DSM CHAPTER: NEURODEVELOPMENTAL DISORDERS
Autism Spectrum Disorder (ASD) → Not included in HiTOP model!
A. Persistent deficits in social communication and social interaction across multiple
contexts, as manifested by all of the following, currently or by history (examples are
illustrative, not exhaustive; see text):
1. 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.
2. 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.
3. 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):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple
motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic
phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of
verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties
with transitions, rigid thinking patterns, greeting rituals, need to take same route or
eat same food every day).
3. 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 interests).
4. Hyper- or hypo-reactivity to sensory input or unusual interest 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).
Severity specifiers for ASD:
- Level 1: Requiring support
- Level 2: Requiring substantial support
- Level 3: Requiring very substantial support
,Attention-Deficit Hyperactivity Disorder (ADHD) → HiTOP: Disinhibited Externalizing
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6
months to a degree that is inconsistent with developmental level and that
negatively impacts directly on social and academic/occupational activities:
Note: The symptoms are not solely a manifestation of oppositional behavior,
defiance, hostility, or failure to understand tasks or instructions. For older
adolescents and adults (age 17 and older), at least five symptoms are required.
a) Often fails to give close attention to details or makes careless mistakes in
schoolwork, at work, or during other activities (e.g., overlooks or misses
details, work is inaccurate).
b) Often has difficulty sustaining attention in tasks or play activities (e.g., has
difficulty remaining focused during lectures, conversations, or lengthy
reading).
c) Often does not seem to listen when spoken to directly (e.g., mind seems
elsewhere, even in the absence of any obvious distraction).
d) Often does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and
is easily sidetracked).
e) Often has difficulty organizing tasks and activities (e.g., difficulty managing
sequential tasks; difficulty keeping materials and belongings in order; messy,
disorganized work; has poor time management; fails to meet deadlines).
f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort (e.g., schoolwork or homework; for older adolescents and adults,
preparing reports, completing forms, reviewing lengthy papers).
g) Often loses things necessary for tasks or activities (e.g., school materials,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h) Is often easily distracted by extraneous stimuli (for older adolescents and
adults, may include unrelated thoughts).
i) Is often forgetful in daily activities (e.g., doing chores, running errands; for
older adolescents and adults, returning calls, paying bills, keeping
appointments).
2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have
persisted for at least 6 months to a degree that is inconsistent with developmental
level and that negatively impacts directly on social and academic/occupational
activities:
Note: The symptoms are not solely a manifestation of oppositional behaviour,
defiance, hostility, or a failure to understand tasks or instructions. For older
adolescents and adults (age 17 and older), at least five symptoms are required.
a) Often fidgets with or taps hands or feet or squirms in seat.
b) Often leaves seat in situations when remaining seated is expected (e.g., leaves
his or her place in the classroom, in the office or other workplace, or in other
situations that require remaining in place).
c) Often runs about or climbs in situations where it is inappropriate. (Note: In
adolescents or adults, may be limited to feeling restless.)
, d) Often unable to play or engage in leisure activities quietly.
e) Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or
uncomfortable being still for extended time, as in restaurants, meetings; may
be experienced by others as being restless or difficult to keep up with).
f) Often talks excessively.
g) Often blurts out an answer before a question has been completed (e.g.,
completes people’s sentences; cannot wait for turn in conversation).
h) Often has difficulty waiting his or her turn (e.g., while waiting in line).
i) Often interrupts or intrudes on others (e.g., butts into conversations, games, or
activities; may start using other people’s things without asking or receiving
permission; for adolescents and adults, may intrude into or take over what
others are doing).
DSM CHAPTER: SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC
DISORDERS
Delusional Disorder → HiTOP: Thought disorder
A. The presence of one (or more) delusions with a duration of 1 month or longer
Brief Psychotic Disorder → HiTOP: Thought disorder
A. Presence of one (or more) of the following symptoms. At least one of these must be
(1), (2), or (3).
Note: Do not include a symptom if it is a culturally sanctioned response.
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behaviour.
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month,
with eventual full return to premorbid level of functioning.
Schizophreniform Disorder → HiTOP: Thought disorder
A. Two (or more) of the following, each present for a significant portion of time during
a 1-month period (or less if successfully treated). At least one of these must be (1),
(2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behaviour.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the
diagnosis must be made without waiting for recovery, it should be qualified as
“provisional.”
Schizophrenia → HiTOP: Thought disorder
A. Two (or more) of the following, each present for a significant portion of time during a
1-month period (or less if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions.
Autism Spectrum Disorder (ASD) → Not included in HiTOP model!
A. Persistent deficits in social communication and social interaction across multiple
contexts, as manifested by all of the following, currently or by history (examples are
illustrative, not exhaustive; see text):
1. 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.
2. 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.
3. 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):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple
motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic
phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of
verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties
with transitions, rigid thinking patterns, greeting rituals, need to take same route or
eat same food every day).
3. 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 interests).
4. Hyper- or hypo-reactivity to sensory input or unusual interest 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).
Severity specifiers for ASD:
- Level 1: Requiring support
- Level 2: Requiring substantial support
- Level 3: Requiring very substantial support
,Attention-Deficit Hyperactivity Disorder (ADHD) → HiTOP: Disinhibited Externalizing
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6
months to a degree that is inconsistent with developmental level and that
negatively impacts directly on social and academic/occupational activities:
Note: The symptoms are not solely a manifestation of oppositional behavior,
defiance, hostility, or failure to understand tasks or instructions. For older
adolescents and adults (age 17 and older), at least five symptoms are required.
a) Often fails to give close attention to details or makes careless mistakes in
schoolwork, at work, or during other activities (e.g., overlooks or misses
details, work is inaccurate).
b) Often has difficulty sustaining attention in tasks or play activities (e.g., has
difficulty remaining focused during lectures, conversations, or lengthy
reading).
c) Often does not seem to listen when spoken to directly (e.g., mind seems
elsewhere, even in the absence of any obvious distraction).
d) Often does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and
is easily sidetracked).
e) Often has difficulty organizing tasks and activities (e.g., difficulty managing
sequential tasks; difficulty keeping materials and belongings in order; messy,
disorganized work; has poor time management; fails to meet deadlines).
f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort (e.g., schoolwork or homework; for older adolescents and adults,
preparing reports, completing forms, reviewing lengthy papers).
g) Often loses things necessary for tasks or activities (e.g., school materials,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h) Is often easily distracted by extraneous stimuli (for older adolescents and
adults, may include unrelated thoughts).
i) Is often forgetful in daily activities (e.g., doing chores, running errands; for
older adolescents and adults, returning calls, paying bills, keeping
appointments).
2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have
persisted for at least 6 months to a degree that is inconsistent with developmental
level and that negatively impacts directly on social and academic/occupational
activities:
Note: The symptoms are not solely a manifestation of oppositional behaviour,
defiance, hostility, or a failure to understand tasks or instructions. For older
adolescents and adults (age 17 and older), at least five symptoms are required.
a) Often fidgets with or taps hands or feet or squirms in seat.
b) Often leaves seat in situations when remaining seated is expected (e.g., leaves
his or her place in the classroom, in the office or other workplace, or in other
situations that require remaining in place).
c) Often runs about or climbs in situations where it is inappropriate. (Note: In
adolescents or adults, may be limited to feeling restless.)
, d) Often unable to play or engage in leisure activities quietly.
e) Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or
uncomfortable being still for extended time, as in restaurants, meetings; may
be experienced by others as being restless or difficult to keep up with).
f) Often talks excessively.
g) Often blurts out an answer before a question has been completed (e.g.,
completes people’s sentences; cannot wait for turn in conversation).
h) Often has difficulty waiting his or her turn (e.g., while waiting in line).
i) Often interrupts or intrudes on others (e.g., butts into conversations, games, or
activities; may start using other people’s things without asking or receiving
permission; for adolescents and adults, may intrude into or take over what
others are doing).
DSM CHAPTER: SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC
DISORDERS
Delusional Disorder → HiTOP: Thought disorder
A. The presence of one (or more) delusions with a duration of 1 month or longer
Brief Psychotic Disorder → HiTOP: Thought disorder
A. Presence of one (or more) of the following symptoms. At least one of these must be
(1), (2), or (3).
Note: Do not include a symptom if it is a culturally sanctioned response.
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behaviour.
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month,
with eventual full return to premorbid level of functioning.
Schizophreniform Disorder → HiTOP: Thought disorder
A. Two (or more) of the following, each present for a significant portion of time during
a 1-month period (or less if successfully treated). At least one of these must be (1),
(2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behaviour.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the
diagnosis must be made without waiting for recovery, it should be qualified as
“provisional.”
Schizophrenia → HiTOP: Thought disorder
A. Two (or more) of the following, each present for a significant portion of time during a
1-month period (or less if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions.
