Abnormal Psychology Textbook PDF
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Camille Faye J. Elcano-de la Paz
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This document is an abnormal psychology textbook outlining the biopsychosocial model and DSM-5 classification system. It also covers neurodevelopmental disorders, including intellectual developmental disorders, communication disorders, and autism spectrum disorder. The text dives into detailed definitions, causes, and criteria.
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ABNORMAL PSYCHOLOGY Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand) BIOPSYCHOSOCIAL MODEL BIOLOGICAL PSYHOLOGICAL SOCIO-CULTURAL INFLUENCES INFLUENCES INFLUENCES...
ABNORMAL PSYCHOLOGY Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand) BIOPSYCHOSOCIAL MODEL BIOLOGICAL PSYHOLOGICAL SOCIO-CULTURAL INFLUENCES INFLUENCES INFLUENCES Views these Views disorders as Views disorders as disorders as a the result of a result of thinking result of abnormal genes or processes, environmental neurobiological personality style conditions and dysfunction and conditioning cultural norms HOW TO USE THE DSM-5 CLASSIFICATION SYSTEM? Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand) USING THE DSM-5 CLASSIFICATION SYSTEM Unlike the DSM-IV-TR, DSM-5 has consolidated all mental, personality, and physical disorders into a single location, with the principal diagnosis listed first, followed by any secondary diagnoses. Each mental diagnosis should be recorded, with many patients having multiple diagnoses. USING THE DSM-5 CLASSIFICATION SYSTEM Consider using the DSM-5 qualifier "(provisional)" when uncertain about a diagnosis. This qualifier may be appropriate when you believe a diagnosis is correct but lack sufficient history, when it's early in the course of the illness, or when waiting for laboratory tests to confirm another medical condition. STEPS IN WRITING A DIAGNOSIS 1. Locate the disorder that meets criteria 2. Write out the name of the disorder a. (ex. Posttraumatic Stress Disorder) 3. Add any subtype or specifiers that fit the presentation: a. (ex. Posttraumatic Stress Disorder, with dissociative symptoms, with delayed expression ) 4. Add the code number a. Located either at the top of the criteria set or within the subtypes or specifiers): b. Two code numbers are listed, one in bold (ICD-9) and one in parentheses (ICD-10), for example, 309.81 (F43.10) SAMPLE DIAGNOSIS F34.1 Persistent Depressive Disorder, mild severity, with early onset, with pure dysthymic syndrome (DSM-5) Z63.5 Disruption of family by separation (ICD-10) NEURODEVELOPMENTAL DISORDERS Prepared by: Camille Faye J. Elcano-de la Paz, RPm, MA(Cand) EARLIER DSM CHAPTERS.... "Disorders Usually First Evident in Infancy, Childhood, or Adolescence" Evaluating older patients, from later adolescence to maturity and beyond. NEURODEVELOPMENTAL DISORDERS 01. INTELLECTUAL DEVELOPMENTAL DISORDERS (3) 02. COMMUNICATION DISORDERS (5) 03. AUTISM SPECTRUM DISORDER (1) 04. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (3) 05. SPECIFIC LEARNING DISORDER (1) 06. MOTOR DISORDERS (7) 07. OTHER NEURODEVELOPMENTAL DISORDERS (2) 01. INTELLECTUAL DEVELOPMENTAL DISORDERS INTELLECTUAL DISABILITY (INTELLECTUAL DEVELOPMENTAL DISORDER) Formerly called Mental Retardation Diagnosis typically involves markedly below-average intelligence, often defined as an IQ of less than 70, assessed with standard individual tests. INTELLECTUAL DISABILITY (INTELLECTUAL DEVELOPMENTAL DISORDER) ID begins during developmental years (childhood and adolescence), usually manifesting early in life, but can also occur later, often termed major neurocognitive disorder (dementia). ID affects about 1% of the general population. Males outnumber females roughly 3:2. RISK AND PROGNOSTIC FACTORS 01. PRENATAL ETIOLOGIES Genetic syndromes (e.g. chromosomal disorders) Inborn errors of metabolism Brain malformations Maternal diseases and environmental influences (e.g., alcohol, drugs, toxins) 02. PERINATAL CAUSES labor and delivery-related events leading to neonatal encephalopathy. 03. POSTNATAL CAUSES Hypoxic ischemic injury Traumatic brain injury Infections Demyelinating disorders Seizure disorders (e.g., infantile spasms) Severe and chronic social deprivation Toxic metabolic syndromes and intoxications (e.g., lead, mercury) Assessed both clinically and with formal testing – difficulty with cognitive tasks such as reasoning, making plans, thinking in the abstracts, making judgments, and learning from formal studies or from life experiences Cognitive impairment leads to difficulty adapting their behavior so that they become citizens who are independent and socially accountable. These problems occur in communication, social interaction, and practical living skills. Affect the patient across multiple life areas—family, school, work, and social relations. ADAPTIVE FUNCTIONING CONCEPTUAL PRACTICAL SOCIAL (ACADEMIC) Competence in Awareness of others' Learning and self- memory, language, thoughts, feelings, and management across reading, writing, math experiences; empathy; various life settings, reasoning, problem- interpersonal including personal care, job solving, and judgment communication skills; responsibilities, money in novel situations. friendship abilities; and management, recreation, social judgment. self-management of behavior, and organization of school and work tasks. 01. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) 02. DEPRESSIVE AND BIPOLAR DISORDERS 03. ANXIETY DISORDERS 04. AUTISM SPECTRUM DISORDER 05. STEREOTYPIC MOVEMENT DISORDER (WITH OR WITHOUT SELF-INJURIOUS BEHAVIOR) 06. IMPULSE-CONTROL DISORDERS COMORBIDITY 07. MAJOR NEUROCOGNITIVE DISORDER 02. COMMUNICATION DISORDERS 01. LANGUAGE DISORDER 02. SPEECH SOUND DISORDER 03. CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING) 04. SOCIAL (PRAGMATIC) COMMUNICATION DISORDER COMMUNICATION DISORDERS COMMUNICATION Exchange of ideas Oral or Verbal Gestural Written LANGUAGE Tool to communicate Complex Varied levels of usage Contextual SPEECH Oral Expression of Language Most commonly used Complex process WHEN CAN WE SAY THAT LANGUAGE / SPEECH DIABILITY EXISTS? 01. INTERFERENCE IN COMMUNICATION 02. PERCEPTION OF INTENDED MESSAGE IS LOST 03. DEVIATION FROM EXPECTED SKILLS OF CHILDREN IN THE SAME AGE RANGE COMMUNICATION RECEPTIVE EXPRESSIVE Auditory Conveys message, comprehension of wants, commands language. Fluency Attaching of Grammar meaning to an Verbal Expression Spontaneous auditory stimuli Speech Difficulty in the acquisition and use of language across modalities Langauge ability is below those expected for age Leads to functional limitations Onset : Early Developmental Period Not attributable to hearing or sensory impairment, motor dysfunction, etc. 01. SPECIFIC LEARNING DISORDER (LITERACY AND NUMERACY) COMORBIDITY 02. INTELLECTUAL DEVELOPMENTAL DISORDER 03. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 04. AUTISM SPECTRUM DISORDER 05. DEVELOPMENTAL COORDINATION DISORDER 06. SOCIAL (PRAGMATIC) COMMUNICATION DISORDER Difficulty with speech sound production Limitations in effective communication Leads to functional limitations Onset: Early Developmental Period Not attributable to congenital or acquired conditions. SPEECH-SOUND ARTICULATION VOICE FLUENCY Manner of Volume Rate of production Pitch speaking of phonemes Quality Continuity of Speech Disturbances in the normal fluency and time patterning of speech 1. Sound and syllable repetitions. 2. Sound prolongations of consonants as well as vowels. 3. Broken words (e.g., 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 an excess of physical tension. 7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”) Causes anxiety about speaking Leads to functional limitations Onset: Early Developmental Period Not attributable to a speech- motor or sensory deficit, dysfluency associated with neurological insult. 01. ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER 02. AUTISM SPECTRUM DISORDER 03. INTELLECTUAL DEVELOPMENTAL DISORDER 04. LANGUAGE DISORDER 05. SPECIFIC LEARNING DISORDER COMORBIDITY 06. SOCIAL (PRAGMATIC) COMMUNICATION DISORDER Difficulties in the social use of verbal and nonverbal communication 1.Deficits in using communication for social purposes 2.Impairment of the ability to change communication to match context or the needs of the listener 3.Difficulties following rules for conversation and storytelling Difficulties understanding what is not explicitly stated Causes anxiety about speaking Leads to functional limitations Onset: Early Developmental Period Not attributable to a speech- motor or sensory deficit, dysfluency associated with neurological insult. 03. AUTISM SPECTRUM DISORDER AUTISM SPECTRUM DISORDER Autism is a complex neurodevelopmental disorder characterized by abnormalities in: social behavior, language and communication skills, and unusual behaviors and interests. It is defined as a developmental disability significantly affecting verbal and nonverbal communication and social interaction generally evident before the age of three, which adversely affects a child's educational performance. CAUSES OF AUTISM SPECTRUM DISORDER The exact cause/s of ASD is currently unknown, however, some journals had accounted it as a condition that may occur as a result of: Genes which a child inherit a from his/her parents Environmental factors (exposure to unhealthy environment) Other health conditions (prenatal, postnatal, complications) MISCONCEPTIONS ABOUT THE CAUSES OF AUTISM SPECTRUM DISORDER Extensive research has found no evidence to suggest that any of these contribute to the condition. These include: MMR vaccine Thiomersal - a compound that contains mercury, which is used as a preservative in some vaccines The way the person has been brought up Diet, such as eating gluten or dairy products (NHS choices, 2016) TWO DISTINCT BEHAVIORS IN AUTISM SPECTRUM DISORDER RESTRICTED IMPAIRED REPETITIVE SOCIAL BEHAVIORS; OR INTERACTION NARROW, AND OBSESSIVE COMMUNICATION INTERESTS Criterion A Impaired social interaction and communication(all three DEFICITS should be present) social-emotional reciprocity non-verbal communication developing and maintaining relationships Criterion B Restricted Repetitive Behaviors (RRBs) or narrow, obsessive interests (any TWO of four DEFICITS should be present) Stereotyped behavior Routines (excessive adherence) Fixation Hypo/Hyper response to SENSORY stimulation Criterion C Present in EARLY childhood (but may not become fully manifest until social demands exceeds limited capacities) CRITERION D Symptoms together limit and impair everyday functioning 01. PHYSICAL 04. PSYCHOSOCIAL 02. GROSS-MOTOR 05. LANGUAGE, COGNITIVE, INTELLECTUAL ACHIEVEMENT 03. FINE-MOTOR 06. SELF-HELP DETAILED CHARACTERISICS OF CHILDREN WITH AUTISM PHYSICAL GENERALLY DISTURBED HEALTHY SLEEPING PICKY EATER, TENDS PATTERNS TO SMELL FOOD / OBJECT AND PUT THINGS IN MOUTH UNABLE TO HIGH PAIN LOCALIZE THRESHOLD PAIN GROSS MOTOR WALKS ON TIP WELL-BALANCED TOE ESP. AND GENERALLY HYPERACTIVE COORDINATED BUT DRING EARLY LACKS IMPULSE NOT INHIBITED YEARS CONTROL REPETITIVE MOVEMENTS DOES NOT ECHOPRAXIA (RITUAL WALKING, TIRE EASILY BODY ROCKING, ETC) FINE MOTOR MAY EITHER SELF- HAVE GOOD STIMULATES BY OR POOR TOUCHING PERCEPTUAL ABSORBED/ SURFACE/EDGES, MOTOR SKILLS ATTRACTED TO ARRANGING DEPENDING OBJECTS ALIGNING ON OBJECTS ATTENTION PRECISELY/ SPAN REPETITIVELY PSYCHOSOCIAL LIMITED / ALOOF / PASSIVE ; INAPPROPRIATE SOLITARY. FLEETING EYE SOCIALLY IMMATURE EMOTIONAL CONTACT & HANDICAPPED RESPONSE MALADAPTIVE TO UNUSUAL TENDS TO BE CHANGES IN FOODS, CLOTHES, ROUTINE, FEARS SELF- ROUTES OR INJURIOUS ARRANGEMENT OF THINGS LANGUAGE-COGNITIVE INTELLECTUAL ACHIEVEMENT DELAYED UNDERREACTS TO UNDERREACTS OR OVERALL LANGUAGE AND OVERREACTS TO INTELLECTUAL VISUALS SOUNDS RESPONSE DELAYED IN LANGUAGE- CONCEPTUAL ABILITIES: ROTE REASONING, INFERENTIAL ECHOLALIC LEARNING THINKING, PROBLEM SOLVING, DEDUCTIVE INDUCTIVE THINKING, ETC. SELF-HELP DELAYED IN PERFORMING UNABLE TO LAGS BEHIND IN EATING, ASSUME AGE- DISCRIMINATING DRESSING AND APPROPRIATE AND AVOIDING GROOMING RESPONSIBILITIES DANGERS TASKS Screening procedures evaluate the main characteristics that differentiate ASD from other developmental disorders, including difficulties in 01. EYE GAZE 05. IMITATION 02. ORIENTING TO ONE’S NAME 06. NONVERBAL COMMUNICATION 03. POINTING TO OR SHOWING OBJECTS OF INTEREST 07. LANGUAGE DEVELOPMENT 04. PRETEND PLAY ASSESSMENT AND EVALUATION BEHAVIOR-BASED APPROACHES TEACHING CHILDREN NEW BEHAVIORS AND SKILLS BY USING SPECIALIZED, STRUCTURED TECHNIQUES. FOR DEVELOPING SKILLS AND ENCOURAGING APPROPRIATE BEHAVIOR. BEHAVIOR-BASED APPROACHES ARE PROBABLY THE MOST SCRUTINIZED AND BEST SUPPORTED BY EVIDENCE AND RESEARCH. INTERVENTIONS USING AN APPLIED BEHAVIOR ANALYSIS (ABA) APPROACH ARE PARTICULARLY COMMON AND WELL SUPPORTED. INTERVENTIONS 01. PARENT EDUCATION AND TRAINING 02. SOCIAL SKILLS TRAINING AND SPEECH-LANGUAGE THERAPY 03. COGNITIVE BEHAVIOR THERAPY 04. APPLIED BEHAVIORAL ANALYSIS (ABA) 05. SENSORY INTEGRATION/ OCCUPATIONAL THERAPY INTERVENTIONS 01. INTELLECTUAL DEVELOPMENTAL DISORDER 02. LANGUAGE DISORDER 03. SPECIFIC LEARNING DIFFICULTIES 04. DEVELOPMENTAL COORDINATION DISORDER COMORBIDITY 04. ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER ATTENTION-DEFICIT / HYPERACTIVITY DISORDER Affects how well someone can sit still, focus, and pay attention. People with ADHD have differences in the parts of their brains that control attention and activity. Comorbid diagnosis with Autism Spectrum Disorder is now allowed. ADHD in children – 6 symptoms ADHD in adults – 5 symptoms 01. HEREDITY 02. EXPOSURE TO TOXIC SUBSTANCE (ARTIFICIAL FOOD COLORS AND PRESERVATIVES) 03. INJURY TO THE BRAIN FROM TRAUMA, BRAIN TUMORS, STROKES OR DISEASE 04. PRENATAL EXPOSURE TO ALCOHOL CAUSES A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1. Inattention 2. Hyperactivity and impulsivity INATTENTION Doesn't follow directions or finish tasks Doesn't appear to be listening Doesn't pay attention and makes careless mistakes Forgets about daily activities Has problems organizing daily tasks Doesn’t like to do things that require sitting still Often loses things Tends to daydream HYPERACTIVITY Often squirms, fidgets, or bounces when sitting Doesn't stay seated Has trouble playing quietly Is always moving, such as running or climbing on things (In teens and this is more commonly described as restlessness.) Talks excessively Is always “on the go” as if “driven by a motor” IMPULSIVITY Has trouble waiting for his or her turn Blurts out answers Interrupts others MANIFESTATIONS OF SYMPTOMS IN ADULTS CHRONIC LATENESS AND FORGETFULNESS PROCRASTINATION ANXIETY EASILY FRUSTRATED LOW SELF-ESTEEM CHRONIC BOREDOM PROBLEMS AT WORK TROUBLE CONCENTRATING TROUBLE CONTROLLING WHEN READING ANGER MOOD SWINGS IMPULSIVENESS DEPRESSION SUBSTANCE ABUSE OR RELATIONSHIPS PROBLEMS ADDICTION CORE VARIABLES 1. SEVERAL INATTENTIVE OR HYPERACTIVE-IMPULSIVE SYMPTOMS WERE PRESENT PRIOR TO AGE 12 2. SEEN IN TWO OR MORE SETTINGS WITH SEVERAL SYMPTOMS OBSERVED 3. BEHAVIOR AFFECTS LEARNING OUTCOMES 4. BEHAVIOR CONSISTENTLY SEEN FOR AT LEAST 6 MONTHS 5. MANIFESTED ATTRIBUTES AT LEAST SIX SYMPTOMS ON ONE DOMAIN FOR THE YOUNG / FIVE FOR ADULTS ASSESSMENT AND EVALUATION TO THE CHILD WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER TO ASSESS WHETHER A PERSON/ A CHILD HAS ADHD, WE CONSIDER SEVERAL CRITICAL QUESTIONS: 1. ARE THESE BEHAVIORS EXCESSIVE, LONG-TERM, AND PERVASIVE? 2. DO THEY OCCUR MORE OFTEN THAN IN OTHER PEOPLE THE SAME AGE? INTERVENTIONS OVERVIEW TASK DURATION (ATTENTION SPAN - BRIEF) DIRECT INSTRUCTION (NOTE-TAKING STRATEGIES INCREASES THE BENEFITS OF DIRECT INSTRUCTION.) PEER TUTORING (PROVIDES MANY OF THE INSTRUCTIONAL VARIABLES KNOWN TO BE IMPORTANT IN SETTING UP STUDENTS WITH ADHD FOR SUCCESS) SCHEDULING NOVELTY (NOVEL, INTERESTING, HIGHLY MOTIVATING MATERIAL WILL IMPROVE ATTENTION.) INTERVENTIONS OVERVIEW STRUCTURE AND ORGANIZATION RULE REMINDERS AND VISUAL CUES (VISIBLE MODES OF PRESENTATION) AUDITORY CUES (USE OF A TAPE WITH TONES PLACED AT IRREGULAR INTERVALS TO REMIND STUDENTS TO MONITOR THEIR ON-TASK BEHAVIOR) PACING OF WORK (TO SET THEIR OWN PACE FOR TASK COMPLETION) INSTRUCTIONS (SHORT, SPECIFIC AND DIRECT) PRODUCTIVE PHYSICAL MOVEMENT TIME-OUT (EFFECTIVE IN REDUCING AGGRESSIVE AND DISRUPTIVE ACTIONS IN THE CLASSROOM, ESPECIALLY WHEN THESE BEHAVIORS ARE STRENGTHENED BY PEER ATTENTION.) EDUCATIONAL APPROACH ACCOMMODATIONS IN TEACHING CHILDREN WITH ADHD 1. SEATING THE STUDENT NEAR THE TEACHER AND AWAY FROM DOORS AND WINDOWS. 2. GRANTING EXTRA TIME FOR TEST TAKING. 3. ALLOWING THE STUDENT TO TAKE TESTS IN A DIFFERENT LOCATION. 4. ENGAGING THE STUDENTS ENERGY BY INVOLVING THEM IN ERRANDS OR ACTIVITIES NEEDED BY THE TEACHER. STRATEGIES IN TEACHING CHILDREN WITH ADHD SCHEDULES, ADAPTING THE CLEAR GOALS, RULES ENVIRONMENT INSTRUCTIONS AND ROLES 01. OPPOSITIONAL DEFIANT DISORDER COMORBIDITY 02. AUTISM SPECTRUM DISORDER 03. PERSONALITY AND SUBSTANCE USE DISORDER 04. DISRUPTIVE MOOD DYSREGULATION DISORDER 05. ANXIETY DISORDERS, MAJOR DEPRESSIVE DISORDER, OBSESSIVE- COMPULSIVE DISORDER, AND INTERMITTENT EXPLOSIVE DISORDER 06. NEURODEVELOPMENTAL DISORDERS 05. SPECIFIC LEARNING DISORDER SPECIFIC LEARNING DISORDER According to IDEA, Learning Disability is a disorder in one or more of the basic psychological processes involved in... understanding or in using language – spoken or written, Disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. 01. NEUROLOGICAL PROBLEM 02. HEREDITARY 03. ILLNESS AND INJURY DURING OR AFTER BIRTH Lack of oxygen to the infant’s brain Exposure to drugs or alcohol during pregnancy Low birth weight Premature and prolonged labor Head injuries, nutritional deprivation, and exposure to toxic substance such as lead are some incidents after birth that can contribute to learning disabilities. CAUSES Difficulties learning and using academic skills persisting for at least 6 months despite interventions. Symptoms include: Inaccurate or slow word reading Difficulty understanding meaning of what is read Difficulties with spelling Difficulties with written expression Difficulties with number sense, facts, or calculation Difficulties with mathematical reasoning SPECIFIC LEARNING DISORDER Academic Skills Criteria: Substantial deficits in academic skills compared to chronological age Significant interference with academic, occupational, or daily living activities Confirmed by standardized achievement measures and clinical assessment For individuals 17 and older, history of impairing learning difficulties can substitute for assessment. Onset and Nature of Learning Difficulties: Begin during school-age years but may fully manifest later under increased academic demands. SPECIFIC LEARNING DISORDER SEVERITY LEVELS MILD MODERATE SEVERE Marked difficulties in one Severe difficulties in or more academic multiple academic domains Some difficulties in one or domains Unlikely to learn skills two academic domains Unlikely to become without ongoing intensive Compensation possible proficient without individualized teaching for with appropriate intervals of intensive and most of the school years accommodations or specialized teaching May not complete activities support services, Some accommodations or efficiently even with especially during school supportive services appropriate years needed part of the day at accommodations or school, workplace, or services home 01. MAINSTREAMING/INCLUSION PROGRAM Education for mildly learning disabled students within mainstream settings with accommodations. 02. RESOURCE ROOM Dedicated space for LD students to access extra learning time and materials with resource teachers. 03. HOME-BASED SUPPORT Tailored educational assistance including home tutorials and extracurricular activities for LD individuals. INTERVENTION 06. MOTOR DISORDERS Acquisition and execution of coordinated motor skills substantially below chronological age and learning opportunities Manifested as clumsiness, slowness, and inaccuracy in motor skills (e.g., catching, using scissors, handwriting, riding a bike) Motor skills deficit significantly interferes with daily activities appropriate to chronological age and impacts academic, vocational, leisure, and play activities Onset of symptoms in early developmental period Motor skills deficits not better explained by intellectual developmental disorder or visual impairment Not attributable to neurological conditions affecting movement Repetitive, seemingly driven, and purposeless motor behavior (e.g., hand shaking, body rocking) Behavior interferes with social, academic, or other activities and may lead to self-injury Onset in early developmental period Not due to substance effects or neurological conditions, not explained by other neurodevelopmental or mental disorders Mild: Symptoms easily suppressed by sensory stimulus or distraction Moderate: Symptoms require explicit protective measures and behavioral modification Severe: Continuous monitoring and protective measures needed to prevent serious injury Presence of multiple motor and one or more vocal tics at some point, not necessarily concurrently Tics may vary in frequency but persist for more than 1 year since first onset Onset before age 18 Not attributable to substance effects or other medical conditions Presence of single or multiple motor or vocal tics, but not both Tics may vary in frequency but persist for more than 1 year since first onset Onset before age 18 Not attributable to substance effects or other medical conditions (e.g., Huntington’s disease, postviral encephalitis) Criteria never met for Tourette’s disorder Specify if: With motor tics only With vocal tics only Presence of single or multiple motor and/or vocal tics Tics present for less than 1 year since first onset Onset before age 18 Not attributable to substance effects or other medical conditions (e.g., Huntington’s disease, postviral encephalitis) Criteria never met for Tourette’s disorder or Persistent (Chronic) Motor or Vocal Tic Disorde 01. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) 02. DISRUPTIVE BEHAVIOR DISORDERS 03. OBSESSIVE-COMPULSIVE DISORDER (OCD) AND RELATED DISORDERS COMORBIDITY END OF CHAPTER 2