Disorders Usually First Diagnosed In Infancy, Childhood, or Adolescence
Mental Retardation
Additional information was added regarding the association of certain etiological factors and comorbid symptoms and disorders (e.g., Fragile-X syndrome and Attention-Deficit/Hyperactivity Disorder).
Communication Disorders
Text was added to indicate that a thorough functional assessment of the individual's language ability can be made when standardized tests are unavailable or inappropriate (e.g., because the available tests were standardized only in limited populations). Prevalence and Course sections for Expressive Language Disorder, Mixed Receptive-Expressive Language Disorder, and Phonological Disorder were updated, as well as the Course section for Stuttering.
Autistic Disorder
The text in the Diagnostic Features section was modified to highlight difficulties in the pragmatic aspects of language, which are especially important in higher functioning individuals. In addition, better examples of restricted, repetitive, and stereotyped patterns of behavior, interests, and activities were added. The text was also modified to reflect evidence that in up to a fifth of cases, parents retrospectively report relatively normal development for the first one or two years. The section about associated cognitive deficits and associated general medical conditions was updated. The range of prevalence figures was revised to reflect a number of more recent studies suggesting a higher prevalence. More specific information regarding sibling risk was added to Familial Pattern.
Rett's Disorder
Text was added reflecting the finding that some cases of Rett's Disorder are associated with a specific genetic mutation.
Asperger's Disorder
Because of the limited data available about this newly introduced disorder, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) text for Asperger's Disorder provided little more than a restatement of the diagnostic criteria. Accordingly, the text for Asperger's Disorder was extensively revised in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Specific examples of the typical manifestations of the impairment in reciprocal social interaction and in restricted, repetitive behavior and interests was provided in order to better differentiate these individuals from those with Autistic Disorder. In addition, text was added to clarify that the requirement for no clinically significant delays in language does not imply that individuals with Asperger's Disorder do not have problems with communication. The Associated Features, Specific Age Features, Course, and Differential Diagnosis sections were greatly expanded.
Pervasive Developmental Disorder Not Otherwise Specified
The definition was changed to correct an error that inadvertently allowed this diagnosis to be made in cases in which there was a pervasive impairment in only one developmental area (e.g., in the development of reciprocal social interaction, communication skills, or stereotyped behaviors, interests, or activities). The definition now requires that there be impairment in reciprocal social interaction, which is associated with an impairment in communication skills or the presence of stereotyped behaviors, interests, or activities.
Attention-Deficit/Hyperactivity Disorder
Many of the changes highlighted differences among the subtypes. For example, individuals with the Predominantly Inattentive and Combined Types tend to have academic deficits and school-related problems, whereas those with the Predominantly Hyperactive-Impulsive Type tend to have more peer rejection and accidental injuries, and gender ratio is less predominantly male in the Predominantly Inattentive Type. Additional information about Associated Features (e.g., variability in IQ, presence of family discord) and Specific Age Features (especially Attention-Deficit/Hyperactivity Disorder in adults) was included. Estimates of prevalence rates were revised upward, reflecting increased prevalence due to the inclusion of the Predominantly Hyperactive-Impulsive and Predominantly Inattentive Types in DSM-IV.
Conduct Disorder
The list of risk factors for developing Conduct Disorder was expanded. The relationship between Oppositional Defiant Disorder and the subsequent development of Childhood-Onset Type of Conduct Disorder is noted in Course.
Oppositional Defiant Disorder
The Course section of the text clarified that although Childhood-Onset cases of Conduct Disorder are often preceded by Oppositional Defiant Disorder, many children with Oppositional Defiant Disorder do not go on to develop Conduct Disorder.
Pica
Prevalence data were provided and comorbidity with Pervasive Developmental Disorders was noted.
Feeding Disorder of Infancy or Early Childhood
Changes were made in Prevalence (community prevalence is noted) and Course sections (persistence of decreased height and weight as compared to peers into adolescence).
Tic Disorders
The DSM-IV criteria set for Tic Disorders was corrected by eliminating the requirement for “clinically significant distress or impairment,” which was added to the majority of disorders in DSM-IV (Tic Disorders among them). There are a number of reasons why this criterion had been problematic in Tic Disorders, including that fact that it was at variance with clinical experience (i.e., most children with Tourette's do not experience marked distress or impairment), and that it hindered epidemiological research and family studies. Other changes in the text included an expanded description of the types of tics as well as an expansion of the Differential Diagnosis between tics and other types of movements, Associated Features (including comorbidity patterns), Specific Age Features (gender ratio), Prevalence, Course, and Familial Pattern.
Encopresis
Encopresis with functional constipation is the most common form. Text regarding physiological predispositions to constipation was updated and expanded.
Enuresis
New information about different mechanisms underlying the Diurnal Only Type was added. Associated Features (particularly predisposing factors), Prevalence, and Familial Pattern were updated.
Separation Anxiety Disorder
Prevalence and Course sections were updated to indicate a decrease in prevalence from childhood through adolescence and to indicate that most children with separation anxiety are free of an impairing Anxiety Disorder at extended follow-up.
Reactive Attachment Disorder
Associated Features (risk factors such as extreme neglect and institutional care) and Course (persistence of indiscriminant sociability) were updated.
Stereotyped Movement Disorder
Pathological skin picking was removed from the list of examples; such cases should be diagnosed as Impulse Control Disorder Not Otherwise Specified. Associated Features (e.g., clarification that the disorder can occur in non-developmentally-delayed populations) were modified.