DSM-5. Presented by CCESC School Psychologist Interns: Kayla Dodson, M.Ed. Ellen Doll, M.S. Rich Marsicano, Ph.D. Elaine Wahl, Ph.D.

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1 DSM-5 Presented by CCESC School Psychologist Interns: Kayla Dodson, M.Ed. Ellen Doll, M.S. Rich Marsicano, Ph.D. Elaine Wahl, Ph.D.

2 Introduction Lifespan approach to diagnosis Diagnoses occurring in children a presented earlier in the DSM-V The mediating effect of culture on symptom variability is more explicitly discussed Nonaxial documentation of diagnoses NOS Not Elsewhere Classified Living document

3 Intellectual Disability Previously mental retardation Continue to be 3 criteria that must be met Deficits in intellectual functioning Deficits in adaptive functioning Onset during developmental period

4 Intellectual Disability Deficits in Intellectual Functioning DSM-IV - defined as significantly subaverage intellectual functioning as an IQ of about 70 or below DSM-5 - needs to be supported by both an individual standardized IQ test and clinical assessment DSM-5 also broadens the definition of intelligence, a specific IQ score criteria is not offered

5 Intellectual Disability Deficits in Adaptive Functioning DSM-5 defines adaptive functioning in 3 domains (conceptual, social, and practical) as compared to the 11 areas (2 areas requiring deficits) in DSM-IV

6 Intellectual Disability Still have levels of severity (mild, moderate, severe, profound) DSM-IV - based on IQ score DSM-5 - based on adaptive behavior and provides detailed descriptions of what each level looks like and how they affect functioning in various settings (i. e., how preschool, school-age, adolescents are affected)

7 Intellectual Disability Rationale for Changes Encourage more comprehensive assessments Encourages clinician to consider what supports are needed to normalize an individual s life to the extent it is possible

8 Intellectual Disability Implications for Us Important to keep in mind that while criteria are similar, IDEA has additional criterion of requiring documentation of an adverse effect on academic functioning Emphasis on adaptive functioning may mean school psychologists and other education professionals will have greater role in clinical diagnosis

9 Communication Disorders Language Disorder Combines Expressive and Mixed Receptive-Expressive Language Disorders from DSM-IV Difficulty in acquisition and use of language across modalities (spoken, written, sign language, etc.) Speech Sound Disorder Phonological Disorder in DSM-IV Difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication

10 Communication Disorders Childhood-onset fluency disorder Formerly Stuttering in DSM-IV Disturbances in normal fluency and time patterning of speech...causes anxiety about speaking Social (pragmatic) communication disorder New in DSM-5 Many who met DSM-IV criteria for PDD-NOS may now meet criteria for Social (Pragmatic) Communication Disorder in DSM-5

11 Communication Disorders DSM-5 Criteria: Social (Pragmatic) Disorder Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following: Deficits in using communication for social purposes Impairment of the ability to change communication to match context or the needs of the listener Difficulty following rules for conversation or storytelling Difficulty understanding what is not explicitly stated and nonliteral or ambiguous meanings of language

12 Communication Disorders DSM-5 Criteria: Social (Pragmatic) Disorder Results in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance Onset in early developmental period Symptoms not attributable to another condition, and are not better explained by ASD, ID, or Global Developmental Delay

13 Communication Disorders: Rationale for Changes Overarching, theoretical umbrella Social (Pragmatic) Communication Disorder More accurate diagnosis Many were just lumped under PDD-NOS Now, unique needs can be met

14 Communication Disorders: Implications for Us Interpretation of outside reports ASD vs. Social (Pragmatic) Communication Disorder ASD must be ruled out before Social (Pragmatic) Communication Disorder can be diagnosed Collaboration with SLPs

15 Specific Learning Disorder Previously: Now: Reading Disorder Mathematics Disorder Disorder of Written Learning Disorder NOS Learning Disorder - person has shortcomings in general academic skills w/ specificers (e.g., reading) Dyslexia and dyscalculia definitions were too variable

16 Specific Learning Disorder Diagnosis of SLD should consist of a clinical review of the person s history Medical history Test scores Teacher observations Response to academic interventions

17 Specific Learning Disorder Rationale: Learning disabilities typically co-occur with one another across content areas. Making the definition more general will reduced the number of children that go undiagnosed. A deficit in reading, for example, is a symptom of a larger disturbance.

18 Specific Learning Disorder What it means for us More referrals (maybe)! Need for increased collaboration with medical professionals

19 Motor Disorders General changes Removed - there was never a no-tic period of more than three months Added - the tics may wax and wane in frequency but have persisted for more than a year [except for Provisional Tic Disorder] Tic criteria have been standardized across all tic disorders

20 Motor Disorders Provisional Tic Disorder Formally - Transient Tic Disorder Stereotypic Movement Disorder Specifiers Self-injurious Severity Association with another condition Differentiated from Body-Focused Repetitive Behavior Disorders Associated with OCD

21 Motor Disorders What it means for us Context-dependent tic disorders? Stereotypic and anxiety-related behaviors Intervention

22 Autism Spectrum Disorder Autism spectrum disorder is a new DSM-5 name. It was determined that four previously separate disorders are actually a single condition with different levels of symptom severity in two core domains.

23 ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified

24 ASD is characterized by 1) deficits in social communication and social interaction 2) restricted repetitive behaviors, interests, and activities (RRBs) Because both components are required for diagnosis of ASD, social communication disorder is diagnosed if no RRBs are present.

25 People with ASD tend to have communication deficits: responding inappropriately in conversations misreading nonverbal interactions having difficulty building friendships appropriate to their age. In addition, people with ASD may be: overly dependent on routines highly sensitive to changes in their environment intensely focused on inappropriate items

26 Under the DSM-5 criteria, individuals with ASD must show symptoms from early childhood. This criteria change encourages earlier diagnosis of ASD but also allows people whose symptoms may not be fully recognized until social demands exceed their capacity to receive the diagnosis. It is an important change from DSM-IV criteria, which was geared toward identifying schoolaged children with autism-related disorders, but not as useful in diagnosing younger children.

27 Attention-Deficit/Hyperactivity Disorder The diagnostic criteria for attentiondeficit/hyperactivity disorder (ADHD) in DSM-5 are similar to those in DSM-IV. The same 18 symptoms are used as in DSM-IV, and continue to be divided into two symptom domains (inattention and hyperactivity/impulsivity), of which at least six symptoms in one domain are required for diagnosis.

28 ADHD is characterized by a pattern of behavior, present in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings. As in DSM-IV, symptoms will be divided into two categories of inattention and hyperactivity and impulsivity that include behaviors like failure to pay close attention to details, difficulty organizing tasks and activities, excessive talking, fidgeting, or an inability to remain seated in appropriate situations.

29 1) Examples have been added to the criterion items to facilitate application across the lifespan. 2) The cross-situational requirement has been strengthened to several symptoms in each setting. 3) The onset criterion has been changed from symptoms that caused impairment were present before age 7 years to several inattentive or hyperactive-impulsive symptoms were present prior to age 12. 4) Subtypes have been replaced with presentation specifiers that map directly to the prior subtypes. 5) A comorbid diagnosis with autism spectrum disorder is now allowed. 6) A symptom threshold change has been made for adults, to reflect their substantial evidence of clinically significant ADHD impairment, with the cutoff for ADHD of five symptoms, instead of six required for younger persons, both for inattention and for hyperactivity and impulsivity. 7) ADHD was placed in the neurodevelopmental disorders chapter to reflect brain developmental correlates with ADHD and the DSM-5 decision to eliminate the DSM-IV chapter that includes all diagnoses usually first made in infancy, childhood, or adolescence.

30 Conclusion NASP says While DSM should not direct our actions, it absolutely should direct our attention Questions?

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