11.2 W1 3.常見兒童發展障礙的診斷準則(E3-2041)

1 11/7/20141Dr. Lee Pui IConsultant PediatricianPediatric and Neonatology department CHCSJ, Macau2/11/2014 Diagnostic criteria for common developmental problem of children dsm 5 dsm 5 The Diagnostic and Statistical Manual of Mental Disorders DSM History of DSM DSM I 1952 , 60 DSM II 1968 , DSM III 1980 DSM III R 1987 DSM IV 1994 297 DSM IV DSM IV TR 2000 2013 5 18 DSM V dsm 5 ( dsm 5 ) 1999 (Steve Hyman (Steven M.))

2 Mirin David J. Kupfer (NIMH) 11/7/20142 Revision of Disease Relative to Children 2007 2 2008 2 5 Characteristics of DSM5 5 dsm 5 2013 5 18 (APA) : dsm 5 (Spectrum) dsm 5 Main changes of the diagnosis criteria dsm 5 ABCDE bereavement gambling disorder dsm 5 Neurodevelopmental Disorders intellectual Disabilities intellectual Disability ( intellectual Developmental Disorder) Global Developmental Delay Unspecified intellectual Disability ( intellectual Developmental Disorder) Communication Disorders Language Disorder Speech Sound Disorder (previously Phonological Disorder)

3 Childhood Onset Fluency Disorder (Stuttering) Social (Pragmatic) Communication Disorder Unspecified Communication Disorder Autism Spectrum Disorder Autism Spectrum Disorder Attention Deficit/Hyperactivity Disorder Attention Deficit/Hyperactivity Disorder Other Specified Attention Deficit/Hyperactivity Disorder Unspecified Attention Deficit/Hyperactivity Disorder Specific Learning Disorder Specific Learning Disorder Motor Disorders Developmental Coordination Disorder Stereotypic Movement Disorder Tic Disorders Tourette s Disorder Persistent (Chronic) Motor or Vocal Tic Disorder Provisional Tic Disorder Other Specified Tic Disorder Unspecified Tic Disorder Other Neurodevelopmental Disorders Other Specified NeurodevelopmentalDisorder Unspecified NeurodevelopmentalDisorder11/7/20143 intellectual Disabilities intellectual Disability ( intellectual Developmental Disorder) Global Developmental Delay Unspecified intellectual Disability ( intellectual Developmental Disorder) Communication Disorders Language Disorder Speech Sound Disorder (previously Phonological Disorder) ) Childhood Onset Fluency Disorder (Stuttering) Social (Pragmatic)

4 Communication Disorder Unspecified Communication Disorde dsm 5 Autism Spectrum Disorder Autism Spectrum Disorder Attention Deficit/Hyperactivity Disorder / Attention Deficit/Hyperactivity Disorder / Other Specified Attention Deficit/Hyperactivity Disorder / Unspecified Attention Deficit/Hyperactivity Disorder / Specific Learning Disorder Specific Learning Disorder dsm 5 Motor Disorders Developmental Coordination Disorder Stereotypic Movement Disorder Tic Disorders Tourette s Disorder Persistent (Chronic) Motor or Vocal Tic Disorder Provisional Tic Disorder Other Specified Tic Disorder Other Neurodevelopmental Disorders Other Specified Neurodevelopmental Disorder Unspecified Neurodevelopmental Disorder11/7/20144 Different from dsm 5 to DSM IV Neurodevelopmental Disorders Mental Retardation intellectual disability intellectual developmental disorder Phonological disorder communication disorders speech sound disorder childhood onset fluency disorder Social communication disorder

5 Neurodevelopmental Disorders Onset early in development, often before the child enters grade school characterization: developmental deficits: impairments of personal, social, academic, or occupational functioning . Mental retardation = intellectual developmental disorder = Neurodevelopmental Disorders intellectual Disabilities intellectual Disability ( intellectual Developmental Disorder) A. Deficits in intellectual functions, B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility Global Developmental Delay under the age of 5 years Unspecified intellectual Disability ( intellectual Developmental Disorder) over the age of 5 years when assessment of the degree of intellectual disability requires reassessment after a period of timeDiagnostic Features A.

6 Deficits in general mental abilities B. impairment in everyday adaptive functioning, in comparison to an individual s age , gender , and socioculturally matched peers C. Onset is during the developmental period The diagnosis of intellectual disability is based on both clinical assessment and standardized testing of intellectual and adaptive intellectual disability has an overall general population prevalence of approximately 1%, and prevalence rates vary by age. Prevalence for severe intellectual disability is approximately 6 per 1,000 Overall, males are more likely than females to be diagnosed with both mild (average male:female ratio :1) and severe (average male:female ratio.)

7 1) forms of intellectual disabilityThe communication disorders language disorder speech sound disorder ) childhood onset fluency disorder (stuttering) ( ) social (pragmatic) communication disorder ( ) The first three disorders are characterized by deficits in the development and use of language, speech, and social communication, Disorder The language deficits are evident in spoken Communication , written communication , or sign language affects vocabulary and grammar 11/7/20146 Diagnosis of language disorder based on the synthesis of the individual s history direct clinical observation in different contexts(home, school, or work)

8 , and scores from standardized tests of language ability that can be used to guide estimates of of Language disorder Genetic and physiological Language disorders are highly heritable, and family members are more likely to have a history of language sound disorder Diagnostic Criteria A. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages. B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination. C. Onset of symptoms is in the early developmental period.

9 D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological onset fluency disorder A. Disturbances in the normal fluency and time patterning of speech 1. Sound and syllable repetitions. 2. Sound prolongations of consonants as well as vowels. 3. Broken words ( , pauses within a word). 4. Audible or silent blocking (filled or unfilled pauses in speech). 5. Circumlocutions (word substitutions to avoid problematic words). 6. Words produced with an excess of physical tension. 7. Monosyllabic whole word repetitions ( , I I I I see him ).11/7/20147 Childhood onset fluency disorder B.

10 The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination. C. The onset of symptoms is in the early D. The disturbance is not attributable to a speech motor or sensory deficit, dysfluency associated with neurological insultSocial (pragmatic) communication disorder ( ) Persistent difficulties in the social use of verbal and nonverbal communication Social (pragmatic) communication disorder is characterized by a primary difficulty with pragmatics, or the social use of language and communication, as manifested by deficits in understanding and following social rules of verbal and nonverbal communication in naturalistic contexts, changing language according to the needs of the listener or situation, and following rules for conversations and Different in dsm 5 ( Pervasive developmental disorder) (Autism spectrum disorder, ASD) (subtype)