Review of DSM5 Mental Disorders for NCMHCE Study

1. Intellectual Disabilities2. Communication Disorders3. Autism Spectrum Disorders4. Attention Deficit/ Hyperactivity Disorder5. Specific Learning Disorders6. Motor Disorders7. Tic Disorders

Diagnosis IMust include both:A. Low intelligenceIQ of less than 70 (Wechsler)Impaired reasoning, abstract thinking, learning, judgment, memoryB. Impaired adaptive functioningInvolves 3 domains: Conceptual (reading, math, problem solving), Social, and Practical (self management, daily living)Impaired enough to require ongoing supportC. Onset before age 18 Some developmental delays may not be noticed until school age

Diagnosis IIContributing factors:GeneticNutritional and other deficitsBrain injury

Rule Out:1.Learning Disorders2.Communication Disorders 3.Dementia

Co-occurring:ADHDImpulse Control DisordersDepressive Disorder, Bipolar Disorder and suicidal ideationAutismAnxiety DisordersCerebral Palsy, and Epilepsy

S2. Assess & Refer1. Interviews with important people to get observations2. Intelligence tests:SBIS Stanford Binet Intelligence ScaleWIS Wechsler Intelligence ScalesTNI Test of Nonverbal lntelligence3. Adaptive functioning (personal and social skills) tests:VABS Vineland Adaptive Behavior ScalesSIB Scale of Independent BehaviorAACAP Practice Behaviors

S4. Treatments1. Education2. Skills TrainingLife skillsSocial skills

Diagnosis IA. Persistent social deficits Poor reciprocal communication and interactionLittle or no sharing of emotion, or empathyHard to read social cues and grasp social rules

B. Restricted and repetitive behaviors or interestsSimple repeated movements with hands and headRepetitive use of objects Fixated and narrow interestsOdd use of speechRigid routines

Diagnosis IIC. From early age Typically seen at age 1-2May have seemed normal then regressMay not be fully manifest until greater social demands D. Causes impaired functioning

Diagnosis IIIRule Out:Intellectual Disability or Global Developmental Delay: More socially disengagedSocial Communication Disorder: No odd movements

Co-occurring:ADHDSchizophreniaSelf injuryAnxiety disordersDepressive disorders

S1. Find OutObservations by important people and self report

S2. Assess & ReferTestingChildhood Autism Rating Scale (CARS)Disorders Screening TestIndividual Education PlanSocial Communication QuestionnaireT&J Social Skills

S4. Treatments to use1. Behavioral (No best treatment)Floor TechniquePivotal Response Training2. Psychoeducation for individual and family3. Skills trainingSocial skillsSelf care

Diagnosis IRelative to age and in 2 settings (school, home, work)Poor attention span: distracted, can’t listen, can’t organize tasks Hyperactivity: fidgeting, running, talkingImpulsivity: interrupting, can’t wait turn6 months or moreOnset before age 12; can persist in adultsInterferes with functioning

Specifiers: Mainly Inattention or Mainly Hyperactivity/Impulsivity orBoth

Diagnosis IIContributing factors: Abuse, neglect, and institutionalizationGenetic and family factorsTemperament

Co-occurring conditions:Intellectual DisabilityAutism ODD, or Conduct Disorder or Anti-social Personality DisorderAnxiety disordersDepressive & Bipolar disordersSubstance abuseTic DisordersDisruptive Mood Dysregulation DisorderSpecific Learning DisorderIntermittent Explosive Disorder

Diagnosis IIIRule Out: Oppositional Defiant Disorder: Can sustain attention, less impulsiveIntermittent Explosive Disorder: More aggressiveIntellectual Disability: No symptoms outside of academic tasksAutism: More isolated, disengaged Anxiety disorders: More worried and ruminatingDepressive & Bipolar disorders: Symptoms only during episodes

S1. Find OutEnvironmental factors (symptoms gone if remedied)

S2. Refer & Assess1. Cognitive tests Wechsler IQ WJ-R or WIAT Wechsler Individual

Achievement Test CPT Continuous Performance Test2. Behavioral rating scales (not reliable) Disruptive Behavior Disorders Rating

Scale Child Behavior Checklist Impairment Rating Scale Connors Rating Scale

S4. Treatments 1. MedicationStimulants like Ritalin, Adderall, Concerta2. CounselingTo take responsibility for personal behaviorTo see how difficulties with focus and thinking are related to difficulties managing behavior

3. Psychoeducation4. Group counseling for adults5. Skills training, often Cognitive Behavioral Anger managementStress managementSocial skillsProblem solvingAttention managementBehavior management

S5. Monitoring Self report and observation of overt behavior regarding:Interrupting othersInability to delay getting what they wantActing without thinking about consequencesForgetting what they are saying or what someone just saidLosing focus when talking

S6. Termination

DiagnosisTic: Sudden, rapid, repeating movement or vocalizationInvolving face, head and limbs1. May come and go2. Onset before age 18Typically before age 6, peaking by age 12Tourette’s DisorderMost severeBoth motor and vocal tics present, including offensive outburstsOver 1 year

Co-Occurring:ADHDOCD

Rule Out:Obsessive Compulsive disorders: More cognitive and complex

S1. Find Out S2. Assess & ReferTestYale Global Tic Severity Scale

S4. Treatments1. Behavior therapyERP Exposure and Response PreventionHRT Habit Reversal Training

2. MedicationMild: Anti-anxiety, like Clonidine More severe: Neuroleptics like Risperdal or Haldol