Abnormal Psy

ADHD
 ADHD (Attention-Deficit/Hyperactivity Disorder) is a neurodevelopmental disorder that
primarily affects children but can continue into adulthood. It is characterized by symptoms such
as inattention, hyperactivity, and impulsiveness
 Earlier as ADD or Attention-Deficit Disorder, is an older term that was used to describe
individuals who had problems with attention but did not display significant hyperactivity or
impulsiveness. ADD is now considered part of the inattentive subtype of ADHD. The term was
officially replaced by ADHD in the 1994 revision of the DSM (Diagnostic and Statistical Manual
of Mental Disorders), and now ADHD encompasses both inattentive and hyperactive-impulsive
symptoms.
 The diagnostic criteria for ADHD (Attention-Deficit/Hyperactivity Disorder) are outlined in the
Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), published by the
American Psychiatric Association. These criteria help professionals accurately diagnose ADHD
by assessing the presence and impact of symptoms in children or adults.

 1. Onset of Symptoms

• ADHD symptoms must present during the developmental period, typically before the age
of 12. Although symptoms often appear earlier (in preschool years), they should be
noticeable before adolescence to be considered part of ADHD diagnosis.

 2. Manifestation in Multiple Settings

• Symptoms must be observed in two or more settings (e.g., home, school, social
interactions). This is important because ADHD is a pervasive disorder that affects various
aspects of a child’s life, not just one environment.
• Example: A child may have difficulty concentrating both in class and while doing
homework, as well as when playing with friends.

 3. Duration of Symptoms

• Symptoms must have persisted for at least 6 months. These behaviors should be
inappropriate for the child’s developmental level.

 4. Core Symptoms (Inattention and/or Hyperactivity-Impulsivity)

Symptoms fall into two primary categories: inattention, and hyperactivity-impulsivity. A

child may display symptoms from either or both categories.

 A. Inattention (at least 6 of the following for children):

• Fails to give close attention to details or makes careless mistakes in schoolwork or

other activities.
 • Difficulty sustaining attention in tasks or play activities.
• Does not seem to listen when spoken to directly.
• Does not follow through on instructions and fails to finish schoolwork or chores.
• Difficulty organizing tasks and activities.
• Avoids or dislikes tasks that require sustained mental effort.
• Frequently loses items necessary for tasks or activities.
• Easily distracted by extraneous stimuli.
• Forgetful in daily activities.

B. Hyperactivity and Impulsivity (at least 6 of the following for children):

• Fidgets with hands or feet or squirms in the seat.

• Leaves seat in situations where remaining seated is expected.
Runs or climbs in inappropriate situations.
• Unable to play quietly.
• Acts as if “driven by a motor”, always “on the go.”
• Example: The child seems restless, always needing to move around or do something.
• Talks excessively.
• Blurts out answers before a question is completed.
• Has difficulty waiting for their turn.
• Interrupts or intrudes on others
.

5. Impairment in Personal, Social, Academic, or Occupational Functioning

• ADHD symptoms must cause significant impairment in key areas of functioning:

• Personal: Difficulty managing emotions and controlling impulsive behavior, leading to
frustration or low self-esteem.
• Example: A child might become easily upset when things don’t go as planned, leading to
emotional outbursts.
• Social: Difficulty maintaining friendships, understanding social cues, or controlling
impulses in social settings.
• Example: A child may interrupt peers during play, which can lead to social exclusion.
Academic: Reduced ability to focus in class, organize tasks, or follow through with
schoolwork.
• Example: A child might consistently receive lower grades because they struggle to finish
assignments or understand instructions.
• Occupational (for adolescents/adults): Adults or older adolescents with ADHD may
struggle with job performance, meeting deadlines, or interacting with coworkers.
• Example: A teen with a part-time job may struggle with staying on task and completing
responsibilities.

6. Delay in Achieving Developmental Milestones

 Children with ADHD may show delays in reaching certain developmental milestones,
particularly in areas related to self-control, attention regulation, and social development.

These delays can lead to challenges in:

• Academic Milestones: Difficulty learning to read, write, or complete tasks like other
children their age.
• Example: A child might struggle to learn to read because they can’t focus on the text long
enough.
• Social Milestones: Children may experience difficulties in understanding how to take
turns, share, or engage in reciprocal play.
• Example: A child might have trouble waiting for their turn during games, leading to
conflicts with peers.
• Occupational Milestones (older children/adolescents): Difficulty in completing tasks at
part-time jobs, managing schedules, or taking responsibility for assigned tasks.
• Example: An older child might lose track of shifts or miss deadlines at their job.

Conclusion
To diagnose ADHD, healthcare providers look for persistent and impairing symptoms of
inattention or hyperactivity-impulsivity that start before the age of 12, affect multiple areas of the
child’s life, and last for at least six months. These symptoms must not be better explained by
another condition and should result in functional impairment in personal, academic, or social areas.
Early diagnosis and intervention can help manage ADHD effectively, improving the child’s quality of
life.

 1. Medication Options for ADHD:

• Concerta: This is a medication with a delayed-release mechanism, delivering 22% of the

dose immediately and the remaining 78% over the next 4 hours. This gradual release allows
for a longer-lasting effect (7 to 9 hours in adults).
• Adderall XR: A delayed-release medication that mimics the effect of two equal doses taken
4 hours apart. It also provides longer action throughout the day.
• Alternative Medications: Some antidepressants (like bupropion, atomoxetine, and
imipramine) are prescribed to treat mild to moderate ADHD, especially in cases where
stimulant medications might not be appropriate. These antidepressants typically take 2 to 3
days to begin working.
• Non-Stimulant Medication (Strattera): This is another alternative, often prescribed for
individuals who either have mild symptoms or may have coexisting conditions like anxiety
or tic disorders.

2. Concerns and Considerations:

 • Parental Concerns: Many parents are worried about the side effects of stimulant medications,
such as growth delays, but research suggests that while there might be minor differences in
height, these effects are not typically significant.
 • Over prescription Criticism: Some critics argue that stimulant medications like Ritalin are
overprescribed. They worry about the potential long-term cognitive effects of ADHD
medication.

3. Non-Pharmacological Interventions:

Besides medication, non-pharmacological approaches are highly recommended for

managing ADHD. A comprehensive approach combining multiple interventions is often
most effective.

4. Eight Non-Pharmacological Strategies:


 1. Psychoeducation: Providing knowledge and information to the individual with ADHD and
their family is essential. Understanding ADHD and its impact can help them manage the
condition better and develop coping strategies.
 2. Psychological Therapy: Therapy such as individual counseling helps address coexisting
conditions like depression or anxiety, and provides tools for managing ADHD symptoms.
Cognitive-behavioral techniques are used to change maladaptive behaviors and thoughts.
 3. Compensatory Behavior and Self-Management Training: These programs teach individuals to
manage their time and responsibilities better, using tools like appointment books or to-do lists
to stay organized.
 4. Other Psychological Therapies: Family or marital counseling can help address how ADHD
affects relationships. Group therapy and college planning are also recommended, especially for
older individuals.
 5. Coaching: Coaching focuses on practical goal-setting and helping individuals with ADHD
work toward specific objectives. It involves behavioral and results-oriented strategies.
 6. Technology-Based Programs: ADHD-friendly apps and programs can help with organization,
scheduling, and communication, aiding in daily tasks like managing time and completing
assignments.
 7. School and Workplace Accommodations: Simple changes in the environment, such as quiet
workspaces and frequent performance reviews, can greatly enhance the productivity of
individuals with ADHD. Teachers and employers are encouraged to adjust their expectations
and use the individual’s strengths.
 8. Advocacy: Advocating for oneself is crucial, as it helps individuals gain control over their
condition and their lives. This also promotes greater understanding and success in managing
ADHD.
 Behavioral Therapy:

 Behavioral therapy focuses on modifying problematic behaviors by reinforcing positive

behaviors and discouraging negative ones. It is particularly effective for children with ADHD.

 Example: A 7-year-old child with ADHD might have difficulty sitting still and focusing in class. In
behavioral therapy, the therapist might use a reward system where the child earns a sticker for
every 15 minutes they remain seated and attentive. After earning a certain number of stickers,
the child can choose a reward, such as extra playtime or a small treat. Over time, this positive
reinforcement helps the child develop better self-regulation and focus.

2. Cognitive-Behavioral Therapy (CBT):

 CBT helps individuals with ADHD become more aware of how their thoughts affect their
behavior. This therapy focuses on changing negative thought patterns that can contribute to
impulsive or inattentive behavior.

 Example: A teenager with ADHD might struggle with procrastination, particularly on school
assignments. In CBT, the therapist would help the teen identify the negative thoughts that
contribute to procrastination, such as “I’ll never be able to finish this, so why start?” The
therapist might teach the teen how to break assignments into smaller, manageable tasks and set
achievable goals to help them stay on track.

3. Parent Training in Behavior Management:

 This intervention involves teaching parents strategies to manage their child’s behavior more
effectively. It focuses on creating structure, establishing clear expectations, and using consistent
consequences and rewards.

 Example: A parent might struggle with their child’s constant forgetfulness and inability to
complete chores. During parent training, the therapist might suggest setting up a chore chart
with clear instructions and deadlines for each task. The parent is encouraged to use a token
system where the child earns tokens for completing tasks, which can be exchanged for
privileges, like screen time. The parent is also trained to give consistent and calm consequences
when the child does not complete tasks.

 4. School-Based Interventions:

 School accommodations can help children with ADHD perform better academically and socially.
Teachers can implement strategies to provide structure and minimize distractions in the
classroom.

 Example: A child with ADHD who has trouble focusing on tasks might benefit from a 504 plan or
an Individualized Education Program (IEP). This might include seating the child near the front
 of the class, providing extra time for tests, or giving the child frequent breaks to move around.
Teachers might also use a visual schedule that outlines daily activities to help the child stay
organized and reduce anxiety about transitions

 Social Skills Training:

 Children and teens with ADHD often struggle with social interactions. Social skills training helps
them learn appropriate ways to interact with peers, such as waiting their turn to speak,
maintaining conversations, and understanding social cues

 Example: A child with ADHD might frequently interrupt others during group activities, leading
to difficulties forming friendships. In social skills training, the child is taught to recognize when
it’s their turn to speak by practicing with role-playing activities. They might also learn
techniques for managing impulsive behaviors, such as counting to five before responding to
someone.

 Exercise and Mindfulness-Based Interventions:

 Physical exercise and mindfulness can be beneficial in reducing hyperactivity and improving
focus. Research shows that regular physical activity can help manage ADHD symptoms.

 Example: A 12-year-old child with ADHD participates in a mindfulness meditation program at

school, where they learn breathing exercises to help manage impulsivity and increase focus.
They also join a karate class, which provides structure and improves their ability to focus
through physical movement and self-discipline.

Conclusion:

 ADHD management often requires a combination of both pharmacological (e.g., stimulant and
non-stimulant medications) and non-pharmacological interventions (e.g., psychoeducation,
therapy, coaching, and accommodations). A comprehensive and tailored Interventions for
ADHD (Attention-Deficit/Hyperactivity Disorder) are typically multi-faceted, addressing
behavioral, cognitive, and sometimes medical aspects of the disorder. The goal is to help
individuals manage their symptoms and improve their functioning in various areas of life, such
as at school, home, or work. Below are some key interventions with examples:

Causes
Genetic Factors
 Family History: ADHD tends to run in families, suggesting a genetic component. Studies
show that individuals with a parent or sibling with ADHD are more likely to develop the
disorder.
2 . Brain Structure and Function
  Neurotransmitter Imbalances: Research indicates that imbalances in neurotransmitters,
particularly dopamine and norepinephrine, may play a role in ADHD.
 Brain Structure: Imaging studies have found differences in the size and activity of certain
brain areas, such as the prefrontal cortex, which is involved in attention and impulse
control.

 Barkley’s theory (1997) highlights that the core issue in ADHD is the inability to inhibit
responses due to impairments in the prefrontal cortex. This impairment affects:
 1. Inhibition of responses
 2. Mental representation and memory
 3. Motivation and emotional regulation
 4. Reconstruction of thoughts and actions

3. Environmental Factors
 Prenatal Exposure: Exposure to substances during pregnancy, such as tobacco smoke,
alcohol, or drugs, can increase the risk of ADHD in children.
 Lead Exposure: Exposure to lead and other environmental toxins, particularly in early
childhood, has been linked to increased ADHD symptoms.

4. Developmental Factors
 Premature Birth: Children born prematurely or with low birth weight may be at a higher
risk for developing ADHD.
 Early Childhood Trauma: Adverse experiences in early childhood, such as abuse, neglect,
or significant stress, can contribute to the development of ADHD symptoms.

ADHD in Girls:
ADHD in girls is often missed or misdiagnosed because their symptoms tend to be less obvious than
boys’. Girls often internalize their symptoms, which can lead to anxiety and low self-esteem.
Educators and clinicians may overlook these subtler symptoms.

ADHD in Adulthood:
Adult ADHD manifests primarily as difficulties with attention and organization. Adults with ADHD
tend to make careless mistakes, lose things, and have issues prioritizing tasks due to deficits in
executive functioning. These challenges can affect relationships, both personal and professional.
Comorbidity refers to the presence of one or more additional disorders co-occurring with a
primary disorder. In the case of ADHD, it is common for individuals to experience other conditions
alongside it. Here are some of the most frequent comorbidities associated with ADHD:
Substance Use Disorders
 Example: Adolescents and adults with ADHD are at a higher risk for developing substance
use disorders. A young adult with untreated ADHD might turn to alcohol or drugs as a way
to cope with their symptoms, leading to addiction issues.
Anxiety Disorders
 Example: Many children and adults with ADHD also struggle with anxiety disorders, such
as generalized anxiety disorder or social anxiety disorder. For instance, a child with ADHD
may feel overwhelmed in social situations, leading to heightened anxiety and avoidance
behaviors.
2. Depressive Disorders
 Example: Depression can often co-occur with ADHD. An adolescent with ADHD may
experience feelings of low self-esteem or frustration due to their challenges with attention
and impulse control, leading to depressive symptoms.
3. Learning Disabilities
 Example: Children with ADHD frequently have learning disabilities, such as dyslexia or
dyscalculia. For example, a child with ADHD might struggle with reading comprehension
due to distractibility, which can be compounded by dyslexia, making it even harder for them
to succeed academically.

Autism Spectrum disorder

Autism Spectrum Disorder (ASD) is classified in the DSM-5-TR (Diagnostic and Statistical Manual of
Mental Disorders). It includes impairments in social communication, restricted and repetitive
behaviors, and interests. The severity and persistence of the condition vary, but improvement is
possible with appropriate support.
The Centers for Disease Control and Prevention (CDC) reported in 2007 that approximately 1 out of
every 150 children in the United States was diagnosed with autism spectrum disorder. Over the
years, this rate has increased significantly to around 1 in 54 children. This rise is likely due to
changes in diagnostic criteria, greater awareness, and improved reporting practices.
Example: A 2007 study might have identified fewer children with autism due to less awareness or
different diagnostic tools compared to a more recent study that identifies more children because of
better diagnostic standards.
 The diagnosis of ASD in DSM-5-TR replaces earlier terms like autistic disorder and
Asperger’s disorder. ASD now exists on a continuum of severity, rather than as separate disorders.
This shift helps to better distinguish children with typical development from those with ASD, while
also accounting for a broad range of behaviors and impairments.
3. Clinicians assess ASD in two main areas:
• Social communication and relationships
• Restricted, repetitive patterns of behavior or interests
4. Children with ASD might exhibit delayed language development, difficulty engaging
in social interactions, and atypical body language (e.g., avoiding eye contact or showing unusual
facial expressions). These behaviors may seem odd or unusual to others.

Characteristic of Autism spectrum disorder with additional behavior and challenges \

1. Motor Disturbances and Repetitive Behaviors:

Definition: People with ASD may engage in restricted or repetitive motor behaviors. This can
include actions like tapping fingers or twisting their bodies in unusual ways. Their repetitive
behaviors can also affect their speech.
Example: The text mentions echolalia, a behavior in which individuals repeat words or phrases over
and over. For instance, a child might echo the same word or sound repeatedly, rather than forming
new sentences.

2. Need for Routine:

Definition: Neurodivergent individuals, such as those with ASD, often prefer strict routines. Any
changes in these routines, such as alterations in daily activities like getting dressed or eating, can
cause significant distress.
Example: A child with ASD may get very upset if their morning routine changes. If they usually eat
breakfast first and then get dressed, switching this order might result in confusion or frustration.

3. Altered Sensitivity to Sensory Stimuli:

Definition: Many individuals with ASD exhibit either heightened or diminished sensitivity to
sensory stimuli. Some may not feel pain or temperature changes as typical people do, while others
may find sensory input like noise or light overwhelming.
Example: A child may not react to extreme temperatures and unknowingly touch something very
hot, leading to injury. On the other hand, another child might find normal levels of noise or bright
lights extremely uncomfortable and may need to wear headphones or avoid busy environments.
4. Challenges in Adulthood:
Definition: Neurodivergent individuals, such as those with ASD, may face challenges in maintaining
quality of life as they grow older. This can include difficulties in relationships, poorer physical
health, and lower levels of life satisfaction.
Example: Adults with ASD might struggle to form close friendships or romantic relationships, or
they may experience difficulties in maintaining employment due to social or communication
challenges.

5. Risk of Self-Harm:
Definition: Individuals with ASD are at a higher risk of self-harm, particularly by the age of 16. This
is possibly due to the combination of social challenges, sensory issues, and difficulties in emotional
regulation.
Example: Some teens with ASD might engage in self-harming behaviors like hitting themselves or
biting when they feel overwhelmed by sensory stimuli or social stress.

6. Autistic Savant Syndrome:

Definition: Some individuals with ASD possess extraordinary abilities in specific areas, such as
music, mathematics, or art. This condition is known as autistic savant syndrome.
Example: The text mentions savant calendar calculators, people with ASD who can accurately name
the day of the week for any given date, past or future. Another example could be a child who hears a
piece of music once and can play it perfectly on the piano, as shown in the image.

7. Exceptional Memory or Skills:

Definition: Children with savant syndrome often exhibit remarkable memory or skills in specific
domains, like puzzles, music, or art. This is often accompanied by a deep focus on particular details.
Example: A child may be able to recall exact details of events from years ago or have an exceptional
talent for drawing highly detailed pictures. However, their skills in other areas, such as social
interactions, might be less developed.

8. Regressive Autism:
Definition: Some children with ASD develop typically for the first few years but then lose language
and motor skills around the age of 10. This is known as regressive autism.
Example: A child may start speaking and interacting typically, but around age 3 or 4, they might
stop talking and lose skills they had previously developed, such as riding a bike or using utensils.
Onset in the Developmental Period according to dsm5
 Early Signs: Symptoms of ASD typically manifest in the early developmental period, often
before age 3. However, they may not become fully apparent until social demands exceed the
individual's limited capacities.
 Example of Symptoms: Early signs can include delays in communication (e.g., lack of
babbling or gestures), social engagement (e.g., not responding to name), or repetitive
behaviors.
Impairments in Key Areas
1. Personal Functioning:
o Self-Care Skills: Individuals may show delays in self-care milestones (e.g., dressing,
feeding) and may need support for routine tasks.
o Independence: Challenges in developing self-management skills can impact daily
living.
2. Social Functioning:
o Social Interaction Difficulties: Individuals often have difficulty understanding
social cues and engaging in reciprocal conversations. They may not share interests
or emotions effectively.
o Friendship Challenges: There is a marked impairment in the ability to form and
maintain friendships, leading to social isolation.
3. Academic Functioning:
o Learning Differences: Academic performance can be affected by difficulties with
communication, attention, and social interactions. Some children may have specific
learning disabilities or require individualized education plans (IEPs).
o Classroom Engagement: Challenges with group work or participating in classroom
discussions can hinder academic progress.
4. Occupational Functioning:
o Transition to Adulthood: As individuals age, they may struggle with employment
due to social difficulties, understanding workplace norms, and managing tasks.
o Skill Development: Difficulties in acquiring skills necessary for independent living
(e.g., time management, budgeting) can affect occupational success.
Delays in Achieving Milestones
 Communication: Delays may manifest as limited spoken language, use of echolalia, or
challenges in initiating and sustaining conversations.
  Motor Skills: Fine and gross motor skills may be delayed, impacting physical activities and
tasks requiring coordination.
 Social Play: Engaging in imaginative or cooperative play with peers can be limited, affecting
social development and the ability to form friendships.

Causes

4. Interventions and Behavioral Treatments:

• Naturalistic Developmental Behavioral Interventions (NDBI): One effective

approach for treating children with ASD is using naturalistic interventions that occur in daily life.
Teachers or therapists shape behavior by creating structured routines and goals tailored to the
child’s developmental level. These interventions aim to increase functional behavior, such as
improving communication skills or social interactions.
• Example: A teacher might focus on encouraging a child to ask for a toy by
reinforcing the request with positive feedback each time they attempt to communicate.
• Token Economies: Another behavioral intervention involves using token economies,
where children receive tokens or rewards for desired behaviors. These tokens can later be
exchanged for a reward the child values.
• Example: A child with ASD might receive a token each time they make eye contact or
follow instructions, and after earning several tokens, they can trade them for something they enjoy,
like extra playtime.
• Peer Interventions: Instead of adults leading interventions, some approaches
encourage children with ASD to learn by interacting with peers. This method simulates more typical
social environments and can enhance social learning. Peers may provide reinforcement through
play or shared activities, helping children with ASD develop communication skills naturally.
• Example: A child with ASD might play with a peer who teaches them how to share
toys by modeling the behavior, rather than an adult stepping in to instruct them.

2. Challenges in Estimating Prevalence:

Diagnostic Variability: One of the main difficulties in estimating the prevalence of ASD is that the
standards for diagnosing the disorder vary across different regions and researchers. The question
remains whether children are truly diagnosed with autism, or if different sources of information
such as case reports and clinical summaries impact how these numbers are reported.
Solution: Researchers recommend using standardized diagnostic tools and interviews to ensure
more reliable assessments rather than relying on subjective case records.
Example: A doctor using a standardized ASD assessment tool will likely provide a more consistent
diagnosis compared to a doctor relying solely on notes from a child’s previous behavior report

3. Theories and Genetic Factors of Autism Spectrum Disorder:

Genetic Heritability: Research supports the idea that ASD has a genetic basis, with studies showing
high heritability estimates. This means that the disorder can be passed down from parents to
children, with multiple genes implicated in the development of ASD. Genes related to chromosomes
20, 17, 8, and 2 are commonly mentioned.
Example: If a child has a parent or sibling with autism, the likelihood of them also having autism is
higher due to shared genetic factors.
Neurological Theories: Advances in brain-scanning techniques are helping researchers better
understand neurological abnormalities in people with ASD. For example, some studies suggest that
people with autism may show altered brain activity during periods of rest, which may indicate
problems with communication between the brain’s hemispheres.
Example: Brain scans might reveal that children with ASD process sensory information differently,
leading to challenges in social communication or behavior regulation.

Causes
1. Genetic Factors
 Hereditary Influence: Autism tends to run in families, suggesting a genetic component.
Specific genes have been implicated, including those related to brain development and
function.
 Chromosomal Abnormalities: Some studies have identified chromosomal abnormalities
that may increase the risk of autism, such as variations in chromosomes 7, 15, and 16.
2. Environmental Factors
 Prenatal Exposure: Factors during pregnancy, such as maternal infections (e.g., rubella),
exposure to toxins (e.g., pesticides, heavy metals), or medications (e.g., valproic acid), can
increase the risk of autism.
 Birth Complications: Low birth weight, prematurity, or complications during delivery may
be associated with a higher risk of autism.
3. Neurological Factors
 Brain Structure and Function: Research has shown differences in the brain structure and
connectivity in individuals with autism, particularly in areas responsible for social behavior
and communication.
  Neurotransmitter Imbalances: Abnormal levels of neurotransmitters like serotonin and
dopamine may play a role in the development of autism.
4. Metabolic and Immunological Factors
 Immune System Function: Some studies suggest that immune system abnormalities may
contribute to the development of autism, particularly if the immune system reacts
abnormally to environmental exposures.
 Metabolic Disorders: Certain metabolic conditions, such as phenylketonuria (PKU), can
lead to neurodevelopmental issues, including symptoms resembling autism.
5. Sociocultural Factors
 Parental Age: Advanced parental age at the time of conception has been linked to an
increased risk of autism, although the mechanisms are not fully understood.
 Socioeconomic Factors: While not a direct cause, lower socioeconomic status can affect
access to healthcare and early intervention, impacting developmental outcomes.

Rett Syndrome:

 Overview: Rett syndrome is a genetic neurological disorder that becomes noticeable within
the first 18 months of life and primarily affects girls.
• Symptoms:
• Constant repetitive hand movements (such as wringing or clapping).
• Loss of speech and purposeful hand skills.
• Gait abnormalities (walking problems).
• Complete or partial loss of social interaction skills.
• Progression:
As children age, social engagement deteriorates into what is known as regressive Rett
syndrome. Early symptoms may be confused with autism, but DSM-5-TR advises that Rett
syndrome should be used in differential diagnoses of ASD when children regress after a
period of normal development.
• Genetics and Treatment:
• Caused by mutations in the MECP2 gene, which disrupts normal brain functioning.
• Researchers have identified potential mouse model studies to explore treatment, but no
effective clinical therapies currently exist. However, behavioral and rehabilitation
interventions focusing on motor, communication, and cognitive skills have shown some
promise.
 • Psychological interventions are also noted as useful in managing symptoms of Rett
syndrome.

High-Functioning Autism Spectrum Disorder (Asperger’s Syndrome):

• Definition and Historical Context:

• Asperger’s syndrome was historically used to refer to individuals on the high-functioning
end of the autism spectrum. Although it is no longer a separate diagnosis in DSM-5, the term
is still relevant for understanding variations in autism.
• Hans Asperger initially described children with good language skills and cognitive
abilities but significant social challenges. These children were often labeled as socially
awkward or “little professors” for their intense knowledge in niche subjects.
• Characteristics of High-Functioning Autism:
• Individuals on this end of the spectrum may develop language normally but struggle with:
• Understanding non-verbal communication (like facial expressions and body language).
• Interpreting social cues, leading to difficulties in social interactions.
• Engaging in conversations—they may speak extensively about a specific topic without
noticing others’ lack of interest.
• These individuals can have intense and narrow interests (e.g., astronomy or math) and
may talk excessively about them without realizing that others are not engaged.
• Case Study Example:
• An example is given of “Robert,” an 11-year-old with the verbal skills of a teenager but the
social skills of a 3-year-old. Despite his advanced knowledge in certain areas, his one-sided
communication style led to social rejection. This highlights the challenge of navigating peer
relationships with high-functioning autism.
• Career Planning and Strengths:
• For individuals with high-functioning autism, career planning becomes critical, focusing
on their strengths (such as analytical thinking) and the types of jobs suited to their abilities
(like STEM fields).
• Adults with autism may develop self-awareness and learn social skills over time, allowing
them to navigate professional environments and personal relationships more effectively.
 Therapeutic Approaches and Future Directions for Autism Treatment:

• Virtual Reality (VR) Interventions:

• A 28-week study explored the use of virtual reality therapy to improve social and
emotional functioning in children aged 6 to 12 years. The study showed positive outcomes,
suggesting that technology-based interventions can be effective tools for children with ASD.
• Although VR is not yet mainstream, it is expected to gain popularity as a therapeutic tool
in the coming years.
• Physical and Social Well-being:
• Encouraging exercise through behavioral reinforcements has shown promise in helping
individuals with ASD improve health and well-being. The use of reinforcement techniques
can motivate participation in physical activities, leading to better health outcomes.

Learning and Speech disorder

DSM 5 and its History

Before World War II, mental disorders were predominantly understood through a physiological
lens, with a strong emphasis on biological causes. Psychological conditions were often thought to
stem from physical ailments or abnormalities in the brain, neglecting environmental or social
factors.
Historical Perspective on Mental Disorders
1. Physiological Understanding:
o In the early 19th century, mental disorders were largely considered the result of
physiological issues. Conditions that we now recognize as Post-Traumatic Stress
Disorder (PTSD) were often labeled as "nervous disorders" or "hysteria," focusing
primarily on physical symptoms.
o Treatments were primarily medical, including rest cures, hydrotherapy, and
occasionally more invasive procedures, without addressing psychological or
contextual factors.
2. Shell Shock in World War I:
o The term "shell shock" emerged during World War I to describe soldiers who
experienced debilitating psychological symptoms following combat. Initially, these
 symptoms were thought to result from physical injuries, such as concussions from
blasts.
o As understanding evolved, it became evident that many soldiers who had not
sustained any physical injuries still suffered severe psychological distress, indicating
a psychological response to the traumas of war.
3. Post-World War II Insights:
o After World War II, further research and clinical observations revealed that PTSD
could affect individuals regardless of physical injuries. This shift in understanding
highlighted the importance of psychological and environmental factors, including
the impact of trauma exposure and stress.
o The recognition that healthy individuals could develop PTSD as a result of traumatic
experiences led to a more comprehensive understanding of mental health,
incorporating the interplay between biological, psychological, and environmental
influences.
Conclusion
The evolution of thought regarding mental disorders, particularly PTSD, illustrates a significant
shift from a purely physiological perspective to a more holistic understanding that includes
psychological and environmental factors. This change has been crucial for developing effective
treatments and support systems for individuals coping with trauma and mental health challenges.

DSM 1 – 1952

The DSM-I (Diagnostic and Statistical Manual of Mental Disorders, First Edition) was published in
1952 by the American Psychiatric Association, featuring 106 reaction. Prior to this publication,
mental health conditions were not categorized as "disorders," reflecting a less standardized
understanding of mental health.
Historical Context and Features of DSM-I
1. Psychoanalytic Influence:
o The DSM-I was significantly influenced by the psychoanalytic approach, particularly
the work of Adolf Meyer, who emphasized a psychodynamic perspective. This
approach focused on unconscious processes and childhood experiences as critical
factors in understanding mental health.
2. Terminology and Clarity:
o The language used in the DSM-I was often wordy and complex, lacking clarity.
Descriptions of disorders were lengthy and sometimes vague, making it difficult for
clinicians to identify specific diagnostic criteria for particular conditions.
3. Classification of Disorders:
 o Disorders in DSM-I were categorized primarily based on perceived causality,
dividing them into two main groups:
 Organic Disorders: Linked to identifiable impairments in brain tissue or
neurological functions.
 Psychogenic Disorders: Considered to arise from psychological or
emotional factors, reflecting the belief in the mind's role in mental health.

DSM 2 – 1968
 Increased Number of Diagnoses:
 The DSM-II expanded its scope to include approximately 182 diagnoses, reflecting a broader
understanding of mental health conditions.
 Terminology Changes:
 The terminology used in DSM-I, which often referred to psychoanalysis, was largely
dropped. This shift signified a move toward more descriptive and clinically relevant
language.
 Psycho-Physical Disorders:
 While the focus on psychoanalytic terminology diminished, psycho-physical disorders
remained in the classification. These disorders were viewed as having both psychological
and physical components.
 Removal of Homosexuality as a Disorder:
 In 1974, following significant political and social advocacy, homosexuality was removed
from the DSM-II as a mental disorder. This change reflected a growing understanding of
sexual orientation and a movement toward reducing stigma.
 Ego-Dystonic Homosexuality:
 Despite the removal of homosexuality as a disorder, the concept of ego-dystonic
homosexuality (where an individual's sexual orientation is in conflict with their personal
identity) remained in the manual until the DSM-III
DSM-III (1980)
The DSM-III, published in 1980, marked a significant transformation in the field of psychiatry,
reflecting a shift toward a more empirical and descriptive approach to mental disorders. Here are
the key features and changes:
1. Expanded Diagnoses:
o The DSM-III included approximately 265 disorders, significantly broadening the
scope of psychiatric diagnosis.
2. Shift from Psychodynamic to Empirical Perspectives:
o This edition dropped the psychoanalytic perspective that characterized earlier
versions, favoring an empirically based approach. It emphasized observable
symptoms and standardized diagnostic criteria.
3. Influence of Emil Kraepelin:
o The DSM-III drew heavily on the work of German psychiatrist Emil Kraepelin,
particularly his concepts regarding the classification of mental disorders. Kraepelin
emphasized the biological and genetic underpinnings of conditions such as
"dementia praecox," which was later renamed schizophrenia.
4. Introduction of Pharmacopsychology:
o Kraepelin also contributed to the field of pharmacopsychology, recognizing the
impact of biological factors on mental health and the potential for pharmacological
treatments.
5. Emergence of a New Theoretical Orientation:
o In the 1960s, a group of psychiatrists at Washington University, dissatisfied with the
psychoanalytic emphasis of previous DSM editions, sought to return psychiatry to
its medical roots. This movement advocated for a focus on descriptive and
epidemiological approaches in psychology.
6. Reliability and Validity:
o The changes implemented in DSM-III resulted in a manual that was much more
reliable and valid than its predecessors, establishing a clearer foundation for
diagnosing mental disorders.

The DSM-III introduced a multi-axial classification system, which provided a comprehensive

framework for diagnosing and understanding mental disorders

Axis I: Clinical Disorders

This axis encompassed the major mental disorders, including mood disorders, anxiety disorders,
schizophrenia, and substance use disorders.
Axis II: Personality Disorders and Intellectual Disabilities
This axis included stable, enduring patterns of behavior and inner experiences that deviate from
cultural norms.
Axis III: General Medical Conditions
This included chronic illnesses, neurological disorders, and any medical conditions relevant to the
individual's mental health treatment.
Axis IV: Psychosocial and Environmental Problems
Examples included stressors such as unemployment, relationship issues, or legal problems.
Axis V: Global Assessment of Functioning (GAF)
Axis V provided a rating scale to assess an individual’s overall functioning. It ranged from 0 to 100,
with higher scores indicating better functioning.

DSM-III-R Overview
Year Published: 1987
Number of Disorders: Approximately 292
Key Features
1. Removal of the Neurological Exclusion Rule:
o The DSM-III-R continued the trend established by DSM-III by eliminating the
neurological exclusion rule, which previously restricted the diagnosis of certain
mental disorders in the presence of neurological conditions. This change allowed for
a more nuanced understanding of mental health, acknowledging that mental
disorders could coexist with neurological issues.
2. Increased Recognition of Comorbidity:
o As a result of the removal of this exclusion rule, comorbidity—where an individual
has multiple co-occurring mental disorders—was more widely recognized. This
acknowledgment improved clinical practice by allowing for more comprehensive
assessments and treatment plans.
3. Refinement of Diagnostic Criteria:
o DSM-III-R refined diagnostic criteria for various disorders, enhancing clarity and
precision in diagnosis. This revision aimed to improve the reliability of diagnoses
and better reflect the complexity of mental health conditions.
DSM-IV Overview
Year Published: 1994
Number of Disorders: Approximately 365
Key Improvements
1. Comprehensive Diagnostic Criteria:
o DSM-IV provided more detailed and specific diagnostic criteria for each disorder,
improving clarity and consistency in diagnoses. This helped clinicians better
understand the nuances of various mental health conditions.
2. Multiaxial System Enhancement:
o The multiaxial classification system was retained and further refined. Each axis was
clearly defined, allowing for a more holistic assessment of the individual, including
clinical disorders, personality disorders, medical conditions, psychosocial factors,
and overall functioning.
3. Incorporation of New Disorders:
o DSM-IV introduced several new disorders based on emerging research and clinical
observations, expanding the classification to better capture the diversity of mental
health issues.

The DSM-5 (2013)

No of disorder – 400 +

1. Elimination of the Multi-Axial System: The traditional five-axis system used in the
DSM-IV was removed. Diagnoses now focus on a single-axis approach, where all mental and medical
conditions are considered together without separate axes.
2. New Disorders: A few new disorders were introduced, such as:
• Hoarding Disorder: Previously considered a subtype of obsessive-compulsive
disorder (OCD), it was recognized as a distinct condition.
• Binge Eating Disorder: Elevated from a condition under “eating disorders not
otherwise specified” (EDNOS) to its own full diagnosis.
• Disruptive Mood Dysregulation Disorder (DMDD): Created to address the over-
diagnosis of pediatric bipolar disorder, this condition is characterized by chronic irritability and
frequent temper outbursts in children.
 • Premenstrual Dysphoric Disorder (PMDD): Moved from an appendix of conditions
needing further study to a formal diagnosis.
3. Reorganization of Categories:
• Mood Disorders were divided into two separate categories:
• Depressive Disorders: Includes conditions like major depressive disorder.
• Bipolar and Related Disorders: Separates bipolar disorders into their own category
to distinguish them more clearly from unipolar depression.
4. Removal of the Bereavement Exclusion: In earlier versions of the DSM, individuals
experiencing symptoms of depression after the death of a loved one were excluded from a diagnosis
of major depressive disorder (MDD) for two months, known as the bereavement exclusion. The
DSM-5 removed this exclusion, allowing for the diagnosis of MDD even if symptoms appear shortly
after a significant loss, acknowledging that grief and depression can coexist.

DSM-5-TR Overview
The DSM-5 Text Revision (DSM-5-TR) was published in 2021, updating the original DSM-5 from
2013.
Major Changes
1. New Diagnoses Added:
o Prolonged Grief Disorder

o Unspecified Mood Disorder

o Stimulant-Induced Mild Neurocognitive Disorder

o Nonsuicidal Self-Injury (NSSI)

o Attenuated Psychosis Syndrome (APS)

2. Updated Criteria for Existing Disorders:

o Changes made to over 75 diagnoses for clarity.

3. Cultural Updates:
o Emphasis on addressing race and discrimination in diagnoses.

o Updated terminology, e.g., "racialized," "ethnoracial," and "Latinx."

4. Gender and Sexuality Updates:

o Revised language in gender dysphoria entries for inclusivity.

Specific Updates
  Prolonged Grief Disorder: Recognizes persistent grief symptoms affecting daily
functioning.
 Unspecified Mood Disorder: Reinstated for mood symptoms that don’t meet full criteria.
 Stimulant-Induced Mild Neurocognitive Disorder: Addresses cognitive effects from
stimulant use.
 No suicidal Self-Injury (NSSI): Defined as self-harm without suicidal intent, allowing for
targeted clinical attention.
 Attenuated Psychosis Syndrome (APS): Captures subclinical psychotic symptoms to
prevent misdiagnosis.

Learning speech disorder

This section discusses Specific Learning Disorders (SLDs), which are characterized by delays or
deficits in acquiring basic academic skills like reading, writing, or mathematics, despite normal
intelligence levels.

Here’s a breakdown with examples:

1. General Definition:
• Children with SLDs struggle to develop skills that are expected at their age,
education, and intelligence levels. Their performance is lower than what would be expected.
• For example, an 8-year-old child may still be unable to read simple words or solve
basic math problems that other children of the same age can.

Communication Disorders, which are characterized by difficulties with language, speech, or

communication. Here’s an explanation of the key points along with examples:

1. Language Disorder:

• Children with a language disorder have trouble expressing themselves in ways that
are suitable for their age or developmental level. They may use simplified grammar, leave out key
words, or use words in the wrong order.
 • Example: A child with this disorder might say, “I go park yesterday” instead of “I
went to the park yesterday,” showing difficulty with verb tense.

2. Speech Sound Disorder:

• In this condition, the child has trouble with speech sounds, often substituting,
omitting, or mispronouncing them. This affects how clearly they speak.
• Example: A child may replace the “k” sound with a “t” sound, saying “tiss” instead of
“kiss.” While some speech errors are cute in young children, they may persist and cause problems
in school.

3. Childhood-Onset Fluency Disorder (Stuttering):

• Children who stutter have disruptions in their speech flow, such as repeating
sounds or prolonging syllables. They may also avoid difficult words or have tense speech.
• Example: A child might struggle to say a word, starting with “s-s-s-sun” instead of
“sun,” or use fillers like “um” to delay speech.
• Impact: Research has shown a connection between stuttering and negative
academic outcomes, partly because children may become anxious about speaking and be less
engaged in class.
• Intervention: Treatment includes not only speech therapy but also building
resilience. Parents can help by creating supportive environments where the child can practice skills,
such as dressing independently or solving puzzles, to boost their confidence.

4. Social (Pragmatic) Communication Disorder:

• This disorder involves difficulty using verbal and nonverbal communication

appropriately in social contexts. Children with this condition might struggle to follow social rules,
like understanding how to greet others or interpreting jokes and metaphors.
• Example: A child may not know how to switch between formal and informal
language, speaking to a teacher in the same way they would speak to a friend. They also have
difficulty understanding humor, missing the nuances of jokes or sarcasm.
• Impact: These communication difficulties make it hard for individuals to interact
effectively, not only in personal situations but also in professional environments.
 2. Prevalence and Risk Factors:
• In the U.S., around 8% of children are diagnosed with a learning disorder. Risk
factors include growing up in a low socioeconomic environment, being raised in a stepfamily, or
being exposed to poor parenting practices.
• For instance, a child raised in a household where there is a lot of conflict or lack of
communication may be more at risk of developing SLDs.
3. Specific Learning Disorder with Impairment in Mathematics:
• This refers to difficulties in learning numbers, symbols, and calculations. Affected
individuals may not grasp basic math concepts or solve arithmetic problems, which can lead to
dyscalculia.
• Example: A school-age child may struggle to understand how to add and subtract
numbers, or they may not recognize mathematical symbols like plus (+) or minus (–).
4. Specific Learning Disorder with Impairment in Written Expression:
• Children with this disorder face challenges in organizing their writing, using proper
grammar, and spelling correctly. They may have difficulty constructing sentences or organizing
ideas on paper.
• Example: A child might write sentences with no punctuation, frequent spelling
errors, and ideas that don’t flow logically.
5. Specific Learning Disorder with Impairment in Reading (Dyslexia):
• Children with dyslexia read slowly and often confuse words or letters. This disorder
hampers their ability to read and comprehend written language.
• Example: A child might see the word “cat” and read it as “tac” or skip over words
entirely. They may also take much longer to read simple sentences than their peers.
6. Consequences and Challenges:
• Long-term impacts of SLDs can include struggles in school, fewer job opportunities,
and higher risks of unemployment or financial struggles in adulthood.
• For example, an adult with an SLD may find it challenging to manage their finances
or keep a job that requires basic reading and writing skills.

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition),
the diagnostic criteria for Speech Sound Disorder (previously referred to as phonological disorder
or articulation disorder) and Specific Learning Disorder related to speech include the following:

Speech Sound Disorder (SSD) Diagnostic Criteria:

 1. Persistent difficulty with speech sound production that interferes with speech
intelligibility or prevents verbal communication of messages.
• Example: Substituting one sound for another, omitting sounds, or having difficulty
with articulation.
2. The disturbance causes limitations in effective communication that interfere with
social participation, academic achievement, or occupational performance, either individually or in
combination.
• Example: Difficulty being understood by peers or teachers due to improper
pronunciation affecting relationships or academic performance.
3. Onset of symptoms is in the early developmental period.
• The speech sound disorder is typically evident in early childhood as the child begins
speaking.
4. The difficulties are not attributable to congenital or acquired conditions like
cerebral palsy, cleft palate, deafness, hearing loss, or other neurological or medical conditions.
• Example: The disorder should not be due to a physical condition affecting the
mouth, tongue, or speech mechanisms.

Specific Learning Disorder with Impairment in Reading, Writing, or Mathematics (related to

speech):

In the context of learning disorders where speech-related issues might arise, the DSM-5 specifies
criteria under Specific Learning Disorder:

1. Difficulties learning and using academic skills, as indicated by at least one of the
following symptoms that have persisted for at least 6 months, despite the provision of interventions
that target those difficulties:
• Inaccurate or slow and effortful word reading (commonly associated with dyslexia).
• Difficulty understanding the meaning of what is read.
• Spelling difficulties.
• Difficulties with written expression (e.g., grammatical or punctuation errors, poor
paragraph organization).
2. The affected academic skills are substantially below those expected for the
individual’s age and cause significant interference with academic or occupational performance, or
with activities of daily living.
 3. The learning difficulties began during the school-age years but may not become fully
evident until the demands for those affected academic skills exceed the individual’s capacities.
4. The learning difficulties are not better accounted for by intellectual disabilities,
uncorrected visual or auditory problems, other mental or neurological disorders, or psychosocial
adversity.
Exclusions for Speech Sound Disorder or Learning Disorder:
• The issue is not due to sensory deficits (like hearing impairment), neurological conditions,
or intellectual disabilities.
• Other environmental factors such as lack of instruction or socio-cultural differences are also
ruled out before diagnosis.

Causes
1. Genetic Factors: Family history of speech and language disorders.
2. Neurological Conditions: Issues with brain development or injury affecting
communication.
3. Hearing Loss: Difficulty hearing can impede language development.
4. Environmental Factors: Lack of exposure to language-rich environments during critical
developmental periods.
5. Psychological Factors: Anxiety or trauma may affect speech fluency and confidence.
6. Developmental Disorders: Conditions like autism spectrum disorder can impact
communication skills

7. Intervention Strategies:
• The best approach to address SLDs is early intervention, using evidence-based
practices like the Response to Intervention (RTI) model. Children are given targeted interventions
and their progress is monitored.
• Example: A child who struggles with reading might receive extra support through
special reading programs in school. If they don’t respond to this, they may undergo further
assessment to identify more specific interventions.
8. Vocational Support for Adults:
• Adults with learning disorders can benefit from vocational rehabilitation programs,
where they receive training tailored to their needs.
• Example: An adult with dyslexia may receive job coaching to help them use tools like
text-to-speech software, making it easier to perform work tasks.
For Speech Sound Disorder, signs usually appear around ages 3 to 4, and if difficulties persist
beyond age 7 to 8, it may indicate a disorder.
For Specific Learning Disorder, it typically becomes noticeable around ages 6 to 7 when
children begin formal education.

Motor Disorder - A motor disorder is a condition that impairs a person's ability to control and
coordinate movements. It can manifest as difficulties with fine or gross motor skills, involuntary
movements, or abnormal muscle tone.

1. Developmental Coordination Disorder (DCD)

Definition
DCD is a motor skill disorder characterized by marked impairment in the development of motor
coordination, which can significantly affect daily functioning and academic performance.
DSM-5 Diagnostic Criteria
 A. The acquisition and execution of coordinated motor skills is substantially below what is
expected given the individual's age and opportunity for skill learning and use (e.g.,
clumsiness, poor handwriting, difficulties with sports).
 B. The motor skills deficit significantly interferes with activities of daily living (e.g., self-
care) and academic achievement or occupational performance.
 C. The symptoms must be present in the early developmental period (but may not become
fully manifest until the demands of the environment exceed the limited capacities).
 D. The motor skills deficit is not better explained by an intellectual disability or visual
impairment and is not attributable to a medical condition.
Age of Onset: Symptoms typically become noticeable in early childhood, often before age 5.
However, the difficulties may not fully manifest until the child enters school and faces increased
demands for motor skills.

Causes
 Genetic factors
 Neurological differences
 Environmental influences (e.g., limited opportunities for physical activity)
Interventions
  Occupational Therapy: Focused on improving motor skills through tailored activities (e.g.,
sports, crafts).
 Physical Therapy: Helps improve balance and coordination through specific exercises.
 Examples: Practicing specific tasks, using adaptive equipment, and engaging in group
activities to promote social skills.

2. Stereotypic Movement Disorder

Definition
This disorder involves repetitive, non-functional motor behavior that interferes with daily activities
or may cause injury.
DSM-5 Diagnostic Criteria
 A. Repetitive, seemingly purposeless motor behavior (e.g., hand-flapping, rocking) that is
excessive and persists over time.
 B. The behavior causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
 C. The symptoms are not attributable to another medical condition or better explained by
another neurodevelopmental disorder.
Age of Onset: This disorder usually presents in early childhood, often between ages 2 and 4. The
movements may continue into later childhood or adolescence, but the behaviors may diminish as
the child matures
Causes
 Often associated with developmental disorders (e.g., autism spectrum disorder).
 May result from sensory processing differences.
Interventions
 Behavioral Therapy: Techniques like habit reversal training to reduce stereotypic
movements.
 Sensory Integration Therapy: Helps improve sensory processing and responses to
sensory input.
 Examples: Teaching alternative coping strategies or providing sensory tools (e.g., fidget
toys).

3. Tic Disorders
Definition
Tic disorders involve sudden, rapid, recurrent motor movements or vocalizations that are
involuntary.
DSM-5 Diagnostic Criteria
 A. The presence of multiple motor tics and one or more vocal tics over a period.
 B. The tics occur many times a day, nearly every day, or intermittently over a period of
more than one year.
 C. The tics cause significant distress or impairment in social, occupational, or other areas of
functioning.
 D. The onset is before age 18, and the tics are not attributable to substance use or another
medical condition.
Age of Onset: Tic disorders often begin in early childhood, typically between ages 5 and 10. The
onset can be sudden or gradual, with motor tics often appearing before vocal tics. Tics may
fluctuate in severity and can change in type over time.
Causes
 Genetic predisposition
 Environmental factors (e.g., stress, infections)
 Neurological factors
Interventions
 Cognitive Behavioral Therapy (CBT): Often includes habit reversal training.
 Medications: Such as antipsychotics or other medications to help manage tics.
 Examples: Behavioral strategies to manage tics in social situations, family education, and
support.

Tourette Syndrome is a complex condition involving involuntary movements and sounds known
as tics. Tics are sudden, rapid, recurrent movements (motor tics) or vocalizations (vocal tics).
Symptoms
1. Motor Tics: These can include:
o Blinking

o Head jerking

o Shoulder shrugging

o Facial grimacing

o Other repetitive movements

 2. Vocal Tics: These can involve:
o Grunting

o Throat clearing

o Repeating words or phrases (echolalia)

o In some cases, inappropriate or offensive remarks (coprolalia), though this is less

common.
Age of Onset
 Typical Onset: Symptoms usually appear between ages 5 and 10. Motor tics often develop
first, followed by vocal tics.
Diagnostic Criteria (DSM-5)
1. A. The presence of multiple motor tics and one or more vocal tics over a period.
2. B. The tics occur many times a day, nearly every day, or intermittently over a period of
more than one year.
3. C. The tics cause significant distress or impairment in social, occupational, or other
important areas of functioning.
4. D. The onset is before age 18, and the tics are not attributable to substance use or another
medical condition.
Causes
 Genetic Factors: There is a hereditary component; TS tends to run in families.
 Neurological Factors: Differences in brain structure and neurotransmitter functioning
(especially dopamine).
 Environmental Influences: Stress, infections (e.g., streptococcal infections linked to
Pediatric Autoimmune Neuropsychiatric Disorders), and other factors may exacerbate
symptoms.
Interventions
1. Behavioral Therapy:
o Cognitive Behavioral Therapy (CBT): Helps individuals manage tics and cope with
the associated challenges.
o Habit Reversal Training: A specific technique that teaches awareness of tics and
replacement behaviors.
2. Medications:
o Antipsychotics (e.g., haloperidol, aripiprazole) and other medications (like
clonidine) can help manage tics.
 3. Supportive Interventions:
o Educational support, social skills training, and family education to help cope with
the challenges of TS.

Intellectual Disability
Definition: Intellectual disability is characterized by limitations in intellectual functioning and
adaptive behavior, affecting everyday functioning and development.
Diagnostic Criteria (DSM-5)
1. Deficits in Intellectual Functioning:
o Significantly below average intellectual functioning, typically an IQ score of around
70 or below (considering a standard deviation of 15).
2. Deficits in Adaptive Functioning:
o Impairments in adaptive functioning in one or more areas, such as:

 Communication: Difficulty understanding or using language.

 Social Skills: Challenges in forming relationships and social interactions.
 Daily Living Skills: Difficulty with personal care, job skills, or academic
tasks.
3. Onset during the Developmental Period:
o The intellectual and adaptive deficits must be present during the developmental
period, typically before age 18.

Intellectual disability is categorized into four levels of severity based on the degree of impairment
in intellectual functioning and adaptive behavior. Here’s a brief overview of each level:
1. Mild
 Intellectual Functioning: IQ between 50-70.
 Adaptive Functioning: Individuals may have difficulty with complex tasks but can often
live independently with minimal support. They may require assistance with budgeting, job
skills, and understanding social cues.
 Development: May achieve academic skills up to about a 6th-grade level. Many can hold
jobs and manage daily activities.
2. Moderate
 Intellectual Functioning: IQ between 35-49.
  Adaptive Functioning: Individuals require more support in daily living, such as personal
care and communication. They often need supervision in social situations and may work in
supervised settings.
 Development: Typically achieve academic skills up to about a 2nd-grade level. They can
learn basic self-care skills with guidance.
3. Severe
 Intellectual Functioning: IQ between 20-34.
 Adaptive Functioning: Individuals require significant support in all areas of daily living.
They may have very limited communication abilities and may rely on caregivers for most
tasks.
 Development: Often do not progress to formal academic skills, but can learn basic self-care
and routines with consistent support.
4. Profound
 Intellectual Functioning: IQ below 20.
 Adaptive Functioning: Individuals require extensive support for all aspects of daily life.
They may have severe limitations in communication and motor skills and typically cannot
live independently.
 Development: They may respond to stimuli and engage in simple interactions but require
lifelong care and support.