In this article we will cover the broad category of “cognitive” disorders – these include neurocognitive, neurodevelopmental, intelligence and education-related, and tic disorders.
Cognitive refers to the cognitive processes or cognitions – the way we think. These disorders will all be related to disordered thinking that causes distress in work performance, school performance, and executive functioning.
Some symptoms that can lead to the consideration of one of these diagnoses include the following:
Speech/language/communication issues
Learning difficulty
Memory issues
Concentration issues
Trouble at work/school
Disorientation
Unrealistic/abnormal speech/thoughts
Development stunting
Note: ALL disorders in the DSM-5 include the criteria that symptoms and dysfunction must not be attributed to other mental disorders, effects of substances, or a medical condition.
NEUROLOGICAL/COGNITIVE DISORDERS
Major-Mild Neurocognitive Disorders F02
A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based on:
a. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and
b. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
c. The cognitive deficits do not interfere with capacity for independence in everyday activities
Delirium
B. Disturbance of consciousness (i.e. reduced clarity of awareness of the environment) with reduced ability to focus, sustain or shift attention.
C. A change in cognition or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established or evolving dementia.
D. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day
F. There is evidence from the history, physical examination or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition.
Developmental Coordination Disorder F82
A. The acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for learning and use. Manifested as clumsiness as well as slowness and inaccuracy of performance of motor skills.
a. This could be dropping/bumping into things, trouble catching objects/handwriting/holding culturally appropriate utensils.
B. These deficits significantly and persistently interfere with activities of daily living appropriate with chronological age and impacts normal function/performance.
C. Onset of symptoms is in the early developmental period.
Tic Disorders
A. Must have one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase).have been present for no longer than 12 months in a row.
B. Must have tics that start before age 18 years.
Tourette's Disorder F95.2
Motor or Vocal Tic Disorder F95
Stereotypic Movement Disorder F98.4
A. Repetitive, seemingly driven, and nonfunctional motor behavior (e.g., hand shaking or waving, body rocking, head banging, mouthing of objects, self-biting, picking at skin or bodily orifices, hitting own body).
B. The behavior markedly interferes with normal activities or results in self-inflicted bodily injury that requires medical treatment (or would result in an injury if preventive measures were not used).
C. If Mental Retardation is present, the stereotypic or self-injurious behavior is of sufficient severity to become a focus of treatment.
D. The behavior persists for 4 weeks or longer.
LEARNING DISORDERS
Intellectual Disability F70(-73)
1. Deficits in intellectual functioning (proven by an IQ test of 2 SD below average)
This includes various mental abilities:
Reasoning;
Problem solving;
Planning;
Abstract thinking;
Judgment;
Academic learning (ability to learn in school via traditional teaching methods);
Experiential learning (the ability to learn through experience, trial and error, and observation).
2. deficits or impairments in adaptive functioning:
Communication
Social skills
Personal independence
School or work functioning
3. The limitations occur during the development period and are evident during childhood or adolescence. If they begin after this period, they are likely neurocognitive.
Specific Learning Disorder
Specific Learning Disorder F81
A. the individual’s performance in a particular area is well below average for age. Typically - at least 1.5 standard deviations below the norm for their age on standardized achievement tests within domain of difficulty.
B. Learning difficulties are typically readily apparent in the early school years in most individuals, sometimes the learning difficulties may not manifest fully until later school years.
C. Types:
with impairment in reading F81.0 (AKA Dyslexia)
with impairment in written expression F81.1
with impairment in mathematics F81.2 (AKA Dyscalculia)
COMMUNICATION DISORDERS
Language Disorder F80.9
A. The individual has a consistently hard time using language in different manners (speaking, writing, using sign language, or other) due to deficits in understanding or production that include:
Reduced vocabulary
Limited sentence structure or limited ability to put words together to form basic, grammatically correct sentences
Impairments in discourse, for limited ability to use vocabulary and connect sentences or to keep up good conversation
The individual’s language capacity is significantly below what is expected at his or her age, which may result in hindered communication, social participation, and academic achievement.
The symptoms set in during the individual’s early developmental period.
B. These given difficulties are not result of a sensory impairment, motor dysfunction, or another medical condition, and cannot be attributed to intellectual disability or global developmental delay.
Social (Pragmatic) Communication Disorder F80.89
A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for social context.
Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meaning of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation.)
B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
Speech Sound Disorder F80.0
1. Persistent unintelligible speech consisting of phoneme addition, omission, distortion, or substitution, which interferes with verbal communication.
2. There is interference with either social participation, academic performance, or occupational performance (or any combination thereof).
3. The onset of symptoms is during childhood.
Childhood-onset Fluency Disorder (Stuttering) F80.81
A. Interruptions in normal fluency and time patterning of speech (unsuitable for the individual’s age), exemplified by repeated occurrences of 1 or more of the following:
Sound and syllable repetitions
Sound prolongations
Interjections
Broken words (such as breaks within a word)
Audible or silent blocking (filled or unfilled gaps in speech)
Circumlocutions (word substitutions to evade challenging words)
Words formed with an overload of physical tension
Monosyllabic whole-word repetitions
B. The interruptions in fluency gets in the way with academic or occupational accomplishments or with social communications
C. If a speech-motor or sensory deficit is evident, the speech challenges are in excess of those typically connected with these problems:
Deficits in intellectual functions, like reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, established through the use of both clinical assessment and individualized, standardized intelligence testing.
Deficits in adaptive functioning that end up in failure to achieve developmental and sociocultural standards for personal autonomy and social responsibility. Lacking continuing support, the adaptive deficits hinder functioning in one or more activities of daily life, including communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.
Start of intellectual and adaptive deficits throughout the developmental period.
AUTISM/ADHD
Autism Spectrum Disorder F84.0
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).
Attention-Deficit Hyperactive Disorder F90
A. Five or more symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity must have persisted for ≥6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities.
B. Several symptoms (inattentive or hyperactive/impulsive) were present before the age of 12 years.
C. Several symptoms (inattentive or hyperactive/impulsive) must be present in ≥2 settings (eg, at home, school, or work; with friends or relatives; in other activities).
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