F8 Disorders of

Psychological
Development
Common features

1. Onset that is invariably during infancy or childhood

2. Impairment or delay in the development of functions that are strongly
related to biological maturation of the central nervous system
3. A steady course that does not involve the remissions and relapses that
tend to be characteristic of many mental disorder
 F80 Specific Developmental
Disorder of Speech and Language

F81 Specific Developmental

Disorder of Scholastic Skills

Classification ICD 10 F82 Specific Developmental

Disorder of Motor Function

F83 Mixed Specific Developmental

Disorders

F84 Pervasive Developmental

Disorders
Specific Developmental
Disorder
F80 Specific Developmental Disorder of Speech and Language
Normal patterns of language acquisition are disturbed from early stages of
development
Difficulties

1. Differentiation from normal variations in development → “slow speakers” go on to develop

entirely normally, children with developmental disorders have multiple associated problems. 4
criteria:
a. Severity → outside limits of 2 standard deviations
b. Course → current level of impairment is mild but there is history of severe impairment
there is likelihood the functioning represents sequelae of significant disorder
c. Pattern → abnormal: deviant and not just of a kind appropriate for an earlier phase of
development
d. Associated problems → scholastic deficits, interpersonal relationship abnormalities,
emotional or behavioral disturbance
2. Differentiation from mental retardation or global developmental delay → specific delay is
significantly out of keeping with the general level of cognitive functioning
3. Differentiation from disorder secondary to severe deafness of specific neurological or other
structural abnormalities
F80.0 Specific Speech Articulation Disorder

● Child’s use of speech sounds is below the appropriate level for his/her mental age
● Normal level of language skill and nonverbal intelligence
● Abnormalities are not directly attributable to a sensory, structural, or neurological abnormality

Normal development:

● 4 years: errors in speech sound production but child able to be understood by strangers
● 6-7 years: most speech sounds will be acquired, difficulties may remain but no problem of
communication
● 11-12 years: mastery of almost all speech sounds

Abnormal development

● Misarticulations in child’s speech with consequent difficulties for others in understanding them
● Omissions, distortion or substitutions of speech sounds
● Inconsistencies in the co-occurrence of sounds
F80.1 Expressive language disorder

● Child’s ability to use expressive spoken language is markedly below the appropriate level for his
or her mental age, but in which language comprehension is within normal limits
● Absence of single words by age of 2 years and failure to generate simple 2 word phrases by 3
years → include restricted vocabulary development, overuse of a small set of general words,
difficulties in selecting appropriate words, and word substitutions, short utterance length,
immature sentence structure, syntactical errors, especially omissions of word endings or
prefixes, and misuse of or failure to use grammatical features such as prepositions, pronouns,
articles, and verb and noun inflexions
● Intact use of nonverbal cues and internal language as reflected in imaginative play
F80.2 Receptive language disorder

● Failure to respond to familiar names (in absence of nonverbal clues) by the first birthday,
inability to identify at least a few common objects by 18 months, or failure to follow simple,
routine instruction by the age of 2
● Later difficulties → inability to understand grammatical structures and lack of understanding of
more subtle aspect of language
● Severity of the delay is outside the normal limits of variation for the child’s mental age and
criteria for pervasive developmental disorder are not met
● Highest rate of socio-emotional-behavioural disturbance
● Showing normal social reciprocity, normal make-believe play, normal use of parents for
comfor, near-normal use of gesture, and only mild impairments in nonverbal communication
F80.3 Acquired aphasia with epilepsy [Landau-Kleffner syndrome]

● Child having previously made normal progress in language development loses both receptive
and expressive language skills but retains general intelligence
● Accompanied by paroxysmal abnormalities on EEG (almost always from temporal lobes, usually
bilateral but often more widespread disturbance) and in major cases epileptic seizure
● Onset between 3-7 yo
● Loss of language over a period of some months but more often loss is abrupt with skill lost
over days or weeks
● Impaired receptive language with difficulties in auditory comprehension often being the first
manifestation
● Child may become mute, restricted to jargon-like sounds, or show milder deficit in word fluency
and output often accompanied by misarticulation
● Emotional disturbance in months after initial language loss but improve as child acquires some
means of communication
● Etiology possible inflammatory encephalitic process
F81 Specific Developmental Disorders of Scholastic Skills
Normal pattern of skill acquisition are disturbed from early stages of
development

Diagnostic criteria:

● Clinically significant degree of impairment in the specified scholastic skill

○ Severity → degree that may be expected to occur in less than 3% of schoolchildren
○ Developmental precursors → preceded by developmental delays
○ Associated problem → inattention, overactivity, emotional disturbance, conduct
difficulties
○ Pattern → presence of qualitative abnormalities that are not part of normal development
○ Response → scholastic difficulties do not rapidly and readily remit with increased help
● Not explained by mental retardation → IQ appropriate
● Impairment must be developmental → during early years of schooling
● No external factors for scholastic difficulties → adequate learning opportunities
● Must not be directly due to uncorrected visual or hearing impairment
Difficulties:

1. Differentiate with normal variations in scholastic achievement

2. Need to take developmental course into account
a. Severity → significance of 1 year’s retardation in reading at age 7 years is quite different
from that of 1 year’s retardation at 14 years
b. Change in pattern → common for language delay in preschool years to resolve so far as
spoken language is concerned but to be followed by a secific reading retardation which in
turn diminish in adolescence
3. Difficulty that scholastic skills have to be taught and learned → not simply
a function of biological maturation → difficult differentiating lack of
adequate experiences
4. Differentiate those that cause reading difficulties from those that derive
from or are associated with poor reading skills
5. Continuing uncertainties of subdividing the specific developmental
disorders of scholastic skills
F81.0 Specific Reading Disorder

● Reading performance should be significantly below level expected on basis of age, general
intelligence, and school placement
● Assessed by means of individually administered, standardized test of reading accuracy and
comprehension
● Reading problem on expected level of reading, and on the language and script
● Early stages: difficulties in reciting the alphabet, in giving correct names of letters, in giving
simple rhymes for words, in analysing or categorizing sounds
● Later stages, error in:
○ Omission, substitution, distortions, or addition of words or parts of words
○ Slow reading rate
○ False starts, long hesitations or “loss of place” in text, and inaccurate phrasing
○ Reversals of words in sentences or of letters within words
● Deficits in reading comprehension for example
○ Inability to recall facts read
○ Inability to draw conclusions or interference from material read
○ Use of general knowledge as background information rather than of information from a
particular story to answer questions about a story read
F81.1 Specific Spelling Disorder

● Specific and significant impairment in development of spelling skills

● In absence of history of specific reading disorder (normal accuracy and comprehension), not
solely accounted for by low mental age, visual acuity problem, or inadequate schooling

F81.2 Specific Disorder of Arithmetical Skills

● Specific impairment in arithmetical skills

● Not solely explicable on the basis of general mental retardation, grossly inadequate schooling,
direct effects of defects of visual, hearing, or neurological condition
● May include:
○ Failure to recognize numerical symbols
○ Difficulty in carrying out standard arithmetical manipulation (addition, subtraction,
multiplication, and division )
○ Difficulty in understanding which numbers are relevant to the arithmetical problem being
considered
○ Difficulty in properly aligning numbers or in inserting decimal points or symbols during
calculations
○ Poor spatial organization of arithmetical calculation
○ Inability to learn multiplication on tables satisfactorily

F81.3 Mixed Disorder of Scholastic Skills

F82 Specific Developmental Disorder of Motor Function
● Impairment in development of motor coordination (fine or gross motor
tasks) significantly below the level expected on the basis of his or her age
and general intelligence
● Not solely explicable in terms of general intellectual retardation or any
specific congenital or acquired neurological disorder
● Difficulties from early in development
● Young child: awkward general gait, slow to learn to run, hob, and go up
and down stairs, difficulty learning to tie shoe laces, fasten unfasten
buttons, throw and catch balls, clumsy in fine or gross movements
F83 Mixed Specific Developmental Disorders
Some admixture of specific developmental disorders of speech and language,
scholastic skills, and/or of motor function but which none predominates
sufficiently to constitute the prime diagnosis
Pervasive Developmental
Disorder
Definition
DSM V → autism spectrum disorder (ASD)

Wide range of impairments in social communication and restricted and

repetitive behaviors

Characteristic:

● Social communication
● Restricted and repetitive behavior
● Aberrant language development and usage
Epidemiology
Prevalence: 1% in US, 8/10.000 based on DSM-IV-TR

Usually appear in first or second year of life. Average age of diagnosis:

● Autistic disorder 3,1 years

● Pervasive developmental disorder not otherwise specified 3,9 years
● Asperger’s disorder 7,2 years

4 times more common in boys than in girls, but girls with ASD more often
exhibit intellectual disability than boys
Etiology
● Genetic factors → family and twin studies → chromosomes that may
contribute: 2, 7, 16, 17
● Biomarkers
○ Elevated serotonin in blood → alterations in neuronal migration and growth in brain
○ Disrupted mTOR-linked synaptic plasticity mechanism
○ Altered GABA inhibitory system
○ Increased total brain volume → macrocephaly, increase amygdala and striatum (repetitive
behaviours) → sensitive periods within brain’s plasticity that may be disrupted
● Immunological factors → reports of maternal antibodies directed as fetus
→ damaged embryonic neural tissue
● Prenatal and perinatal factors → higher incidence of complications
● Comorbid neurological disorders → EEG abnormalities, seizure
Classification
DSM V (Autism Spectrum Disorder) ICD 19 (F84 Pervasive Developmental
Disorders)
● Autistic disorder
● Asperger’s disorder ● F84.0 Childhood autism
● Childhood disintegrative disorder ● F84.1 Atypical autism
● Rett syndrome ● F84.2 Rett’s syndrome
● Pervasive developmental disorder not ● F84.3 Other childhood disintegrative
otherwise specified disorder
● F84.4 Overactive disorder associated
with mental retardation and
stereotyped movement
● F84.5 Asperger’s syndrome
● F84.8 Other
● F84.9 Unspecified
Diagnosis
Criteria -
DSM V
Assessment Tools
● CHATS (Checklist for Autism in Toddlers)
● ADOS-G (Autism Diagnostic Observation Schedule-Generic)
Treatment
Goals: target core behaviours to improve social interaction, communication,
broaden strategies to integrate into schools, develop meaningful peer
relationships, increase long-term skills in independent living

● Psychosocial interventions
○ Early intensive behavioral and developmental interventions
○ Social skill training
○ Behavioral intervention and CBT for repetitive behaviours and associated symptoms
○ Intervention for comorbid symptoms → neurofeedback, management for insomnia
○ Educational intervention for children
● Psychopharmacological interventions
○ Irritability → atypical antipsychotic (risperidone, aripripazole)
○ Hyperactivity, impulsivity, inattention → methylphenidate
○ Repetitive stereotypic behavior → SSRI, atypical antypsychotic, mood-stabilizers
Autism
Diagnosis Criteria - ICD 10
F84.0 Children Autism

● Presence of abnormal and/or impaired development that is manifest

before the age of 3 years, and by the characteristic type of abnormal
functioning in all 3 areas of:
○ Social interaction
■ inadequate appreciation of socio-emotional cues (lack of response to other people’s
emotion and/or lack of modulation of behavior according to social context)
■ poor use of social signals and a weak integration of social, emotional, and
communicative behaviours
■ lack of socio-emotional reciprocity
 ○ Communication
■ lack of social usage of whatever language skills are present
■ impairment in make-believe and social imitative play
■ poor synchrony and lack of reciprocity in conversational interchange
■ poor flexibility in language expression and a relative lack of creativity and fantasy in thought
processes
■ lack of emotional response to other people’s verbal and nonverbal overtures
■ impaired use of variations in cadence or emphasis to reflect communicative modulation
■ similar lack of accompanying gesture to provide emphasis or aid meaning in spoken
communication
○ Restricted, repetitive, and stereotyped patterns of behaviour
■ Tendency to impose rigidity and routine on a wide range of aspects of day to day functioning
■ Novel activities as well as to familiar habits and play pattern
■ In early childhood there may be specific attachment to unusual typically non-soft object
■ May insist in performance of particular routines in ritual of a nonfunctional character
■ Stereotyped preoccupations with interests such as dates, routes or timetables
■ Motor stereotypes
■ Specific interest in non-functional elements of object (smell or feel)
■ Resistance to changes in routine or in details of the personal environment (moving furniture, etc)
● Nonspecific problem: fear/phobias, sleeping and eating disturbances,
temper tantrums, aggression, self injury, lack creativity
F84.1 Atypical Autism

● Pervasive developmental disorder that differs from autism in either of

age of onset or of failure to fulfill all three sets of diagnostic criteria
○ Abnormal and/or impaired development manifest for the first time only after age 3 years
○ There are insufficient demonstrable abnormalities in one or two of 3 areas of
psychopathology required to diagnose autism in spite of characteristic abnormalities in
the other area(s)
● Arises most often in profoundly retarded individuals whose very low level
of functioning provides little scope for exhibition of the specific deviant
behaviours required for the diagnostic of autism
● Also occurs in individuals with a severe specific developmental disorder of
receptive language
Rett’s Syndrome
Normal development for 6 months → devastating developmental
deterioration

Occurred only in females

Etiology: unknown → but symptoms compatible with metabolic disorder

● Hyperammonemia → enzyme metabolizing ammonia is deficient → but

not in most patients
● Genetic basis

Head circumference growth decelerates → microcephaly

Diagnosis Criteria - ICD 10
● In most cases onset is between 7 and 24 months
● Loss of purposive hand movement and acquired fine motor manipulative skill
● Accompanied by
○ Loss, partial loss or lack of development of language
○ Distinctive stereotyped tortuous wringing or “hand-washing” movement → arm flexed in front of the
chest or chin
○ Stereotypic wetting of the hands with saliva
○ Lack of proper chewing of food
○ Often episodes of hyperventilation
○ Almost always a failure to gain bowel and bladder control
○ Often excessive drooling and protrusion of the tongue
○ Loss of social engagement
● Typical: “social smile” looking at or “through” people, but not interacting socially with them in
early childhood stance and gait tend to be broad-based, muscles are hypotonic, trunk
movements usually poorly coordinated, scoliosis/kyphoscoliosis usually develops
● Adolescence or adulthood → spinal atrophies, severe motor disability
● Later → rigid spasticity, more in lower limb
● Before age of 8 years → epileptic fits
Treatment
Symptomatic

Physiotherapy → muscular dysfunction

Anticonvulsant → seizure

Behavior therapy + medication → self injurious behaviours

Other Childhood
Disintegrative Disorder
Marked regression in several areas of functioning after at least 2 years of
apparently normal development → deterioration over several months of
intellectual, social, and language function occurring in 3 and 4 years old

Childhood disintegrative disorder → Heller’s syndrome, disintegrative

psychosis

More common in males

Etiology associated with other neurological conditions (seizure, tuberous

sclerosis, various metabolic disorder)

Treatment = autistic disorder

Diagnosis Criteria - ICD 10
● Apparently normal development up to age of at least 2 year, followed by a definite loss of
previously acquired skills
● Accompanied by qualitatively abnormal social functioning
● Usual for there to be a profound regression in, or loss of, language, a regression in the level of
play, social skills, and adaptive behaviour, and often a loss of bowel or bladder control,
sometimes with a deteriorating motor control
● Typically accompanied by general loss of interest in the environment, by stereotyped, repetitive
motor mannerism, and by an autistic-like impairment of social interaction and communication
● Resembles dementia but differs in: no evidence of organic disease, loss of skills may be
followed by a degree of recovery, and impairment in socialization and communication has
deviant qualities typical to autism rather than of intellectual decline
Overactive Disorder Associated
with Mental Retardation and
Stereotyped Movements
Diagnosis Criteria - ICD 10
● Combination of:
○ Developmentally inappropriate severe overactivity → hyperactivity and inattention
○ Motor stereotypes
○ Severe mental retardation → IQ below 50
● Tend not to benefit from stimulant drugs and may exhibit a severe
dysphoric reaction when given stimulants
● In adolescence overactivity tend to be replaced by underactivity
Asperger’s Syndrome
Characteristic: impairment and oddity of social interaction and restricted
interest in behaviour but no significant delays in language or cognitive
development

Etiology: genetic contribution and potentially environmental and perinatal

contributing factors

8 times more common in males

Diagnosis Criteria - ICD 10
● Lack of any clinically significant general delay in language or cognitive
development → normal general intelligence but common to be clumsy
● Presence of qualitative deficiencies in reciprocal social interaction
● Restricted, repetitive, stereotyped patterns of behaviour, interest and
activities
● May or may not be problems in communication similar to those
associated with autism but significant language retardation would rule
out the diagnosis
Treatment
Aims: promote social communication and peer relationship

Goal: shaping interaction so that they better match those peers

Comfort with routines → utilized to foster positive habit

Self-sufficiency and problem solving techniques for individuals in social

situations and work setting