Published on December 25, 2008
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
The patient's intellectual functioning is markedly below average (IQ of 70 or less on a standardized, individually administered intelligence test). Starts before age 18. Mental Retardation
In 2 or more of the following areas, the patient has more trouble functioning than would be expected for age and cultural group: -communication -self-care -home living -social and interpersonal skills -using community resources -self-direction -academic ability -work -free time -health -safety Mental Retardation
CODING 317 Mild Mental Retardation. (IQ 50-55 to 70) 318.0 Moderate Mental Retardation. (IQ 35-40 to 50-55) 318.1 Severe Mental Retardation. (IQ 20-25 to 35-40) 318.2 Profound Mental Retardation. (IQ less than 20-25) 319 Mental Retardation, Severity Unspecified. - the patient cannot be tested, but significant retardation seems highly likely Mental Retardation
Mental Retardation is coded on Axis II. For infants, the clinician must make a subjective judgment of intellectual functioning. On Axis III code any general medical condition that has caused Mental Retardation. Mental Retardation
WAGR Syndrome Cockayne Syndrome Rubinstein-Taybi Syndrome Bardet-Biedl Syndrome Laurence-Moon Syndrome Angelman Syndrome Cri-du-Chat Syndrome De Lange Syndrome Fragile X Syndrome Prader-Willi Syndrome Williams Syndrome Rett Syndrome Phenylketonuria Mental Retardation
Mental Retardation, in some cases, can be arrested, slowed, or partially reversed Most dramatic examples: Giving thyroid to an infant with hypothyroidism Early introduction of a shunt for hydrocephalus Low phenylalanine diet for phenylketonuria Mental Retardation
Involve the use of multiple tests to determine. Most often, an IQ test, followed by an Achievement test. A test screening for brain dysfunction is also generally used. This deficiency materially impedes academic achievement or daily living. If there is also a sensory defect, the deficiency is worse than you would expect with it. Coding Note: On Axis III code any sensory deficit or general medical condition (such as a neurological disorder). Learning Disorders
Learning Disorders 315.00 Reading Disorder As measured by a standardized test that is given individually, the patient's ability to read (accuracy or comprehension) is substantially less than you would expect considering age, intelligence and education. Reading disorder (2 - 8% of school children; boys more than girls) Begin with difficulties in learning to read before age 7 Includes spelling problems by age 7 Writing problems by age 8
315.1 Mathematics Disorder As measured by a standardized test that is given individually, the patient's mathematical ability is substantially less than you would expect considering age, intelligence and education. Mathematics disorder (about 6% of school children; boy:girl = 4:1) Usually first noticed when rote memorization required Learning Disorders
315.2 Disorder of Written Expression As measured by functional assessment or by a standardized test that is given individually, the patient's writing ability is substantially less than you would expect considering age, intelligence and education. Learning Disorders Signs associated with a disorder of written expression include: Written sentences and paragraphs that are inadequately formed Excessive spelling errors Excessive punctuation errors Excessive grammatical errors Extremely poor handwriting
Children frequently have: Low self-esteem Social problems Increased dropout rate at school Disorder of written expression may also be associated with: Conduct disorder Attention deficit disorder Depression Other learning disorders 315.2 Disorder of Written Expression (cont’d) Learning Disorders
315.4 Developmental Coordination Disorder Motor coordination in daily activities is substantially less than you would expect, considering the patient's age and intelligence. This may be shown by dropping things, general clumsiness, poor handwriting or sports ability or by pronounced delays in developmental motor milestones such as sitting, crawling or walking. The clumsy child; “spaz,” “klutz” Be careful to rule out ADHD It is not due to a general medical condition such as cerebral palsy or muscular dystrophy. Criteria for a Pervasive Developmental Disorder are not fulfilled. If there is Mental Retardation, the incoordination is worse than you would expect with these problems. Motor Skills Disorder
315.31 Expressive Language Disorder Using standardized measures, the patient's scores of expressive language development are materially lower than those of both nonverbal intellectual capacity and receptive language development. Clinically, the patient may have severely limited vocabulary, make errors of tense, recall words poorly or produce sentences that are shorter or less complex than is developmentally appropriate. This disorder interferes with educational or occupational achievement or with social communication. It does not fulfill criteria for a Mixed Receptive-Expressive Language Disorder or a Pervasive Developmental Disorder. Communication Disorders
Communication Disorders 315.31 Mixed Receptive-Expressive Language Disorder As measured by standardized tests that are given individually, the patient's receptive and expressive language development scores are materially lower than those of nonverbal intellectual capacity. Clinically, the patient may have the same problems as with Expressive Language Disorder as well as problems understanding sentences, words or specific classes of words, such as spatial terms. 315.39 Phonological Disorder The patient doesn't use speech sounds that are expected for age or dialect. Examples: substituting consonant sounds for one another; omitting final consonants.
307.0 Stuttering Inappropriate for age, the patient lacks normal fluency and time patterning of speech. This is characterized by frequent occurrences of at least 1 of the following: -Repetitions of sounds and syllables -Sound prolongations -Interjections -Broken words (a pause within a word) -Blocking that is audible or silent -Circumlocutions (substitutions to avoid words hard to pronounce) -Words spoken with excessive physical tension -Repetitions of monosyllabic whole words such as " a-a-a-a dog bit me " 307.9 Communication Disorder Not Otherwise Specified Communication Disorders
BEHAVIOR AFFECTS Fears and worries -7 or more Wetting bed within past year Nightmares Temper loss Overactivity Restlessness Stuttering Unusual movements Biting nails Grinding teeth Sucking thumb or fingers 43% 17% 28% 80% 49% 30% 4% 12% 27% 14% 10% Other Childhood Problems
299.00 Autistic Disorder The patient fulfills a total of at least 6 criteria from the following 3 lists Impaired social interaction (at least 2): -Markedly deficient regulation of social interaction by using multiple non-verbal behaviors such as eye contact, facial expression, body posture and gestures -Lack of peer relationships that are appropriate to the developmental level -Doesn't seek to share achievements, interests or pleasure with others -Lacks social or emotional reciprocity Pervasive Developmental Disorders
Impaired communication (at least 1): -Delayed or absent development of spoken language for which the patient doesn't try to compensate with gestures -In patients who can speak, inadequate attempts to begin or sustain a conversation -Language that is repetitive, stereotyped or idiosyncratic -Appropriate to developmental stage, absence of social imitative play or spontaneous, make-believe play Activities, behavior and interests that are repetitive, restricted and stereotyped (at least 1): -Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things) -Rigidly sticks to routines or rituals that don't appear to have a function -Has stereotyped, repetitive motor mannerisms (such as hand flapping) -Persistently preoccupied with parts of objects Pervasive Developmental Disorders
299.00 Autistic Disorder (cont’d) Before age three, the patient shows delayed or abnormal functioning in 1 or more of these areas: -Social interaction -Language used in social communication -Imaginative or symbolic play These symptoms are not better explained by Childhood Disintegrative Disorder or Rett's Disorder. Pervasive Developmental Disorders
299.80 Rett's Disorder Prenatal and perinatal development appear normal Psychomotor development appears normal at least until month 6 Head circumference is normal at birth After this apparently normal beginning, all of: Head growth slows abnormally between 5 and 48 months. Between 5 and 30 months, the child loses already acquired purposeful hand movements and develops stereotyped hand movements such as handwashing or handwringing. Early in the course, the child loses interest in the social environment. (However, social interaction often develops later.) Gait or movements of trunk are poorly coordinated. Severe psychomotor retardation and impairment of expressive and receptive language. Pervasive Developmental Disorders
299.10 Childhood Disintegrative Disorder At least until age two, the child develops normally as shown by having age-appropriate adaptive behavior, play, social relationships and non-verbal and verbal communication. Before age 10, the child experiences clinically important loss of previously learned skills in the following areas (2 or more required): -Language (expressive or receptive) -Adaptive behavior or social skills -Bladder or bowel control -Play -Motor skills Pervasive Developmental Disorders
299.10 Childhood Disintegrative Disorder (cont’d) The child functions abnormally in 2 or more of the following: -Social interaction characterized by impaired non-verbal behaviors, peer relationships or emotional or social reciprocity -Communication characterized by delayed or absent spoken language, inability to converse, language use that is repetitive or stereotyped or absence of varied make-believe play -Activities, behavior and interests are repetitive, restricted and stereotyped. This includes motor mannerisms and stereotypies. These symptoms are not better explained by Schizophrenia or another specific Pervasive Developmental Disorder. Pervasive Developmental Disorders
299.80 Asperger's Disorder At least 2 demonstrations of impaired social interaction. The patient: -Shows a marked inability to regulate social interaction by using multiple non-verbal behaviors such as body posture and gestures, eye contact and facial expression. -Doesn't develop peer relationships that are appropriate to the developmental level. -Doesn't seek to share achievements, interests or pleasure with others -Lacks social or emotional reciprocity. Pervasive Developmental Disorders
299.80 Asperger's Disorder (cont’d) Activities, behavior and interests that are repetitive, restricted and stereotyped (at least 1 of): -Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things) -Rigidly sticks to routines or rituals that don't appear to have a function -Has stereotyped, repetitive motor mannerisms (such as hand flapping) -Persistently preoccupied with parts of objects Pervasive Developmental Disorders
299.80 Asperger's Disorder (cont’d) The symptoms cause clinically important impairment in social, occupational or personal functioning. There is no clinically important general language delay (the child can speak words by age two, phrases by age three). There is no clinically important delay in developing cognition, age-appropriate self-help skills, adaptive behavior (except social interaction) and normal curiosity about the environment. The patient doesn't fulfill criteria for Schizophrenia or another specific Pervasive Developmental Disorder. 299.80 Pervasive Developmental Disorder NOS Pervasive Developmental Disorders
Attention-deficit/Hyperactivity Disorder Persisting for at least 6 months to a degree that is maladaptive and immature, the patient has either inattention or hyperactivity-impulsivity (or both) as shown by: Inattention. At least 6 of the following often apply: -Fails to pay close attention to details or makes careless errors in schoolwork, work or other activities -Has trouble keeping attention on tasks or play -Doesn't appear to listen when being told something -Neither follows through on instructions nor completes chores, schoolwork, or jobs (not due to oppositional behavior or failure to understand) -Has trouble organizing activities and tasks -Dislikes or avoids tasks that involve sustained mental effort (homework, schoolwork) -Loses materials needed for activities (assignments, books, pencils, tools, toys) -Easily distracted by extraneous stimuli -Forgetful Attention-Deficit and Disruptive Behavior D/O
Hyperactivity-Impulsivity. At least 6 of the following often apply: HYPERACTIVITY -Squirms in seat or fidgets -Inappropriately leaves seat -Inappropriately runs or climbs (in adolescents or adults, there may be only a subjective feeling of restlessness) -Has trouble quietly playing or engaging in leisure activity -Appears driven or "on the go" -Talks excessively IMPULSIVITY -Answers questions before they have been completely asked -Has trouble or awaiting turn -Interrupts or intrudes on others Attention-Deficit and Disruptive Behavior D/O
Begins before age 7. Symptoms must be present in at least 2 types of situations, such as school, work, home. The disorder impairs school, social or occupational functioning. The symptoms do not occur solely during a Pervasive Developmental Disorder or any psychotic disorder including Schizophrenia. The symptoms are not explained better by a Mood, Anxiety, Dissociative or Personality Disorder. Code Number is based on the symptoms during the past 6 months: Attention-Deficit and Disruptive Behavior D/O
314.00 Attention-deficit/Hyperactivity Disorder, Predominantly Inattentive Type . The patient has recently met the criteria for inattention but not for hyperactivity-impulsivity. 314.01 Attention-deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type . The patient has recently met the criteria for hyperactivity-impulsivity but not for inattention. 314.01 Attention-deficit/Hyperactivity Disorder, Combined Type . The patient has recently met the criteria for both inattention and hyperactivity-impulsivity. (Most ADHD children have symptoms of the Combined Type.) Specify "In Partial Remission" for patients (especially adults or adolescents) whose current symptoms do not fulfill the criteria. Attention-Deficit and Disruptive Behavior D/O
312.8 Conduct Disorder For 12 months or more the patient has repeatedly violated rules, age-appropriate societal norms or the rights of others. This is shown by 3 or more of the following, at least 1 of which has occurred in the previous 6 months: Aggression against people or animals -Frequent bullying or threatening -Often starts fights -Used a weapon that could cause serious injury (gun, knife, club, broken glass) -Physical cruelty to people -Physical cruelty to animals -Theft with confrontation (armed robbery, extortion, mugging, purse snatching) -Forced sex upon someone Attention-Deficit and Disruptive Behavior D/O
Property destruction -Deliberately set fires to cause serious damage -Deliberately destroyed the property of others (except fire-setting) Lying or theft -Broke into building, car or house belonging to someone else -Frequently lied or broke promises for gain or to avoid obligations ("conning") -Stole valuables without confrontation (burglary, forgery, shoplifting) Serious rule violation -Beginning by age twelve, frequently stayed out at night against parents' wishes -Runaway from parents overnight twice or more (once if for an extended period) -Frequent truancy before age 13 Attention-Deficit and Disruptive Behavior D/O
These symptoms cause clinically important job, school or social impairment. If older than age 18, the patient does not meet criteria for Antisocial Personality Disorder. Based on age of onset, specify: Childhood-Onset Type: at least 1 problem with conduct before age 10 Adolescent-Onset Type: no problems with conduct before age 10 Specify Severity: Mild (both are required): There are few problems with conduct more than are needed to make the diagnosis, and All of these problems cause little harm to other people. Moderate. Number and effect of conduct problems is between Mild and Severe Severe (either or both of): Many more conduct symptoms than are needed to make the diagnosis, or The conduct symptoms cause other people considerable harm. Attention-Deficit and Disruptive Behavior D/O
313.81 Oppositional Defiant Disorder For at least 6 months, these patients show defiant, hostile, negativistic behavior; 4 or more of the following apply:* -Losing temper -Arguing with adults -Actively defying or refusing to carry out the rules or requests of adults -Deliberately doing things that annoy others -Blaming others for own mistakes or misbehavior -Being touchy or easily annoyed by others -Being angry and resentful -Being spiteful or vindictive *Only score a criterion positive if that behavior occurs more often than expected for age and developmental level. 312.9 Disruptive Behavior Disorder NOS Attention-Deficit and Disruptive Behavior D/O
307.52 Pica For at least 1 month the patient persists in eating dirt or other nonnutritive substances. This behavior is not appropriate to the patient's developmental level. It is not sanctioned in the patient's culture. If this behavior occurs solely in the context of another mental disorder (such as Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is serious enough to require independent clinical attention. Feeding and Eating Disorders of Infancy or Early Childhood
307.53 Rumination Disorder After a period of normal functioning, for at least 1 month the patient repeatedly regurgitates and rechews food. This behavior is not caused by a gastrointestinal illness or other general medical condition (such as esophageal reflux). The behavior doesn't occur solely during Anorexia Nervosa or Bulimia Nervosa. If it occurs solely during Mental Retardation or a Pervasive Developmental Disorder, it is serious enough to require independent clinical attention Feeding and Eating Disorders of Infancy or Early Childhood
307.59 Feeding Disorder of Infancy or Childhood For 1 month or more, the patient has persistently failed to eat adequately and has either not gained weight or lost weight. This behavior is not due to a gastrointestinal illness or other general medical condition (such as esophageal reflux). Neither another mental disorder (such as Rumination Disorder) nor the lack of available food better explain the symptoms. It begins before age 6. Feeding and Eating Disorders of Infancy or Early Childhood
307.23 Tourette's Disorder At some time during the illness, though not necessarily at the same time, the patient has had both of: At least one vocal tic* and Multiple motor tics For longer than 1 year, these tics have occurred many times each day, nearly every day or at intervals. *A tic is a motor movement or vocalization that is nonrhythmic, rapid, repeated, stereotyped and sudden. Tic Disorders
307.22 Chronic Motor or Vocal Tic Disorder At some time, the patient has had either, but not both, vocal or motor tics. For longer than 1 year, these tics have occurred many times each day, nearly every day or at intervals. During this time, the patient never goes longer than 3 months without the tics. They begin before age 18. The patient has never fulfilled criteria for Tourette's Disorder. The symptoms are not directly caused by a general medical condition (such as Huntington's disease or a postviral encephalitis) or to substance use (such as a CNS stimulant). Tic Disorders
307.21 Transient Tic Disorder The patient has vocal or motor tics, or both. They can be single or multiple. For at least 4 weeks but no longer than 12 consecutive months, these tics have occurred many times each day, nearly every day. They began before age 18. The symptoms are not directly caused by a general medical condition The patient has never fulfilled criteria for Tourette's Disorder or Chronic Motor or Vocal Tic Disorder. Specify whether: Single Episode or Recurrent 307.20 Tic Disorder Not Otherwise Specified Tic Disorders
Encopresis Accidentally or on purpose, the patient repeatedly passes feces into inappropriate places (clothing, the floor). For at least 3 months, this has happened at least once per month. The patient is at least 4 years old (or the developmental equivalent). This behavior is not caused solely by substance use (such as laxatives) or by a general medical condition (except through some mechanism that involves constipation).* 787.6 Encopresis With Constipation and Overflow Incontinence 307.7 Encopresis Without Constipation and Overflow Incontinence *Mechanisms that involve constipation could include hypothyroidism, side effects of medication, and a febrile illness that causes dehydration. Elimination Disorders
307.6 Enuresis Accidentally or on purpose, the patient repeatedly urinates into clothing or the bed. The clinical importance of this behavior is shown by either -It occurs at least twice a week for at least 3 consecutive months or -It causes clinically important distress or impairs work (scholastic), social or personal functioning The patient is at least 5 years old (or the developmental equivalent). This behavior is not directly caused by a general medical condition (such as diabetes, seizures, spina bifida) or by the use of a substance (such as a diuretic). Specify type: Nocturnal Only, Diurnal Only, or Nocturnal and Diurnal Elimination Disorders
309.21 Separation Anxiety Disorder The patient has developmentally inappropriate, excessive anxiety about being separated from home or from those to whom the patient is attached. Of the following symptoms, 3 or more persist or recur: -Excessive distress when anticipating or experiencing separation from home or parents* -Excessive worry about loss of or harm to parents -Excessive worry that the child will be separated from a parent by a serious event (such as being kidnapped or becoming lost) -Fears of separation cause refusal or reluctance to go somewhere (such as school) -Excessive fears of being alone or without parents at home or without important adults elsewhere -Refusal or reluctance to sleep away from home or to go to sleep without being near a parent -Recurrent nightmares about separation -Recurrent physical symptoms (such as headache, abdominal pain, nausea, vomiting) when anticipating or experiencing separation from parents Specify if: Early Onset. (Begins before age 6) Other Disorders of Infancy, Childhood or Adolescence
313.23 Selective Mutism Despite speaking in other situations, the patient consistently does not speak in specific social situations where speech is expected, such as at school. This behavior interferes with educational or occupational achievement or with social communication. It has lasted at least 1 month (excluding the first month of school). It is not caused by unfamiliarity or discomfort with the spoken language needed in the social situation. It is not better explained by a Communication Disorder (such as Stuttering). It does not occur solely during a Pervasive Developmental Disorder or any Psychotic Disorder such as Schizophrenia. Other Disorders of Infancy, Childhood or Adolescence
313.89 Reactive Attachment Disorder of Infancy or Early Childhood Beginning before age 5 and occurring in most situations, the patient's social relatedness is markedly disturbed and developmentally inappropriate. This is shown by either of: -Inhibitions. In most social situations, the child doesn't interact in a developmentally appropriate way. This is shown by responses that are excessively inhibited, hypervigilant or ambivalent and contradictory. For example, the child responds to caregivers with frozen watchfulness or mixed approach-avoidance and resistance to comforting. -Disinhibitions. The child's attachments are diffuse, as shown by indiscriminate sociability with inability to form appropriate selective attachments. For example, the child is overly familiar with strangers or lacks selectivity in choosing attachment figures. Other Disorders of Infancy, Childhood or Adolescence
Evidence of persistent pathogenic care is shown by 1 or more of: -The caregiver neglects the child's basic emotional needs for affection, comfort and stimulation. -The caregiver neglects the child's basic physical needs. -Stable attachments cannot form because of repeated changes of primary caregiver (such as frequent changes of foster care). -It appears that the pathogenic care just described has caused the disturbed behavior (for example, the behavior began after the pathogenic behavior). Specify type, based on predominant clinical presentation: Inhibited Type. Failure to interact predominates Disinhibited Type. Indiscriminate sociability predominates Other Disorders of Infancy, Childhood or Adolescence
307.3 Stereotypic Movement Disorder The child's motor behavior seems driven, repetitive and nonfunctional. Examples include biting or hitting self, body rocking, hand shaking or waving, head banging, mouthing of objects, picking at skin or body openings. This behavior seriously interferes with normal activities or causes physical injury that requires medical treatment (or would, if the child were not interfered with). If the patient also has Mental Retardation, the stereotypic behavior is serious enough to be a focus of treatment. The behavior is not better explained by a compulsion (as in Obsessive-Compulsive Disorder), a tic (Tic Disorder), hair pulling (Trichotillomania) or a PDD. It is not directly caused by a general medical condition or the effects of substance use. The behavior has persisted for at least 4 weeks. Specify if With Self-Injurious Behavior. The behavior causes bodily injury that requires medical treatment (or would, if the child were not interfered with).
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