Unit 2 Clinical Features and Diagnostic Criteria For Mental Retardation and Disorders of

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.
• Diagnostic Criteria:
• 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.
Specifier Description
- 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 2 Clinical Features and Diagnostic Criteria For Mental Retardation and Disorders of

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Unit 2 Clinical Features and Diagnostic Criteria For Mental Retardation and Disorders of

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Unit -2: Clinical features and diagnostic criteria for Mental retardation and

disorders of Psychological development

Mental retardation- Manuals

3. Chinese Classification of Mental Disorders and Psycho Dynamic

The DSM is a widely-used classification system developed by the American Psychiatric

- DSM-I (1952): Introduced standardized diagnostic criteria influenced by psychoanalytic

- Neurodevelopmental Disorders: Autism spectrum disorder, attention-deficit/hyperactivity

Aspect International Classification of Diseases (ICD)

The International Classification of Diseases (ICD) is a globally recognized classification

- Neurodevelopmental Disorders: Autism spectrum disorder, attention-deficit/hyperactivity

Psycho Dynamic Diagnostic Manual

The Psycho Dynamic Diagnostic Manual

- The CCMD was first published in 1985 and has

The PDM-2 does not use a formal axis

- Mood Disorders - Anxiety Disorders -

Developed by the American Psychiatric Developed by the World Health

Covers a broader range of diseases

Predominantly used in North America, Globally recognized and used in

Currently on ICD-11, with

Offers a more concise

Organizes disorders into distinct categories Classifies disorders into chapters

Formerly used a multiaxial system for

Focuses solely on mental disorders, providing Covers a wide range of diseases

Developed by the World Health

Provides standardized diagnostic

Follows a hierarchical, multiaxial,

Subject to regular revisions and

Adopted by countries worldwide as

Designed for healthcare

Developed and maintained by the

Classification: Intellectual disability is classified based on the severity of limitations in

Intellectual disability, previously termed mental retardation, is a neurodevelopmental

- Derogatory Language: Individuals with intellectual disabilities are often subjected to

6. Specific developmental disorders of speech and language

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

Disorder Category Description Diagnostic Criteria Examples

Essential Features Additional Clinical Features

- Persistent errors of pronunciation, - Delays in the acquisition, production, and perception of

- Errors manifest as developmentally typical - Phonological errors may be consistent or inconsistent,

- Familiar listeners may accommodate and decode speech

- Imprecision and inconsistency of oral movements (childhood

- Common co-occurrence with other neurodevelopmental

Sex- and/or Gender-

- Many children experience - More common in boys,

- Early speech difficulties in

- Co-occurring developmental - Gender differences decline

- Boys more likely to have

- Many pre-school children exhibit typical

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

Boundary with Developmental Speech

- Can co-occur with

- Speech sound errors in Developmental Speech

Boundary with Secondary

- Speech difficulties secondary to

- Diagnosis of Secondary Speech

- Unlike dysphonia, - Dysarthria may cause difficulties in - Distinct from Developmental

Disorder primarily affects typical in Developmental Speech Sound characterized by errors in

Boundary with Normality (Threshold):

Children with Developmental Speech Sound Disorder have persistent and

6A01.1 Developmental speech fluency disorder

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

Exclusions Tic disorders are excluded from this diagnosis.