Tag: Psychiatric disorders

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Psychiatric Disorders

Major Depressive Disorder – Diagnostic Criteria, Features, and Prevalence

Written by Najwa Bashir

Major depression disorder (MDD) is a complicated and common mental illness. According to the sources, in 2008, the WHO ranked MDD as the third most common cause of disease in the world, and they predict that it will be the most common cause of disease by 2030. Mood problems that don’t go away, losing interest in enjoyable activities, feelings of shame or inadequacy, fatigue, trouble focusing, fluctuations in hunger, psychomotor retardation or unrest, sleep problems, or suicidal thoughts are all signs of this disorder.

Empirical evidence reveals that every year, more and more people encounter depression. About 300 million people around the world have MDD, which has become one of the main reasons people can’t work. MDD is more common in some groups, like pregnant women, older adults, kids, and others. This may be because of genetic, psychological, or social factors. Recurrent seizures can happen along with depression. They may happen even when the person is not depressed or may last longer than the condition itself.

Research has also found that a link exists between the growth of social skills and the frequency of MDD. According to a survey, MDD is starting to show up at younger ages because of changes in the economy and more stress in everyday life. Women are about twice as likely as men to have MDD. In particular, women are more likely to show signs of depression when they are dealing with social problems or high levels of stress. Furthermore, it has been found that fall and winter are times when seasonal sadness is more common.

The following article mentions the diagnostic criteria and features of MDD in light of DSM 5 TR.

Diagnostic Criteria

A. At least five of the following symptoms have been present for at least two weeks and are different from how they were before; at least one of these symptoms is either (1) depression or (2) reduced interest or pleasure.

  1. Feeling down most of the day, almost every day, as shown by their own words (like “feels sad, empty, or hopeless”) or by what other people say (like “appears tearful”) (Note: irritable mood in case of children and adolescents).
  2. A noticeable loss of interest or pleasure in all or almost all activities for most of the day, almost every day (as shown by an observation or a psychological report).
  3. Losing or gaining a lot of weight while not dieting (more than 5% of body weight in a month), or having less or more hunger almost every day. (Note: If a kid does not gain weight as expected, this is something to think about).
  4. Trouble sleeping or too much sleep almost every day.
  5. Psychomotor restlessness or slowing down almost every day (not just feeling antsy or being slowed down); this must be seen by others.
  6. Feeling tired or lacking energy almost every day.
  7. Nearly every day, having feelings of inadequacy or too much or the incorrect kind of guilt (which could be delusions)—not just self-blame or guilt about being sick.
  8. Making it harder to think or focus, or being unable to make up your mind, almost every day (either from your own story or what other people have seen). 9: Frequent thoughts of death (not just fear of dying), frequent suicidal ideas without a clear plan, or a suicide attempt or a clear plan to kill oneself.

B. The symptoms cause distress or harm in social, occupational, or other important performance areas that are clinically relevant.

C. The episode is not caused by the effects of a drug or another physical situation on the body. Keep in mind that criteria A–C show a major depressed state.
Note: After a big loss, like a death in the family, losing everything you owned, or getting sick or disabled, you may experience intense sadness, ruminating about the loss, insomnia, loss of appetite, and weight loss listed in Criterion A. This can look like a depressive episode. Even though these symptoms may make sense or seem suitable given the loss, it is important to carefully consider the presence of a major depressive episode in addition to the normal reaction to a big loss. It is necessary to use clinical opinion when making this choice, taking into account the person’s past and the community norms for showing sadness during a loss.

D. At least one major depressive episode cannot be explained by schizoaffective disorder and can’t be added to schizophrenia, schizophreniform disorder, delusional disorder, or other specific and unspecific schizophrenia spectrum disorders or other psychotic disorders.

E. No manic or hypomanic attack occurred ever.

Note: This exception does not apply if all of the manic or hypomanic events are caused by drugs or the effects of another medical condition on the body.

Diagnostic Features

  • Symptoms of depression must continue at least two weeks and involve feeling low or losing interest in most or all activities virtually every day (Criterion A).
  • Four other symptoms must be present within the two-week timeframe. These might include changes in food, weight, sleep, or psychomotor activity; reduced energy; feelings of worthlessness or guilt; difficulties thinking, focusing, or making decisions; or thoughts of death, suicide, a suicide attempt, or a suicide plot.
  • The indicators must occur practically daily for at least two weeks, except for suicidal or death thoughts, which must occur several times, and attempted suicide or forming a plan, which only has to occur once.
  • The experience must be accompanied by clinically substantial anxiety or impairment in social, professional, or other crucial areas of functioning. For individuals with milder bouts, functioning may seem normal but requires more effort.
  • People typically complain of drowsiness or fatigue rather than depression or disinterest. You may miss depression if you do not seek for it.
  • Many with this disease feel exhausted and have problems sleeping. Psychomotor issues and delusional or near-delusional shame are rare but worsening.
  • Depressed, sad, helpless, disheartened, or “down in the dumps” are common symptoms of severe depression (Criterion A1). During the interview, sadness may be mentioned (e.g., the person looks like they’re crying).
  • Some people say they are “blah,” have no sensations, or are frightened, yet their facial expressions and conduct show they are sad.
  • Some people talk more about physiological aches and pains than melancholy. People who are more irritable may have persistent anger, a tendency to shout or blame others, or an overdone feeling of annoyance over trivial things.
  • Kids and teenagers usually feel restless or irritated, not sad. This should not be confused with feeling furious while disturbed.
  • Normal duties are usually less enjoyable. People may declare they’re “not caring anymore” about their activities or no longer appreciate them (Criterion A2).
  • Family members notice when someone quits having fun or socializing. A former golfer or sports fanatic youngster may quit playing. Some people lose a lot of sexual drive.
  • Changes might affect appetite. Sad individuals claim they must push themselves to eat. Some may eat more and seek sweets or carbohydrates. A person’s appetite may alter a lot, causing them to lose or gain weight or not acquire weight as predicted in youngsters (Criterion A3).
  • Sleep disorders include insomnia or oversleeping (Criterion A4). Insomnia sufferers commonly experience middle insomnia (waking up during the night and having problems getting back to sleep) or terminal insomnia. Initial insomnia may occur. Hypersleepers sleep longer at night or more during the day. Some people go to treatment for insomnia.
  • People who can’t sit still, pace, wring their hands, or tug or massage their skin, clothes, or other items are agitated. Retardation occurs when their speech, thoughts, and bodily movements slow down; they stop longer before replying; their speech is quiet, varied, or inexpressive; or they are mute (Criterion A5). Psychomotor agitation or delay must be visible to others, not only the person’s thoughts. Psychomotor agitation or delay is often accompanied by the other type. Fatigue and energy loss are common (Criterion A6).
  • A person may state they are always fatigued even while not moving. It feels like even minor tasks are laborious. Tasks may take longer or be done poorly. Someone may claim that getting dressed and washing their clothing in the morning is hard and takes twice as long. During acute bouts and partial remission, this symptom causes several serious depressive disorder issues.
  • A serious depressive episode can make a person feel worthless or guilty, including having an excessively low self-esteem or focusing on previous misdeeds (Criterion A7). Such people misinterpret neutral or minor circumstances in their everyday lives for personal defects and accept too much responsibility for unpleasant things. Someone who believes they create world poverty may have illusions due to worthlessness or shame. Depression makes people blame themselves for being unwell and unable to satisfy social or professional duties. Unless deluded, this does not fit this requirement.
  • Many people struggle with thinking, focusing, and making little decisions (Criterion A8). They may appear distracted or have problems remembering. Mentally demanding tasks often leave people helpless. Kids with unexpected grade drops may not be focused. Older people’s major complaint may be memory issues, which may be misinterpreted for dementia (sometimes termed “pseudodementia”).
  • Once the major depressed episode is over, memory issues usually disappear. In elderly persons, a major depressive episode may be the earliest indicator of irreversible dementia. Many individuals think about suicide or try to commit suicide (Criterion A9). They can range from a buried desire to not wake up in the morning to a fleeting thought that others would be better off if the individual were dead to a thorough suicide plot. Seriously suicidal people may have revised their wills, paid off their bills, obtained a rope or pistol, and chosen a location and time to commit suicide.
  • People may commit suicide because they want to give up because they cannot move over issues, stop an emotionally painful condition they fear will never end, cannot find joy in life, or don’t want to burden others. Eliminating these ideas may be a better predictor of decreased suicide risk than rejecting any further suicide intentions.
  • Even in milder situations, a severe depressive episode must induce clinically substantial sorrow or interfere with social, professional, or other crucial areas of functioning (Criterion B). If the handicap is severe, the person may not work socially or professionally. In the worst case, the individual may be unable to eat, dress, or clean oneself.
  • If they have difficulties focusing, forget things, or reject, minimize, or explain away their symptoms, they may not be honest. More information from others can assist determine the path of large depressive episodes and manic or hypomanic episodes.
  • Since major depressive episodes develop slowly, clinical facts regarding the worst phase of the current episode may be the greatest indicator.
  • Some severe depressive episode symptoms are similar to those of other medical conditions. Diabetes can cause weight loss, cancer can cause fatigue, and pregnancy or postpartum sleepiness can constitute hypersomnia. When obviously and totally caused by another medical condition, these indications do not indicate serious depression.
  • Check for non-vegetative indicators of sadness, a loss of enjoyment, guilt or worthlessness, difficulties focusing or making decisions, and suicidal thoughts. Restricting major depressive episodes to these non-vegetative symptoms seems to discover the same persons as the complete criteria.
Categories
Psychiatric Disorders

Diagnostic Features of Dyscalculia

Written by Najwa Bashir

Dyscalculia

Two of the most common learning disorders are dyslexia and dysgraphia. One is dyscalculia, characterized by having trouble with math (Ahuja et al., 2021). Dyscalculia is a learning disorder that makes it hard to understand and use numbers. This can affect students’ mathematics education and well-being (Asalisa & Meiliasari, 2023). According to the International Classification of Diseases (ICD-10), dyscalculia is a unique developmental disease that causes problems with speech, motor skills, and the ability to see and understand where things are in space (Aquil, 2020). Although dyscalculia is as prevalent as dyslexia and dysgraphia, it is less well-known and has received less research attention than the other two (Grigore, 2020). Consequently, many educators possess an inadequate understanding of dyscalculia (Kunwar & Sharma, 2020), and pupils afflicted with dyscalculia fail to receive the necessary assistance during their mathematical education (Salisa & Meiliasari, 2023).

Prevalence

Dyscalculia affects 3-7% of all children, adolescents, and adults. Severe, ongoing difficulties with math computations cause significant impairment in the workplace, in school, and daily life. It also increases the likelihood of co-occurring mental problems (Haberstroh & Schulte-Körne, 2019).

According to large-scale cohort research conducted in England, there are significant psychological and economic problems linked to low mathematical proficiency: Of those impacted, 70–90% dropped out of school before the age of 16, and just a small percentage had full-time jobs when they were 30. Compared to people without dyscalculia, their chances of being jobless and experiencing depressed symptoms were twice as high (Parsons & Bynner, 2005). An estimated £2.4 billion is spent annually in Great Britain on expenses related to severe mathematical impairment (Gross, 2006).

Diagnostic Criteria for Dyscalculia

Behavioral specialists can determine whether an individual has dyscalculia or a severe arithmetic problem by using the Dutch protocol “Dyscalculia: Diagnostics for Behavioural Professionals” (DDBP). The following criteria are addressed by the DDBP procedure in order to diagnose dyscalculia:

  • First criterion: To ascertain whether the math issue exists and how serious it is
  • Second criterion: To identify the math issue associated with the individual’s capabilities
  • Third criterion: Assessing the mathematical problem’s obstinacy

The protocol also notes that a fourth criterion—difficulties that predate the age of seven—is incorporated in many studies. For most kids, this is accurate; nevertheless, dyscalculia is typically identified later in life among (very) brilliant kids.

Diagnostic Features of Dyscalculia

The following are the typical features of dyscalculia (Salisa & Meiliasari, 2023):

Trouble understanding and using numbers and amounts starting in preschool

  • It’s hard to make the connection between a number (like 2) and the thing it stands for (like 2 apples).
  • People don’t fully understand the relationship between numbers and amounts (two apples and one apple = 2 + 1).
  • Because of this, it’s hard to count, compare two numbers or amounts, quickly evaluate and name small groups of dots, find a number’s position on the number line, understand the place-value system, and transcode.

Problems with simple math operations and other math-related tasks

  • Individuals don’t understand how to use computation rules because they don’t understand numbers and amounts well enough (17 + 14 = 1 + 1 and 7 + 4 = 13 or 211).
  • Questions with remembering math facts (like the multiplication table), which are facts that let you get the answers to simple math questions without having to do the math all over again.
  • No change from counting to non-counting methods (8 + 4 = 8 + 2 and 2 = 12) when doing math (8 + 4 = 9, 10, 11, 12 = 12).
  • These problems get worse as the math gets harder (bigger number range, written calculations, computations with multiple steps, word problems).

Important

  • Finger-counting is not a sign of dyscalculia; it is a normal way to help you remember math facts and learn how to do calculations quickly and correctly. Finger-counting over and over, especially for simple calculations that are done over and over, does show that there is a problem with the calculations.
  • What matters is not just that there are mistakes in the calculations; what matters is their range, how long they last, and how often they happen.

The main thing that is used to diagnose dyscalculia is a difference between a person’s brain and their supposed math skills. In a full test that can also be used to plan a therapy intervention, the cause of dyscalculia and problems understanding visual information should both be taken into account. This should be taken into account when choosing the right test methods. The new definition of dyscalculia takes into account not only IQ and math success in school, but also problems with basic skills that are common in people with dyscalculia. The IQ difference and the best IQ test for dyscalculia are still debated. One new thing about this work is that it uses a multidisciplinary method to give a full picture of dyscalculia and how to diagnose it. This could help scholars from other fields (Aquil, 2020).

Early diagnosis of dyscalculia will ensure early management of the problem. The aforementioned criteria and diagnostic features can help diagnose dyscalculia.

References

  • Ahuja, N. J., Thapliyal, M., Bisht, A., Stephan, T., Kannan, R., Al-Rakhami, M. S., & Mahmud, M. (2021). An investigative study on the effects of pedagogical agents on intrinsic, extraneous and germane cognitive load: experimental findings with dyscalculia and non-dyscalculia learners. IEEE Access, 10, 3904-3922. https://doi.org/10.1109/ACCESS.2021.3115409
  • Aquil, M. A. I. (2020). Diagnosis of dyscalculia: A comprehensive overview. South Asian Journal of Social Sciences and Humanities, 1(1), 43-59. Available at: https://acspublisher.com/journals/index.php/sajssh/article/view/1124
  • Grigore, M. (2020). Towards a standard diagnostic tool for dyscalculia in school children. CORE Proceedings, 1(1). https://doi.org/https://doi.org/10.21428/bfdb1df5.d4be3454
  • Gross, J. (2006). The long term costs of literacy difficulties. KPMG Foundation.
  • Haberstroh, S., & Schulte-Körne, G. (2019). The diagnosis and treatment of dyscalculia. Deutsches Ärzteblatt International, 116(7), 107. https://doi.org/10.3238/arztebl.2019.0107
  • Kunwar, R., & Sharma, L. (2020). Exploring Teachers’ Knowledge and Students’ Status about Dyscalculia at Basic Level Students in Nepal. Eurasia Journal of Mathematics, Science and Technology Education, 16(12). https://doi.org/10.29333/ejmste/8940
  • Parsons, S., & Bynner, J. (2005). National Research and Development Centre for adult literacy and numeracy. London: Institute of Education.
  • Salisa, R. D., & Meiliasari, M. (2023). A literature review on dyscalculia: What dyscalculia is, its characteristics, and difficulties students face in mathematics class. Alifmatika: Jurnal Pendidikan dan Pembelajaran Matematika, 5(1), 82-94. https://doi.org/10.35316/alifmatika.2023.v5i1.82-94
  • Van Luit, J. E. (2019). Diagnostics of dyscalculia. International handbook of mathematical learning difficulties: From the laboratory to the classroom, 653-668. https://doi.org/10.1007/978-3-319-97148-3_38
Categories
Psychiatric Disorders

Diagnostic Features of Dyslexia

Written by Najwa Bashir

Dyslexia

Individuals with dyslexia face trouble learning to read out loud and spell. According to the DSM5, dyslexia is a type of neurological disease. Neurodevelopmental diseases are genetic conditions that last a lifetime and show symptoms early in life. Research on dyslexia was based for a long time on the idea that it was a specific learning disability. By this, we meant that the disability could not be explained by clear causes like sensory issues or general learning challenges (low IQ). Then, because it wasn’t possible to tell the difference between how well kids with dyslexia and kids with more general learning problems read and use sounds, this way of defining “discrepancy” lost favor (Snowling et al., 2020).

Given that they have problems with the phonological part of language, people with dyslexia have trouble connecting spoken and written language. Decoding words correctly and quickly can make it harder to understand what you read and build your knowledge (Kim et al., 2012). Spelling problems can make it hard to compose written work properly. Dyslexia can make people do badly in school, feel bad about themselves, and lose drive. This doesn’t mean someone is stupid, lazy, or has bad eyesight; it happens to people of all brain levels (Berninger et al., 2013).

At first, the word dyslexia was called “word blindness” (Campbell, 2011). It comes from the Greek words for “days” (lexi, from lexicon) and “ia,” which means “impaired.” People with developmental dyslexia have trouble reading, decoding, and writing words at the word level; writing seems to be the most chronic problem (Berninger et al., 2008). The Working Definition of Dyslexia under the Individuals with Disabilities Education Act (IDEA) is a “specific learning disability” (Roitsch & Watson, 2019). Developmental dyslexia is one important example of a learning disability that has social and emotional effects that aren’t thought to be the main symptoms of the disorder. These problems can still be there or even get worse as an adult (Livingston et al., 2018). Therefore, early diagnosis and treatment of the disorder are essential to ensure the prevention of adverse consequences. Given next are the diagnostic features of dyslexia.

Diagnostic Features

The following are prominent features of dyslexia (Roitsch & Watson, 2019):

  1. Trouble developing sound awareness and thinking skills.
  2. Trouble correctly interpreting nonsense or things you need to know.
  3. Trouble reading single words on their own.
  4. Oral reading is wrong and hard to do.
  5. Not being able to read quickly.
  6. Different levels of learning the names of letters and the sounds they make.
  7. Trouble learning how to spell.
  8. Trouble finding words and naming things quickly.
  9. Having different levels of trouble with different parts of writing.
  10. Different levels of trouble understanding what they read.

Most of the time, kids in preschool and early elementary school who have dyslexia have trouble learning to talk, learn sounds and letters, colors and numbers, write, use their fine motor skills, and recognize sight words. The fact that these kids have trouble with pronunciation is often a sign that they might have trouble reading later on. Older kids with dyslexia may have bad handwriting, trouble learning foreign languages, issues with ordering language, trouble remembering things, spelling mistakes, and ongoing reading, writing, and math problems (IDA, 2019). Spelling and remembering words with more than one letter can be noticed in written language. Comprehension and understanding may be hard in reading skills, and reading skills that are slow and often wrong may be noticed. People who have dyslexia often have trouble phonologically coding words, which means they have trouble knowing how words sound and what they mean (Snowling, 2019, as quoted in Roitsch & Watson, 2019).

Cognitively, people with dyslexia have trouble recognizing hidden shapes (Martinelli & Schembri, 2014), shifting their attention, and having problems with parts of their working memory that deal with spoken and written language (the phonological loop) (Berninger et al., 2015). Working memory is one of the most common symptoms of dyslexia that people name. When someone with dyslexia has trouble with working memory, they have trouble temporarily storing knowledge while doing other cognitive tasks at the same time (Baddeley, 1992, as cited in Roitsch & Watson, 2019). Teenagers’ ability to read quickly is affected by their language knowledge, which is linked to their verbal working memory (Shaywitz et al., 2008). Language experts, interventionists, and diagnosticians face new problems with a group of people that consists of those who are talented and also have dyslexia. People who are “twice exceptional” often do better than their regular peers on tasks that test their speech, working memory, and language skills, but they take longer to learn phonological awareness and how to name things quickly. Additionally, these individuals show very high verbal reasoning skills. However, it can be hard for teachers and parents to diagnose dyslexia in these individuals because their abilities often hide the effects of dyslexia on spoken and written language tasks as well as standardized tests (van Viersen et al., 2016), while the core deficits associated with dyslexia remain (Nielson et al., 2016). The same is true for adults with dyslexia: their symptoms are often less obvious because they have learned how to deal with the condition and the problems that come with it. Mental problems like not understanding sounds and naming things quickly, as well as problems with working memory and written language, may still be present (Kilpatrick, 2015), along with other thinking and reading problems (Chung et al., 2011).

Conclusion

Dyslexia is a learning disorder that makes it hard to read, write, spell, and even talk. The International Dyslexia Association says that about 10% of people have dyslexia. Individuals with dyslexia cannot meet school standards because of their disabilities, which makes them feel overwhelmed and unimportant. With a world prevalence of at least 10%, a lot of students with dyslexia don’t get identified or get help for their symptoms. However, 90% of dyslexic children can be taught in normal classrooms with other kids their age if they get help early enough. It’s concerning that dyslexia was found in a large portion of the study sample. This highlights the need for more research and programs, such as campaigns to raise awareness among teachers, parents, and school officials. It’s also important to find children who haven’t been diagnosed with dyslexia yet and give them the right help as soon as possible (Sunil et al., 2023). The features mentioned above can help identify and diagnose dyslexia.

References

  • Berninger, V. W., Lee, Y. L., Abbott, R. D., & Breznitz, Z. (2013). Teaching children with dyslexia to spell in a reading-writers’ workshop. Annals of Dyslexia, 63, 1-24. https://doi.org/10.1007/s11881-011-0054-0
  • Berninger, V. W., Raskind, W., Richards, T., Abbott, R., & Stock, P. (2008). A multidisciplinary approach to understanding developmental dyslexia within working-memory architecture: Genotypes, phenotypes, brain, and instruction. Developmental neuropsychology, 33(6), 707-744. https://doi.org/10.1080/87565640802418662
  • Berninger, V. W., Richards, T. L., & Abbott, R. D. (2015). Differential diagnosis of dysgraphia, dyslexia, and OWL LD: Behavioral and neuroimaging evidence. Reading and Writing, 28, 1119-1153. https://doi.org/10.1007/s11145-015-9565-0
  • Campbell, T. (2011). From aphasia to dyslexia, a fragment of a genealogy: An analysis of the formation of a ‘medical diagnosis’. Health Sociology Review, 20(4), 450-461. https://doi.org/10.5172/hesr.2011.20.4.450
  • Chung, K. K., Ho, C. S. H., Chan, D. W., Tsang, S. M., & Lee, S. H. (2011). Cognitive skills and literacy performance of Chinese adolescents with and without dyslexia. Reading and Writing, 24, 835-859. https://doi.org/10.1007/s11145-010-9227-1
  • International Dyslexia Association (IDA, 2019). Dyslexia Basics. Retrieved from https://dyslexiaida.org/dyslexia-basics-2/
  • Kilpatrick, D. A. (2015). Essentials of assessing, preventing, and overcoming reading difficulties. John Wiley & Sons.
  • Kim, Y. S., Wagner, R. K., & Lopez, D. (2012). Developmental relations between reading fluency and reading comprehension: A longitudinal study from Grade 1 to Grade 2. Journal of experimental child psychology, 113(1), 93-111. https://doi.org/10.1016/j.jecp.2012.03.002
  • Livingston, E. M., Siegel, L. S., & Ribary, U. (2018). Developmental dyslexia: Emotional impact and consequences. Australian Journal of Learning Difficulties, 23(2), 107-135. https://doi.org/10.1080/19404158.2018.1479975
  • Martinelli, V., & Schembri, J. (2014). Dyslexia, spatial awareness and creativity in adolescent boys. The British Psychological Society. Available at: https://www.um.edu.mt/library/oar/handle/123456789/91865
  • Nielsen, K., Abbott, R., Griffin, W., Lott, J., Raskind, W., & Berninger, V. W. (2016). Evidence-based reading and writing assessment for dyslexia in adolescents and young adults. Learning disabilities (Pittsburgh, Pa.), 21(1), 38. https://doi.org/10.18666/LDMJ-2016-V21-I1-6971
  • Roitsch, J., & Watson, S. M. (2019). An overview of dyslexia: definition, characteristics, assessment, identification, and intervention. Science Journal of Education, 7(4). https://doi.org/10.11648/j.sjedu.20190704.11
  • Shaywitz, S. E., Morris, R., & Shaywitz, B. A. (2008). The education of dyslexic children from childhood to young adulthood. Annu. Rev. Psychol., 59(1), 451-475. https://doi.org/10.1146/annurev.psych.59.103006.093633
  • Snowling, M. J., Hulme, C., & Nation, K. (2020). Defining and understanding dyslexia: past, present and future. Oxford review of education, 46(4), 501-513. https://doi.org/10.1080/03054985.2020.1765756
  • Sunil, A. B., Banerjee, A., Divya, M., Rathod, H. K., Patel, J., & Gupta, M. (2023). Dyslexia: An invisible disability or different ability. Industrial psychiatry journal, 32(Suppl 1), S72-S75. https://doi.org/10.4103/ipj.ipj_196_23 van Viersen, S., Kroesbergen, E. H., Slot, E. M., & de Bree, E. H. (2016). High reading skills mask dyslexia in gifted children. Journal of learning disabilities, 49(2), 189-199. https://doi.org/10.1177/0022219414538517
Categories
Entertainment Film

10 Movies & Shows on Autism You Should Watch

Written By Najwa Bashir

Whether you are a psychology student looking for movies and shows to understand the diagnostic features of autism spectrum disorder (ASD) or someone just interested in enhancing your knowledge about this psychiatric disorder, add the following 10 movies and shows on autism to your watch list! Each of these movies and shows showcases autism in its unique way and will surely serve the purpose you are planning to watch them for!

Hollywood Movies

Rain Man (1988)

Rain Man, with Tom Cruise as the autistic child, is an original and famous movie that changed the way movies hugely show autism. This thriller from 1988, directed by Barry Levinson, got great reviews. Tom Cruise plays Charlie Babbitt, and Dustin Hoffman plays Raymond Babbitt, Charlie’s older brother, who is presented as having autism. The movie is about Charlie, a young man who is self-centered and interested in material things. He finds out about his long-lost brother Raymond when their father dies and leaves Raymond a large income. Charlie goes on a road trip with Raymond at first because he wants to save money, but he ends up learning a lot about his brother’s illness and the amazing skills that come with it.

A Brilliant Young Mind (2014)

For people with autism, making new friends can be hard, especially when they are teenagers. This movie is good for the whole family because it shows how a smart young man who has trouble making friends makes friends with a girl when he makes it onto the British team for the International Mathematics Olympiad. The moving story shows that even though it can be hard, making new friends can be done if you have ASD. His family will cheer for both his team and his new friendship.

Fly Away (2011)

The story of Fly Away is about how hard it is for Jeanne to be with her autistic teenage daughter Mandy. Mandy does a lot of bad things that Jeanne has to deal with while she tries to run her own life. Mandy’s behavior gets so bad at one point that her mother has to care for her 24 hours a day, seven days a week, and loses her job as a result. Mandy’s father and Jeanne need to find out if domestic placement is a choice for her. This could give her a safe place to live and more freedom.

Hollywood Shows

Atypical (2017)

This show is about a young man with autism who is 18 years old and wants to find a girlfriend and won’t let the fact that his mother is watchful stop him. His search throws his family into a panic as they try to find their freedom and learn how hard it has been to care for someone with ASD. It’s a show that makes you feel good, breaks your heart, and makes you think.

The Good Doctor (2017)

In The Good Doctor, a young autistic surgeon and genius from a difficult past moves from Wyoming to busy San Jose, California, to work at a famous hospital. His amazing skills and gifts as a surgeon keep him going as he deals with relationships and other problems in a new place. This show is a great medical story that shows the beautiful, unique, and complicated conflicts of life with ASD.

Bollywood Movies

Barfi (2012)

Jhilmil is a young girl with autism who is played by Priyanka Chopra in the movie. Priyanka learned a lot about autistic kids and how they act to get ready for the part. This comedy-drama movie was one of the best-reviewed and most-bought movies of that year. It was also India’s official entry for the 85th Academy Award for “Best Foreign Language Film.” Jhilmil, played by Priyanka Chopra, is autistic and finds love with Barfi, played by Ranbir Kapoor, who is deaf and dumb. Through Jhilmil’s trip, the movie did a great job of showing a small part of the daily lives of autistic people and the different ways they feel. Chopra’s performance as the character was so complex and natural that The Forum for Autism (FFA) asked her to be the face of their campaign.

Yuuvraj (2008)

The role played by Anil Kapoor in the 2008 movie Yuuvraj is said to have autism. In the movie, he plays Gyanesh, a rock star musician. The movie is based on the Tom Cruise and Dustin Hoffman movie Rain Man. In that movie, Hoffman plays a genius with autism.

The main focus of everything is Gyanesh Yuvvraaj. However, since he is autistic and a genius, he has no idea what money is, so his huge fortune doesn’t affect him at all. He only wants love. Without it, he dies. He has a genius problem by some strange turn of events. He has been very good at all kinds of singing since he was a child. He walks into Deven’s world of music and instantly turns into the hero Deven always wanted to be.

Turkish Shows

Dönence

Gece is at the heart of the story in this drama. She had planned to go to college and spend the summer making music with her boyfriend Emir. But she had to change her plans because her disabled sister Gülce is having a hard time in Istanbul with all the noise and people. Gece finds herself in Foça with her family out of the blue because she doesn’t want to leave her lover and all her dreams in Istanbul. Right away, her whole world changes, then she meets Özgür, a teacher at the sailing club where her brother is a member. After his parents died in a fire, Özgür, a beautiful young man, has given his whole life to his brother Rüzgar, who has Asperger’s Syndrome. Gece learns how to look at life more maturely as she spends more time with Özgür, and Özgür learns from Gece that she shouldn’t put life off.

Mucize Doktor

This drama is about Ali, a young autistic genius who just graduated from medical school and had a hard childhood. He is very smart, but his situation makes it hard for him to talk to other people. He really wants to become a surgeon. Adil is Ali’s uncle and the head doctor at the Anka Private Hospital. When Ali gets a good score in TUS, he wants to hire him as an assistant doctor in the hospital where he is the top physician. The hospital, on the other hand, is very against Adil. Ali has to deal with a lot of problems in this new world. Because of how smart he is, he helps many people, gets through tough times, and saves lives. But because of his situation, he also makes mistakes along the way. On the other hand, he keeps fighting his handicap and tries to figure out how to talk to other people. He learns what it means to be a person and slowly starts to stand on his own. In that hospital, Ali learns more than just how to be a surgeon.

Pakistani Dramas

Pyar ke Sadke

Pyar ke Sadke, which was written by Zanjabeel Asim, screens the main characters, Bilal Abbas and Yumna Zaidi. Both of them have Autism Spectrum Disorder and are dealing with life’s problems in their unique ways. Even though they both think about what they want in life all the time, it is clear that they are willing to fight hard for it. It gets worse for both characters because they have to keep up with the rest of the world and even go ahead of it. After all, that’s what their gender roles and societal rules say they should do. The weight of hopes and disappointments is so great that constant pain is unavoidable. Pyar ke Sadkey shows the sad truths of life in the best way possible. The beautiful plot is made even better by the light humor and real feelings of someone with ASD. As the series goes on, we see more changes and unexpected events. We also get to see Yumna and Bilal find peace in each other because only they can understand the pain that their society causes them.

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
Brain Health

The Effects of Trauma on Parts of the Brain

Animals and people are more likely to have cognitive-behavioral, mental, and physical problems later on if they have traumatic events early in life. In people, stressful events are strong indicators of mental sickness. More and more studies have focused on changes in the structure and function of the brain that show how genetic changes happen after stress (Thomason & Marusak, 2017).

Stress Hormones

Teenagers who have been through stress and show signs of post-traumatic stress disorder make more of the steroid cortisol than teens who have never been through trauma. Research on animals show that too much corticosterone can hurt brain cells in parts of the brain that have a lot of glucocorticoid receptors, such as the hippocampus and the prefrontal cortex (PFC). You need to be able to remember things and make decisions, which are both very important for learning (Carrion & Wong, 2012).

Brain Areas

A talk at the National Summit for Stress and the Brain talked about structural and functional imaging results in the hippocampus and PFC of young people who have PTSD (Carrion & Wong, 2012).

It was said in the lecture that young people with PTSS have higher amounts of cortisol. Cortisol levels before bedtime can predict long-term declines in the size of the hippocampus. There is a negative relationship between cortisol levels and volume in the PFC. Teenagers with PTSS have lower activity in the hippocampi and prefrontal cortex (PFC) when they are doing memory and executive function tasks compared to healthy teens (Carrion & Wong, 2012).

As memory is a particularly important function of the limbic region and the Prefrontal Cortex, this short essay will infer that memory problems could indicate functional changes in the brain.

Hippocampus

The hippocampus is a part of the brain that helps us learn and remember things. It is also very sensitive to stress. When people are stressed, their bodies create a lot of glucocorticoids, which are chemicals that hurt neurons in the CA3 area of the hippocampus. These chemicals cause neurons to die and dendritic branches to stop growing. Glucocorticoids mess up the chemistry of cells and make hippocampal neurons more vulnerable to amino acids that make them fire, like glutamate. Bremner and others (1999) used cognitive tests to find out how well people with PTSD could use declarative memory. They picked tests that had been shown to be accurate in studies of epilepsy patients as ways to look into how the hippocampus works. These mental tests, like delayed paragraph memory and learning word lists, were linked to the loss of neurons in the hippocampus in people who had surgery to remove part of their hippocampus to treat seizures.

In the first study to use brain imaging to look at PTSD, war soldiers had an 8% decrease in the volume of their right hippocampal area, as measured by magnetic resonance imaging (MRI). There was no change in reference areas like the caudate, amygdala, or temporal lobe. People with PTSD had problems with their short-term memories when the size of their right hippocampal region shrunk.

Prefrontal Cortex

The prefrontal cortex (PFC) controls behaviour, thoughts, and emotions from the top down. It creates the mental models needed for flexible, goal-directed behaviour, such as the ability to control attention, reality testing, and understanding of one’s own and others’ actions. Through working memory, the dorsolateral PFC (dlPFC) controls ideas, attention, and movements in animals. Damage to the PFC makes it harder to concentrate or pay attention, and it can also make it harder to control your impulses, which can lead to risky behaviour. Structural imaging studies have found that the dlPFC, ventromedial Prefrontal Cortex (vmPFC), subgenual PFC, and temporal association cortex are all thinner in people with high levels of distress (Arnstein et al., 2015).

Damage to both sides of the vmPFC makes it harder to control emotional responses, leading to more anger, trouble making decisions, and a lack of understanding. PFC injuries can also make it harder to stop cognitive distraction, like stopping memories that aren’t relevant. The dorsal PFC is needed for reality checking, which is a skill that helps people tell the difference between a strong memory and a real event, like the flashbacks that people with PTSD experience. Lastly, the PFC can control how alert we are by connecting to noradrenergic neurons and stopping them from firing. This lowers the stress reaction (Arnstein et al., 2015).

In Mammals

Animal tests have shown that even a small stressor that can’t be stopped, like loud white noise, can quickly hurt the working memory of monkeys and rats in the PFC. A lot of the time, people who are worried feel like they are unable to regulate the issue that causes them stressed (Arnstein et al., 2015). It’s intriguing to note that the PFC may halt the stress response if it believes that the individual is in charge.

Humans

People can also lose the ability to use their working memory when they are under a lot of stress that they can’t control. For example, watching a disturbing and violent movie can hurt working memory and lower the dlPFC BOLD response. Even Special Forces troops who are under a lot of stress have been seen to have trouble with their working memories (Arnstein et al., 2015). Acute, uncontrolled worry also makes PFC less self-controlled and makes them more likely to abuse drugs.

Conclusion

Scientists have argued for long that psychological phenomena interact with the brain. As is demonstrated by the research cited above, the investigation has reached a point where we could measure changes in the brain, both on a functional and structural level. This is a promising direction which could highlight even better psychological interventions. After all, if stress can be contained through specific psychotherapeutic measures, these measures could be studied individually in relation to the effect on the brain.

This direction continues to marry the sciences of Neurology and Clinical Psychology.

References

  • Arnsten, A. F., Raskind, M. A., Taylor, F. B., & Connor, D. F. (2015). The effects of stress exposure on prefrontal cortex: Translating basic research into successful treatments for post-traumatic stress disorder. Neurobiology of stress, 1, 89-99
  • Bremner, J. D. (1999). The lasting effects of psychological trauma on memory and the hippocampus. Law and Psychiatry.
  • Carrion, V. G., & Wong, S. S. (2012). Can traumatic stress alter the brain? Understanding the implications of early trauma on brain development and learning. Journal of adolescent health, 51(2), S23-S28.
  • Thomason, M. E., & Marusak, H. A. (2017). Toward understanding the impact of trauma on the early developing human brain. Neuroscience, 342, 55-67.
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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