Najwa Bashir

I am a passionate and knowledgeable psychologist, with a Master of Philosophy (MPhil) in Psychology specializing in Counseling Psychology. Through my writing, I share my insights and thoughts on various psychiatric disorders, conduct analysis on films that touch on psychological issues, and explore other topics related to psychology, while also providing valuable information to psychology enthusiasts, students as well the general community.

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Psychology in Pakistan

History of Psychology in Pakistan

Written by Najwa Bashir

The formal history of psychology in Pakistan dates back to the 1960’s. In Pakistan, psychology was recognized as a distinct academic discipline over 59 years ago (Zadeh, 2017). According to Michal J. Stevens, Wedding Danny, Dr. Nosheen Khan Rehman, and Taylor and Francis (2004), Pakistan had two universities in 1947. The psychology department was first set up in 1887 at the University of Punjab in Lahore (West Pakistan) and again in 1921 at Dhaka (East Pakistan; now Bangladesh). The University of Karachi, Sindh was founded in 1946, and the psychology school has been running since 1951.

Further psychology departments were set up in Peshawar in 1950 and in Rajshahi (East Pakistan) in 1953. Pakistan’s oldest psychology labs can be found at University of the Punjab, Government College University Lahore, and Dhaka University, which is now in Bangladesh but used to be in East Pakistan. In the 1960s, only the academic and theory parts of psychology were up and running. Experimentation was not a big focus.

In 1964, there were only 250 teachers working, no national psychological association, and no study magazine. However, later on, a psychological laboratory was set up at Punjab University in Lahore to study applied psychology. Universities were also encouraged to do experiments and research in psychology, and more journals for psychological research were published by Michal J. Stevens, Wedding Danny, Dr. Nosheen Khan Rehman, and Taylor and Francis (2004) (Firdous, 2010).

Up until 1960, one of the places where psychology was taught as part of the philosophy curriculum was the Government College in Lahore (Rafiq et al., 2022). GC Lahore used to teach psychology as part of the philosophy curriculum up until the 1960s. Psychology became its department at GC Lahore in 1962, thanks to the strong direction of Dr. Muhammad Ajmal. He became the department’s founder and head (Zadeh, 2017).

Forman Christian College, Lahore, was the second school that taught psychology. At Karachi University, the first separate school of psychology was set up. It was led by Qazi Muhammad Aslam, whose main area of study was philosophy. While Sindh University became its own thing in 1960. Syed Muhammad Hafeez Zaidi was seen in Frontiers of Psychological Research in Pakistan in 1975.

The main goal was for philosophy teachers to become involved in the field of psychology. Due to this, traditional indigenous people started studying psychology, which was mostly based on theory. There were early works in Pakistani psychology written by Hafeez Zaidi and a few others.

After 1960, many psychology schools sprung up. But at first, these departments couldn’t get many students, usually only three to seven. The reason was an opening in the job market. Before 1991, there were more than 10 universities in Pakistan that mostly offered M.A. and M.Sc. degrees in Psychology. Today, in 2018, about 12 universities have started to offer BS (Hons), MS, and Ph.D. studies in clinical psychology.

From the start until now, psychologists have needed a governing group, but the idea hasn’t fully grown yet. The University of Punjab and the University of Karachi both set up the Center for Clinical Psychology because President Zia Ul Haq was very interested in the field (Rafiq et al., 2022).

From 1960 to the present day, the field of psychology in Pakistan has been progressing slowly, but steadily. The growth can be seen in the fact that full-fledged psychology schools have been set up at the universities in Karachi, Sind, and Peshawar. Several associated schools began offering M.A. programs in psychology, and it became a separate subject to study at the Inter, B.A., and BSc levels. In 2007, HEC started a four-year BS Psychology program, which changed the way psychologists are trained at the college level in a big way.

In 1983, two schools of clinical psychology opened in Karachi and Lahore, two of Pakistan’s biggest metropolises. This was a big step forward for clinical psychology. At first, both schools gave people with a Master’s degree a one-year diploma in clinical psychology. After a while, both schools added graduate programs in clinical psychology. Dr. FarrukhZahor Ahmad started the Institute of Clinical Psychology in Karachi. He is a clinical psychologist who first learned his craft at the University of Stanford in Pakistan(Zadeh, 2017).

When the National Institute of Psychology, Islamabad opened in 1976, it added another important milestone to the history of psychology (Zaman, 1991). In 2000, Bahria University in Karachi opened the Institute of Professional Psychology. Several universities in Pakistan offer bachelor, graduate, and postgraduate programs in psychology and clinical psychology. These include the International Islamic University in Islamabad, NUST in Islamabad, and Beacon House in Lahore. The Pakistan Psychological Association (PPA) was founded in 1968, and the Pakistan Association of Clinical Psychologist (PACP) was founded in 1988. Both of these events were major turning points in the field. These are two national groups for psychologists, with the third one being just for professional psychologists(Zadeh, 2017).

Psychological journals can also be used to see how psychology has changed over time. The first psychology magazine came out in 1965, and there were five more until 1991 (Zaman, 1991). The Government College, Lahore’s Journal of Psychology, now called the Psychology Quarterly, has been out since 1962. In 1978, an Urdu journal called “Zehan” started coming out. From 1992 to 1995, the Institute of Clinical Psychology at the University of Karachi put out the Pakistan Journal of Clinical Psychology every other year. Journal printing stopped from 1995 to 2005, but it started up again in 2006 and has been going strong ever since (Zadeh, 2017).

The eleven years from 1995 to 2006 marks the time when the field of psychology grew incredibly in Pakistan and a huge number of people got PhDs in psychology. During this time, a culture of research grew, and as a result of rules set by the Higher Education Commission (HEC), research papers were required for academic job openings and raises (HEC, 2019). These requirements led to a rush of research papers being published in Pakistan, and many new research magazines were also set up. Back then, from 1995 to 2006, the internet wasn’t very common, and even where it was, there weren’t many places where you could get free papers. Many researchers in Pakistan relied on the research magazines that were available in their university libraries. Due to this, these studies were mentioned hundreds of times and were the easiest to find examples of published studies. Also, most of the people who wrote these studies were professors working at both public and private colleges. These professors also oversee MPhil and PhD studies, and most of the research done at that time was for MPhil or PhD theses (Kamrani et al., 2022).

References

  • Firdous, N. (2010). Historical Perspective of Psychology in Balochistan: Depiction, Dynamics and Development. Bi-Annual Research Journal “Balochistan Review”,23(2), 93-111. Available at: http://www.uob.edu.pk/Journals/Balochistan-Review/data/BR%2002%202010/93-111%20HISTORICAL%20PERSPECTIVE%20OF%20PSYCHOLOGY%20IN%20BALOCHISTAN%20DEPICTION,%20DYNAMICS%20AND%20DEVELOPMENT,%20Neelam%20Firdous.pdf
  • Higher Education Commission (2019). Quality Assurance. https://hec.gov.pk/english/services/universities/QA/Pages/faculty-appointment-criteria.aspx
  • Kamrani, F., Kamrani, N., &Kamrani, F. (2022). Eleven Years of Psychological Researches in Pakistan (1995-2006): What Titles Reveal About Pakistani Research. Journal of Professional & Applied Psychology, 3(2), 319-326. https://doi.org/10.52053/jpap.v3i2.117
  • Rafiq, M., Zareen, G., Khalid, A., Chahal, F. M., Maqbool, T., &Hadi, F. (2022). Clinical and neuropsychology in pakistan: challenges and wayforward. Pak-Euro Journal of Medical and Life Sciences, 5(1), 119-128. Available at:https://readersinsight.net/PJMLS/article/view/2442
  • Zadeh, Z. F. (2017). Clinical Psychology in Pakistan: Past, Present and Future. International Journal of Humanities and Social Science, 7(11), 26-28. Available at: https://www.ijhssnet.com/journals/Vol_7_No_11_November_2017/4.pdf Zaman,R.M. (1991). Clinical Psychology in Pakistan. Psychology and Developing Societies. Sage Publication. Available at: http://www.sagepublication.com?content/3/2/221.
Categories
Psychiatric Disorders

Diagnostic Features of Attention-Deficit/Hyperactivity Disorder

Written by Najwa Bashir

ADHD is a brain condition characterized by problems with not paying attention, getting things done, or being too active and impulsive. People with inattention and disorganization can’t stay on task, don’t seem to listen and lose things they need for jobs at levels that aren’t appropriate for their age or level of development. Overactivity, pacing, not being able to stay sat, interrupting other people’s activities, and not being able to wait are all signs of hyperactivity-impulsivity that are too much for the person’s age or level of development. During youth, ADHD often happens at the same time as “externalizing disorders” like oppositional defiant disorder and conduct disorder of some people. ADHD often lasts into adulthood, which can make it hard to function in social, school, and work settings (American Psychiatric Association, 2022, p. 36).

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental and behavioral illnesses that kids and teens come to see for help. People with ADHD often have signs and problems that last a long time, even into adulthood. A lot of the time, ADHD is linked to other problems, like mood, worry, or drug abuse issues. Untreated ADHD has a lot of social and community costs over a person’s lifetime, such as poor academic and job performance, crime, car accident safety, and relationship problems (Wilens & Spencer, 2010). ADHD is one of the most common neurological diseases in the world. About 5–7% of children and teens (Polanczyk et al., 2007; Thomas et al., 2015) and about 2.5% of adults (Fayyad et al., 2017; Song et al., 2021) have it. A careful clinical review of symptoms and functional problems is needed to make a diagnosis of ADHD. Important standard factors help doctors make accurate diagnoses, such as the Diagnostic and Statistical Manual of Mental Disorders – 5th version (DSM 5) (Da Silva et al., 2023). According to DSM 5 TR, the following are the diagnostic criteria and features of attention-deficit/hyperactivity disorder.

Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

A. A pattern of persistent lack of attention and/or hyperactivity-impulsivity that gets in the way of working or growth, as shown by (1) and/or (2):

  1. Not paying attention: at least six of the following symptoms have been present for at least six months in a way that is not consistent with the child’s developmental level and has a direct negative effect on social, academic, or work activities:
    Note: The symptoms are not just a sign of oppositional behavior, resistance, anger, or not being able to understand what to do or how to do it. There must be at least five signs for older teens and adults (17 years and up).
    a. Doesn’t pay close attention to details or makes careless mistakes in school, work, or other activities (for example, forgets or skips details, produces incorrect work).
    b. Often has trouble staying focused on tasks or games (for example, has trouble staying on task during classes, talks, or long reading).
    c. During direct communication, often doesn’t seem to listen (e.g., mind seems elsewhere, even when there aren’t any obvious distractions).
    d. In general, doesn’t do what they’re told and doesn’t finish schoolwork, jobs, or work duties (for example, they might start a task but get distracted quickly).
    e. Has a lot of trouble planning activities and tasks (for example, can’t keep things in order; work is often messy and disorganized; suffers from poor time management and misses deadlines).
    f. Usually avoids, dislikes, or doesn’t want to do things that take long-term mental effort, like schoolwork or chores; for older teens and adults, this could include writing reports, filling out forms, or going over long papers.
    g. Frequently drops things they need to do things (like school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, cell phones, etc.).
    h. Is quickly distracted by outside stimuli, which for later teens and adults may include thoughts that aren’t connected.
    i. Forgets to do things like do jobs and run errands, or for older teens and adults, remember to return calls, pay bills, and keep meetings.
  2. Hyperactivity and impulsivity: At least six of the following symptoms have been present for at least six months in a way that is not consistent with the child’s age or level of development and has a bad effect on social, academic, or work activities:
    Note: The symptoms are not just a sign of oppositional behavior, resistance, anger, or not being able to understand what to do or how to do it. There must be at least five signs for older teens and adults (17 years and up).
    a. Moves their hands or feet around a lot or squirms in their seat.
    b. Often gets up from their seat when they are supposed to stay put, like when they are in class, the office, or another place of work, or when they need to stay put in other situations.
    c. Runs around or climbs up often when it’s not proper to do so. Note: In teens and adults, it may just mean feeling restless.
    d. Not able to play or do other fun things alone very often.
    “Is often on the go,” acting like they are “driven by a motor” (e.g., can’t or doesn’t like being still for long periods of time, like in restaurants or meetings; others may see them as restless or hard to keep up with).
    f. Talks too much a lot of the time.
    g. Often blurts out an answer before the question is finished (for example, finishing other people’s words; can’t wait their turn in a talk).
    h. Often has trouble waiting for his or her turn (for example, in line).
    Often stops or gets in the way of other people’s conversations, games, or activities (for example, butts into conversations, games, or activities; may start using other people’s things without asking or getting permission; for teens and adults, may get in the way of or take over what others are doing).

B. Several signs of not paying attention or being restless and reckless were present before the age of 12.
C. In two or more places (like at home, school, or job; with friends or family; doing other things), the person shows several signs of not paying attention or being hyperactive-impulsive.
D. There is strong proof that the symptoms impair or lower the quality of social, academic, or professional performance.
E. The symptoms aren’t just a part of schizophrenia or another psychotic disorder, and they can’t be explained by another mental disorder, like a mood disorder, an anxiety disorder, a dissociative disorder, a personality disorder, or heavy or light drug use.

Specify if:
F90.2 If both Criteria A1 (not paying attention) and A2 (being hyperactive or impulsive) have been met for the past 6 months, the person will be given a combined presentation.
F90.0 Presentation that is mostly not paying attention: If Criteria A1 (not paying attention) is met but Criteria A2 (hyperactivity or recklessness) has not been met in the last 6 months.
F90.1 If Criteria A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) has not been met in the last 6 months, the person is likely to be hyperactive or impulsive.
Specify if:
In partial remission: Less than the full set of standards have been met for the past 6 months, but the symptoms still make it hard to function in social, school, or occupational settings.
Specify the current severity:
Mild: There are few or no symptoms that go beyond those needed to make the diagnosis, and the symptoms don’t make it hard to do things at work or in social situations.
Moderate: There are symptoms or problems with functioning that are between “mild” and “severe.”
Severe: There are a lot of symptoms, more than what is needed to make a diagnosis, or several very bad symptoms. The symptoms make it very hard to function in social or work settings.

Diagnostic Features for Attention-Deficit/Hyperactivity Disorder

  • Attention-deficit/hyperactivity disorder (ADHD) is characterized by a pattern of chronic inattention and/or hyperactivity-impulsivity that gets in the way of working or growth. ADHD kids with inattention act out by getting sidetracked, not following through on directions, not finishing work or jobs, having trouble staying focused, and being disorganized. This isn’t because they are defiant or don’t understand.
  • Hyperactivity is when a person does too much of something, like running around when it’s not proper, or when they fidget, tap, or talk too much. Adults with hyperactivity may be very antsy or wear other people out with all their activity. If someone acts impulsively, they do things quickly and without thinking, which could hurt themselves (for example, running into the street without looking).
  • Impulsivity could mean that a person wants benefits right away or can’t wait to get them. People who act on impulse may be socially offensive (for example, talking over other people too much) or make big decisions without thinking about the long-term effects (for example, applying for a job without enough information).
  • ADHD starts in childhood.
  • The fact that several symptoms must be present before age 12 shows how important a significant clinical picture during childhood is. At the same time, a younger age at onset is not given because it is hard to say for sure when the symptoms started in youth.
  • It is not always accurate for adults to remember symptoms from their youth, so it is helpful to get extra information. ADHD can’t be confirmed if there aren’t any signs before age 12.
  • If signs of what seems to be ADHD show up for the first time after age 13, they are more likely to be caused by another mental problem or the brain effects of drugs.
  • The problem must show up in more than one place, like at home, at school, and at work. It’s usually not possible to get a good picture of a person’s major symptoms in different settings without talking to people who have seen them in those situations.
  • Most of the time, signs change based on the situation and place.
  • Signs of the disorder might not be present if the person is rewarded often for good behavior, is closely watched, is in a new place, is doing very interesting things, is constantly stimulated from the outside (for example, by electronic screens), or is interacting with one person at a time (for example, in the clinician’s office).

The aforementioned criteria and features by DSM 5 TR can be kept into consideration to diagnose individuals with attention-deficit/hyperactivity disorder. Early diagnosis can ensure the treatment is started in the early phase of the individual’s life to help him deal with the issues and avoid farsighted adverse consequences.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Da Silva, B. S., Grevet, E. H., Silva, L. C. F., Ramos, J. K. N., Rovaris, D. L., & Bau, C. H. D. (2023). An overview on neurobiology and therapeutics of attention-deficit/hyperactivity disorder. Discover Mental Health, 3(1), 2. https://doi.org/10.1007/s44192-022-00030-1
  • Fayyad, J., Sampson, N. A., Hwang, I., Adamowski, T., Aguilar-Gaxiola, S., Al-Hamzawi, A., … & Kessler, R. C. (2017). The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys. ADHD Attention Deficit and Hyperactivity Disorders, 9, 47-65. https://doi.org/10.1007/s12402-016-0208-3
  • Polanczyk, G., De Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American journal of psychiatry, 164(6), 942-948. https://doi.org/10.1176/ajp.2007.164.6.942
  • Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health, 11. https://doi.org/10.7189/jogh.11.04009
  • Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994-e1001. https://doi.org/10.1542/peds.2014-3482
  • Wilens, T. E., & Spencer, T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate medicine, 122(5), 97-109. https:/doi.org/10.3810/pgm.2010.09.2206
Categories
Psychiatric Disorders

Diagnostic Features of Autism Spectrum Disorder

Written by Najwa Bashir

Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by problems communicating with others, limited hobbies, and doing the same things over and over again (American Psychiatric Association, 2013). Autism spectrum disorder, or ASD, is a group of brain disorders. Patterns of behavior, hobbies, activities, and social problems that happen over and over again are what define this range. Some kids with ASD have behavior and mental health issues. This is because ASD is a difficult neurodevelopmental disease. Unfortunately, these kids get upset when things change around them because they aren’t very good at adapting. The signs start in early childhood and make it hard to do normal things. Language problems, brain challenges, and epilepsy happen more often in children with ASD than in the general population (Mughal et al., 2022).

The World Health Organization (WHO) reports that 0.76 percent of children around the world have ASD. However, this only includes about 16 percent of all children in the world (Baxter et al., 2015). The Centers for Disease Control and Prevention (CDC) says that about 1.68% of 8-year-old children in the US (or 1 in 59 children) are identified with ASD (Biao, 2018; Palinkas et al., 2019). Parent-reported ASD findings in the US in 2016 were 2.5% on average (Kogan et al., 2018). Autism and Developmental Disabilities Monitoring Network (ADDM) data shows that the number of people with ASD in the US more than doubled between 2000–2002 and 2010–2012 (Biao, 2018). It might be too early to say anything about trends, but in the US, the number of people with ASD seems to have leveled off, with no statistically significant rise from 2014 to 2016 (Xu et al., 2018). No changes have been made to the DSM-5 diagnostic standards yet, so it’s too early to say what effect they will have on frequency (Palinkas et al., 2019).

ASD can happen to people of any race, ethnicity, or income level, but not everyone with ASD is diagnosed the same way. It has been shown that ASD is more common in white children than in black or Hispanic children (Baio, 2018). Even though the differences seem to be going down, they may still be there because of shame, limited access to healthcare services, or the fact that a patient’s first language is not English (Hodges et al., 2020).

People all over the world who have ASD have a lot of health problems. Finding ASD early can lower the number of children who have developmental problems and help them communicate better (Salari et al., 2022). The following text mentions the diagnostic criteria and features of autism spectrum disorder according to DSM 5 TR (American Psychiatric Association, 2022).

Diagnostic Criteria for Autism Spectrum Disorder

A. Consistent problems with social contact and interaction in a variety of settings, shown by any or all of the following, either now or in the past (examples are meant to show, not list all of them; see text):

  1. Problems with social and emotional exchange, such as an odd social approach and an inability to have a normal back-and-forth talk; less sharing of interests, feelings, or affect; or failing to start or respond to social interactions.
  2. Lack of skills in nonverbal communication behaviors used for social interaction, such as not combining verbal and nonverbal communication well, having problems with eye contact and body language, not understanding and using gestures properly, or not using any facial expressions or nonverbal communication at all.
  3. Problems with making, keeping, and understanding relationships, such as having trouble changing how they act in different social situations, having trouble making friends or sharing pretend play, or not being interested in their peers.

B. Limited, recurring patterns of behavior, hobbies, or activities, as shown by at least two of the following, either now or in the past (examples are provided for reference only; see text):

  1. Movements, objects, or words that are patterned or repeated, such as simple motor stereotypies like lining up toys or spinning objects, echolalia, or using unique phrases.
  2. Insisting on things staying the same, not changing, or speaking or acting in a certain way over and over again (for example, being very upset by small changes, having trouble with transitions, having rigid thought patterns, welcome practices, or having to take the same route or eat the same food every day).
  3. Very limited, fixed interests that are intense or focused in a way that isn’t normal (for example, a strong connection to or preoccupation with strange items, interests that are too limited or that last too long).
  4. Being overly or underly sensitive to sensory input or showing an odd interest in sensory parts of the environment (for example, not caring about pain or temperature, being sensitive to certain sounds or textures, smelling or touching things too much, or being visually interested in lights or movement).

C. Symptoms must be present in the early stages of development, but they may not show up fully until social demands are too much for the person’s limited abilities, or they may be hidden by tactics learned later in life.
D. The symptoms make it hard to act normally in social, professional, or other important areas of life.
E. Intellectual developmental disorder (also called intellectual disability) or global developmental delay are not better ways to explain these problems. A lot of the time, intellectual developmental disorder and autism spectrum disorder happen together. To identify both of them at the same time, a person’s social speech skills must be below what is normal for their age.

Note: People who have a sure-fire DSM-IV diagnosis of autism spectrum disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise defined should be given that label. If someone has major problems with social communication but doesn’t otherwise meet the standards for autism spectrum disorder, they should be checked for social (pragmatic) communication disorder.
Specify the current level based on problems with social contact and limited, repeated patterns of behavior:
Requiring very strong strength
Requiring a lot of help
Needing help:
Specify if:
Whether there is intellectual disability along with it
Together with or without language problems
Specify if:
linked to a known genetic or other health problem or external cause (Note on the code: add more code to find the genetic or other medical problem that goes with it.)
linked to a mental, behavioral, or neurological issue
Specify if:
With catatonia

Diagnostic Features of Autism Spectrum Disorder

  • As per criteria A and B, people with autism spectrum disorder have limited, repetitive patterns of behavior, hobbies, or activities and chronic problems with reciprocal social contact and social interaction. These signs show up early in life and make it hard to do normal things (Criteria C and D).
  • Core diagnostic features are clear during the developmental stage, but problems may not be seen in some situations because of assistance, compensation, and present supports.
  • The disorder also shows up in very different ways based on how severe the autism is, the person’s level of development, their chronological age, and maybe even their gender. This is where the word “spectrum” comes from.
  • People who don’t have intellectual or language impairments may have more minor signs of deficits (e.g., Criterion A, Criterion B) than people who do have intellectual or language impairments and may be working hard to hide these deficits.
  • Lack of social communication problems will be less obvious if a person has better communication skills in general (for example, speaks clearly and doesn’t have any brain disabilities). In the same way, Criterion B weaknesses (limited patterns of behavior and interests) might not be as clear if the interests are more in line with what kids their age normally like (like trains or Ancient Egypt instead of moving a string).
  • The problems with social contact and conversation that are listed in Criterion A are widespread and last a long time.
  • Verbal and unconscious communication problems in social situations show up in different ways based on the person’s age, level of intelligence, language skills, and other things like past and present care and support.
  • Lack of speech, language delays, trouble understanding speech, repeated speech, or speech that is too precise or stilted are just a few of the language problems that many people have. Autism spectrum disease makes it hard to use language for social contact, even when formal language skills like vocabulary and grammar are fine.
  • Lack of social-emotional exchange, or the ability to interact with others and share thoughts and feelings, can be seen in young children who don’t initiate social interactions or share emotions, and who also don’t copy other people’s behavior closely or at all.
  • Languages that do exist are often one-sided and don’t involve social reciprocity. They are used to ask for things or name things instead of to talk, share thoughts, or make comments. When it comes to older kids and people who don’t have intellectual disabilities or language delays, problems with social-emotional reciprocity may show up as issues with understanding and responding to complicated social cues like learning when and how to join a chat and what not to say.
  • Individuals who have come up with ways to deal with some social challenges still have trouble in new or uncontrolled situations and find it hard and stressful to consciously figure out what is socially natural for most people. Researchers think that this behavior may make it harder to diagnose autism spectrum disorder in these people, maybe especially in older women.
  • People who have problems with nonverbal communication skills for social interactions may not make eye contact, make eye contact less often, or use movements, facial expressions, body language, or speech intonation in ways that are not normal for their culture.
  • Impaired joint attention is an early sign of autism spectrum disorder. This can show up as not pointing, showing, or bringing things to share an interest with others, or as not following someone’s eye look or pointing.
  • People may learn a few useful gestures, but their collection is smaller than other people’s, and they don’t always use expressive motions when they’re talking to others. Teenagers and adults who speak more than one language may have trouble matching their body language with their speech, which can make their relationships seem strange, awkward, or over the top.
  • In some situations, impairment may be pretty subtle (for example, someone may make good eye contact when talking), but it will be clear if they can’t combine eye contact, gesture, body posture, prosody, and facial expression when they’re talking to other people, or if they have trouble keeping these things up for long periods of time or when they’re stressed. People who have trouble making, keeping, and understanding relationships should be rated by how well they meet age, gender, and cultural norms.
  • It’s possible that there isn’t any, very little, or normal social interest, which can show up as rejecting others, being passive, or approaching them in a way that seems hostile or annoying. These issues are especially clear with young kids, who don’t get enough shared social play and imaginative play (like age-appropriate, open pretend play). Later, they become very set in their ways when they play.
  • Older people may find it hard to understand what behavior is acceptable in some settings but not others (for example, being relaxed during a job interview) or the various ways that language can be used to communicate (for example, comedy, white lies). There may be a clear desire for doing things by yourself or with people who are much younger or older than you.
  • Many times, people want to make friends without having a full or accurate picture of what friendship really means (for example, bonds that only involve shared hobbies). It’s also important to think about your relationships with peers, coworkers, and providers (in terms of reciprocity).
  • As stated in Criterion B, someone with autism spectrum disorder also has limited, repetitive patterns of behavior, hobbies, or activities. These patterns can look different depending on the person’s age, ability, intervention, and present supports.
  • Some examples of stereotyped or repetitive behaviors are flapping the hands or flicking the fingers, using the same objects over and over (like spinning coins or lining up toys), and talking in the same way over and over (echolalia, which is the delayed or immediate repetition of heard words; using “you” when talking about oneself; using stereotyped words, phrases, or prosodic patterns).
  • Too much adherence to routines and limited patterns of behavior can show up as resistance to change (e.g., distress at what seem like small changes, like taking a different route to school or work; insisting on following rules; rigidity of thought) or ritualized patterns of speaking or acting (e.g., asking the same questions over and over, pacing a perimeter).
  • People with autism spectrum disorder often have very narrow, fixed interests that aren’t focused or intense enough. For example, a baby who is very attached to a pan or piece of string; a child who is obsessed with vacuum cleaners; an adult who spends hours making schedules.
  • Some interests and habits may be caused by an apparent over- or under-reactivity to sensory input. This can show up as strong reactions to certain sounds or textures, touching or smelling things too much, being fascinated by lights or spinning objects, or sometimes not caring about pain, heat, or cold.
  • Extreme reactions or routines about the way food tastes, smells, feels, or looks, or limiting food too much, are common and may be a sign of autism spectrum disorder.
  • A lot of people with autism spectrum disorder who don’t have problems with their intelligence or speaking learn to control their repeated behaviors in public. For these people, doing the same thing over and over, like rocking or moving their fingers, may help them relax or calm down. Special hobbies can be fun and inspiring, and they can also help you get an education and a job later on.
  • Limited, repeated patterns of behavior, hobbies, or activities may have been present as a kid or in the past, even if the symptoms are not present now. This means that the diagnostic criteria were met.
  • Criterion D says that the traits must make it clinically significant harder to do important things in social, occupational, or other areas of present performance.
  • Criterion E says that the person’s social communication problems, which may be joined by an intellectual developmental disorder (ID), are not in line with their developmental level; the problems are worse than what would be expected based on their level of development.

Conclusion

Individuals all over the world who have ASD have a lot of health problems. Diagnosing ASD early can lower the number of children who have developmental problems and help people communicate better. So, health officials need to know how common ASD is and how it’s getting worse so they can plan and carry out the right steps to lessen its effects.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Baio, J. (2018). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR. Surveillance Summaries, 67. http://dx.doi.org/10.15585/mmwr.ss6706a1
  • Baxter, A. J., Brugha, T. S., Erskine, H. E., Scheurer, R. W., Vos, T., & Scott, J. G. (2015). The epidemiology and global burden of autism spectrum disorders. Psychological medicine, 45(3), 601-613. https://doi.org/10.1017/S003329171400172X
  • Hodges, H., Fealko, C., & Soares, N. (2020). Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Translational pediatrics, 9(Suppl 1), S55. https://doi.org/10.21037/tp.2019.09.09
  • Kogan, M. D., Vladutiu, C. J., Schieve, L. A., Ghandour, R. M., Blumberg, S. J., Zablotsky, B., … & Lu, M. C. (2018). The prevalence of parent-reported autism spectrum disorder among US children. Pediatrics, 142(6). https://doi.org/10.1542/peds.2017-4161
  • Mughal, S., Faizy, R. M, Saadabadi, A. (2022). Autism Spectrum Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525976/
  • Palinkas, L. A., Mendon, S. J., & Hamilton, A. B. (2019). Innovations in mixed methods evaluations. Annual review of public health, 40(1), 423-442. https://doi.org/10.1146/annurev-publhealth-040218-044215
  • Salari, N., Rasoulpoor, S., Rasoulpoor, S., Shohaimi, S., Jafarpour, S., Abdoli, N., … & Mohammadi, M. (2022). The global prevalence of autism spectrum disorder: a comprehensive systematic review and meta-analysis. Italian Journal of Pediatrics, 48(1), 112. https://doi.org/10.1186/s13052-022-01310-w
  • Xu, G., Strathearn, L., Liu, B., & Bao, W. (2018). Prevalence of autism spectrum disorder among US children and adolescents, 2014-2016. Jama, 319(1), 81-82. https://doi.org/10.1001/jama.2017.17812
Categories
Psychiatric Disorders

Diagnostic Features of Social (Pragmatic) Communication Disorder

Written by Najwa Bashir

In the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a new condition called Social (Pragmatic) Communication condition (SPCD) was added. Individuals with this disorder have problems with their pragmatic communication skills (Amoretti et al., 2021). Individuals with this condition, which is a type of Communication Disorder (CD), have a major issue with their functional skills in a broad sense. Sometimes people with SPCD have trouble communicating with others, can’t change what they say depending on the situation, and have trouble following the rules of speech (American Psychiatric Association, 2013, p. 47).

Children who don’t meet the standards for an autism spectrum disorder may have social problems when they talk to others. This is referred to as social (pragmatic) communication disorder (Flax et al., 2019). In the past, before DSM-5, three types of behavior were needed to diagnose ASD: interacting with others, communicating, and restricted, repetitive, or stereotypical behaviors. Communication and social interaction have been combined into a single criterion called “Social Communication,” with structure language used as an additional descriptor. The RRB criteria have stayed mostly the same, with the addition of sensory problems and behaviors that were not in DSM-IV. The term “Social Pragmatic Communication Disorder” (SPCD) was created to include kids who didn’t meet the new criteria for ASD but might have met criteria for DSM-IV, and PDD-NOS in the past, such as having limited hobbies and doing the same things over and over again (Swineford et al., 2014). ASD 299.00 (F84.0) or Language Disorder 315.39 (F80.9) are not the only problems that kids with SPCD have when it comes to communicating with others. As Flax et al. (2019) say, SPCD is a developmental condition that causes problems with social, vocal, and nonverbal communication.

Prevalence

Not much is known about how common SPCD is in the general population using DSM-5 criteria right now. Also, there isn’t much known about what functional effects come from weaknesses in certain types of social-pragmatic communication (Adams et al., 2015). South Korean kids ages 7 to 12 who were evaluated for autism had SPCD in 0.5% of the cases (Kim et al., 2014). A clinical group of kids with autism was screened, and only 8% met the standards for SPCD. Most of these kids had major behavior problems (Mandy et al., 2017). The structure language skills, on the other hand, were not reviewed independently (Saul et al., 2023).

Functional Impairment

Many kids who have problems with social and pragmatics also have issues with their behavior and emotions (Mandy et al., 2017). Gemillion and Martel (2014) also say that kids who have behavior problems often have issues with speaking, social skills, and everyday life skills. Some people have said that social-pragmatic skills help connect structured language to behavior, especially in poor areas (Law et al., 2014). It has also been said that social and functional communication skills are important for getting ready for school (Pace et al., 2019). These skills play a big role in how well kids do in reading and math at a young age and in their ability to control their emotions (Ramshook et al., 2020). As expected, kids with SPCD have trouble with schoolwork, especially reading (Freed et al., 2015), because they need to use their social cognitive and inferencing skills to understand what they read. So far, research has shown that social-pragmatic deficits are linked to other developmental issues that raise the risk of bad outcomes. This shows how much SPCD might cost the public health system and how important it is to plan good health and education services for kids who have these problems (Saul et al., 2023).

Diagnostic Criteria for Social (Pragmatic) Communication Disorder

According to DSM 5 TR (APA, 2022), the following are the diagnostic criteria for social (pragmatic) communication disorder:    

A. People who have persistent problems with social verbal and unconscious interactions show it in the following ways:

  1. Problems making friends and communicating in a way that fits the social situation, like saying hello and sharing information.
  2. Being unable to change the way you talk depending on the setting or the person you are talking to includes not using too much serious language, talking differently in a classroom than on the field, and talking differently to a child than to an adult.
  3. Problems following the rules for talking and sharing stories, such as being patient, asking questions when something isn’t clear, and knowing how to use spoken and silent hints to manage interactions.
  4. Difficulty understanding subtext (like making conclusions) and unclear language (like puns, jokes, metaphors, and words that can mean more than one thing depending on the context).

B. The problems make it hard to communicate, meet new people, form relationships, do well in school, or do well at work, either on their own or together with other problems.
C. The signs start in the early stages of development, but the problems might not show up fully until they have to deal with social situations that are too hard for them to handle.
D. The symptoms aren’t caused by another neurological or medical condition or by not being good at grammar and word structure. They also don’t fit better with autism spectrum disorder, intellectual developmental disorder (ID), global developmental delay, or another mental disorder.

Diagnostic Features of Social (Pragmatic) Communication Disorder

Drawing on DSM 5 TR (APA, 2022), here are the signs  that someone has  childhood fluency disorder:

  • Finding it hard to understand pragmatics, which is the social use of words and conversation. This shows up as problems understanding and following the rules of both spoken and unspoken communication in real-life situations, as well as changing their language to fit the listener’s needs or the situation, and following the rules for conversations and telling stories.
  • Due to problems with social communication, people can’t communicate effectively, participate in social activities, make friends, do well in school, or do their jobs successfully. There is no better way to understand the problems than by having low skills in structural language, cognitive ability, or autism spectrum disease.

Associated Features

Below-mentioned are some associated features of social (pragmatic) communication disorder:

  • Language impairment, which means falling behind in language stages and having structured language problems in the past or present, is the most common social (pragmatic) communication disorder trait.
  • People who have trouble communicating with others may avoid social situations.
  • People who are affected are also more likely to have attention-deficit/hyperactivity disorder (ADHD), mental and behavioral problems, and certain learning issues.

Looking at the prevalence scores of this disorder, it appears that the condition is not diagnosed much and there have not been enough studies on it. However, the aforementioned diagnostic criteria and features can help spot individuals with SPCD so professional treatment can be sought in time.

References

  • Adams, C., Gaile, J., Lockton, E., & Freed, J. (2015). Integrating language, pragmatics, and social intervention in a single-subject case study of a child with a developmental social communication disorder. Language, Speech, and Hearing Services in Schools, 46(4), 294-311. https://doi.org/10.1044/2015_LSHSS-14-0084
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Amoretti, M. C., Lalumera, E., & Serpico, D. (2021). The DSM-5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review. History and Philosophy of the Life Sciences, 43(4), 108. https://doi.org/10.1007/s40656-021-00460-0
  • Flax, J., Gwin, C., Wilson, S., Fradkin, Y., Buyske, S., & Brzustowicz, L. (2019). Social (pragmatic) communication disorder: Another name for the broad autism phenotype? Autism, 23(8), 1982-1992. https://doi.org/10.1177/1362361318822503
  • Freed, J., Adams, C., & Lockton, E. (2015). Predictors of reading comprehension ability in primary school-aged children who have pragmatic language impairment. Research in developmental disabilities, 41, 13-21. https://doi.org/10.1016/j.ridd.2015.03.003
  • Gremillion, M. L., & Martel, M. M. (2014). Merely misunderstood? Receptive, expressive, and pragmatic language in young children with disruptive behavior disorders. Journal of Clinical Child & Adolescent Psychology, 43(5), 765-776. https://doi.org/10.1080/15374416.2013.822306
  • Kim, Y. S., Fombonne, E., Koh, Y. J., Kim, S. J., Cheon, K. A., & Leventhal, B. L. (2014). A comparison of DSM-IV pervasive developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample. Journal of the American Academy of Child & Adolescent Psychiatry, 53(5), 500-508. https://doi.org/10.1016/j.jaac.2013.12.021
  • Law, J., Rush, R., & McBean, K. (2014). The relative roles played by structural and pragmatic language skills in relation to behaviour in a population of primary school children from socially disadvantaged backgrounds. Emotional and Behavioural Difficulties, 19(1), 28-40. https://doi.org/10.1080/13632752.2013.854960
  • Mandy, W., Wang, A., Lee, I., & Skuse, D. (2017). Evaluating social (pragmatic) communication disorder. Journal of Child Psychology and Psychiatry, 58(10), 1166-1175. https://doi.org/10.1111/jcpp.12785
  • Pace, A., Alper, R., Burchinal, M. R., Golinkoff, R. M., & Hirsh-Pasek, K. (2019). Measuring success: Within and cross-domain predictors of academic and social trajectories in elementary school. Early Childhood Research Quarterly, 46, 112-125. https://doi.org/10.1016/j.ecresq.2018.04.001
  • Ramsook, K. A., Welsh, J. A., & Bierman, K. L. (2020). What you say, and how you say it: Preschoolers’ growth in vocabulary and communication skills differentially predict kindergarten academic achievement and self‐regulation. Social Development, 29(3), 783-800. https://doi.org/10.1111/sode.12425
  • Saul, J., Griffiths, S., & Norbury, C. F. (2023). Prevalence and functional impact of social (pragmatic) communication disorders. Journal of Child Psychology and Psychiatry, 64(3), 376-387. https://doi.org/10.1111/jcpp.13705
  • Swineford, L. B., Thurm, A., Baird, G., Wetherby, A. M., & Swedo, S. (2014). Social (pragmatic) communication disorder: A research review of this new DSM-5 diagnostic category. Journal of neurodevelopmental disorders, 6, 1-8. https://doi.org/10.1186/1866-1955-6-41
Categories
Psychiatric Disorders

Diagnostic Features of Childhood-Onset Fluency Disorder (Stuttering)

Written by Najwa Bashir

Stuttering

Sometimes called stammering and more generally disfluent speech, stuttering is a speech condition marked by repeating sounds, syllables, or words; sound delay; and speech breaks called blocks (NIDCD, 2017). The childhood-onset fluency disorder is a chronic change in the normal flow and timing of speech that is not proper for the person’s age (American Psychiatric Association, 2013 as cited in SheikhBahaei et al., 2022).

Individuals who stutter know exactly what they want to say but struggle to organize it smoothly. People with trouble speaking may also show signs of stress, like blinking their eyes quickly or trembling their lips. People who stutter may find it hard to talk to others, which can impact their quality of life and ties with others. Stuttering can also make it harder to get a job which can negatively impact your chances of getting hired, and treatment can cost a lot of money. People who stutter can have very different symptoms at different times of the day. Most of the time, stuttering gets worse when someone speaks in front of a group or on the phone. On the other hand, singing, reading, or speaking in unison can briefly make stuttering better (NIDCD, 2017).

Differences in the structure, function, and control of dopamine in the brain have been linked to stuttering. These differences are thought to be genetic. It is important to make sure that the right evaluation or recommendation is made for children because more and more people agree that starting speech therapy early for kids who stutter is very important. For adults, stuttering can be linked to a lot of mental and social problems, like social nervousness and a low quality of life. Recently, pharmacologic treatment has gotten a lot of attention, but there isn’t a lot of clinical evidence to back it up. Speech therapy is still the most common way to help kids and adults (Perez & Stoeckle, 2016). The number of people who have DS depends on their age and the exact meaning of stuttering that is used. The most common number given is a lifetime frequency (chance that a person will ever stutter) of 5%. However, new information suggests that the total frequency is more like 10% (Yairi & Ambrose, 2013), with kids being most affected. Up to 90% of kids who stutter (CWS) will get better on their own as kids. Persistent DS is when an adult did not heal from DS as a kid. This happens to less than 1% of the population (Yairi & Ambrose, 2013). Stuttering that is thought to be caused by mental stress or brain damage is less common, but no one knows how common it is (Theys et al., 2011). According to Yari and Ambrose (2013), men are four times more likely than women to have DS, and men are also more likely to have it last longer than women. Other things that can help you tell if someone will continue with stuttering are a late start age, longer length of stuttering, a family history of persistence, and lower language and nonverbal skills (Yairi et al., 1996). It is very important to diagnose children right away because early treatment has the best results (Weir & Bianchet, 2004).

Diagnostic Criteria for Childhood-Onset Fluency Disorder

According to DSM 5 TR (APA, 2022), the following is the diagnostic criteria for childhood-onset fluency disorder:

A. Disturbances in the regular flow and timing of speech that aren’t acceptable for the person’s age or language skills, last a long time, and are marked by one or more of the following happening often and clearly:

  1. Repetition of sounds and syllables.
  2. Sound expansions of vowels and consonants.
  3. Broken words (e.g., stops within a word).
  4. Audible or silence blocking (filled or unfilled breaks in words).
  5. Circumlocutions are word changes that get rid of troublesome words.
  6. Words that are spoken with too much physical stress.
  7. Whole words that repeat on one syllable, like “I-I-I-I see him”

B. The problem makes people nervous about saying out loud or makes it harder for them to communicate, interact with others, or do well in school or at work, either on its own or in combination with other problems.
C. Symptoms start in the early stages of growth. Note: cases that start later are called F98.5 adult-onset speech disorder.
D. It’s not caused by a problem with speech, movement, or senses; it’s not slurred speech from a brain injury (like a stroke, tumor, or trauma); it’s not caused by another medical condition; and it’s not better explained by another mental disease.

Diagnostic Features of Childhood-Onset Fluency Disorder

In the light of DSM 5 TR, the following are the diagnostic features of childhood-fluency disorder:

  • A main feature of childhood-onset fluency disorder (stuttering) is a change in the usual flow and timing of speech that isn’t proper for the person’s age.
  • This disorder is marked by repeated or prolonged sounds or syllables and different kinds of speech problems, such as broken words (like pauses within a word), audible or silent blocking (like filled or unfilled pauses in speech), circumlocutions (like changing words to avoid problematic ones), words made with too much physical tension, and repeated monosyllabic whole-words (like “I-I-I-I see him”).
  • The problem with speech could make it harder to do well in school or at work and to talk to other people.
  • Situationally, the level of disturbance changes, and it’s usually worse when there’s extra pressure to talk (like when you have to give a report at school or talk about a job).
  • Most of the time, dysfluency doesn’t show up when reading out loud, singing, or talking to pets or inanimate objects.

Associated Features

The associated features are as follows (APA, 2022):

  • Individuals may start to fear the problem before it happens.
  • Disfluencies can be avoided by changing the rate of speech or ignoring certain words or sounds. The speaker may also try to avoid certain speech situations, like talking on the phone or in public.
  • Not only do worry and anxiety make dysfluency worse, they are also symptoms of the disease.
  • Motor movements may happen along with a childhood-onset fluency disorder. These can include eye blinks, tics, twitches of the lips or face, jerks of the head, breathing movements, and tightening of the hand.
  • There are different levels of speaking skills in kids with speech disorders, and it’s not clear what the link is between the two. Studies have shown that kids who stutter have differences in both the structure and function of their brains. Estimates vary based on age and the possible cause of stuttering, but men are more likely than women to stumble.
  • Stuttering has many causes, some of which are genetic and some of which are neurological.

Conclusion

The childhood-onset fluency disorder is a serious concern as it can cause trouble in communication, academics, and overall functioning of the children, either directly or indirectly. Therefore, it is important to take the signs and symptoms of stuttering seriously and seek treatment immediately.

References

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • NIDCD (2017). Stuttering. Available from: https://www.nidcd.nih.gov/health/stuttering#:~:text= Stuttering%20is%20a%20speech%20disorder,a%20normal %20flow%20of%20speech.
  • Perez, H. R., & Stoeckle, J. H. (2016). Stuttering: clinical and research update. Canadian family physician, 62(6), 479-484. Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907555/
  • SheikhBahaei, S., Millwater, M., & Maguire, G. A. (2023). Stuttering as a spectrum disorder: A hypothesis. Current Research in Neurobiology, 5, 100116. https://doi.org/10.1016/j.crneur.2023.100116
  • Theys, C., Van Wieringen, A., Sunaert, S., Thijs, V., & De Nil, L. F. (2011). A one year prospective study of neurogenic stuttering following stroke: incidence and co-occurring disorders. Journal of communication disorders, 44(6), 678-687. https://doi.org/10.1016/j.jcomdis.2011.06.001
  • Weir, E., & Bianchet, S. (2004). Developmental dysfluency: early intervention is key. Cmaj, 170(12), 1790-1791. https://doi.org/10.1503/cmaj.1040733
  • Yairi, E., & Ambrose, N. (2013). Epidemiology of stuttering: 21st century advances. Journal of fluency disorders, 38(2), 66-87. https://doi.org/10.1016/j.jfludis.2012.11.002
  • Yairi, E., Ambrose, N. G., Paden, E. P., & Throneburg, R. N. (1996). Predictive factors of persistence and recovery: Pathways of childhood stuttering. Journal of communication disorders, 29(1), 51-77. https://doi.org/10.1016/0021-9924(95)00051-8
Categories
Psychiatric Disorders

Diagnostic Features of Narcissistic Personality Disorder

Written by Najwa Bashir

Narcissism

Book III of Ovid’s Metamorphoses is where the word “narcissism” was first used. There is a story that Narcissus falls in love with his own image because of a curse. Narcissism, on the other hand, wasn’t used in psychology until the late 1800s (Mitra et al., 2024).

Northcote (1929) says that psychologist Havelock Ellis first used the word “narcissism” in 1898 to describe a patient whose behavior was similar to Narcissus’s. Freud wrote about “narcissistic libido” soon after in his book Three Essays on the Theory of Sexuality (Van Haute &Westerink, 2016).Ernest Jones, a psychologist, said that narcissism is a flaw in character (Kirsner, 2007). There was a case report on grave narcissism written by Robert Waelder in 1925. According to what he termed it, “narcissistic personality” (Guttman& with the Assistance of Irene Kagan Guttman, 1987). The DSM-I did not initially include NPD, even after these revisions. Narcissism wasnot even mentioned in the DSM until the release of DSM-II in 1968 (Schmidt, 2019).

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is characterized by feeling better than others, wanting to be admired, and lacking the ability to relate to other people’s feelings. It is not uncommon for individuals with NPD to experience difficulties in social and professional environments, and it is also common for them to have psychiatric and substance use issues. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and its cluster-based classification go into detail about the traits that make Cluster B personality disorders unique. These disorders include NPD, antisocial personality disorder, borderline personality disorder, and histrionic personality disorder (Mitra et al., 2024). In community groups, the rate of NPD is thought to be between 0% and 6.2%. Between 50 and 75 percent of people who have been labelled with NPD are men. Cluster B of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is where NPD fits in. This group is for “dramatic, emotional, and erratic” personality disorders. Antisocial, Borderline, and Histrionic Personality Disorders are also in this group (Kacel et al., 2017).

Diagnostic Criteria for Narcissistic Personality Disorder

An individual with narcissistic personality disorder consistently acts or fantasizes about being very important, needs praise, and doesn’t care about other people, according to DSM 5 TR (APA, 2022). These traits show up in a number of situations starting in early adulthood and include five or more than five of the below mentioned characteristics:

  1. Really thinks they’re great (for example, they might talk about their skills and achievements and want to be seen as better than other people even though they haven’t done as much).
  2. Is full of hopes for long-lasting success, power, beauty, brightness, or the perfect love.
  3. Thinks that they are “special” and unique, and that only other “special” or high-status people (or groups) can understand them or should hang out with them.
  4. Wants praise too much.
  5. Feels too privileged, which means they think they should be treated extra well or have all their needs met naturally.
  6. Shows interpersonal exploitative behavior, which means using other people to get what you want.
  7. In this case, the person doesn’t want to learn or connect with other people’s feelings and needs.
  8. Is or thinks that other people are jealous of them a lot of the time.
  9. Shows arrogant, haughty behaviors or attitudes.

Diagnostic Features of Narcissistic Personality Disorder

In the light of DSM 5 TR (APA, 2022):

  • Narcissistic personality disorder is characterized by a persistent pattern of arrogance, need for praise, and lack of empathy that starts in early adulthood and shows up in a range of situations.
  • People with narcissistic personality disorder often dream about being rich, powerful, smart, beautiful, or in love(Criterion 2). They may feel good about the respect and comfort they’ve been waiting for a long time and think of how they compare to popular or wealthy people.
  • People with narcissistic personality disorder believe they are one of a kind and expect others to agree (Criterion 3). These people can be shocked or even heartbroken when they don’t get the praise they think they deserve from other people. They might think that only high-status people can understand them and that they should only hang out with those people. The people they hang out with might seem “unique”, “perfect,” or “gifted.” People who have this problem think that their wants are unique and not something that regular people can understand. They feel better about their own self-worth when they think highly of the people they hang out with. They may insist on only having the “best” person (doctor, lawyer, barber, and teacher) or being connected with the “best” schools, but they may not trust the titles of those who let them down.
  • People with narcissistic personality disorder usually need a lot of praise (Criterion 4). They almost always have very low self-esteem, and because they deal with extreme self-doubt, self-criticism, and emptiness, they need to actively seek the admiration of others. A lot of their thoughts may be on how well they are doing and what other people think of them. They might think that everyone will be very happy to see them and be shocked if people don’t want their things. They may always want praise, and a lot of the time, they do a great job of it.
  • • These people think they deserve special treatment, which shows they have a sense of entitlement that comes from having a skewed sense of self-worth (Criterion 5). They expect they will be taken care of and get upset or angry when this doesn’t happen. For instance, they might think they don’t have to wait in queue and that other people should put their needs ahead of everyone else’s. They then get angry when other people don’t help them with “their very important work.” No matter what it means to other people, they will get what they want or think they need. Like, these people might expect others to be very committed, so they might give them too much work without considering how it will affect their own lives.
  • This feeling of privilege, along with not knowing or caring about other people’s wants and needs, can lead to people taking advantage of others, whether they are aware of it or not (Criterion 6). They only date or become friends with someone if they think that person will help them reach their goals or make them feel better about themselves in some other way. They often take extra things and special rights that they believe are theirs. Some people with narcissistic personality disorder take advantage of other people’s feelings, friendships, intelligence, or money on purpose so they can get what they want.
  • People with narcissistic personality disorder don’t want to or don’t understand what other people want, experience, or feel (Criterion 7). They usually have some cognitive empathy, which means they can see things from someone else’s point of view, but not much emotional empathy, which means they can’t actually feel what someone else is feeling. Some people may not realize how hurtful their words can be.
  • When needs, wants, or feelings are seen as signs of weakness or fear, people are less likely to care about them. People who are close to someone with narcissistic personality disorder often feel emotionally cold and uninterested in them back. These people are often jealous of other people or think that other people are jealous of them (Criterion 8).
  • They might feel bad about other people’s accomplishments or goods because they think they deserve those things more. They may severely undervalue the work of others, especially if those people have already been recognized or praised for their efforts. These people act cocky and haughty, and they often have snobbish, condescending, or condescending attitudes (Criterion 9).

Conclusion

Narcissistic personality disorder is a tough clinical syndrome because it shows up in different ways, is hard to treat, and makes it harder to treat other illnesses that often happen at the same time. Therefore, early diagnosis and seeking professional help on time is crucial. This article provides the diagnostic criteria and features for narcissistic personality disorder, which can facilitate the identification of the disorder’s evident symptoms.

References

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Guttman, S. A., & with the Assistance of Irene Kagan Guttman. (1987). Robert Waelder on psychoanalytic technique: Five lectures. The Psychoanalytic Quarterly, 56(1), 1-67.https://doi.org/10.1080/21674086.1987.11927165
  • Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic personality disorder in clinical health psychology practice: Case studies of comorbid psychological distress and life-limiting illness. Behavioral Medicine, 43(3), 156-164. https://doi.org/10.1080/08964289.2017.1301875
  • Kirsner, D. (2007). Saving psychoanalysts: Ernest Jones and the Isakowers. Psychoanalysis and History, 9(1), 83-91.https://doi.org/10.3366/pah.2007.9.1.83
  • Mitra P, Torrico TJ, Fluyau D. Narcissistic Personality Disorder. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556001/
  • Northcote, H. (1929). Havelock Ellis’s studies. The Eugenics Review, 21(3), 237. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984869/
  • Schmidt, A. (2019). Comparison of Kernberg’s and Kohut’s Theory of Narcissistic Personality Disorder. Turk PsikiyatriDergisi, 30(2).https://doi.org/10.5080/u23484
  • Van Haute, P., &Westerink, H. (2016). Sexuality and its object in Freud’s 1905 edition of Three Essays on the Theory of Sexuality. The International Journal of Psychoanalysis, 97(3), 563-589.https://doi.org/10.1111/1745-8315.12480
Categories
Psychiatric Disorders

Diagnostic Features of Language Disorder

Written by Najwa Bashir

Language Disorder

Language disorder is characterized by problems with vocabulary understanding and sentence structure, which lead to deficits in language learning and use. These problems can be noticed when sending and receiving information in spoken, written, and sign language.

Symptoms may include having a smaller or more limited vocabulary than would be expected for their age or not being able to put words together in a way that follows appropriate language rules. The individual’s speaking skills are drastically below what is normally expected for their age and level of growth, which causes a lot of problems in areas like social relationships and schoolwork. The signs must have started when the person was still developing.

Unfortunately, these issues usually last into adults, and receptive language problems are more likely to have a worse outcome than active language problems. Language disorders affect about 10 to 15 percent of kids younger than 3 years old, and boys are much more likely to have them than girls (Wilson &Scarpa, 2017).

Having a language disorder can make it hard to understand and/or use spoken, written, and other kinds of language. The form, meaning, or purpose of language may be difficult for students who have a language disorder. Disorders that affect how the brain processes language knowledge are called language disorders or language disabilities.

For a language student, the most common problems may be with grammar (syntax or morphology), meaning, or other parts of language. These issues could be receptive, like not being able to understand words well, or vocal, like having trouble making sounds, or a mix of the two. Learners with language disorders may have trouble with both spoken and writing words. It can be hard for someone to find the right words and make clear lines when they talk. This is called a language disorder. It can also be hard to understand what someone else is saying. A child might have trouble understanding what other people are saying or putting their thoughts into words, or maybe both.

One can see that a child has a very limited language and that his words are short, wrong, and missing parts. The child might not be able to keep up with his friends as they talk and joke around. He might miss the jokes. He might also only use two words at a time and have trouble answering even easy questions. It’s important to know the difference between a language disorder and a hearing or speech disorder.

Most of the time, kids with language problems don’t have any trouble hearing or writing words. The hard part for them is learning and using the rules of words, like spelling. They are not just “late talkers.” If they do not get help, their speech problems will get worse, which could cause mental problems and trouble in school (Bansal, 2019).

Diagnostic Criteria for Language Disorder

According to APA (2022), the following criteria needs to be met to be diagnosed with language disorder:

  1. Inability to learn and use language over time in any form (spoken, written, sign language, or other) because of problems with understanding or producing it, such as:
    – Less understanding and use of words.
    – Poor sentence structure (not being able to use grammar and morphology rules to put words and word ends together to make sentences).
    – Having trouble with discourse means not being able to use words and put sentences together to talk, explain, or discuss a subject or set of events.
  2. Language skills are significantly and quantifiably lower than what would be expected for their age, which makes it hard for them to communicate effectively, make friends, do well in school, or do well at work, either alone or in combination. 
  3. The signs start in the early stages of growth.
  4. The problems arenot caused by hearing or other sensory loss, motor failure, or another medical or neurological issue. They also don’t make more sense if you think about intellectual disability or global developmental delay.

Diagnostic Features of Language Disorder

According to DSM 5 TR (APA, 2022), the following are the diagnostic features of language disorder:

  1. Trouble learning and using language due to having trouble understanding or producing words, grammar, sentence structure, and conversation. These language problems can be heard or seen when people talk, write, or use sign language. Both receptive and expressive skills are needed to learn and use a language. The latter is the ability to send messages through speech, body language, or vocalizations while the former is the ability to receive and understand language messages. Both language skills need to be tested because they can be different in how hard they are.
  2. People with language disorders often have problems with their words and spelling, which makes it harder for them to communicate. The child is likely to be late in starting to say words and phrases. His or her vocabulary is smaller and less varied than predicted, and sentences are shorter and less complicated, with a lot of grammar mistakes in the past tense. People often don’t give kids enough credit for their language learning problems because they may be good at using context to figure out what something means.
  3. Having trouble finding words, giving vocal definitions, or understanding synonyms, words with more than one meaning, or word play that is acceptable for their age and society. For people who have trouble remembering new words and sentences, it can be hard to follow instructions that get longer, practice long strings of spoken information (like a phone number or a shopping list), and remember new sound sequences, which may be valuable for learning new words.
  4. Trouble giving enough information about the main events and telling a story that makes sense. The language problem shows up as skills that are significantly and quantitatively below what is expected for the person’s age. It also gets in the way of school success, job performance, effective conversation, or socializing (Criterion B).

An individual is diagnosed with a language disorder after looking at their past, being directly observed by a clinician in various settings (such as home, school, or work), and their scores on standardized language tests that can help determine how severe the disorder is (APA, 2022).

Effects of Language Disorder on Daily Life

Many experts and members of the public still don’t know much about language disorder and its effects on children’s daily lives, even though it affects many areas of their lives (Lyons, 2021).

McGregor (2020) showed that these kids have a lot of problems that could make it hard for them to do well in school. They are six times more likely to have reading disabilities, six times more likely to have spelling problems, four times more likely to have math problems, and twelve times more likely to have all three problems. She also said that these kids were more likely to have problems in their mental and social lives. For example, they are six times more likely to have clinical anxiety and three times more likely to have clinical depression. Girls are three times more likely to be sexually abused, boys were four times more likely to act badly towards others, and adults were twice as likely to be unemployed for more than a year as other adults.

Conclusion

The article sheds light on the diagnostic features of language disorder. Considering the alarming consequences of the language disorder, it is important to identify its signs and seek professional aid on time in order to avoid the aforementioned struggles in the individuals’ academic and social life.

References

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Bansal, S. K. (2019). A Study on Language Disorders in Learners. Research gate. Available from:https://www.researchgate.net/publication/338117828_A_Study_on_Language_Disorders_in_Learners
  • Lyons, R. (2021). Impact of language disorders on children’s everyday lives from 4 to 13 years: Commentary on Le, Mensah, Eadie, McKean, Schiberras, Bavin, Reilly and Gold (2020). Journal of Child Psychology and Psychiatry, 62(12), 1485-1487. https://doi.org/10.1111/jcpp.13391
  • McGregor, K. K. (2020). How we fail children with developmental language disorder. Language, speech, and hearing services in schools, 51(4), 981-992.https://doi.org/10.1044/2020_LSHSS-20-00003
  • Wilson, L. C., &Scarpa, A. (2017). Child and Adolescent Psychopathology ☆. Reference Module in Neuroscience and Biobehavioral Psychology. https://doi.org/10.1016/b978-0-12-809324-5.06368-9 
Categories
Uncategorized

Introduction to IQ

By Najwa Bashir

Being intelligent is defined as having the ability to think, learn well, understand complex ideas, and adapt to one’s surroundings. Therefore, it is reasonable to consider intelligence to be a general ability that influences performance on a range of cognitive tasks.

The intelligence quotient, or IQ, is a measure of a person’s intelligence in proportion to peers of a similar age.

IQ is one of the most heritable psychological traits, and the results of a modern IQ test can be used to predict a variety of life outcomes, such as longevity, good health, and even happiness, as well as success in the job and in school (Gottfredson, 1998 as cited in Matzel& Sauce, 2017).

Animals differ greatly from one another in this ability, yet many species share a “general cognitive ability” that affects how well they perform on a wide range of cognitive activities (Matzel& Sauce, 2017). Humans and even animals are categorized as smart or dumb on the basis of their IQ scores.

But where did IQ originate from and how to measure it?

The History of IQ Testing

William Stern, a German psychologist, came up with the word “IQ,” which stands for Intelligenz-Quotient. A person’s IQ was determined by taking one of many standardized tests that are given by psychologists in order to gauge their level of intellect. Initially, scientists doubted that it was possible to evaluate human intellect with any degree of accuracy.

The first IQ test was developed very recently, despite the fact that intelligence has always needed to be measured.

In 1904, French government officials hired psychologist Alfred Binet to help them identify and support these kids by helping them identify which students were most likely to have difficulties in the classroom. Education through primary school was required in France. Binet asked a colleague, Theodore Simon, to help him create an exam with questions on life skills like problem solving, attention to detail, and recall that the children were not taught in school.

The now-classic idea of mental age originated from the observation that some youngsters could respond to questions that were beyond the level of their age group. Binet and Simon developed the Binet-Simon Scale, the original standardized IQ test. The Binet-Simon scale was adapted by Stanford University psychologist Lewis Terman in 1916 for use with the broader American population.

The modified Binet-Simon Scale gained popularity fast and was recognized as the official intelligence exam in the United States for several years after being dubbed the Stanford-Binet Intelligence Scale. On the so-called Stanford-Binet, an individual’s test score is represented by a single number known as their “intelligence quotient,” or “IQ” (Hally, 2015).

Measuring IQ

Formula

William Stern is most known for creating the IQ formula, according to most psychologists, even those who study human intellect (Kovacs &Pléh, 2023).Stern’s concept of the intelligence quotient (IQ) modified Binet’s calculation of the ratio between the gap between mental age (Intelligenzalter) and chronological age.

Since IQ is “independent of the absolute magnitude of chronological age,” the resulting quotient, rather than the original difference score, proved to be a more trustworthy indicator of growth when compared to peers.

Stern so states that the formula is mental quotient ~ mental age ÷ chronological age. For children who are just beginning to function at their normal level, the value is 1, for advanced children, it is greater than unity, and for mentally retarded children, it is a proper fraction (Stern 1914, p. 42 as cited in Kovacs & Pléh, 2023).

In other instances, the term “intellectual quotient” (IQ) is described as the ratio of mental age (MA) to chronological age (CA) multiplied by 100. With respect to this formula, in order for IQ to stay constant, MA and CA need to increase with time (Goddard, 2012).

IQ = MA/CA × 100

Those individuals who have IQ scores less than 70 are usually diagnosed with intellectual disability

Intelligence Tests

Other ways of measuring IQ include standardized tests such as Wechsler Adult Intelligence Scale, Wide Range Achievement Test, and National Adult Reading Test (Subramaniapillai et al., 2021) in addition to previously mentioned Binet-Simon Scale.

Depending on the test used, an individual’s IQ can be assessed by looking at their reading comprehension, abstract reasoning, spelling, arithmetic problem solving, and/or pronunciation of a set of words varying in complexity (Subramaniapillai et al., 2021).

For example, the Wechsler Adult Intelligence Scale III (WAIS-III) (The Psychological Corporation, 1997; Wechsler, 1997 as cited in Ganuthula& Sinha, 2019), the most commonly used IQ test, assesses a person’s performance on four intellectual abilities: working memory, verbal comprehension, processing speed, and perceptual organization (Wechsler, 1997 as cited in Ganuthula& Sinha, 2019).

Each of the four mental skills is covered by a set of thirteen different activities. Each of these activities has a certain amount of items that go towards the final score (Ganuthula& Sinha, 2019).

The Wide-Range Achievement Test (WRAT) was developed in the 1930s by psychologist Joseph Jastak and was first made operational in 1946. WRAT 4, the most recent edition, is intended for use with people between the ages of 5 and 94. The WRAT 4 consists of four subtests: arithmetic calculation, phrase comprehension, spelling, and word reading. The reading and sentence comprehension exams must be given individually, while the spelling and arithmetic calculation exams can be given individually or in small groups (Robertson, 2010).

The second edition of the National Adult Reading Test (NART) measures premorbid intellectual performance. For adults aged 20 to 70, the most recent version (1991) underwent a re-standardization. The NART is an untimed test made up of fifty words spoken phonemically differently. Students are expected to read aloud each word as it is delivered one at a time. (Venegas & Clark, 2011).

It is currently claimed that tests of intelligence evaluate a variety of cognitive skills as opposed to the more ethereal notion of intelligence. Tests of intelligence are believed to gauge a person’s aptitude for particular tasks. The argument over whether intelligence tests are helpful in general and whether they measure IQ in particular is still ongoing, despite the suggestion that they do so since they are standardized, valid, and trustworthy (Kaufman, 1994 as cited in Goddard, 2012).

Factors Influencing IQ

However, it is crucial to remember that IQ levels are fluid and subject to change throughout time. While some experts contend that a person’s intellect remains mostly constant throughout their lives, others counter that IQ levels may be raised by taking into account variables like education, upbringing, and life events.

Empirical evidence have shown that numerous environmental variables, including a child’s residency, physical activity, family income, parents’ work, and education, have a significant impact on the child’s IQ (Makharia et al., 2016).

IQ has been extensively studied with academic performance. Studies have shown that IQ and academic performance can be impacted by a number of variables, including family size, school type, diet, education, socioeconomic position, age, and gender (Ejekwu et al., 2012; Jaeger, 2008 as cited in Akubuilo et al., 2020).

Large family sizes, public school attendance, and poor socioeconomic status all have a negative impact on IQ and academic achievement. Therefore, in order to increase intelligence and academic performance, environmental interventions are required to reduce large family sizes (i.e., more than four children) and enhance the socioeconomic position of families (Akubuilo et al., 2020).

In a nutshell, IQ is a metric for intellectual capacity that is based on standardized examinations intended to evaluate cognitive ability and is subject to a variety of factors. While IQ tests can be a useful tool for determining an individual’s strengths and limitations in terms of cognition, it is crucial to keep in mind that intelligence is a complicated concept with many facets that cannot be adequately represented by a single score.

References

  • Akubuilo, U. C., Iloh, K. K., Onu, J. U., Ayuk, A. C., Ubesie, A. C., &Ikefuna, A. N. (2020). Academic performance and intelligence quotient of primary school children in Enugu. Pan African Medical Journal, 36(1). https://doi.org/10.11604/pamj.2020.36.129.22901
  • Ganuthula, V. R. R., & Sinha, S. (2019). The looking glass for intelligence quotient tests: the interplay of motivation, cognitive functioning, and affect. Frontiers in psychology, 10, 459731.https://doi.org/10.3389/fpsyg.2019.02857
  • Goddard, N. (2012). Psychology. Core Psychiatry, 63–82. https://doi.org/10.1016/b978-0-7020-3397-1.00005-7 
  • Hally, T. J. (2015). A Brief History of IQ Tests. ResearchGate. https://www.researchgate.net/publication/275354727_A_Brief_History_of_IQ_Test
  • Kovacs, K., &Pléh, C. (2023). William Stern: The Relevance of His Program of ‘Differential Psychology’for Contemporary Intelligence Measurement and Research. Journal of Intelligence, 11(3), 41.https://doi.org/10.3390/jintelligence11030041
  • Makharia, A., Nagarajan, A., Mishra, A., Peddisetty, S., Chahal, D., & Singh, Y. (2016). Effect of environmental factors on intelligence quotient of children. Industrial psychiatry journal, 25(2), 189-194. https://doi.org/10.4103/ipj.ipj_52_16
  • Matzel, L. D., & Sauce, B. (2017). IQ. In Springer eBooks (pp. 1–9). https://doi.org/10.1007/978-3-319-47829-6_1080-1
  • Robertson, G. J. (2010). Wide‐range achievement test. The Corsini encyclopedia of psychology, 1-2.https://doi.org/10.1002/9780470479216.corpsy1038
  • Subramaniapillai, S., Almey, A., Rajah, M. N., & Einstein, G. (2021). Sex and gender differences in cognitive and brain reserve: Implications for Alzheimer’s disease in women. Frontiers in Neuroendocrinology, 60, 100879.https://doi.org/10.1016/j.yfrne.2020.100879
  • Venegas, J., & Clark, E. (2011). National Adult Reading Test. In Springer eBooks (p. 1705). https://doi.org/10.1007/978-0-387-79948-3_1467
Categories
Psychiatric Disorders

Diagnostic Features of Intellectual Disability

Written by Najwa Bashir

Generally referred to as intelligence, intellectual functioning encompasses a broad variety of mental abilities, including the capacity for logical thinking, practical intelligence (problem-solving), learning, language skills, and so on. It can take many different forms, including talents, behaviors, ideas, and emotions. Stated differently, the ability to comprehend and engage with reality on a global scale is referred to as intellectual functioning (Lee et al., 2023).

According to American Association on Intellectual and Developmental Disabilities (AAID) (Shogren & Turnbull, 2010), intelligence is an all-encompassing mental ability that includes planning, reasoning, problem-solving, abstract thought, understanding complicated concepts, efficient learning, and experience-based learning. A standardized measure of intelligence, specifically an IQ score of less than 70 (two standard deviations below the population mean of 100), has historically been used to define intellectual disability (formerly known as “mental retardation”).

This measure has also historically been used to describe significant deficits in functional and adaptive skills. The capacity to do age-appropriate everyday tasks is a component of adaptive skills. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the American Association on Intellectual and Developmental Disabilities (AAIDD) system are the two classification schemes used in the US for intellectual disability (ID). Both of these methods use the degrees of support required to help an individual reach their maximum potential for personal functioning to determine the severity of ID (Boat et al., 2015).

Intellectual Disability

Intellectual Disability, also referred to as Intellectual Developmental Disorder, is defined as having an IQ of less than 70 and deficits in adaptive behavior or everyday living abilities (such as eating, dressing, communicating, and participating in activities with others). Individuals with intellectual disabilities struggle with complex concepts and learn slowly. Reduced cognitive capacity, or intellectual disability, results in a variation in the rate and efficiency with which an individual learns, retains, and applies new information in comparison to the general population (Shree & Shukla, 2016).

According to DSM-5, Intellectual Disability is a class of developmental disorders marked by deficits of cognitive functions that are linked to learning, adaptive behavior, and skill constraints (Carulla et al., 2011).

Diagnostic Criteria for Intellectual Disability

The DSM-5 TR (APA, 2000) has outlined a specific diagnostic criteria related to Intellectual Disability. The following three criteria needs to be met for individuals to be diagnosed with an Intellectual Disability:

  1. Shortcomings in intellectual abilities – as demonstrated by individual, standardized intelligence tests as well as clinical evaluation – including logical problem-solving, organizing, abstract judgment, scholastic learning, and acquiring knowledge from experience.
  2. Deficiencies in adaptive functioning that lead to a failure to fulfil social and developmental norms about social responsibility and personal independence.Without continued assistance, the adaptive impairments make it difficult for the person to operate in a variety of settings, including the community, workplace, school, and home, as well as in one or more everyday tasks including social interaction, communication, and independent living.
  3. Intellectual and adaptive deficiencies that appear at the beginning of the developmental stage.

Diagnostic Features of Intellectual Disability

The DSM-5 TR (APA, 2016) lists many diagnostic features of Intellectual Disability. These characteristics consist of the following:

  1. Deficits in general mental abilities
  2. Impairment in day-to-day adaptive functioning relative to peers who are matched for age, gender, and sociocultural background
  3. Onset takes place at the stage of development.

Standardized cognitive tests, standardized neuropsychological tests, and standardized measures of adaptive functioning are used in conjunction with clinical examination to diagnose intellectual developmental disorders.

Testing for intelligence quotient (IQ) and deficiencies in adaptive functioning – a measure of a person’s capacity to manage the typical stresses of daily life – are two ways to assess intellectual functioning.

The requirement to evaluate intellectual functioning using standardized instruments that produce intelligence quotients (IQs) is acknowledged by both DSM-5 and ICD-10. The DSM-5 limits the use of IQ to determine ID, using a threshold of 65–75 (IQ 70± standard error of 5). On the other hand, the ICD-10 recommends an IQ of 70 in order to diagnose ID, and it uses a range of IQs to classify four severity levels: mild (IQ: 50–69), moderate (IQ: 35–49), severe (IQ: 20–34), and profound (IQ <20). The IQ score can be regarded as one of the clinical descriptors that are significant in defining the severity level, although the ICD-11 Working Group argued that severity levels for IDD should be based on a clinical description of the traits of each subcategory. As a result, the ICD-10 guidelines, which rely on IQ to determine the severity levels of ID as well as to diagnose the condition, should be used until ICD-11 is implemented (Kishore et al., 2019).

Furthermore, the DSM-5 TR stipulates that intellectual impairment must also arise throughout the developmental period, which is often understood to be before the age of 18.

Standardized intelligence tests, such the Stanford-Binet Intelligence Scales or the Wechsler Intelligence Scale for Children (WISC), are used to measure intellectual functioning. People who are diagnosed with intellectual impairment usually have an IQ of less than 70, which is regarded as severely below average. It is crucial to remember that adaptive functioning must also be considered in order to diagnose intellectual impairment; IQ levels alone are not sufficient in this regard.

The ability of an individual to autonomously carry out everyday tasks and adjust to novel circumstances is referred to as adaptive functioning. This encompasses interpersonal, communication, self-care, and problem-solving abilities. Adaptive functioning deficits might show themselves as trouble with personal grooming, money management, or social cue interpretation.

Apart from intellectual and adaptive functioning deficiencies, the DSM-5 TR highlights the need of taking into account the cultural background and personal strengths and limitations of the individual undergoing assessment for intellectual impairment. When diagnosing someone, it is important to take into account many factors that may affect their performance on standardized tests, such as cultural differences, poverty, and limited access to education.

It is also critical to acknowledge that intellectual impairment can range in degree from moderate to severe. Even though they can struggle in school or with social skills, people with modest intellectual disabilities are typically able to live freely with assistance. To achieve their everyday requirements, those with moderate to severe intellectual disabilities can need close monitoring and assistance.

Conclusion

In conclusion, deficiencies in intellectual and adaptive functioning that begin throughout the formative stage are among the diagnostic characteristics of intellectual impairment as listed in the DSM-5 TR. When evaluating a patient for intellectual impairment, physicians should take into account the patient’s strengths and limitations, cultural influences, and cognitive and practical functioning. In order to help people with intellectual disabilities realize their full potential and enhance their quality of life, early detection and intervention are essential.

References

American Psychiatric Association. (2016). Diagnostic and statistical manual of mental disorders. Text revision.

Boat, T. F., Wu, J. T., & National Academies of Sciences, Engineering, and Medicine. (2015). Clinical characteristics of intellectual disabilities. In Mental disorders and disabilities among low-income children. National Academies Press (US). Available at: https://www.ncbi.nlm.nih.gov/books/NBK332877/

Carulla, L. S., Reed, G. M., Vaez-Azizi, L. M., Cooper, S. A., Leal, R. M., Bertelli, M., …&Saxena, S. (2011). Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD-11. World Psychiatry, 10(3), 175. https://doi.org/10.1002/j.2051-5545.2011.tb00045.x

Kishore, M. T., Udipi, G. A., &Seshadri, S. P. (2019). Clinical practice guidelines for assessment and management of intellectual disability. Indian journal of psychiatry, 61(Suppl 2), 194-210. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_507_18

Lee, K., Cascella, M., &Marwaha, R. (2023). Intellectual disability. Available at: https://www.ncbi.nlm.nih.gov/books/NBK547654/

Shogren, K. A., & Turnbull, H. R. (2010). Public policy and outcomes for persons with intellectual disability: extending and expanding the public policy framework of AAIDD’s 11th Edition of Intellectual Disability: Definition, Classification, and Systems of Support. Intellectual and Developmental Disabilities, 48(5), 375-386. https://doi.org/10.1352/1934-9556-48.5.375

Shree, A., & Shukla, P. C. (2016). Intellectual Disability: Definition, classification, causes and characteristics. Learning Community-An International Journal of Educational and Social Development, 7(1), 9-20. https://doi.org/10.5958/2231-458X.2016.00002.6

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