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They may ccur with intellectual disability Both diagnoses are made if full criteria are met for intellectual disability and a cation disorder or specific learning disorder Autism spectrum disorder | [
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] | 801 |
Assessment of intellectual ability may be complicated by and behavior deficits inherent to auti sm spectrum disorder which may interfere with understanding and comply ing with test procedures | [
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] | 802 |
Appropriate sessment of intellectual functioning in autism spectrum disorder is essential with sessment across the developmental period becaus e IQ scores in auti sm spectrum disorder may be unstable particularly in early childhood Comorbidity mental neurodevelopmental me dical and physical conditions are frequent in intellectual disability with rates of some conditions g ment al disorders cerebral palsy and three to fo ur times higher than in the ge neral population | [
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The prognosis and outcome of diagnoses may be influenced by the presence of intellectual disability | [
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] | 804 |
Assessment procedur es may require modifications because of associated ders including communication disorders autism spectrum disorder and motor sensory or other disorders | [
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] | 805 |
Knowledgeable informan ts are essential for identifying symptoms such as irritability mood dysregulation aggression eating problems and sleep problems and for assessing adaptive functioning in various community settings The most common mental an d neurodevelopmental disorders are depressi ve and bipolar anxiety autism spectrum stereotypic movement d isorder or without and ma jor neurocognitive disorder | [
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] | 806 |
Major sive disorder may occur througho ut the range of severity of intellectual disability | [
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] | 807 |
injurious behavior requires pr ompt diagnostic attention and may warrant a separate agnosis of stereotypic movement disorder | [
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Individuals with intellectual disability ularly those with more severe intellectual disability may also exhibit aggression and disruptive behaviors including harm of others or property destruction Relationship to Ot her Classifications development at the time of this uses the term intellectual mental disorders to indicate that these are disorders that involve impaired brain functioning early in life | [
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] | 809 |
These disorders are described in as a metasyndrome occurring in the developmental period analogous to dementia or neurocognitive disorder in later life There are four subtypes in mild moderate severe and profound The American Association on Intellectual and Developmental Disabilities also uses the term intellectual disability with a similar meaning to the term as used in thisGlobal Developmental Delay 41 manual | [
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] | 810 |
The classification is multidimensional rather than categorical and is based on the disability construc t | [
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] | 811 |
Rather than listing specifie rs as is done in the AAIDD emphasizes a profile of supports based on severity Global Developmental Delay 315 8 This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood | [
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] | 812 |
This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of tual functioning and applies to individuals who are unable to undergo systematic ments of intellectual functioning including children who are too young to participate in standardized testing | [
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] | 813 |
This category requires reassessment after a period of time Unspecified Intellectual Disability Developmental 319 This category is rese rved for individuals over the age of 5 years when assessment of the degree of intellectual disabi lity developmental by means of locally available procedures is rendered difficult or impossible because of associated sensory or physical impairments as in blindness or prel ingual locomotor or ence of severe problem behaviors or mental disorder | [
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] | 814 |
This category should only be used in exceptional circumstances and requires reassessment after a period of time Communication Disorders Disorders of communication include deficits in language speech and communication Speech is the expressive production of sounds and includes an indivi articulation fluency voice and resonance quality | [
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Language includes the form fu nction and use of a conventional system of symbol s e spoken words sign language written words in a rule manner for communication | [
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] | 817 |
Assessments of speech language and cation abilities must take into account the cultural and language context particularly for individuals growing up in bilingual environments | [
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] | 818 |
The standardized sures of language development and of nonverba l intellectual capacity must be relevant for the cultural and linguistic group e tests developed and standardized for one group may not provide appropriate norms for a different | [
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The diagnostic category of nication disorders includes the language disorder speech sound disorder fluency disord er social communication der and other specified and unspecified communica tion disorders 42 Neurodevelopmental Disorders Language Disorder Diagnostic Criteria 315 32 A | [
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Persistent difficulties in the acquisition and use of language across modalities e spoken written sign language or due to deficits in comprehension or tion that include the 1 | [
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] | 824 |
Language abilities are substantially and quantifiably below those expected for age sulting in functional limitations in effective communication social participation demic achievement or occupational performance individually or in any combination C | [
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] | 825 |
Onset of symptoms is in the early developmental period D | [
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] | 826 |
The difficulties are not attributable to hearing or other sensory impairment motor function or another medical or neurological condition and are not better explained by tellectual disability developmental or global developmental delay Diagnostic Features The core diagnostic features of language disorder are difficulties in the acquisition and use of language due to deficits in the comprehe nsion or production of vocabulary sentence structure and discourse | [
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] | 829 |
Expressive ability refers to the production of vocal tural or verbal signals while receptive ability refers to the process of receiving and prehending language messages | [
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] | 830 |
Language skills need to be assessed in both expressive and receptive modalities as these may differ in severity | [
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For example an pressive language may be seve rely impaired while his recept ive language is hardly paired at all Language disorder usually affects vocabulary and grammar and these effects then limit the capacity for discourse | [
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] | 832 |
The fi rst words and phrases are likely to be delayed in vocabulary size is smaller and less varied than and sentences are shorter and less complex with grammatical errors especially in past tense | [
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] | 833 |
Deficits in prehension of language are fr equently underestimated as children may be good at using context to infer meaning | [
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Problems with remembering new words and sentences are manifested by difficulties following instructions of increasing length difficulties ing strings of verbal information g remembering a phone number or a shopping and difficulties remembering novel sound se quences a skill that may be important for learning new words | [
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] | 836 |
Difficulties with discour se are shown by a reduced ability to provide adequate information abou t the key events and to narrate a coherent story The language difficulty is manifest by abilities substantially and quantifiably below that expected for age and significantly inte rfering with academic achievement tional performance effective communication or socialization | [
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A diagnosis of language disorder is made based on the synthesis of the history direct clinical observation in different contexts e home school or and scores from ized tests of language ability that can be used to guide estimates of severity Language Disorder 43 Associated Features Supporting Diagnosis A positive family history of language disorders is often present | [
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] | 838 |
Individuals even dren can be adept at accommodating to their limited language | [
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] | 840 |
Affected individuals may prefer to communicate only with family bers or other familiar individuals | [
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] | 841 |
Although these social indicators are not diagnostic of a language disorder if they are notable and pers istent they warrant referral for a full guage assessment | [
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] | 842 |
Language d isorder particularly expressiv e deficits may with speech sound disorder Development and Course Language acquisition is marked by changes from onset in toddlerhood to the adult level of competency that appears during adolescence | [
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] | 843 |
Changes appear across the dimensions of language words grammar narrati texts and conversational in increments and synchron ies | [
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] | 844 |
Language disorder emerges during the early developmental however there is considerable variation in early vocabulary acquisition and early word combinations an d individual differenc es are not as single indicators highly predictive of later outcomes | [
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] | 845 |
By age 4 years individual differences in language ability are more stable with bette r measurement accuracy and are highly dictive of later outcomes | [
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] | 846 |
Language disorder diagnosed from 4 years of age is likely to be stable over time and typically persists into adulthood although the particular profile of language strengths and deficits is likely to change over the course of development Risk and Prognostic Factors Children with receptive language impairment s have a poorer prognosis than those with predominantly expressive impairments | [
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] | 847 |
They are more resistant to treatment and culties with reading comprehe nsion are frequently seen Genetic and physiological | [
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] | 848 |
Language disorders are highly heritable and family bers are more likely to have a history of language impairment Differential Diagnosis Normal variations in language | [
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Regional social or va riations of language g must be considered when an individual is being assessed for language impairment Hearing or other sensory impairment | [
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] | 851 |
Hearing impairment needs to be excluded as the primary cause of language difficulties | [
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] | 852 |
Langua ge deficits may be associated with a hearing impairment other sensory deficit or a deficit | [
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] | 853 |
When language deficits are in excess of those usually associ ated with these problems a di agnosis of language disorder may be made Intellectual disability ectual developmental | [
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] | 854 |
Language delay is often the presenting feature of intellect ual disability and the definitive diagnosis may not be made until the child is able to complete standard ized assessments | [
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] | 855 |
A separate diagnosis is not given unless the language deficits are clearl y in excess of the intellectual limitations Neurological disorders | [
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] | 856 |
Language disorder can be acquired in association with logical disorders including epilepsy g ac quired aphasia or Language regression | [
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Loss of speech and language in a child younger than 3 years may be a sign of autism spectrum disorder developmental or a specific logical condition such as syndrome | [
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Among children older than 3 years language loss may be a symptom of seizures and a diagnostic assessment is necessary to exclude the presence of epilepsy g routine and sleep 44 Neurodevelopmental Disorders Comorbidity Language disorder is strongly associated with other neurodevelopmental disorders in terms of specific learning d isorder and ity disorder autism spectrum disorder and developmental coordination disorder | [
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] | 859 |
It is also associated with social commu nication disorder | [
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] | 860 |
A positive family history of speech or language disorders is often present Speech Sound Disorder Diagnostic Criteria 315 39 A | [
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] | 861 |
Persistent difficulty with speech sound production that interferes with speech bility or prevents verbal communication of messages B | [
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] | 863 |
Onset of symptoms is in the early developmental period D | [
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] | 864 |
The difficulties are not attributable to congenital or acquired conditions such as bral palsy cleft palate deafness or hearing loss traumatic brain injury or other cal or neurological conditions Diagnostic Features Speech sound production descri bes the clear articulation of the phonemes e individual that in combination make up spoken words | [
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] | 865 |
Speech sound production requires both the phonological knowledge of speech sounds and the ability to coordinate the movements of the articulators e the jaw tongue and lips with breathing and vocalizing for speech | [
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] | 866 |
dren with speech production difficulties may experience difficulty with phonological edge of speech sounds or the ability to coordi nate movements for speech in varying degrees Speech sound disorder is thus heterogeneous in its underlying mechanisms and includes nological disorder and articulation disorder | [
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] | 867 |
A speech sound disorder is diagnosed when speech sound production is not what would be expected based on the age and opmental stage and when the deficits are not the result of a physical st ructural neurological or hearing impairment | [
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] | 868 |
Among typically develo ping children at age 4 years overall speech should be intelligible whereas at age 2 years only may be understandable Associated Features Supporting Diagnosis Language disorder particularly expressive de ficits may be found to with speech sound disorder | [
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] | 869 |
A positive family history of speech or language disorders is often present If the ability to rapidly coordinate the articu lators is a particular aspect of difficulty there may be a history of delay or incoordinati on in acquiring skills that also utilize the articulators and related facial among others these sk ills include chewing maintaining mouth closure and blowing the no se | [
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] | 870 |
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] | 871 |
Verbal dyspraxia is a term also used for speech prod uction problems Speech may be differentially impaired in ce rtain genetic conditions g Down drome 22q deletion FoxP2 gene | [
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] | 872 |
If present these should also be coded Development and Course Learning to produce speech sounds clearly and accurately and learning to produce nected speech fluently are developmental skills | [
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] | 873 |
Articulation of speech sounds follows Fluency Disorder 45 developmental pattern which is reflected in the age norms of standardized tests | [
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] | 874 |
It is not unusual for typically developing children to use developmental processes for shortening words and syllables as they are learning to talk but their progression in mastering speech sound production should result in mostly in telligible speech by age 3 years | [
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] | 875 |
Children with speech sound disorder continue to use immature phonological simplification processes past the age when most children can produce words clearly Most speech sounds should be produced cl early and most words should be pronounced accurately according to age an d community norms by age 7 years | [
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0.11509240418672562,
0.014691760763525963,
0.013033146038651466
] | 876 |
The most frequently articulated sounds also tend to be learned later leading them to be called the l r s z th ch dzh and | [
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] | 877 |
Misarticulation of an y of these sounds by it self could be considered within normal limits up to age 8 years | [
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] | 878 |
When multiple sounds are involved it may be priate to target some of those sounds as part of a plan to improve intelligibility prior to the age at which almost all children can produce them a ccurately | [
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] | 879 |
Lisping e misarticulating is particularly common and may involve fr ontal or lateral patterns of airstream tion | [
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It may be associated with an ab normal swallowing pattern Most children with speech sound disorder re spond well to treatment and speech ficulties improve over time and thus the diso rder may not be lifelong | [
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] | 881 |
However when a language disorder is also present the spee ch disorder has a poorer prognosis and may be associated with specific learning disorders Differential Diagnosis Normal variations in speech | [
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] | 882 |
Regional social or variations of speech should be considered before making the diagnosis Hearing or other sensory impairment | [
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] | 883 |
Hearing impairment or deafness may result in abnormalities of speech | [
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] | 884 |
Defici ts of speech sound production may be associated with a hearing impairment other sensory deficit or a tor deficit | [
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] | 885 |
When speech deficits are in excess of those usually associated with these problems a diagnosis of speech sound disorder may be made Structural deficits | [
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] | 886 |
Speech impairment may be due to stru ctural deficits g cleft Dysarthria | [
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] | 887 |
Speech impairment may be attributable to a motor disorder such as cerebral palsy | [
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] | 888 |
Neurological signs as well as distinct ive features of voice differentiate dysarthria from speech sound disorder although in young children 3 differentiation may be difficult particularly when there is no or minima l general body motor ment in e g Selective mutism | [
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] | 889 |
Limited use of speech may be a sign of selective mutism an anxiety disorder that is characterized by a lack of sp eech in one or more contexts or settings | [
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] | 890 |
lective mutism may develop in children with a speech disorder because of embarassment about their impairments but many children with selective mutism exhibit normal speech in settings such as at home or with close friends Fluency Disorder Diagnostic Criteria 315 35 A | [
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] | 899 |
Subsets and Splits