DSM-IV Training Guide

William H. Reid, Michael G. Wise

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317823872
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

First published in 1995. Following on from two previous books that focused on the treatment of the DSM-III and DSM-III-R psychiatric disorders. This book is devoted to training clinicians on the proper use of the DSM and offers a great contribution to the education of mental health professionals. Written by experts in forensic psychiatry and medical education this is a clear and comprehensiveness DSM -IV Training Guide.

Section II
THE DISORDERS

Chapter 10
DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE

This large classification describes disorders that usually begin or become evident in infancy, childhood, or adolescence. Any clinician using this category in children or adolescents should have a basic knowledge of child development in order to be able to distinguish true clinical syndromes from normal variations for age or developmental stage.

Most DSM-IV disorders may be diagnosed in adults, adolescents, or children. Although this section should be consulted when evaluating children or adolescents, disorders described elsewhere in DSM-IV should also be considered, provided there is no proscription against their use before adulthood.

Note the “usually” in the section title. Several of the diagnoses may be applied to adult symptoms (e.g., stuttering). In addition, adults with histories of childhood symptoms (e.g., Attention-Deficit/Hyperactivity Disorder) may be diagnosed as having disorders listed in this section, sometimes In Partial Remission.

MENTAL RETARDATION
(Code on Axis II)

• Mild Mental Retardation
• Moderate
• Severe
• Profound
• Severity Unspecified

NOTE: The reader may wish to consult the classification system of the American Association on Mental Retardation (AAMR) where level, functioning, and needed supports are addressed more completely. Also, the term developmental disability, while often implying Mental Retardation, is not limited to it.

ESSENTIAL FEATURES . Essential features are significantly subaverage general intellectual functioning and significant deficits or impairments in adaptive functioning, both of which present before the age of 18. Although a valid and reliable intelligence quotient (IQ) measurement is a major indicator of retardation, the IQ should be treated with some flexibility in order to allow for additional deficits or acknowledge unusually good adaptation. When a known biological factor is present, it should be coded on Axis III.

For persons under the age of 18 who become functionally retarded after a period of normal intelligence, both Dementia and Mental Retardation are diagnosed if both criteria are met.

COMPLICATIONS . Mental retardation is accompanied by mental illness at a rate several times that of the general population. Although often difficult to diagnose in persons with Mental Retardation, one may discover Mood Disorders, Attention-Deficit/Hyperactivity Disorder (AD/HD), some Developmental Disorders, Stereotypic Movement Disorder, Impulse Control Disorders, and—less commonly—Psychotic Disorders. Symptoms related to the Mental Retardation should be separated from other disorders. Behaviors thought to be symptoms may actually be due to frustration or attempts to communicate.

When social or legal competency is an issue, one should note that persons with Mild Mental Retardation may be more competent than assumed. Well-meaning efforts to limit competency can create unnecessary limitations on activities or individual rights.

ASSOCIATED PHYSICAL, LABORATORY, AND GENERAL MEDICAL FINDINGS . Most borderline or Mild Mental Retardation is associated more with social and environmental deprivation than with physical findings. More significant deficits are associated with a wide variety of genetic, intrauterine, perinatal, and childhood problems and insults. Physical stigmata, including congenital deformity and/or serious, progressive medical illness, often accompany Moderate, Severe, and Profound Mental Retardation. Down’s syndrome is associated with increased incidence, and early presentation, of Dementia of the Alzheimer’s Type.

DIFFERENTIAL DIAGNOSIS . Mental Retardation should be diagnosed when the criteria are met, regardless of other diagnoses. Learning Disorders reflect a delay or failure of development in a specific area, in contrast to Mental Retardation’s general developmental delays. Pervasive Developmental Disorders reflect abnormal development, as contrasted with Mental Retardation’s delay in development. A V-code finding of Borderline Intellectual Functioning does not imply Mental Retardation.

DIAGNOSTIC CRITERIA FOR MENTAL RETARDATION (317–319)
(ICD-10 codes F70.9-F79.9)

1. Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test (for infants, a clinical judgment of significantly subaverage intellectual functioning).
2. Concurrent deficits or impairments in present adaptive functioning (i.e., the person’s effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety.
3. The onset is before age 18 years.

Code based on degree of severity reflecting level of intellectual impairment:

317	Mild Mental Retardation: IQ 50–55 to approximately 70	(ICD-10 code F70.9)
318.0	Moderate: IQ 35–40 to 50–55	(ICD-10 code F71.9)
318.1	Severe: IQ 20–25 to 35–40	(ICD-10 code F72.9)
318.2	Profound: IQ below 20 or 25	(ICD-10 code F73.9)
319	Severity Unspecified: When there is strong presumption of Mental Retardation but the person's intelligence is not testable by standard instruments	(ICD-10 code F79.9)

LEARNING DISORDERS
(Specific Developmental Disorders in DSM-III-R)

• Reading Disorder
• Mathematics Disorder
• Disorder of Written Expression
• Learning Disorder Not Otherwise Specified (NOS)
  

NOTE: Speech, language and motor skills disorders coded as Specific Developmental Disorders in DSM-III-R are generally found in Communication Disorders and Motor Skills Disorders in DSM-IV. They are now coded on Axis I.

ESSENTIAL FEATURES . These disorders are characterized by inadequate development of specific academic, language, speech, and/or motor skills not due to demonstrable physical or neurological disorders, Pervasive Developmental Disorder, Mental Retardation, or lack of educational opportunity. Diagnosis ordinarily depends on standardized, individually administered tests which show achievement substantially (usually two standard deviations) below that of similar age, education, and intelligence. Significant discrepancy between IQ and abilities suggests Learning Disorder. The evaluation should correct for known culture bias.

COMPLICATIONS . Complications can include other developmental deficits, such as Communication Disorders or Disruptive Behavior Disorders. Depression and other Axis I disorders may be seen. Lowered self-esteem and problems in social functioning are common.

PREDISPOSING FACTORS . Predisposing factors are similar to those for Pervasive Developmental Disorders.

DIFFERENTIAL DIAGNOSIS . Inadequate testing, lack of educational opportunity, and cultural factors can mimic a Learning Disorder. Learning deficits caused solely by vision or hearing problems should not be considered Learning Disorders. Learning Disorders should not be diagnosed in the presence of Mental Retardation or Pervasive Developmental Disorder unless a specific deficiency (e.g., reading, mathematics) is below the norm for persons of similar IQ, education, or development. A separate diagnosis should be made for each Learning Disorder for which diagnostic criteria are met.

315.00 Reading Disorder ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• List of DSM-IV and Corresponding ICD-10 Classifications
• Foreword
• Preface
• Section I. The Basics
• Section II. The Disorders
• Glossary
• Index