Exceptionalties “Exceptionalities” is a general, nonclinical term to describe conditions and behaviors that lie outside the norm. These may include physical, emotional, or psychological differences. For the purposes of this DSM-5 update, the focus will be on the exceptionalities that align with the DSM-5 classification of neurodevelopmental disorders. One major shift in the DSM-5 was to abandon the classification of disorders usually first diagnosed in infancy, childhood, or adolescence in favor of more clinically appropriate classifications. That is, the diagnoses formerly found in this group were moved to classifications more specifically related to symptomology. One of the new classifications—neurodevelopmental disorders—includes diagnoses generally made early in childhood. A summary of changes in diagnostic criteria of these disorders can be found below.
Neurodevelopmental Disorders Intellectual Disability (Intellectual Developmental Disorder) This group of diagnoses most closely resembles the formerly described mental retardation diagnoses. The phrase “mental retardation” is no longer used in clinical or educational settings. In addition to a change in the diagnostic label, there has been a change to criteria as well. Mental retardation diagnoses were previously identified as five separate diagnoses reflecting severity of impairment based on IQ score. The new intellectual disability diagnoses include only two diagnoses, with specifiers reflecting severity of impairment. It is important to note that severity is determined by adaptive functioning and cognitive capacity (IQ), rather than solely by the latter, as was the case in the DSM-IV. Communication Disorders This group of disorders includes deficits in language, speech, and communication. Changes from the DSM-IV to the DSM-5 for this group include new diagnostic labels of speech sound disorder (formerly phonological disorder), childhood-onset fluency disorder (formerly stuttering), and language disorder (a combination of expressive and mixed receptive-expressive language disorders). Also included is an entirely new diagnosis of social (pragmatic) communication disorder, which is characterized by persistent deficits in verbal and nonverbal communication. It is important to note that because social communication deficits are a diagnostic criteria of autism spectrum disorders, these diagnoses cannot be comorbid. Autism Spectrum Disorder The diagnostic grouping formerly known as pervasive developmental disorders has been streamlined and renamed autism spectrum disorder. This is a single diagnostic label that includes the formerly identified autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. The autism spectrum disorder is characterized by two key criterion: a) deficits in social communication and social interaction and b) restricted, repetitive behaviors. The specifiers used with this diagnosis include intellectual impairment, language impairment, and associations with other conditions, factors, or comorbid diagnoses. It is important to note that the DSM-IV diagnosis of Rett disorder has been entirely removed, as it is considered the manifestation of the biological condition Rett syndrome.
Characteristics of Rett syndrome often appear to be very similar to autism spectrum disorder at onset; however, symptoms often improve substantially after 5–6 years of age, making differential diagnosis more clear. Attention-Deficit/Hyperactivity Disorder (ADHD) Though the basic diagnostic criteria for ADHD is very similar in the DSM-5, there are a number of key differences from the DSM-IV, including stage-related examples to aid in diagnosis in childhood, adolescence, and adulthood. One of the key changes has been to raise the identification of symptomology from before age 7 to before age 12 and to use a single diagnosis with specifiers rather than several related diagnoses in a group. Specifiers replace prior subtypes, identifying the predominant presenting symptomology. Specifiers are also now used to reflect severity of impairment of functioning. Specific Learning Disorder This is a new diagnosis in the DSM-5 and includes the entire group of disorders from the DSM- IV group learning disorders. These disorders included reading disorder, mathematics disorder, disorder of written expression, and learning disorder not otherwise specified. Specifiers are used to identify the areas of impairment (reading, written expression, or mathematics). Motor Disorders This diagnostic group has replaced the motor skills disorder group from the DSM-IV, which previously included only developmental coordination disorder. In recognition of the neurological foundations of several disorders relating to control of movement and coordination, this new DSM-5 diagnostic group includes developmental coordination disorder, stereotypic movement disorder, and tic disorders. More clear language has also been included in stereotypic movement disorder criteria to better facilitate distinction from similar behaviors associated with obsessive- compulsive disorder. Reference:
• American Psychiatric Association. (2013). Highlights of changes from DSM-IV-TR to DSM-5. Retrieved from: http://www.dsm5.org/Documents/changes%20from%20dsm-iv- tr%20to%20dsm-5.pdf
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