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What are
Presented by
Carol Nati, MD, MS, DFAPA
Medical Director, MHMRTC
DSM = The Diagnostic and Statistical
Manuel of Mental Disorders.
It’s in its 5th edition.
Published in 2013, it has new
definitions and terms that need to
be explained.
What are Intellectual Disabilities?
Disorders that start when
someone is developing.
Individuals must have
deficits in intellectual and
adaptive functioning.
3 Criteria Must be Met
1. The person must have deficits
in reasoning, problem solving,
planning, learning or judgment.
2. The deficits must result in
failure to meet standards for
personal independence and social
3. This must occur during the
developmental period.
Rosa’s Law
• A federal statute in the United
• Public Law 111-256
• It replaced the term mental
retardation with Intellectual
Disability (ID).
• Intellectual Developmental
Disorders (IDD) are another way
that these disorders are described.
Levels of Severity
These are defined on the basis of
adaptive functioning, not IQ scores,
because adaptive functioning
determines the level of support
Global Development Delay
• This is diagnosed in children
under the age of 5 when the
clinical severity cannot be
reliably assessed.
• You can use this term in
children who are too young to
participate in standardized
Unspecified Intellectual Disability
This term is used in children who are
over the age of 5 when assessment of
the degree of intellectual disability is
difficult or impossible.
• This could be due to a lack of
locally available procedures or
due to physical impairments
such as blindness or deafness.
• There also could be severe
behavioral problems or another
mental disorder present.
Social (Pragmatic) Communication Disorder
Persistent difficulties in the social use of
verbal and nonverbal communication.
1. Deficits in using communication
for social purposes.
2. Difficulty in changing
communication to match the
context of the situation.
3. Difficulties in following the rules
of conversation.
4. Difficulties understanding what is
not explicitly stated.
Social (Pragmatic) Communication Disorder
• These deficits need to result in
functional limitations to
• The onset of the symptoms
need to be in the early
developmental period.
• The symptoms cannot be due
to another medical,
neurological condition or
mental disorder.
Autism Spectrum Disorders (ASD)
• These individuals have persistent deficits
in social communication and social
• They also have restricted or repetitive
patterns of behavior, interests or
• Symptoms must be present in the early
developmental period.
• The symptoms have to cause impairment
in social, occupational or other important
areas of functioning.
ASD Continued
These individuals have persistent deficits
in social communication and social
• Abnormal social approach or failure of
normal back and forth conversation
• Problems with nonverbal
communication – eye contact or
• Problems with developing,
maintaining and understanding
ASD Continued
They also have restricted or repetitive
patterns of behavior, interests or
• Repetitive motor movements or
• Insistence on sameness
• Highly restricted interests
• Increased or decreased activity
with sensory input.
ASD Continued
Symptoms must be present in the early
developmental period.
• They may not become fully evident
until social demands limit capacities.
• They also may be masked by learned
strategies in later life.
Note: You can diagnose both an
Intellectual Disability and Autism
Spectrum Disorder in the same person.
What about Asperger’s Disorder?
Individuals who were diagnosed
with Asperger’s Disorder, Autistic
Disorder or Pervasive
Developmental Disorder Not
Otherwise Specified in DSM-IV
will now all be given the
diagnosis of Autism Spectrum
Disorder (ASD).
Other Neurodevelopmental Disorders
Individuals with IDD also can
have other disorders, including:
• Attention-Deficit / Hyperactivity
Disorder (ADD/ADHD)
• Specific Learning Disorders
• Developmental Coordination
• Tic (movement) Disorders
• Along with other possible
Questions/ Comments?
Thank you for the
to speak on this topic.
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