette syndrome Foundation URI:

Code http://id.who.int/icd/entity/1399275592 Code: 8A05.00
Tourette syndrome is a chronic tic disorder characterized by the presence of both

chronic motor tics and vocal (phonic) tics, with onset during the developmental period.
Motor and vocal tics are defined as sudden, rapid, non-rhythmic, and recurrent
movements or vocalizations, respectively. In order to be diagnosed as Tourette
syndrome, both motor and vocal tics must have been present for at least one year,
although they may not manifest concurrently or consistently throughout the
Description symptomatic course.
Inclusions Combined vocal and multiple motor tic disorder
Tourette disorder, Gilles de la Tourette syndrome, Gilles de la Tourette swearing, tic de

Exclusions la Tourette, swearing in Gilles de la Tourette syndrome
- Presence of both motor tic(s) and phonic tic(s) that may or may not manifest
concurrently or continuously during the symptomatic course. - Motor and phonic tics
are defined as sudden, rapid, non-rhythmic, and recurrent movements or vocalizations,
respectively. - Motor and phonic tics have been present for at least 1 year with onset
Diagnostic during the developmental period. - Symptoms are not a manifestation of another
Requirements medical condition or due to substance effects.
- Often co-occurs with ADHD - Tics may be voluntarily suppressed for short periods -
Tics may be exacerbated by stress and diminish during sleep or focused activities - Tics
Additional Clinical are highly suggestible - Symptoms can vary in severity and may wax and wane over
Features time - Majority experience diminished symptoms by early adulthood
- Onset typically occurs during childhood, with peak symptom severity between ages 8
and 12 - Onset characterized by transient bouts of simple motor tics - Phonic tics usually
begin 1-2 years after motor symptoms - Symptoms may remit for weeks or months,
becoming more persistent over time - Most individuals experience diminished
symptoms by early adulthood - Prognosis varies with co-occurring conditions and tends
Course Features to be better for those with solitary Tourette syndrome diagnosis
- Prevalence estimated at approximately 0.5% among school-aged children - Tics most

severe between ages 8 and 12, diminishing throughout adolescence - Awareness of
premonitory urges typically develops around age 10 - Coprolalia (inappropriate
Developmental swearing) affects 10-15% and tends to emerge in mid-adolescence - Co-occurring
Presentations disorders vary by developmental stage
Culture-Related - Symptoms consistent across cultural groups - Movements or vocalizations may have
Features cultural meaning and should be considered in context
Sex- and/or - More common in males (gender ratio 2:1 to 4:1) - Symptom presentation does not
Gender-Related vary by gender - Women with persistent tic disorders may be more likely to experience
Features co-occurring anxiety and depressive disorders
- Distinguished from Autism Spectrum Disorder and Stereotyped Movement Disorder

by characteristics and onset - Differentiated from Obsessive-Compulsive Disorder by
Boundaries with nature of symptoms and premonitory urges - May overlap with self-injurious behaviors
Other Disorders but distinguished by intentionality
Chronic Motor Tic Disorder:

Chronic motor tic disorder Foundation URI: http://id.who.int/icd/entity/1649340159

Code Code: 8A05.01
Chronic motor tic disorder is characterized by the presence of motor tics over a period
of at least one year, although they may not manifest consistently. Motor tics are defined
Description as sudden, rapid, non-rhythmic, and recurrent movements.
Exclusions Tourette syndrome (8A05.00)
- Persistent presence of motor tic(s) - Motor tics are sudden, rapid, non-rhythmic, and
Diagnostic recurrent movements - Motor tics have been present for at least 1 year with onset
Requirements during the developmental period
- Motor tics may be voluntarily suppressed for short periods - Tics may be exacerbated
Additional Clinical by stress and diminish during sleep or focused activities - Tics are highly suggestible,
Features with old tics reappearing transiently when prompted
Boundary with Transient motor tics (e.g., eye blinking) are common during childhood and
Normality differentiated from Chronic Motor Tic Disorder by their transient nature
- Prevalence estimated between 0.3 – 0.8% of school-aged children - Culture-related

Developmental features: Movements with specific cultural meanings should not be considered
Presentations evidence of Chronic Motor Tic Disorder
Sex- and/or Gender- Women with persistent tic disorders may be more likely to experience co-occurring
Related Features Anxiety or Fear-Related Disorders and Depressive Disorders
- Distinguished from Autism Spectrum Disorder and Stereotyped Movement Disorder

by characteristics and onset - Differentiated from Obsessive-Compulsive Disorder by
Boundaries with nature of symptoms and premonitory urges - May overlap with self-injurious behaviors
Other Disorders but distinguished by intentionality
Chronic Phonic Tic Disorder:

Chronic phonic tic disorder Foundation URI:

Code http://id.who.int/icd/entity/169010223 Code: 8A05.02
Chronic phonic tic disorder is characterized by the presence of phonic (vocal) tics
over a period of at least one year, although they may not manifest consistently.
Description Phonic tics are defined as sudden, rapid, non-rhythmic, and recurrent vocalizations.
Exclusions Tourette syndrome (8A05.00)
- Persistent presence of phonic tic(s) - Phonic tics are sudden, rapid, non-rhythmic,
and recurrent vocalizations - Phonic tics have been present for at least 1 year with
Diagnostic Requirements onset during the developmental period
- Phonic tics may be voluntarily suppressed for short periods - Tics may be
exacerbated by stress and diminish during sleep or during periods of focused
Additional Clinical activities - Tics are highly suggestible, with old tics reappearing transiently when
Features prompted
Transient phonic tics (e.g., throat clearing) are common during childhood and
differentiated from Chronic Motor Tic Disorder and Chronic Phonic Tic Disorder
Boundary with Normality by their transient nature
If vocalizations have a specific function or meaning in the context of an individual’s

culture and are used in ways that are consistent with that cultural function or
Culture-Related Features meaning, they should not be considered evidence of Chronic Phonic Tic Disorder
Sex- and/or Gender-Related Women with persistent tic disorders may be more likely to experience co-occurring
Features Anxiety or Fear-Related Disorders and Depressive Disorders
- Differentiated from Obsessive-Compulsive Disorder by nature of symptoms and

premonitory urges - May overlap with Obsessive-Compulsive Disorder, but tics are
not aimed at neutralizing antecedent cognitions or reducing physiological arousal -
Many individuals exhibit symptoms of both Obsessive-Compulsive Disorder and
Boundaries with Other Chronic Phonic Tic Disorder, and both diagnoses may be assigned if the diagnostic
Disorders requirements for each are met.
Transient Motor Tics:

Transient motor tics Foundation URI: http://id.who.int/icd/entity/1087192220

Code Code: 8A05.03
Transient motor tics are sudden, non-rhythmic stereotyped movements such as

blinking, sniffing, tapping, etc. These tics should have been present for less than 1
Description year.
Excluded from Tourette syndrome (8A05.00), Chronic motor tic disorder

Exclusions (8A05.01), and Chronic phonic tic disorder (8A05.02)
- Presence of sudden, non-rhythmic stereotyped movements (motor tics) such as

Diagnostic Requirements blinking, sniffing, tapping, etc. - Tics should have been present for less than 1 year
- These tics are typically transient and may resolve on their own without treatment
- Common during childhood and may occur during periods of stress or excitement
Additional Clinical - Often seen as a normal part of development and tend to decrease or disappear over
Features time
Transient motor tics are common during childhood and are considered a normal
developmental occurrence. They are differentiated from chronic motor tic disorders
Boundary with Normality by their duration of less than 1 year.
- If these stereotyped movements have a specific function or meaning in the context

of an individual’s culture and are used in ways that are consistent with that cultural
function or meaning, they should not be considered evidence of a transient motor
tic disorder - Cultural norms may influence the perception and acceptance of these
Culture-Related Features movements within different societies
Sex- and/or Gender-Related There are no specific sex- or gender-related features associated with transient motor
Features tics.
Transient motor tics are differentiated from chronic tic disorders (Tourette
syndrome, chronic motor tic disorder, chronic phonic tic disorder) by their duration
of less than 1 year. They are also distinguished from stereotyped movement disorder
by their transient nature and the absence of other diagnostic criteria for stereotyped
movement disorder. Transient motor tics may be seen alongside other conditions
Boundaries with Other such as ADHD or anxiety disorders, but they are not considered a symptom of these
Disorders disorders and should be evaluated separately.
Other Specified Primary Tics or Tic Disorders:

Code Other specified primary tics or tic disorders Code: 8A05.0Y
This category includes primary tic disorders that do not fit into the specific
subtypes defined elsewhere. These disorders are characterized by the presence of
chronic motor and/or vocal (phonic) tics. Motor and vocal tics are sudden, rapid,
non-rhythmic, and recurrent movements or vocalizations, respectively. The
duration of tics may vary, but they must have been present for at least one year.
Description Symptoms may not manifest consistently.

(8A05.01), Chronic phonic tic disorder (8A05.02), and Transient motor tics
Exclusions (8A05.03)
- Presence of chronic motor and/or vocal (phonic) tics - Tics must have been
Diagnostic Requirements present for at least one year, although they may not manifest consistently
- Tics may vary in frequency, intensity, and duration - Symptoms may be

suppressed temporarily or exacerbated by stress - Tics may diminish during
Additional Clinical Features periods of focused attention or enjoyable activities
These tic disorders are differentiated from transient motor tics by their duration of
at least one year. They are considered abnormal when they significantly interfere
Boundary with Normality with daily functioning or cause distress to the individual.
Cultural norms may influence the perception and acceptance of tics within
different societies. Tics that are culturally normative and serve a specific function
Culture-Related Features or meaning may not be considered evidence of a tic disorder.
Sex- and/or Gender-Related There are no specific sex- or gender-related features associated with other specified
Features primary tic disorders.
Other specified primary tic disorders may overlap with conditions such as Tourette
syndrome, chronic motor tic disorder, or chronic phonic tic disorder but do not
meet the specific diagnostic criteria for these disorders. They may also co-occur
Boundaries with Other with other neurodevelopmental or psychiatric conditions, such as ADHD or
Disorders anxiety disorders, requiring careful evaluation and differential diagnosis.
Primary Tics or Tic Disorders, Unspecified:

Code Primary tics or tic disorders, unspecified Code: 8A05.0Z
This category encompasses primary tic disorders that do not fit into the
specific subtypes defined elsewhere. It includes cases where the nature of the
tic disorder is not clearly defined or specified. Primary tic disorders are
characterized by the presence of chronic motor and/or vocal (phonic) tics.
Motor and vocal tics are sudden, rapid, non-rhythmic, and recurrent
movements or vocalizations, respectively. Tics may vary in duration and
Description frequency.

(8A05.01), Chronic phonic tic disorder (8A05.02), Transient motor tics
Exclusions (8A05.03), and Other specified primary tics or tic disorders (8A05.0Y)
- Presence of chronic motor and/or vocal (phonic) tics - Tics may have been
Diagnostic Requirements present for varying durations and may not manifest consistently
- Tics may fluctuate in intensity and frequency over time - Symptoms may be
voluntarily suppressed or exacerbated by stress - Tics may diminish during
Additional Clinical Features periods of focused attention or enjoyable activities
These tic disorders are differentiated from transient motor tics by their
chronicity and from specific primary tic disorders by their unspecified nature.
The diagnosis is made when the tic disorder does not fit the criteria for other
primary tic disorders but still significantly affects the individual's functioning
Boundary with Normality or causes distress.
Cultural norms may influence the perception and acceptance of tics within
different societies. Tics that are culturally normative and serve a specific
Culture-Related Features function or meaning may not be considered evidence of a tic disorder.
Sex- and/or Gender-Related There are no specific sex- or gender-related features associated with
Features unspecified primary tic disorders.
Unspecified primary tic disorders may overlap with conditions such as

Tourette syndrome, chronic motor tic disorder, or chronic phonic tic disorder
but do not meet the specific diagnostic criteria for these disorders. They may
also co-occur with other neurodevelopmental or psychiatric conditions, such
as ADHD or anxiety disorders, requiring careful evaluation and differential
Boundaries with Other Disorders diagnosis.
Secondary Tics:
Code 8A05.1
Secondary tics are tic disorders that arise as a direct physiological

consequence of an antecedent infection, drug use, or illness. These tics
can manifest as a result of various conditions and are not considered
primary tic disorders. Secondary tics are distinct from primary tic
disorders such as Tourette syndrome, chronic motor tic disorder, and
Description chronic phonic tic disorder.
- Infectious or postinfectious tics (Code: 8A05.10): Tics resulting from

an antecedent infection. - Tics associated with developmental disorders
(Code: 8A05.11): Tics occurring as a direct consequence of a
developmental disorder. - Other specified secondary tics (Code:
8A05.1Y): Secondary tics due to specific conditions. - Secondary tics,
Subtypes unspecified (Code: 8A05.1Z): Secondary tics with unspecified etiology.
The presence of tics is observed following an antecedent infection, drug

use, or illness. Tics may manifest as motor or vocal (phonic) tics and
should be differentiated from primary tic disorders. Diagnosis involves
assessing the temporal relationship between the onset of tics and the
Diagnostic Requirements antecedent condition, as well as ruling out other causes of tics.
Secondary tics can be associated with various conditions such as

infections (e.g., streptococcal infections), neoplasms (e.g., brain
tumors), autoimmune diseases (e.g., systemic lupus erythematosus),
neurological disorders (e.g., multiple sclerosis), and others. The
specific condition causing the tics should be identified and addressed
Associated Conditions accordingly.
Secondary tics are distinct from primary tic disorders, such as Tourette
syndrome, chronic motor tic disorder, and chronic phonic tic disorder.
Exclusions may also apply based on the underlying cause of secondary
tics, such as excluding infectious tics if the primary diagnosis is a
Exclusions developmental disorder.
Additional codes may be used to specify the underlying cause of

secondary tics, such as infectious agents (e.g., streptococcal infection),
neoplasms (e.g., glioma), developmental disorders (e.g., autism
spectrum disorder), or other related conditions. Postcoordination helps
provide a more detailed description of the specific etiology of
Postcoordination secondary tics.
The prevalence of secondary tics varies depending on the underlying

cause. For example, post-streptococcal tics may occur in approximately
10-15% of children with streptococcal infections, while tics associated
with neurodevelopmental disorders may have different prevalence rates
Prevalence based on the specific disorder.
Symptoms of secondary tics may include sudden, rapid, non-rhythmic

motor movements (motor tics) or vocalizations (phonic tics). These tics
may be transient or persistent, and their severity can vary based on the
underlying condition. Associated symptoms may include premonitory
Symptoms urges, stress exacerbation, and temporary tic suppression.
Secondary tics can have a significant impact on various aspects of an

individual's life, including social interactions, academic performance,
and emotional well-being. The presence of tics may lead to
embarrassment, social stigma, and difficulties in daily functioning.
Understanding and addressing the underlying cause of secondary tics is
Impact crucial for effective management and improving quality of life.
Treatment of secondary tics focuses on addressing the underlying cause

and managing tic symptoms. Treatment strategies may include
addressing the antecedent infection or illness, pharmacological
interventions (e.g., antipsychotics, alpha-2 adrenergic agonists),
behavioral therapy (e.g., habit reversal training), and supportive
Treatment interventions to improve coping and quality of life.
- Educate yourself about the underlying condition causing the tics and
its potential impact on your child's health. - Work closely with
healthcare professionals to develop a comprehensive treatment plan
tailored to your child's needs. - Provide emotional support and
reassurance to your child, emphasizing that tics are not their fault and
Tips for Parents that they can learn to manage them effectively.
1. Infectious or Postinfectious Tics (Code: 8A05.10)
Tic disorder resulting as a direct physiological consequence of an antecedent

Description infection.
- Presence of tics following an antecedent infection. - Differentiation from

Diagnostic Features primary tic disorders such as Tourette syndrome.
Various infectious agents can trigger these tics, including bacteria (e.g.,
Associated Conditions streptococcal infections), viruses (e.g., influenza), and other pathogens.
Exclusions Excludes primary tic disorders such as Tourette syndrome (8A05.00).
Estimated prevalence varies depending on the underlying infection and

population demographics. For example, post-streptococcal tics may occur in
Prevalence approximately 10-15% of children with streptococcal infections.
Symptoms include sudden, rapid, non-rhythmic motor movements (motor tics)

Symptoms or vocalizations (phonic tics) following an infectious episode.
These tics can have a significant impact on an individual's life, including social
Impact interactions, academic performance, and emotional well-being.
Treatment focuses on addressing the underlying infection and managing tic

symptoms. Pharmacological interventions, behavioral therapy, and supportive
Treatment interventions may be employed.
- Seek prompt medical attention if your child develops tics following an

Tips for Parents
infection. - Work closely with healthcare professionals to address both the
infection and tic symptoms. - Provide emotional support and reassurance to

your child during this challenging time.
2. Tics Associated with Developmental Disorders (Code: 8A05.11)
Description Tic disorder occurring as a direct consequence of a developmental disorder.
- Presence of tics associated with a developmental disorder. - Differentiation

Diagnostic Features from primary tic disorders such as Tourette syndrome.
Tics can be associated with various developmental disorders, including autism

spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and
Associated Conditions others.
Exclusions Excludes primary tic disorders such as Tourette syndrome (8A05.00).
Prevalence rates may vary based on the specific developmental disorder and
population demographics. For example, tics may occur in a significant
Prevalence proportion of individuals with ASD or ADHD.

Symptoms or vocalizations (phonic tics) associated with the developmental disorder.
These tics can impact various aspects of an individual's life, including social
Impact interactions, communication, and behavioral regulation.
Treatment involves addressing both the developmental disorder and tic

symptoms. Comprehensive intervention may include behavioral therapy,
Treatment pharmacological interventions, and support services.
- Work closely with healthcare professionals to develop a personalized

treatment plan for your child. - Educate yourself about the developmental
disorder and its potential impact on tic symptoms. - Provide consistent support
Tips for Parents and understanding to your child.
3. Other Specified Secondary Tics (Code: 8A05.1Y)
Secondary tics resulting from specific conditions other than infection or

Description developmental disorders.
- Presence of tics associated with a specific underlying condition. -

Diagnostic Features Differentiation from primary tic disorders such as Tourette syndrome.
Secondary tics may be associated with various conditions such as neoplasms,

Associated Conditions autoimmune diseases, neurological disorders, and others.
Excludes primary tic disorders such as Tourette syndrome (8A05.00) and

Exclusions infectious or postinfectious tics (8A05.10).
Prevalence rates may vary depending on the underlying condition and population
Prevalence demographics.

Symptoms or vocalizations (phonic tics) associated with the specific underlying condition.
The impact of these tics can vary based on the underlying condition and its
Impact severity.
Treatment focuses on addressing the underlying condition and managing tic

symptoms. Treatment approaches may include disease-specific interventions,
Treatment pharmacotherapy, behavioral therapy, and supportive care.
- Collaborate with healthcare professionals to identify and address the underlying

cause of your child's tics. - Advocate for comprehensive care that addresses both
Tips for Parents the underlying condition and tic symptoms.
3. Other behavioural and emotional disorders with onset usually occuring in

childhood and adolescence
Nonorganic Enuresis (F98.0)
Code Subtype Description Exclusions
Characterized by involuntary voiding of urine, by day and by

Nonorganic night, abnormal in relation to the individual's mental age, not due Enuresis NOS
F98.0 enuresis to neurological disorder or structural abnormality. (R32)
Description: Nonorganic enuresis refers to the involuntary voiding of urine, occurring during both
daytime and nighttime, which is abnormal considering the individual's mental age. This condition is not
attributed to any neurological disorder or structural abnormality. It may be associated with emotional
or behavioral disorders.
Nonorganic Encopresis (F98.1)
Involves repeated, voluntary or involuntary passage of faeces in

Nonorganic places not appropriate, not due to neurological disorder or Encopresis
F98.1 encopresis structural abnormality. NOS (R15)
Description: Nonorganic encopresis is characterized by the repeated passage of feces in inappropriate
places, which may be voluntary or involuntary. This behavior is not attributed to any neurological
disorder or structural abnormality. It may occur as part of a wider emotional or behavioral disorder.
Feeding Disorder of Infancy and Childhood (F98.2)
A feeding disorder usually specific to infancy

and early childhood, involving food refusal and Anorexia nervosa and other
Feeding extreme faddiness. It generally occurs in the eating disorders (F50.-), feeding
disorder of presence of an adequate food supply, competent difficulties and mismanagement
infancy and caregiver, and absence of organic disease. May (R63.3), problems of newborn
F98.2 childhood or may not involve rumination. (P92.-)
Description: Feeding disorder of infancy and childhood manifests as food refusal and extreme
selectiveness in eating habits during infancy and early childhood. Despite an adequate food supply and
competent caregiver, the child displays resistance to eating, often leading to nutritional deficiencies.
This disorder may or may not involve rumination, the repeated regurgitation of food.
Pica of Infancy and Childhood (F98.3)
Involves persistent eating of non-nutritive substances (such as Mental

Pica of infancy soil, paint chippings, etc.). Often associated with mental retardation (if
F98.3 and childhood retardation or may be an isolated psychopathological behavior. present)
Description: Pica of infancy and childhood refers to the persistent consumption of non-nutritive
substances, such as soil, paint chips, or paper. This behavior may occur as part of a more widespread
psychiatric disorder, particularly in mentally retarded children. When occurring in isolation, it is
classified under F98.3.
Stereotyped Movement Disorders (F98.4)
Involves voluntary, repetitive, stereotyped,

nonfunctional movements not part of any Movement disorders of
Stereotyped recognized psychiatric or neurological condition. organic origin (G20-G25),
movement Most common in association with mental abnormal involuntary
F98.4 disorders retardation. movements (R25.-)
Description: Stereotyped movement disorders encompass voluntary, repetitive, nonfunctional

movements that are not associated with any recognized psychiatric or neurological condition. These
movements may include body-rocking, head-banging, or hand-flapping and are often observed in
individuals with mental retardation.
Stuttering (F98.5)
Characterized by speech with frequent repetitions,

prolongations, hesitations, or pauses that disrupt the flow of Cluttering (F98.6), Tic
F98.5 Stuttering speech. disorders (F95.-)
Description: Stuttering, also known as stammering, is a speech disorder characterized by frequent

repetitions, prolongations, hesitations, or pauses during speech. The severity of stuttering can
significantly disrupt the fluency of speech, impacting communication.
Cluttering (F98.6)
Involves rapid speech with breakdown in fluency, resulting in

diminished speech intelligibility, but no repetitions or Stuttering (F98.5), Tic
F98.6 Cluttering hesitations. disorders (F95.-)
Description: Cluttering is characterized by rapid speech with a breakdown in fluency, resulting in

diminished speech intelligibility. Unlike stuttering, cluttering does not involve repetitions or hesitations
but may still cause difficulty in understanding speech.
Other Specified Behavioral and Emotional Disorders (F98.8)
Includes various disorders such as attention deficit disorder without

Other specified hyperactivity, excessive masturbation, nail-biting, nose-picking, Tic disorders
F98.8 disorders and thumb-sucking. (F95.-)
Description: Other specified behavioral and emotional disorders include a range of disorders not
covered elsewhere, such as attention deficit disorder without hyperactivity, excessive masturbation,
nail-biting, nose-picking, and thumb-sucking.
Unspecified Behavioral and Emotional Disorders (F98.9)
Unspecified Refers to behavioral and emotional disorders with onset usually

F98.9 disorders occurring in childhood and adolescence, not otherwise specified.
Description: Unspecified behavioral and emotional disorders encompass a range of conditions with
onset typically occurring during childhood and adolescence. This category is used when the specific
disorder cannot be accurately determined or does not fit into any other classification.

Introduction To Developmental Psychopathology: 1. Assessment

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Introduction to Developmental Psychopathology

Conduct a comprehensive interview with the child/adolescent and caregivers to

Administer standardized tests to assess cognitive, emotional, and behavioral

Collect information from parents, teachers, and caregivers through structured

Conduct a thorough medical evaluation to rule out underlying medical conditions or

Review developmental milestones and history to identify delays or deviations from

Collaborate with other professionals, such as pediatricians, psychiatrists, and

Assessing developmental psychopathology involves a comprehensive approach that considers

Psychotherapy Strategy Description

Uses play as a means of communication and expression, facilitating emotional

Involves the entire family in therapy sessions to improve communication, resolve

Medication Strategies Table:

Psychotropic Prescribed by psychiatrists or pediatricians to alleviate symptoms of specific mental health

Regular monitoring by healthcare providers to assess medication effectiveness, monitor side

Behavioral Interventions Table:

Teaches interpersonal and communication skills, problem-solving strategies, and

Educational Support Strategies Table:

Educational Support Description

Collaborative Strategies Table:

Coordination among healthcare providers, educators, therapists, and other professionals

Long-Term Support and Monitoring Strategies Table:

Long-Term Support and

Regular check-ins with healthcare providers to monitor progress, address new

Assistance in transitioning to adulthood, including vocational support, independent

4. Research on child Psychopathology

Research Area Description

Research exploring biological, psychological, social, and environmental factors

Investigations into the genetic and neurobiological underpinnings of childhood mental

Studies focusing on understanding early developmental trajectories of children at risk for

Evaluations of the efficacy and effectiveness of psychosocial interventions, psychotherapy

Prevention and Early

programs targeting at-risk populations to prevent or mitigate the onset or progression of

Studies exploring cultural variations in the expression, experience, and perception of

Assessments of the impact of mental health disorders on various domains of children's

Implementation Studies focusing on the implementation of evidence-based practices in real-world settings,

Epidemiology and Prevalence:

5. ICD classification of child psychopathology

Autism spectrum disorders are characterized by

Intellectual developmental disorders involve

Attention-Deficit ADHD is characterized by persistent patterns of

Specific learning disorders involve difficulties in

Communication disorders encompass deficits in

Emotional Disorders (6A10-6A1Z)

Depressive disorders involve persistent feelings

Anxiety disorders are characterized by excessive

repetitive behaviors or mental acts (compulsions)

PTSD occurs in response to exposure to traumatic

Behavioral Syndromes Associated

Oppositional defiant disorder involves a pattern

Conduct disorder is characterized by a repetitive

Disorders Specifically Associated

Adjustment disorder involves the development of

Reactive attachment disorder is characterized by

Psychotic Disorders (6A40-6A4Z)

Schizophrenia is a severe mental disorder

Schizoaffective Disorder Schizoaffective disorder involves a combination

hallucinations or delusions) that meet criteria for

Disruptive, Impulse-Control, and

Oppositional defiant disorder involves a pattern

Conduct disorder is characterized by a repetitive

Anxiety Disorders (6A60-6A6Z)

Separation anxiety disorder involves excessive