A Clinician’s Guide to the DSM-5-TR _ ___________________________________________________________
Proposed Criteria for ND-PAE • More than minimal exposure to alcohol during gestation, including prior to pregnancy recognition. Confirmation of gestational exposure to alcohol may be obtained from maternal self-report of alcohol use in pregnancy, medical or other records, or clinical observation. • Impaired neurocognitive functioning as manifested by one or more of the following: ‒ Impairment in global intellectual performance (i.e., IQ of 70 or below, or a standard score of 70 or below on a comprehensive developmental assessment) ‒ Impairment in executive functioning (e.g., poor planning and organization; inflexibility; difficulty with behavioral inhibition) ‒ Impairment in learning (e.g., lower academic achievement than expected for intellectual level; specific learning disability) ‒ Memory impairment (e.g., problems remembering information learned recently; repeatedly making the same mistakes; difficulty remembering lengthy verbal instructions) ‒ Impairment in visual-spatial reasoning (e.g., disorganized or poorly planned drawings or constructions; problems differentiating left from right) • Impaired self-regulation as manifested by one or more of the following: ‒ Impairment in mood or behavioral regulation (e.g., mood lability; negative affect or irritability; frequent behavioral outbursts) ‒ Attention deficit (e.g., difficulty shifting attention; difficulty sustaining mental effort) ‒ Impairment in impulse control (e.g., difficulty waiting turn; difficulty complying with rules) • Impairment in adaptive functioning as manifested by two or more of the following, including at least one of the first two criteria: ‒ Communication deficit (e.g., delayed acquisition of language; difficulty understanding spoken language) ‒ Impairment in social communication and interaction (e.g., overly friendly with strangers;
‒ Impairment in motor skills (e.g., poor fine motor development; delayed attainment of gross motor milestones or ongoing deficits in gross motor function; deficits in coordination and balance) • Onset of the disorder (symptoms in Criteria B, C, and D) occurs in childhood. • The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning. • The disorder is not better explained by the direct physiological effects associated with postnatal use of a substance (e.g., a medication, alcohol, or other drugs), a general medical condition (e.g., traumatic brain injury, delirium, dementia), another known teratogen (e.g., fetal hydantoin syndrome), a genetic condition (e.g., Williams syndrome, Down syndrome, Cornelia de Lange syndrome), or environmental neglect. SUICIDAL BEHAVIOR DISORDER Suicidal behavior disorder (SBD) was introduced in the DSM-5 as a condition for further study, indicating that more research was needed before it could be considered for inclusion as an official diagnosis [2]. SBD is characterized by a self-initiated sequence of behaviors believed at the time of initiation to cause one’s death, occurring within the last 24 months. The proposal aimed to improve the recognition, documentation, and treat- ment of suicidal behavior as a distinct clinical concern, separate from, but often related to, other mental health conditions. The inclusion of SBD in the DSM-5 sparked debate in the psychiatric community [2]. Proponents argued that it could enhance research, improve communication during clinical hand-offs, and maintain focus on suicidal behavior as a signifi- cant clinical concern. Critics, however, raised concerns about the potential over-medicalization of behavior and increased liability for mental health professionals. Research on SBD over the past decade has primarily focused on its clinical utility in predicting future suicide risk, its association with related disorders, the development of psychometric measures, its pathophysiology, and potential interventions. However, stud- ies have shown that the clinical utility of SBD for predicting future suicide risk is limited. In the DSM-5-TR, published in 2022, SBD was not included as a formal diagnosis. Instead, new symptom codes were added to indicate current suicidal behavior and history of suicidal behavior, allowing clinicians to document these behaviors without requiring any other mental health diagnosis. This change reflects ongoing efforts to improve the assessment and documentation of suicide risk in clinical practice while acknowledging the complexities involved in classifying suicidal behavior as a distinct disorder.
difficulty reading social cues; difficulty understanding social consequences)
‒ Impairment in daily living skills (e.g., delayed toileting, feeding, or bathing; difficulty managing daily schedule)
34
EliteLearning.com/Social-Work
Powered by FlippingBook