Severity Specifiers

• Mild- few symptoms and minor impairment in social/occupational functioning
• Moderate- Symptoms and impairment between mild and severe
• Severe- symptoms in excess to required to make diagnosis or severe/serious symptoms and imparement

• In Partial Remission- Diagnosis was met in the past now only a few symptoms remain
• In Full Remission - met diagnosis in the past but no symptoms for a considerable time, still significant to note
• Prior History- met a diagniosis in the past but now fully recovered "cured"  

Severity Specifiers for

• Mental retardation
• Conduct Disorder
• Manic Episode
• Major Depressive Episode

Severiry Specifiers for - In-Partial and In-Full Remission for

• Manic Episode
• Major Depressive Episode
• Substance Dependence  

Provisional Diagnosis

If few symptoms and assume base on clinical judgement that diagnosis will be met

Multiaxial System

Axis I- Clinical and V codes

Axis II- Personality Disorders and Mental Retardation

Axis III- General Medical Condition

Axis IV-Psychosocial and Environmental Problems 

Axis V- GAF

GAF - problems with

• primary support group
• social environment
• education
• occupational
• housing
• economic access to health care
• interaction in legal system
• other psychosocial/environmental

GAF Functioning impairment in social, academic and/or occupational also involvement in activities) 

• 100- no sypmtoms/superior functioning
• 90- minimal symptoms/good functioning 
• 80  transient expecterd reaction/slight impairment
• 70- mild simptoms/some imparment/difficulty
• 60- moderate symptoms/moderate impairment
• 50- serious symptoms/serious imparment (suicidal)
• 40- impairment in reality or communication
• 30- serious imparment delusions or hallucinations
• 20- danger of hurting self/others
• 10-persistent danger of hurting self or others  

Mental Retardation

• IQ ↓ 70
• ↓ adaptive functioning - communication, self care, social/interpersonal skills, self-direction, academic, work, leisure, health and safety skills
• before age 18

• Mild IQ- 50-70
• Moderate 35-55
• Severe 20-40
• Profound ↓ 20

Learning Disorders

• Reading
• Mathematic
• Written expression  

For All 3 Disorder

• as by standarized testing ↓ expected for age, intelligence and education
• significantly interfere with academic and home living
• if sensory deficit difficulties are in excess
• code generak medical/neurological on Axis III 

Developmental Coordination Disorder

• Motor coordination ↓ expected for age/intelligence
• walking, crawling, sitting, dropping things, clumsiness, poor sport performance and poor hand writting

• significally interfere with academic/daily living
• not due to general medical
• R/O - cerebral palsy, hemiplegia, muscular dystrophy
• R/O Pervasive development Disorder
• if Mental Rertardation - Motor difficulties are in excess

Expressive Language Disorder

• nonverbal/receptive languge ↓ as per standarize test
• limited vocabulary
• error in tense
• difficulty recalling words or producing sentenses

• interfere with academic/occupational/social
• R/O Mixed Receptive-Expressive Language Disorder or Pervasive Developmental Disorder
• if Mental Retardation- language difficulties are in excess

Mixed Receptive-Expressive Language Disorder

• Receptive/expressive ↓ as per standarize test
• difficulty understanding words/sentenses

• significally interfere with academic/occupational/social communication
• R/O PDD
• If Mental Retardation - language difficulties are in excess of those associate with these problems   

Phonological Disorder (articulation)

• failure to use expected speech sounds
• substitution of one sound for another
• omission of sounds

• interfere with academic/occupational/social communication
• if MR - speech difficulties are in excess

Stuttering

• disturbance of fluency and pattern of speech
• sound syllable repetition
• sound prolongation
• interjections
• broken words
• audible/silent blocking
• circumlocutions (substitute words to avoid problematic words)
• physical tention
• monosyllabic whole-word repetition

• significally interfere with academic/occupational/social communication
• if speech-motor or sensory deficit speech difficulties are in excess
• code speech-motor/sensory deficit in Axis III 

Autistic Disorder

• need 6 items at least {2 from (1), 1 (2) & 1(3)}
• delay in social interaction, language or symbolic/imaginative play
• 1-imparement in social interaction: use nonverbal behavior, eye-gaze, facial expression, body posture, failure to develop peer relationships, lack secking to share with others, lack of showing, pointing, bringing objects of interest, and lack social emotional reciprocity   

• 2- imparment in communication: delay in spoken language, lack ability to initiate or sustain converstation, stereotyped and repetitive language, lack make-believe play/or to imitate
• 3- Restricted repetitive/stereotyped patterns of behavior , interest and activities: preoccupation with one or more patern, inflexible adherance, to routines/rituals, motor manerism, hand/finger flapping/twisting, focus on part of objects 
• R/O Rett's and Childhood Disintegrative Dirorders

Rett's Disorder

• aparently normal prenatal, perinatal, psychomotor and head circumference till 5 months

• decelaration of head growth, lost of hand, skills, stereotype hand movement, loss social engagement, poor gaith or trunk movement, impair expressive/receptive language

Childhood Disintegrative Disorder

• aparent normal development till age 2 including verbal/nonverbal communication, social interaction, play and adaptative behavior

• significant loss of prior adquired skills including the above and bowel/bladder control and motor skills
• stereotype/repetitive use of language
• restricted, repetitive and stereotype patterns of behavior, interest, and activities
• R/O PDD 

Asperger's Disorder

• Impare in social interaction: multiple nonverbal behavior like eye-gaze, facial expression and body posture for social interaction, fail to develop peer relationships, lack seeking to share, lack of showing, bringing, pointing out object of interest, lack emotional/social reciprocity

• Restrictive/repetitive stereotype pattern of behaviors: abnormal focus on something, inflexible adherance to rutine/rituals, motor manerism like finger flapping/twisting, preoccupation with parts of objects
• significant impairment social/occupational   
• no significant delay in language,cognitive development, self-help, adaptative behavior
• R/O PDD  

Attention Deficit/Hyperactivity Disorder

• 6 Innattention items for 6 months
• Attention: fail to give close attention to details, careles mistakes, difficulty sustaining attention, does not sem to listen, does not follow through with instructions, fail to finish task, difficulty organizing task, avoids dislikes or task that require sustain mental effort, loses things, easily distracted by extraneous stimuli, forgetful
• 6 Hyperactivity-Impulsity for 6 month
• Hyperactivity: fidgets (hands/feets) squirms in seat, leaves seat, runs or climbs, difficulty playing quietly, "on the go", talk excessively

• Impulsivity: blurts out answers, difficulty waiting turns, interrupts/intrudes on others
• before age 7
• present in 2+ settings (home/school)
• significant impairment in social/academic/occupational
• R/O PDD, Schizophrenia, Psychotic, Mood, Anxiety, Dissociative or Personality Disorders
• Combine type A/H; Inattentive Type no Imp/H and H/Imp Type no Inattentive  

Conduct Disorder

• violation of basic rights and rules
• 12 month with 1 item met for 6 month
• Aggression to people and animal: bullies, threatens or intimidate, physical fight, use of weapon, physically cruel to people/animals, stealing while confronting the victim, force into sex
• Destruction of property: intentional fire setting or destroy others property   

• Deceitfulness or theft: broken into someone's house or car, often lies, has stolen items without confronting
• Serious violation of rules: stays out at night before age 13, run away from home overnight, truant from school
• significant imparment in social, academic, occupational
• 18 years or older
• Childhood-onset: before 10
• Adolescent-onset: at or after 10 
• Mild-few item enough to make Dx
• Moderate- some items. behaviors nor so serious like stealing without confrontation
• Severe- meet items in excess to making Dx 

Oppositional Defiant Disorder

• negativity, hostile, defiant behavior
• 6month plus 4+ items 
• under 18 years old

• loses temper, often argues, defies or refuses to comply with requests or rules, intentionally annoys, blame others, easily annoyed, angry and reentful, spiteful or vindictive
• significant impairment in social, academic, occupational
• R/O Psychotic, Mood, or Antisocial Personality Disoders  

Pica

• eating of non-nutritive substances
• 1 month

• inapropriate for development level
• not part of cultural practice
• if MR, PDD or Schizophrenia Pica is severly enough to grannt separate Dx

Rummination Disorder

• repeated regurgitation and rechewing of food
• 1 month

• not due to gastroinstestinal  or other medical condition
• not due to Anorexia Nervosa, Bulimia Nervosa,
• id MR or PDD symptoms are severe enough to grant separate Dx

Feeding Disorder of Infancy or Early Childhood

• failure to eat adequtely with significant failure to gain weight or loss significant weight
• 1 month
• before age 6 

• not due to gastrointestinal or other medical condition
• R/O Rumination Disorder

Tic Disorders

• multiple motor and 1+ vocal tics
• occurs many times a day
• for 1 year with never tic free for more than 3-month
• before age 18

• Not due to physiological effects of a substance or medical condition (not due to Huntington Diseas or Postviral encephalitis) 
• Chronic Motor or Vocal tic Disorder: same but only one tic either motor or vocal
• Transient Tic Disorder: same but motor/vocal tics occur for 4 month but no longer than 1 year. R/O Tourette and Chronic Motor or Vocal Tic Disorders

Elimination Disorders

• Encopresis: passege of feces → involuntarily or intentional
• at least 4 years of age
• R/O physiological effects of substances (laxative) or medical condition like constipation
• with constipation/without constipation (medical evideence) 

• Enuresis: passege of urine 
• 2x week for 3 months
• significant distress or impairment in social, academic, occupational
• at least 5 years old
• R/O physiological effects of substances (diuretic) or general medical condition (diabetes, spina bifida, seizure)

Separation Anxiety Disorder

• anxiety concerning separation from home or individuals with whom individual is attach
• 3 items
• excessive distress when separation, worry about loosing attachment figures, worry that an untoward event will lead to separation, reluctant/refusal to go to school or elsewhere, fearful or reluctant to be alone or go to sleep, nightmares involve separation, physical complaints when separation occurs or in anticipation   

• at least 4 weeks
• before age 18
• significant impairment in social, academic or occupational
• R/O PDD, Schizophrenia, Psychotic Disorder , Panic Disorder with Agoraphobia
• specify if early onset before age 6

Selective Mutism

• failure to speak in particular social settings despite speaking in other situations
• interfere with social, academic, occupational
• 1 month (not 1st month of school)
• not due to lack of knowledge or comfort in speaking the language

• R/O Communication Disorder (Stuttering), PDD, Schizophrenia or Psychotic Disorder

Reactive Attachment Disorder of Infancy or Early Chilhood

• inapropriate social relatedness inmost contexts
• before age 5
• 1 or 2
• 1- persistent failure to initiate or respond properly to social interactions, inhibited, hypervigilant or highly ambivalent and contradictory responses
• 2- diffuse attachment → indiscriminate sociability with marked inability to exhibit appropriate selective attachments    

• Pathogenic (parenting) care → disregard basic emotional needs for comfort, stimuly and affection, disregard basic hysical needs, changes in caregiver that prevents attachment
• assumptions tha pathogenic care cause disorder in child
• Inhibited Type - more of 1
• desinhibit RType - more of 2
• R/O PDD and MR

Stereotypic Movement Disorder

• repetitive, seemingly driven and non-functional motor behavior (body rocking, head banging, mouthing ojects, self bitting etc.)
• intefere with normal activities or result in self-harm  
• 4+ weeks

• if MR self injury is severe enough to grant additional Dx
• R/O OCD, Tic Disorder, PDD or Trichotillomania (hair pulling)
• not due to physical effect of substance or medical condition
• Specify if with Self Injurious behavior