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autism: Implications for counselors,” published in the Winter 2007 Journal of Counseling & Development.
Attention-deficit/ hyperactivity disorder (ADhD)
ADHD is now classified in the
DSM-5 as a neurodevelopmental disorder, whereas it was classified in the DSM-IV-TR as a disruptive behavior disorder. It is important to note that
the counseling literature conceptualized ADHD as a neurodevelopmental disorder as early as 1999 (see Jerrold Pollak, Sheldon Levy and Timothy Breitholtz’s article, “Screening for medical and neurodevelopmental disorders
for the professional counselor,” in the Summer 1999 Journal of Counseling & Development).
The DSM-5 uses the same 18 symptoms from the DSM-IV-TR, divided into two symptom domains (inattention and hyperactivity/impulsivity). The presence of at least six symptoms from one domain is required for diagnosis.
For older adolescents (17 and older) and adults, however, only five symptoms
are required for inattention and hyperactivity/impulsivity.
Additional changes in the DSM-5 include:
n Adding a note that “symptoms are not solely a manifestation of oppositional behavior, defiance, hostility or a failure to understand tasks or instructions”
n Adding “and that negatively impacts directly on social and academic/ occupational activities” to Criterion A1 and Criterion A2
n Adding “or taps” to Criterion A2a
n Adding examples to the criterion items to facilitate application across the life span, especially for detecting ADHD symptoms in adults
n Adding the in partial remission course specifier and mild, moderate and severe specifiers
n Changing “Some” to “Several” in Criterion B and Criterion C
n Changing the onset criterion from “before age 7 years” to “present prior to age 12” (research since 1994
has found no clinical differences in terms of course, severity, outcome or treatment response between children identified by age 7 and those identified later)
n Renaming “Subtypes” to “Presentations” because the DSM-5 uses a dimensional paradigm instead of the categorical paradigm used in the DSM-IV-TR
n Removing the word “excessively” from Criterion A2c
n Removing the DSM-IV-TR restriction of comorbid diagnosis with autism spectrum disorder (current research indicates that 29 percent of children between the ages of 4 and 8 with autism spectrum disorder were rated by their parents as having clinically significant symptoms of ADHD)
Specific learning disorder
The DSM-5 combines the DSM- IV-TR diagnoses of reading disorder, mathematics disorder, disorder of written expression and learning disorder not otherwise specified. The new diagnostic criteria are to be met based on a clinical synthesis of the individual’s history (developmental, medical, family and educational), school reports and psychoeducational assessment.
The DSM-5 also acknowledges that specific types of reading deficits are described internationally in various ways as dyslexia, while specific types of mathematics deficits are often called dyscalculia. Because learning deficits in the areas of reading, written expression and mathematics commonly occur together, coded specifiers for the deficit types in each area are included, and counselors should specify all academic domains and subskills that are impaired. For example, counselors would communicate the diagnosis as follows: specific learning disorder with impairment in reading, with impairment in reading rate or fluency and impairment in reading comprehension.
The severity specifiers, which are new for this disorder, are mild (may
be able to compensate or function
well when provided with appropriate accommodations or support services, especially during the school years), moderate (unlikely to become proficient without some intervals of intensive
and specialized teaching during the school years) and severe (unlikely to learn skills without ongoing, intensive, individualized and specialized teaching for most of the school years).
Finally, the DSM-5 added “despite the provision of interventions that target those difficulties” to Criterion A. The provision of interventions is commonly referred to as responsiveness to intervention. I encourage counselors to read Wendy Cavendish’s article, “Identification of learning disabilities: Implications of proposed DSM-5 criteria for school- based Assessment,” from the Journal of Learning Disabilities (see ldx.sagepub.com/ content/46/1/52.full.pdf+html).
Developmental coordination disorder
The DSM-5 makes significant changes to the diagnostic criteria for this disorder. I encourage counselors to read this chapter in the manual to become acquainted with these modifications.
Stereotypic movement disorder
DSM-5 changes to this disorder include:
n Removing “self-inflicted bodily injury that requires medical treatment” from Criterion B
n Changing language in Criterion C to “Onset is in the early developmental period”
n Merging Criterion D and Criterion E n Removing Criterion F (“The behavior
persists for four weeks or longer”)
n Adding the following specifiers:
a) without self-injurious behavior,
b) associated with a known medical or genetic condition, neurodevelopmental disorder or environmental factor and c) mild, moderate, severe
Tourette’s disorder
The DSM-5 changes include removing the following Criterion B language:
“and during this period there was never a tic-free period of more than three consecutive months.”
Persistent (chronic) motor or vocal tic disorder
DSM-5 changes include:
n Removing “(i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations)” from Criterion A
n Removing “and during this period there was never a tic-free period of more than three consecutive months” from Criterion B
n Adding two specifiers: with motor tics only and with vocal tics only
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