The new Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has a number of changes to what used to be disorders first diagnosed in childhood or infancy. This article outlines some of the major changes to these conditions.
According to the American Psychiatric Association (APA), the publisher of the DSM-5, this chapter from the DSM-IV has been superseded by a new chapter entitled, “Neurodevelopmental Disorders.” The new chapter includes intellectual disability (Intellectual Developmental Disorder), communication disorders, autism spectrum disorder, attention deficit hyperactivity disorder, specific learning disorder, and motor disorders.
Intellectual Disability (Intellectual Developmental Disorder)
Bye bye “mental retardation,” a now politically-incorrect term out of vogue for over a decade. Hello “intellectual disability.”
According to the APA, “diagnostic criteria for intellectual disability (intellectual developmental disorder) emphasize the need for an assessment of both cognitive capacity (IQ) and adaptive functioning. Severity is determined by adaptive functioning rather than IQ score.”
Why was the terminology of mental retardation changed? “Intellectual disability is the term that has come into common use over the past two decades among medical, educational, and other professionals, and by the lay public and advocacy groups. Moreover, a federal statue in the United States (Public Law 111-256, Rosas Law) replaces the term mental retardation with intellectual disability. Despite the name change, the deficits in cognitive capacity beginning in the developmental period, with the accompanying diagnostic criteria, are considered to constitute a mental disorder.
“The term intellectual developmental disorder was placed in parentheses to reflect the World Health Organizations classification system, which lists disorders in the International Classification of Diseases (ICD; ICD-11 to be released in 2015) and bases all disabilities on the International Classification of Functioning, Disability, and Health (ICF). Because the ICD-11 will not be adopted for several years, intellectual disability was chosen as the current preferred term with the bridge term for the future in parentheses.”
In another example of the DSM-5 combining multiple disorders into one theoretical, categorical umbrella, communication disorders combines DSM-IV expressive and mixed receptive-expressive language disorders, stuttering and phonological disorders into one over-arching category:
The DSM-5 communication disorders include language disorder (which combines DSM-IV expressive and mixed receptive-expressive language disorders), speech sound disorder (a new name for phonological disorder), and childhood-onset fluency disorder (a new name for stuttering).
Also included is social (pragmatic) communication disorder, a new condition for persistent difficulties in the social uses of verbal and nonverbal communication. Because social communication deficits are one component of autism spectrum disorder (ASD), it is important to note that social (pragmatic) communication disorder cannot be diagnosed in the presence of restricted repetitive behaviors, interests, and activities (the other component of ASD).
The symptoms of some patients diagnosed with DSM-IV pervasive developmental disorder not otherwise specified may meet the DSM-5 criteria for social communication disorder.
Autism Spectrum Disorder
While this change has gotten a lot of media attention, the end result is likely not to be significant to people who are diagnosed with an autism spectrum disorder. Long recognizes as a spectrum disorder by both researchers and clinicians, the changes in the DSM-5 rectify the disconnect between research and the prior, nonsensical naming scheme.
The APA believes the new name reflects the scientific consensus that four previously separate disorders are actually a single condition with different levels of symptom severity in two core domains. ASD now encompasses the previous DSM-IV autistic disorder (autism), Aspergers disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified.
ASD is characterized by:
- Deficits in social communication and social interaction, and
- 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, according to the APA.
Attention-Deficit Hyperactivity Disorder
Please see our separate article on ADHD here.
Specific Learning Disorder
Say goodbye to the list of specific learning problems from the DSM-IV — reading, math and writing, as well as learning disorder NOS. All gone. Replaced with a simple, nice category called “Specific Learning Disorder.”
Why? According to the APA, it’s because “learning deficits in the areas of reading, written expression, and mathematics commonly occur together, coded specifiers for the deficit types in each area are included. The text acknowledges that specific types of reading deficits are described internationally in various ways as dyslexia and specific types of mathematics deficits as dyscalculia.
According to the APA:
The following motor disorders are included in the DSM-5 neurodevelopmental disorders chapter: developmental coordination disorder, stereotypic movement disorder, Tourettes disorder, persistent (chronic) motor or vocal tic disorder, provisional tic disorder, other specified tic disorder, and unspecified tic disorder. The tic criteria have been standardized across all of these disorders in this chapter.
Stereotypic movement disorder has been more clearly differentiated from body-focused repetitive behavior disorders that are in the DSM-5 obsessive-compulsive disorder chapter.