blank lines indicate
combined presentation
classification
associate criteria
clinical practice
a complete description of the underlying pathological processes
the best available description
practical, functional, and flexible
organizing information
reference
nomenclature
in a wide variety of contexts
a common language
concise and explicit
an objective assessment
a tool for collecting and communicating
a structured way to understand and diagnose
mutually compatible
multiple diagnostic categories
common underlying vulnerabilities
a revised organizational structure meant to stimulate new clinical perspectives
how symptoms might be expressed
integration of scientific findings
environmental exposures
a single continuum
restrictive repetitive behaviors
sensitivity and specificity
specific impairments
streamlined classification
mixed features
“dependence” has been easily confused with the term “addiction”
widespread misunderstanding
enhanced specificity
separated into specific subtypes
symptomatic presentations
the names of everyone involved are too numerous to mention here
countless hours
balance and objectivity
the years and travails of the developmental process
the culmination of efforts
the purpose, structure, content, and use
a succinct overview of its key elements
coding and recording procedures
reliable diagnosis
implications for treatment and research
the science of mental disorders continues to evolve
real and durable progress
careful, iterative changes
the touchstone classification of mental disorders
finding the right balance is critical
speculative results do not belong in an official nosology
a too-rigid categorical system does not capture clinical experience or important scientific observations
varying levels of severity
a more accurate description
a clear and concise description
syndrome combinations
normal life variation
transient responses to stress
well-defined boundaries
symptom clusters
many, if not most
shared symptoms
neural substrates
we have come to recognize that the boundaries between disorders
are more porous than originally perceived
eventual cures
providing guidelines
strengths and weaknesses
emerging research that did not support the boundaries
a clear concept of the next evolutionary stage
strategic directions for its revision
revising criteria
basis of rationale, scope of change, expected impact
the deletion of existing disorders
nosology
potential changes
where possible, continuity should be maintained
the degree of change
broader methodological concerns
the presence of contradictory findings
development of a refined definition
not otherwise specified
considered for deletion
routine clinical practices
underlying dimensional features
stratified samples
cross-cutting symptoms
estimates of reliability
diagnostic criteria
evidence for change
antecedent validators
concurrent validators
prospective validators
for consideration and response
blinded results
small iterative changes
major conceptual changes
correcting flaws that had become apparent over time
utility and feasibility
proposed revisions
a historically determined cognitive schema
high rates of comorbidity
rethinking the organizational structures
a linear system
designated by alphanumeric codes
according to some rational and relational structure
remain within the bounds
overly rapid change
reordering and regrouping
revised structure
the clear virtue of creating a common language for communication
relationships within the classification
conditions for further study
different viewpoints emerge
an effort was made
to consider various viewpoints
a shared organizational structure
the use of a shared framework
the proposed linear structure
the initial overall structure
where to place a disorder in the face of incomplete - or more often, conflicting - data
the preponderance of evidence
the contours of individual disorders
simple and linear organization
may not fully capture the complexity
heterogeneity
revised organization
an expanded numeric-alphanumeric coding system
iteration
sequential order
assigned to complement earlier organizational structures
structural problems
a large number of narrow diagnostic categories
relevant evidence
comorbidity
genetic and environmental risk factors
categorical structure
excluding false-positive results
overly narrow
the once plausible goal of identifying homogenous populations for treatment and research
clinical reality
progressive subtyping
like most common human ills
inform possible new groupings
framework
empirical guidelines
developed and published
regrouping
pathophysiological commonalities
a base for future replication
reanalyzed over time to continually asses validity
a “living document”
adaptable to future discoveries
clustering
internalizing and externalizing factors
an empirically supported framework
adjacent placement
dimensional approaches
biological markers
underlying mechanisms
despite the problem posed
training materials
reformulation
supplement or supersede
processes that manifest early in life
a similar approach has been taken
the comprehensive use of lifespan information
to mirror clinical reality
better and more flexible
the next epoch of research
a useful guide
experiences and expression
transmitted, revised, and recreated
family and other social systems and institutions
experiences, symptoms, and behaviors
adaptation
idioms of distress
causal explanations
the boundaries between normality and pathology
thresholds of tolerance
an experience becomes problematic or pathological
the judgment that a given behavior is abnormal
correct mistaken interpretations
vulnerability
stigma or support
alternative and complementary
acceptance or rejection
the clinical encounter
accuracy and acceptance
relatively invariant symptoms
group, community, or context
shared concepts
ways of expressing
naming essential features
everyday experiences
salient features of folk classifications
expectations of treatment
treatment response
potential differences
nomenclature
variations attributable to an individual’s reproductive organs
psychological, behavioral, and social consequences
at risk for a disorder
moderate the overall risk
prevalence and incidence rates
differences in presentation
indirectly relevant
a more comprehensive list of symptoms
reproductive life cycle events
the onset of an illness episode
to communicate the specific reason
providing maximum flexibility
some feature of the presentation itself
this is left entirely up to clinical judgment
to identify gaps
conceptual lack of clarity
routine practice
challenging to determine what to include
a manageable size
field trials
supplementary modules
additional helpful information
the organizational structure
dimensional measures
analyzed over time to continually assess its validity and enhance its value
the history and developmental process
revision
designed to provide a practical guide
primary purpose
a case formulation assessment
a fully informed treatment plan for each individual
cognitive, emotional, behavioral, and physiological processes
far more complex than can be described in these brief summaries
intended to summarize characteristic syndromes of signs and symptoms
it is not sufficient to simply check off the symptoms in the diagnostic criteria
to make a mental disorder diagnosis
a more reliable assessment
relative severity and valence of individual criteria
the relatively limited repertoire of human emotional responses to internal and external stresses
a homeostatic balance
a disruption in normal functioning
the combination of predisposing, precipitating, perpetuating, and protective factors
a psychopathological condition in which physical signs and symptoms exceed normal ranges
available contextual and diagnostic information
a comprehensive treatment plan
recommendations for the selection and use of the more appropriate evidence-based
treatment options for each disorder are beyond the scope of this manual
scientific effort
does not fully describe the full range of mental disorders that individuals experience
genetic/environmental interactions
human development affecting cognitive, emotional and behavioral function
virtually limitless
presentations that do not fit exactly into the diagnostic boundaries
only the most prominent symptom expressions
a particular chapter
possible
no definition can capture all aspects of all disorders
should help
determine prognosis, treatment plans, and potential treatment outcomes
associated with the symptom(s)
risks and benefits
other factors
a clear need for treatment or care
appropriate care
approaches to validating
antecedent validators
concurrent validators
predictive validators
tend to congregate more frequently
incontrovertible etiological or pathophysiological mechanisms
a given set of diagnostic criteria
developed for clinical, public health, and research purposes
additional information is usually required
competency
to separate the concepts
in the absence of clear biological markers
it has not been possible to completely separate normal
gap in information
particularly problematic
mild forms
when necessary
making
text descriptions
only when the full criteria are met
when full criteria are not met
specific criteria for defining disorder severity
descriptive features
course
presentations
subtypes and specifiers
provided for increased specificity
mutually exclusive and jointly exhaustive phenomenological subgrouping
as a consequence, more than one specifier may be given
an opportunity to define a more homogeneous subgrouping
to convey information that is relevant to the management of the individual’s disorder
a number of criteria sets
intensity, frequency, duration
disorder-specific definitions
additional information
and/or
other conditions that are not mental disorders
a separate chapter
devoted
adverse effects of medication
other conditions may be a focus
when more than one diagnosis for an individual is given
occasioning the admission
when more than one diagnosis is given
the reason for visit
the main focus of attention
it is often difficult (and somewhat arbitrary)
for example
for example, it may be unclear
each condition may have contributed equally
indicated by listing it first
listed in order of focus
not enough information is available
unable to give an adequate history
the duration of illness
before remission has occurred
accompanied by an identifying diagnostic and statistical code
specific recording protocols
further specification
further clarified in a section on recording procedures
alternative terms enclosed in parentheses
developing a comprehensive case formulation
well-established measures
extensive review
conditions for further study
the scientific evidence is not yet available to support widespread clinical use
highlight the evolution and direction of scientific advances
considered as a useful aid to communication
designed to be used
to establish a baseline for comparison
to monitor changes
the current consensus on the evolving knowledge in our field
forensic consequences
does not provide treatment guidelines
when used appropriately
the use of an established system
value and reliability
providing a compendium
a check on ungrounded speculation
the functioning of a particular individual
finally
information about longitudinal course may improve decision making
at a past or future point in time
however
informed by an awareness of the risks and limitations of its use
categories, criteria, and textual descriptions
a risk
misused or misunderstood
the imperfect fit between questions
presence
additional information is usually required beyond that contained
precisely
otherwise insufficiently trained
cautioned
does not carry any necessary implications
regarding the etiology or causes
degree of control
even when diminished
at a particular time
parenthetically
where needed
separate recording procedures
to indicate other reasons
adapted
neither reviewed nor approved
additional context
a group of conditions with onset in the developmental period
typically manifest early
impairments
very specific limitations of learning
frequently co-occur
symptoms of excess
only when the characteristic deficits of social communication
are accompanied by excessively repetitive behaviors, restricted interests, and insistence on sameness
reasoning, problem solving, planning, abstract thinking
judgment, academic learning, and learning from experience
impairments in adaptive functioning
disturbances of the normal fluency
broken words
words produced with an excess of physical tension
may produce lifelong functional impairments
persistent deficits in social communication and social interaction across multiple contexts
developing, maintaining, and understanding relationships
the presence of restricted, repetitive patterns
compensatory mechanisms
an opportunity to individualize
a richer clinical description
levels of inattention
disorganization
hyperactivity-impulsivity
inability to stay on task
seeming not to listen
losing materials
overactivity
inability to wait
manifested by clumsiness and slowness
stereotypic movement
repetitive, seemingly driven, and apparently purposeless
sudden, rapid, recurrent, nonrhythmic
waxing-waning
as the name implies
specific deficits in an individual’s ability to perceive or process information
efficiently and accurately
the use of specifiers
symptomatology
etiology
mild
moderate
severe
profound
abstract thinking
executive function
short-term memory
a somewhat concrete approach to problems and solutions
communication, conversation, and language
difficulties regulating emotion and behavior
limited understanding of risk
at risk of being manipulated by others
individuals need some support
support is typically needed
conceptual skills lag markedly
understanding of time
occurs slowly
day-to-day life
much less complex
limited conceptual and communication skills
additional supports and learning opportunities
over an extended period of time
little understanding of written language or concepts involving numbers, quantity, time
extensive supports for problem solving throughout life
conceptual skills generally involve the physical world rather than symbolic processes
co-occurring motor and sensory impairments may prevent functional use of objects
speech may be single words or phrases
may be supplemented through augmentative means
focused on the here and now
relationships with family members and familiar others are a source of pleasure and help
skill acquisition in all domains involves longterm teaching and ongoing support
conceptual skills generally involve the physical world rather than symbolic processes
co-occurring motor and sensory impairments may prevent functional use of objects
symbolic communication in speech or gesture
expresses
desires and emotions
nonverbal, nonsymbolic communication
co-occurring sensory and physical impairments
essential features
deficits in general mental abilities
impairment in everyday adaptive functioning
reasoning, problem solving, planning, abstract thinking
judgment, learning from instruction and experience, and practical understanding
verbal comprehension, working memory, perceptual reasoning
quantitative reasoning, abstract thought, and cognitive efficacy
psychometrically valid, comprehensive, culturally appropriate
psychometrically sound tests of intelligence
approximately two standard deviations or more below the population mean
a margin for measurement error
practice effects
brief intelligence screening tests or group tests
instruments must be normed
for the individual’s sociocultural background
native language
communication, language, and/or motor or sensory function
areas of relative strengths and weaknesses
approximations of conceptual functioning
how well a person meets community standards
personal independence and social responsibility
adaptive reasoning in three domains: conceptual, social, and practical
competence in memory, language, reading, writing, math reasoning, acquisition of practical knowledge
problem solving, and judgment in novel situations, among others
learning and self-management across life settings
standardized measures are used with knowledgeable informants
and the individual
to the extent possible
interpreted using clinical judgment
difficult to assess in a controlled setting
corroborative information
a heterogeneous condition with multiple causes
naivete in social situations
a tendency for being easily led by others
a lack of awareness of risk and danger
periods of worsening
progressive worsening
may change over time
early and ongoing interventions may improve adaptive functioning
significant improvement
no longer appropriate
it is common practice
after an appropriate course of intervention is provided
contingent on the presence of supports
a variety of labor and delivery-related events
cultural sensitivity and knowledge
needed during assessment
a comprehensive evaluation
whenever criteria A, B, and C are met
specific to the communication and learning domains
complicated by social-communication
may interfere with understanding and complying with test procedures
may be unstable
prognosis and outcome
assessment procedures
may require modifications
knowledgeable informants are essential
for identifying symptoms
with a similar meaning
cannot be reliably assessed
unable to undergo systematic assessments
this category requires reassessment after a period of time
presence of severe problem behaviors
this category should only be used in exceptional circumstances
requires reassessment after a period of time
deficits in language, speech and communication
speech is the expressive production of sounds
an individual’s articulation
fluency, voice, and resonance quality
language includes form
function
use of a conventional system of symbols
communication includes any verbal or nonverbal behavior
whether intentional or unintentional
that influences the behavior, ideas, or attitudes of another individual
persistent difficulties in the acquisition and use of language across modalities
reduced vocabulary
limited sentence structure
impairments in discourse
resulting in functional limitations
individually or in any combination
spoken communication, written communication, or sign language
dependent on both receptive and expressive skills
expressive ability
the production of vocal, gestural, or verbal signals
receptive ability
the process of receiving and comprehending language messages
usually affects vocabulary and grammar
limit the capacity for discourse
smaller and less varied than expected
especially in past tense
frequently underestimated
using context to infer meaning
word-finding problems
impoverished verbal definitions
poor understanding of synonyms
multiple meanings
word play
problems with remembering new words and sentences
difficulties following instructions of increasing length
difficulties rehearsing strings of verbal information
difficulties remembering novel sound sequences
a reduced ability to provide adequate information about the key events and to narrate a coherent story
can be use to guide
estimates of severity
a positive family history
adept at accommodating
limited language
may appear to be shy or reticent to talk
notable and persistent
marked by changes
changes appear across the dimensions
sounds, words, grammar
narratives/expository texts
conversational skills
increments and synchronies
considerable variation
highly predictive of later outcomes
stable
highly predictive of later outcomes
likely to change
predominantly expressive impairments
resistant to treatment
highly heritable
a history of language impairment
this distinction may be difficult to make
needs to be excluded
primary cause
usually associated with these problems
loss of speech and language
persistent difficulty
prevents verbal communication of messages
the disturbance causes limitations
individually of in any combination
speech sound production
the clear articulation of the phonemes
the ability to coordinate the movements of the articulators
underlying mechanisms
not what would be expected
should be intelligible
may be understandable
the ability to rapidly coordinate
a particular aspect of difficulty
history of delay
incoordination
chewing, maintaining mouth closure, and blowing the nose
if present, these should also be coded
learning to produce speech sounds clearly and accurately
learning to produce connected speech fluently
articulation of speech sounds
developmental pattern
it is not unusual
processes for shortening words and syllables
immature phonological simplification processes
produced clearly
pronounced accurately
learned later
misarticulation
within normal limits
when multiple sounds are involved
part of a plan
produce them accurately
particularly common
frontal or lateral patterns of airstream direction
abnormal tongue-thrust swallowing pattern
respond well
improve over time
may not be lifelong
normal variations
considered before making
may result in abnormalities
in excess
usually associated with these problems
may be due to structural deficits
distinctive features of voice
differentiation may be difficult
when there is no or minimal general body motor involvement
selective mutism
in one or more contexts or settings
embarrassment
in “safe” settings
disturbances in the normal fluency and time patterning of speech
frequent and marked occurrences
sound and syllable repetitions
sound prolongations of consonants as well as vowels
broken words
pauses within a word
audible or silent blocking
filled or unfilled pauses in speech
circumlocutions
words substitutions to avoid problematic words
words produced with an excess of physical tension
monosyllabic whole-word repetitions
causes anxiety
frequent repetitions
varies from situation to situation
often absent during oral reading, singing, or talking to inanimate objects
fearful anticipation of the problem may develop
insidious or more sudden
start gradually
with repetition
become more frequent and interfering
short and simple utterances
predicting recovery or persistence
whole-word or phrase repetitions
incomplete phrases, interjections, unfilled pauses, and parenthetical remarks
increase in frequency or complexity
a side effect
a temporal relationship
specific neurological insults
vocal tics and repetitive vocalizations
repetitive sounds
nature and timing
persistent difficulties
verbal and nonverbal communication
greeting and sharing information
in a manner that is appropriate for the social context
avoiding use of overly formal language
difficulties following rules
taking turns in conversation
rephrasing when misunderstood
knowing how to use verbal and nonverbal signals to regulate interaction
difficulties understanding what is not explicitly stated
making inferences
nonliteral or ambiguous meanings
idioms, humor, metaphors
multiple meanings that depend on the context
for interpretation
functional limitations in effective communication
exceed limited capacities
difficulty with pragmatics
naturalistic contexts
changing language according to the needs of the listener or situation
following rules for conversations and storytelling
language impairment
a history of delay
may avoid social interactions
may not become apparent
when language and social interactions become more complex
variable
improving substantially over time
continuing to have difficulties
may cause lasting impairments
such as written expression
restricted/repetitive patterns of behavior, interests, or activities
restricted/repetitive patterns of behavior, interests, and activities
a comprehensive history should be obtained
only if the developmental history fails to reveal any evidence of
restricted/repetitive patterns of behavior, interests, or activities
functional limitations of effective communication
the differentiating feature is the timing
in excess of the intellectual limitations
clinically significant distress or impairment
includes presentations in which there is insufficient information
across multiple contexts
examples are illustrative, not exhaustive
abnormal social approach
failure of normal back-and-forth conversation
reduced sharing of interests, emotion, or affect
failure to initiate or respond
nonverbal communicative behaviors
poorly integrated verbal and nonverbal communication
abnormalities in eye contact and body language
deficits in understanding and use of gestures
a total lack of facial expressions
nonverbal communication
difficulties in sharing imaginative play or in making friends
restricted, repetitive patterns of behavior, interests, or activities
stereotyped or repetitive motor movements, use of objects, or speech
insistence on sameness
highly restricted
fixated interests that are abnormal in intensity or focus
apparent indifference to pain/temperature
adverse response to specific sounds or textures
excessive smelling or touching of objects
visual fascination with lights or movement
may be masked by learned strategies
these disturbances are not better explained
used to describe succinctly
may vary by context and fluctuate over time
discussion of personal priorities and targets
often uneven
assessed and described
speaks in full sentences
has fluent speech
receptive language may lag behind
considered separately
the stage at which functional impairment becomes obvious
intervention, compensation, and current supports
in at least some contexts
pervasive and sustained
most valid and reliable when based on multiple sources of information
when possible
varying manifestations
the ability to engage with others and share thoughts and feelings
no sharing of emotions
absent imitation
what language exists
used to request or label rather than to comment
difficulties in processing and responding
when and how to join a conversation
what not to say
struggle in novel or unsupported situations
suffer from the effort and anxiety
consciously calculating
absent, reduced, or atypical use of eye contact
a lack of pointing, showing, or bring objects to share interest with others
often fail to use expressive gestures spontaneously
difficulty in coordinating nonverbal communication
odd, wooden, or exaggerated
may be relatively subtle
should be judged against norms
manifested by rejection
passivity
inappropriate approaches
playing by very fixed rules
appropriate in one situation but not another
irony, white lies
there may be an apparent preference
without a complete or realistic idea
important to consider
simple motor stereotypies
hand flapping
finger flicking
repetitive use of objects
repetitive speech
use of “you” when referring to self
use of words, phrases, or prosodic patterns
excessive adherence to routines
resistance to change
rigidity of thinking
repetitive questioning
abnormal in intensity or focus
fascinations and routines
extreme responses to specific sounds or textures
excessive smelling or touching of objects
fascination with lights or spinning objects
apparent indifference to pain, heat, or cold
learn to suppress repetitive behavior in public
a source of pleasure and motivation
even if symptoms are no longer present
the features must cause clinically significant impairment
not in line
exceed difficulties expected
diagnostic instruments with good psychometric properties
can improve reliability
over time
an uneven profile of abilities
the gap between
disruptive/challenging
cationic-like
typically not of the magnitude of a catatonic episode
it is possible
to experience a marked deterioration
mutism, posturing, grimacing
waxy flexibility
expansion of the diagnostic criteria
increased awareness
a true increase in the frequency
pattern of onset
symptoms are typically recognized
if symptoms are more subtle
in cases where skills have been lost
a history of gradual or relatively rapid deterioration
distinguished from the rare instances
previously described
behavioral features
a lack of interest
plateaus or regression
gradual or relatively rapid
such losses are rare
much more unusual
losses of skills
frequently involve delayed language
without any attempt
odd play patterns
unusual communication patterns
odd and repetitive behaviors
absence of typical play
enjoy repetition
based on the type, frequency, and intensity
lines up objects for hours
continue throughout life
often most marked
in at least some areas
able to fine a niche
naive and vulnerable
difficulties organizing practical demands
coping mechanisms
stress and effort maintaining a socially acceptable facade
scarcely anything is known
perhaps prompted
a breakdown
criteria are currently met
provided there is no evidence
the absence
should not do so
difficulties in at least some contexts
other important areas of functioning
a variety of nonspecific risk factors
estimates
appear to be associated
associated with a known genetic mutation
risk for the remainder
making relatively small contributions
markedly impaired against the norms
recognition
in clinic samples
accompanying intellectual impairments
language delays may go unrecognized
subtler manifestation
insistence on routines
aversion to change
sensory sensitivities
extremely difficult
coping with change
difficulties establishing independence
continued rigidity
difficulty with novelty
functional consequences
unknown
may be observed
a substantial portion
no longer a major area of concern
in certain contexts and settings
in some forms
there may be problems
care should be taken to enquire carefully
difficult to differentiate
developed language
symbolic skills
present a challenge
nonverbal problem solving
no apparent discrepancy
explained
abnormalities of attention
hyperactivity
attentional difficulties
mental
normal, or near normal
hallucinations and delusions
“Do you hear voices when no one is there?”
an inability to comprehend and construct sentences
observable signs
increases in challenging behavior
evaluation
literacy and numeracy
fairly frequent
extreme and narrow
a persistent pattern
that is inconsistent
not solely a manifestation
failure to understand tasks or instructions
close attention to details
makes careless mistakes
difficulty sustaining attention
does not seem to listen
mind seems elsewhere
in the absence of any obvious distraction
does not follow through
easily sidetracked
extraneous stimuli
may include unrelated thoughts
forgetful
remaining in place
feeling restless
uncomfortable being still for extended time
difficult to keep up with
while waiting
persistent pattern of inattention
wandering off task
lacking persistence
difficulty sustaining focus
excessive motor activity
a child running about
excessive fidgeting, tapping, or talkativeness
hasty actions
occur in the moment without forethought
darting into the street without looking
confirmation of substantial symptoms
symptoms vary depending on context
may be minimal or absent
consistent external stimulation
underlying cognitive processes
findings are not diagnostic
highly variable normative behaviors
inattention becomes more prominent and impairing
relatively stable
motoric hyperactivity
restlessness, inattention, poor planning, and impulsivity persist
the main manifestation
inattention becomes more prominent
confined to fidgetiness
an inner feeling of jitteriness
restlessness
impatience
impulsivity may remain problematic
effortful control
constraint
elevated novelty seeking
it is not know whether these associations are causal
neither necessary nor sufficient
possible influences
neurological soft signs
co-occurring clumsiness
interaction patterns
prevalence rates
sustained effort
great variability
marked symptoms
resist conforming to others’ demands
complicating
typically generalized
prolonged observation
frustration, lack of interest, or limited ability
difficult-to-manage behavior
isolation
inability to tolerate a change
expected course of events
during a major transition
attraction to external stimuli
preoccupation with enjoyable activities
inattention due to worry
rumination
restlessness
inability to concentrate
poor concentration
increased activity
poor concentration
increased impulsivity
episodic
occurring several days at a time
features of disorganization
cognitive dysregulation
unspecified
chooses not to specify
inaccurate or slow and effortful word reading
frequently guesses words
sounding out words
may add, omit, or substitute vowels or consonants
written expression of ideas lacks clarity
numbers, their magnitude, and relationships
gets lost
activities of daily living
a pattern of learning difficulties
clarity or organization of written expression
performing accurate or fluent calculations
to complete all activities efficiently
with impairment
the basis for abnormalities
an interaction of genetic, epigenetic, and environmental factors
to perceive or process
efficiently and accurately
persistent difficulties
in contrast to talking or walking
disrupts the normal pattern
it is not simply a consequence of lack of opportunity
a range of observable, descriptive behaviors or symptoms
observed, probed
ascertained
difficulties are persistent, not transitory
extraordinarily high levels of effort or support
significant interference
avoidance of activities
norm-referenced
criterion-referenced
distributed along a continuum
there is no natural outpoint
to a large extent arbitrary
on the basis of clinical judgment
normal levels
identified
presence of neurological signs
comprehensive assessment is required
no single data source is sufficient
based on a synthesis
previous and current
previous or current
typically persists
unless indicated by marked changes
amelioration
worsening
delays in attention
slow, effortful, inaccurate
it remains unclear
cause, correlate, or consequence
underspecified or unknown
circumscribed alterations
cognitive processing
brain structure and function
precursors such as language delays or deficits
difficulties in rhyming or counting
the course and clinical expression are variable
a persistent or shifting array
language sounds
trouble learning nursery rhymes
mispronounce words
trouble remembering names
invented spelling
letter-sound correspondence
fluent word decoding
reading aloud is slow
the magnitude that a spoken or written number represents
problems recognizing and manipulating phonemes
unable to recognize common irregularly spelled words
long, multisyllable words
confuse words that sound alike
poor comprehension
guess wildly
express fear of reading aloud
refuse to read aloud
word decoding
slow and effortful
connected text slowly without much effort
frequently need to reread material to understand or get the main point
trouble making inferences from written text
avoid activities
slow and effortful
problems making important inferences
alternative approaches to access print
broader expression
appears to aggregate in families
the combined role of genetic and environmental factors
genes related to one presentation
highly correlated
genes related to another manifestation
predictive of later difficulties
predictive of worse mental health outcome
systematic, intensive, individualized instruction
evidence-based interventions
improve or ameliorate
mitigating the otherwise poor outcomes
cognitive processing requirements
slow reading of single words
direct mapping
slow but accurate
negative functional consequences
high levels of psychological distress
poorer overall mental health
normal variations
external factors
even when it is different
abnormal findings
marked decline
problems may not necessarily reflect specific difficulties
may reflect difficulties
expected by chance
there is a decline
often rapid
independently interferes with the execution of activities of daily living
the acquisition and execution of coordinated motor skills
clumsiness
dropping or bumping into objects
slowness and inaccuracy of performance of motor skills
catching an object
affecting movement
impaired skills requiring motor coordination
negotiating stairs
completing puzzles
movement execution may appear awkward
less precise
slow speed
speed and accuracy are required
affected by coordination problems
lack of stability
visual function examination
neurological examination
usually suppressed
mirror movements
overflow
still unclear, requiring further evaluation
although there may be improvement
assembling puzzles
continuing difficulty in learning new tasks
complex/automatic motor skills
using tools
presentation, course, and outcome
spatial mentalizing
rapid motoric adjustments
the complexity of the required movements
activities of daily living
consideration of the context
impaired functional performance
co-occurring conditions
problems in coordination
additional findings
in excess of what could be accounted for
may fall, bump into objects, or knock things over
careful observation
different contexts
distractibility
impulsiveness
complex coordination skills
hyperextensible joints
found on physical examination
often with a complaint of pain
problems of inattention
clusters of co-occurrence
impaired movement control
motor planning
ascribing impaiment
repetitive, seemingly driven, and apparently purposeless
sensory stimulus or distraction
continuous monitoring and protective measures
severity
easily suppressed
continuous movements
various dimensions
frequency, impact
retinal detachment
repetitive, seemingly driven, and apparently purposeless
rhythmical movements
movements may or may not respond to efforts to stop them
repetitive movements
self-restraining behaviors
sitting on hands
wrapping arms in clothing
finding a protective device
repertoire of behaviors
variable
individually patterned
rotating hand movements
flicking or fluttering fingers
arm waving or flapping
head nodding
visual impairment
rocking the torso
waving a small string repetitively in front of the face
many times during a day
lasting a few seconds
several minutes or longer
in a single day
excited, stressed, fatigued, or bored
undetected
resolve over time
may persist for years
may change
environmental stress
fear may alter physiological state
by virtue of a particular syndrome
restrained
attitudes toward unusual behaviors
must be considered
in the transition from sleep to awake
distraction or sensory stimulation
reciprocity
absent
sufficiently severe
consistent and fixed
pattern or topography
fixed, rhythmic, and prolonged
brief, rapid, random, fluctuating
the absence of obsessions
the nature of repetitive behaviors
driven to perform repetitive behaviors
an obsession
according to rules
seemingly driven but apparently purposeless
may not be patterned or rhythmical
the exclusion of habits
a neurological history and examination
limb movements


 

Proposals for Revisions, 2019, work in progress translating the DSM-V into one long poem

© 2019 Megan Scheffer.