Desk Reference of the DSM-5-TR
Neurodevelopmental Disorders
Intellectual Developmental Disorders
Intellectual Developmental Disorder (Intellectual Disability)
Intellectual developmental disorder (intellectual disability) is a disorder with onset during the
developmental period that includes both intellectual and adaptive functioning deficits in conceptual,
social, and practical domains. The following three criteria must be met:
A. Deficits in intellectual functions (e.g. reasoning, planning, learning) confirmed by clinical
assessment and standardized intelligence testing
B. Deficits in adaptive functions (personal independence and social responsibility). Without
support limited functioning in one or more activities of daily life (e.g. communication,
dependent living) across multiple environments (e.g. home, school, work)
C. Onset during developmental period. Specify if:
1. Mild: Can generally function and blend into everyday life, with some difficulties in
academic/abstract thinking, social judgment, and more complex daily tasks; may
achieve considerable independence with support.
2. Moderate: Can care for themselves and learn basic personal, household, work, and
communication skills, but often needs instructions and considerable ongoing
support.
3. Severe: Has very limited communication and conceptual skills and needs supervision
and extensive support in most/all daily situations.
4. Profound: Has extremely limited conceptual and day-to-day functioning,
communicates mainly nonverbally, and requires close/continuous supervision and
support for essentially all aspects of daily life.
Global Developmental Delay
A. Under the age of 5 years
B. Severity level cannot be reliably assessed during early childhood (e.g., too young for
standardized testing)
C. Fails to meet expected developmental milestones in several areas of intellectual functioning
D. Requires reassessment after a period of time
Unspecified Intellectual Developmental Disorder (Intellectual Disability)
A. Over the age of 5 years
B. The degree of intellectual disability cannot be reliably assessed because assessment is
difficult or impossible due to associated factors, such as:
• Sensory/physical impairments (e.g., blindness, prelingual deafness, locomotor
disability)
• Severe problem behaviors
• Co-occurring mental disorder
i. Used only in exceptional circumstances
ii. Requires reassessment after a period of time
,Communication Disorders
Language Disorder
C. Persistent difficulties in acquiring and using language across modalities (spoken, written, sign
language, etc.), due to deficits in comprehension or production, including:
1. Reduced vocabulary
2. Limited sentence structure
3. Impairments in discourse (difficulty using language to explain, describe, or have a
conversation)
D. Language abilities are substantially and quantifiably below what is expected for age, resulting
in functional limitations in:
• Effective communication
• Social participation
• Academic achievement
• Occupational performance
E. Onset of symptoms is in the early developmental period.
F. Difficulties are not attributable to:
• Hearing or other sensory impairment
• Motor dysfunction
• Another medical or neurological condition
• Intellectual Developmental Disorder (Intellectual Disability)
• Global Developmental Delay
Speech Sound Disorder
A. Persistent difficulty with speech sound production that interferes with speech intelligibility,
or verbal communication of messages
B. Causes limitations in effective communication that interfere with social participation,
academic achievement, occupational performance
C. Onset of symptoms is in the early developmental period.
D. Difficulties are not attributable to congenital or acquired conditions, such as:
• Cerebral palsy
• Cleft palate
• Deafness/hearing loss
• Traumatic brain injury
• Other medical or neurological conditions
Childhood-Onset Fluency Disorder (Stuttering)
A. Disturbances in the normal fluency and timing/patterning of speech that are inappropriate
for the person’s age and language skills, persist over time, and are characterized by frequent
and marked occurrences of one or more of the following:
1. Sound and syllable repetitions
2. Sound prolongations of consonants or vowels
3. Broken words (pauses within a word)
4. Audible or silent blocking (filled or unfilled pauses in speech)
5. Circumlocutions (word substitutions to avoid problematic words)
6. Words produced with excess physical tension
, 7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”)
B. The disturbance causes anxiety about speaking or limitations in effective communication,
social participation, academic performance, or occupational performance.
C. Onset of symptoms is in the early developmental period. Later-onset cases are diagnosed as
adult-onset fluency disorder.
D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency
associated with neurological insult (e.g., stroke, tumor, trauma), or another medical
condition, and is not better explained by another mental disorder.
Social (Pragmatic) Communication Disorder
A. Persistent difficulties in the social use of verbal and nonverbal communication, shown by all
four of the following:
1. Deficits in using communication for social purposes (eg. greeting, sharing
information), appropriately for the social context.
2. Difficulty changing communication to match the context or needs of the listener.
3. Difficulty following rules for conversation and storytelling (eg. taking turns,
rephrasing when misunderstood).
4. Difficulty understanding what is not explicitly stated (e.g., making inferences) and
understanding nonliteral or ambiguous language (e.g., humor, idioms, metaphors).
B. The deficits result in functional limitations in effective communication, social participation,
social relationships, academic achievement, or occupational performance.
C. Onset is in the early developmental period, although difficulties may not become fully
apparent until social communication demands exceed the person's limited abilities.
D. The symptoms are not attributable to another medical or neurological condition, low abilities
in word structure/grammar, or better explained by autism spectrum disorder, intellectual
developmental disorder, global developmental delay, or another mental disorder.
Unspecified Communication Disorder
Symptoms characteristic of a communication disorder predominate and cause clinically significant
distress or impairment in social, occupational, or other important areas of functioning, but the
person does not meet the full criteria for a communication disorder or another neurodevelopmental
disorder. The clinician does not specify why the full criteria are not met, or there is insufficient
information to make a more specific diagnosis.
Autism Spectrum Disorder
Autism Spectrum Disorder
A. Persistent deficits in social communication and social interaction across multiple contexts,
with all 3 of the following, currently or by history:
1. Deficits in social-emotional reciprocity (e.g., abnormal social approach, failure of
normal back-and-forth conversation, reduced sharing of interests/emotions, or
failure to initiate/respond to social interaction).
, 2. Deficits in nonverbal communication used for social interaction (e.g., abnormal eye
contact/body language, difficulty understanding or using gestures, or lack of
facial/nonverbal communication).
3. Deficits in developing, maintaining, and understanding relationships (e.g., difficulty
adjusting behavior to different social contexts, difficulties with imaginative play or
making friends, or lack of interest in peers).
B. Restricted, repetitive patterns of behavior, interests, or activities, with at least 2 of the
following 4, currently or by history:
1. Stereotyped/repetitive movements, use of objects, or speech (e.g., lining up toys,
echolalia, repetitive movements).
2. Insistence on sameness/inflexibility or ritualized verbal/nonverbal behavior (e.g.,
extreme distress at small changes, rigid routines, same route/food).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g. strong
attachment to or preoccupation with unusual objects).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of
the environment (e.g., indifference to temperature, sensitivity to sounds/textures,
excessive smelling/touching).
C. Symptoms are present in the early developmental period, although they may not become
fully apparent until social demands exceed the person's abilities or may be masked by
learned strategies later in life.
D. Symptoms cause clinically significant impairment in social, occupational, or other important
areas of current functioning.
E. Symptoms are not better explained by Intellectual Developmental Disorder (Intellectual
Disability) or Global Developmental Delay. ASD and IDD can co-occur when social
communication is below what would be expected for the person's general developmental
level.
Note: Someone with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or
pervasive developmental disorder not otherwise specified should receive an Autism Spectrum
Disorder diagnosis.
• Specify current severity based on social communication impairments and
restricted/repetitive behaviors:
o Level 1 – Requiring support: Noticeable social-communication difficulties and
difficulty initiating/interacting socially, with inflexible behavior that interferes with
functioning in one or more contexts.
o Level 2 – Requiring substantial support: Marked social-communication deficits that
remain apparent even with support, with frequent inflexibility/repetitive behaviors
that interfere with functioning across several contexts.
o Level 3 – Requiring very substantial support: Severe social-communication deficits
with very limited initiation and response to social interaction, together with extreme
inflexibility/repetitive behaviors that markedly interfere with functioning across all
areas.
• Specify if:
o With or without accompanying intellectual impairment
o With or without accompanying language impairment
• Specifiy if:
o Associated with a known genetic or other medical condition or environmental factor
Neurodevelopmental Disorders
Intellectual Developmental Disorders
Intellectual Developmental Disorder (Intellectual Disability)
Intellectual developmental disorder (intellectual disability) is a disorder with onset during the
developmental period that includes both intellectual and adaptive functioning deficits in conceptual,
social, and practical domains. The following three criteria must be met:
A. Deficits in intellectual functions (e.g. reasoning, planning, learning) confirmed by clinical
assessment and standardized intelligence testing
B. Deficits in adaptive functions (personal independence and social responsibility). Without
support limited functioning in one or more activities of daily life (e.g. communication,
dependent living) across multiple environments (e.g. home, school, work)
C. Onset during developmental period. Specify if:
1. Mild: Can generally function and blend into everyday life, with some difficulties in
academic/abstract thinking, social judgment, and more complex daily tasks; may
achieve considerable independence with support.
2. Moderate: Can care for themselves and learn basic personal, household, work, and
communication skills, but often needs instructions and considerable ongoing
support.
3. Severe: Has very limited communication and conceptual skills and needs supervision
and extensive support in most/all daily situations.
4. Profound: Has extremely limited conceptual and day-to-day functioning,
communicates mainly nonverbally, and requires close/continuous supervision and
support for essentially all aspects of daily life.
Global Developmental Delay
A. Under the age of 5 years
B. Severity level cannot be reliably assessed during early childhood (e.g., too young for
standardized testing)
C. Fails to meet expected developmental milestones in several areas of intellectual functioning
D. Requires reassessment after a period of time
Unspecified Intellectual Developmental Disorder (Intellectual Disability)
A. Over the age of 5 years
B. The degree of intellectual disability cannot be reliably assessed because assessment is
difficult or impossible due to associated factors, such as:
• Sensory/physical impairments (e.g., blindness, prelingual deafness, locomotor
disability)
• Severe problem behaviors
• Co-occurring mental disorder
i. Used only in exceptional circumstances
ii. Requires reassessment after a period of time
,Communication Disorders
Language Disorder
C. Persistent difficulties in acquiring and using language across modalities (spoken, written, sign
language, etc.), due to deficits in comprehension or production, including:
1. Reduced vocabulary
2. Limited sentence structure
3. Impairments in discourse (difficulty using language to explain, describe, or have a
conversation)
D. Language abilities are substantially and quantifiably below what is expected for age, resulting
in functional limitations in:
• Effective communication
• Social participation
• Academic achievement
• Occupational performance
E. Onset of symptoms is in the early developmental period.
F. Difficulties are not attributable to:
• Hearing or other sensory impairment
• Motor dysfunction
• Another medical or neurological condition
• Intellectual Developmental Disorder (Intellectual Disability)
• Global Developmental Delay
Speech Sound Disorder
A. Persistent difficulty with speech sound production that interferes with speech intelligibility,
or verbal communication of messages
B. Causes limitations in effective communication that interfere with social participation,
academic achievement, occupational performance
C. Onset of symptoms is in the early developmental period.
D. Difficulties are not attributable to congenital or acquired conditions, such as:
• Cerebral palsy
• Cleft palate
• Deafness/hearing loss
• Traumatic brain injury
• Other medical or neurological conditions
Childhood-Onset Fluency Disorder (Stuttering)
A. Disturbances in the normal fluency and timing/patterning of speech that are inappropriate
for the person’s age and language skills, persist over time, and are characterized by frequent
and marked occurrences of one or more of the following:
1. Sound and syllable repetitions
2. Sound prolongations of consonants or vowels
3. Broken words (pauses within a word)
4. Audible or silent blocking (filled or unfilled pauses in speech)
5. Circumlocutions (word substitutions to avoid problematic words)
6. Words produced with excess physical tension
, 7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”)
B. The disturbance causes anxiety about speaking or limitations in effective communication,
social participation, academic performance, or occupational performance.
C. Onset of symptoms is in the early developmental period. Later-onset cases are diagnosed as
adult-onset fluency disorder.
D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency
associated with neurological insult (e.g., stroke, tumor, trauma), or another medical
condition, and is not better explained by another mental disorder.
Social (Pragmatic) Communication Disorder
A. Persistent difficulties in the social use of verbal and nonverbal communication, shown by all
four of the following:
1. Deficits in using communication for social purposes (eg. greeting, sharing
information), appropriately for the social context.
2. Difficulty changing communication to match the context or needs of the listener.
3. Difficulty following rules for conversation and storytelling (eg. taking turns,
rephrasing when misunderstood).
4. Difficulty understanding what is not explicitly stated (e.g., making inferences) and
understanding nonliteral or ambiguous language (e.g., humor, idioms, metaphors).
B. The deficits result in functional limitations in effective communication, social participation,
social relationships, academic achievement, or occupational performance.
C. Onset is in the early developmental period, although difficulties may not become fully
apparent until social communication demands exceed the person's limited abilities.
D. The symptoms are not attributable to another medical or neurological condition, low abilities
in word structure/grammar, or better explained by autism spectrum disorder, intellectual
developmental disorder, global developmental delay, or another mental disorder.
Unspecified Communication Disorder
Symptoms characteristic of a communication disorder predominate and cause clinically significant
distress or impairment in social, occupational, or other important areas of functioning, but the
person does not meet the full criteria for a communication disorder or another neurodevelopmental
disorder. The clinician does not specify why the full criteria are not met, or there is insufficient
information to make a more specific diagnosis.
Autism Spectrum Disorder
Autism Spectrum Disorder
A. Persistent deficits in social communication and social interaction across multiple contexts,
with all 3 of the following, currently or by history:
1. Deficits in social-emotional reciprocity (e.g., abnormal social approach, failure of
normal back-and-forth conversation, reduced sharing of interests/emotions, or
failure to initiate/respond to social interaction).
, 2. Deficits in nonverbal communication used for social interaction (e.g., abnormal eye
contact/body language, difficulty understanding or using gestures, or lack of
facial/nonverbal communication).
3. Deficits in developing, maintaining, and understanding relationships (e.g., difficulty
adjusting behavior to different social contexts, difficulties with imaginative play or
making friends, or lack of interest in peers).
B. Restricted, repetitive patterns of behavior, interests, or activities, with at least 2 of the
following 4, currently or by history:
1. Stereotyped/repetitive movements, use of objects, or speech (e.g., lining up toys,
echolalia, repetitive movements).
2. Insistence on sameness/inflexibility or ritualized verbal/nonverbal behavior (e.g.,
extreme distress at small changes, rigid routines, same route/food).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g. strong
attachment to or preoccupation with unusual objects).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of
the environment (e.g., indifference to temperature, sensitivity to sounds/textures,
excessive smelling/touching).
C. Symptoms are present in the early developmental period, although they may not become
fully apparent until social demands exceed the person's abilities or may be masked by
learned strategies later in life.
D. Symptoms cause clinically significant impairment in social, occupational, or other important
areas of current functioning.
E. Symptoms are not better explained by Intellectual Developmental Disorder (Intellectual
Disability) or Global Developmental Delay. ASD and IDD can co-occur when social
communication is below what would be expected for the person's general developmental
level.
Note: Someone with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or
pervasive developmental disorder not otherwise specified should receive an Autism Spectrum
Disorder diagnosis.
• Specify current severity based on social communication impairments and
restricted/repetitive behaviors:
o Level 1 – Requiring support: Noticeable social-communication difficulties and
difficulty initiating/interacting socially, with inflexible behavior that interferes with
functioning in one or more contexts.
o Level 2 – Requiring substantial support: Marked social-communication deficits that
remain apparent even with support, with frequent inflexibility/repetitive behaviors
that interfere with functioning across several contexts.
o Level 3 – Requiring very substantial support: Severe social-communication deficits
with very limited initiation and response to social interaction, together with extreme
inflexibility/repetitive behaviors that markedly interfere with functioning across all
areas.
• Specify if:
o With or without accompanying intellectual impairment
o With or without accompanying language impairment
• Specifiy if:
o Associated with a known genetic or other medical condition or environmental factor
