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
Unit 2 Clinical Features and Diagnostic Criteria For Mental Retardation and Disorders of
TABLES
Aspect Diagnostic and Statistical Manual of Mental Disorders (DSM)
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)
- 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)
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.
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
- 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.
-
- 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:
- 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.
Course Features:
- Consistent speaking
- Speech difficulties without selectivity, typically
significant intellectual - Reduced intelligibility affecting predictable across
limitations. communication. settings.
- 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.
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.
Aspect Description
Diagnostic Requirements
Aspect Description
- Not better explained by other disorders like intellectual development disorder, nervous
system diseases, sensory impairments, or structural abnormalities.
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.
Aspect Description
- Many typically developing children show minor dysfluencies during the preschool
years, but these do not cause significant communication impairments.
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.
Aspect Description
Boundaries with Other - Differentiated from developmental speech sound disorder and language disorder
Disorders by distinct fluency disruptions.
- Diseases of the nervous system may cause dysfluency but are distinguished by
neurological signs.
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.
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.
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.
Aspect Description
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.
Specifier Description
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.
Autism Spectrum - Language difficulties may be present but are characterized by additional
Disorder impairments in social reciprocity and restricted, repetitive behaviors.
Developmental
Learning Disorder - Language deficits may lead to academic learning difficulties, especially in literacy.
Selective Mutism - Language difficulties apparent in all settings, unlike selective mutism.
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
Feature Description
Correlation of - Typically developing children exhibit tight correlation between understanding and
Language Components production of different language components.
Regression of - Not a feature of Developmental Language Disorder; regression may indicate ASD or
Language Skills neurological conditions.
Feature Description
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.
Features Description
Below expected levels for age, Skills significantly below what is typically expected for an
schooling, intelligence individual's age and intelligence.
Features Description
Manifestation Across Specific difficulties may manifest differently across individuals, impacting
Domains reading, writing, or mathematics skills.
Disorders/Conditions Distinctions
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.
Course Features:
Features Description
Changes Over Severity and manifestations may change over time, influenced by interventions,
Time cognitive development, and coping strategies.
Developmental Presentations:
Features Description
Early Identification and Early identification and intervention can lead to improved outcomes, but
Intervention difficulties may persist without support.
Features Description
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.
Features Detailed Explanation
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.
Developmental Presentations:
Features Detailed Explanation
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.
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:
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
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.
Feature Explanation
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
Feature Explanation
Course Features:
Feature Explanation
Progression Over Stereotyped movement disorder may change over time, especially in individuals
Time with intellectual development disorders.
Developmental Presentations:
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
Abnormal or Impaired
Development Manifests before age three years.
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.
Feature Explanation
Feature Explanation
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.
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.
Feature Explanation
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 Presentations:
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.
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
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.
Variation specifiers
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.
Treatment
Treatment Approach Description
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
Access to support groups, counseling, respite care, and community resources can
Support Services provide valuable support to individuals with ASD and their families.
ICD-
10
Disorder Code Description