abnormal review.docx - ABNORMAL DSM categorical to account...

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ABNORMAL DSM categorical to account for diagnostic heterogeneity criteria polythetic (need some sx, not all) Axis I: clinical; more disruptive/acute (considered primary unless otherwise noted) Axis II: MR and PD (so you pay attention to it) Axis III: medical Axis IV: psychosocial/environmental V GAF (symptom severity and level of functioning) 21-30: unable to function in nearly all; delusions/hallucinations 31-40: severely depressed, unable to work, avoids interactions with people 41-50 suicidal, can’t keep job; suicidal ideation; one friend 0=inadequate info Diagnostic uncertainty: Dx Deferred; Specific Dx provisional or Class NOS Normally Diagnosed in Childhood Mental Retardation 70 or lower IQ impaired adaptive functioning (doesn’t meet standards of personal independence expected of cultural group in 2+ areas—communication, self-care, safety) onset before 18 delayed motor; 4 levels of severity; 10-30% attributable to Down syndrome (heart lesions, cataracts, mod-severe MR) Mild: live and work independently or with some supervision; acquire academic skills to 6 th gr Moderate: with adequate training and education , they can attain learn up to 2nd grade level; unskilled or semiskilled jobs with supervision Mod/severe: attend to their own self-care needs with supervision; some elementary academic skills (e.g., alphabet), elementary hygiene skills, simple tasks under close supervision Profound: minimal functioning; need highly structured environment and close supervision Borderline intellectual Fx (other conditions that may be focus of clinical atten.) IQ 71-84 (MR might be better dx if IQ 71-75 IF significant deficits in adaptive fx) Learning DO: 2 SD or more discrepancy between IQ and achievement (not explained by sensory deficit); most common co-dx is ADHD (20-30%); greater risk for anti-social behavior; associated with chronic otitis media and difficulties in phonological processing Compared to children in the general population, LD children have a higher rate of psychopathology (ex. prevalence of ADHD is 3-5% in the general and 20-25% for in LD. Pervasive Devel. DO Autistic: onset of some symptoms before age 3 1. impaired social interactions (eye contact, facial expressions) 1
2. impaired verbal and non-verbal communication (some don’t speak; pronoun reversal, echolalia, inappropriate tone) 3. restricted, repetitive (arm flap, rock), stereotyped behavior (interest in parts of objects) Etiology: biogenetic disorder, small cerebellum, enlarged ventricles 4-5 times more common in boys Few adults with autism live as independent adults treatment is shaping and discrimination training best prognosis when verbal by age 5/6, IQ>70 and later symptom onset Rett’s: females head growth deceleration develop stereotyped movements severe expressive and receptive language problems loss of purposeful hand movements loss of social interest following a period of normal development of 5 mos or more Childhood disintegrative disorder: after two years of normal development

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