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Banks Snippet view - Banks No preview available - Paul T. Elliott, M. An active parent advocate for Autism Spectrum Disorders, he is also the father of three children, two with Autism. Bibliographic information. Children with Special Needs. The threshold for meeting the diagnostic criteria for ADHD has been lowered slightly [ 47 , 48 ]. However, DSM-5 adds developmentally appropriate new exemplars to the criterion items to facilitate the application of these symptoms across the life span, more appropriate for children, adolescents, and adults.

The combination of older age of onset and removing the impairment requirement is clearly more lenient. As in DSM-IV, it is required that symptoms last for 6 months or more, and keeping at a level that would not overlap with the standard development.

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Need for clinically significant impairment. Therefore, symptoms were required to cause impairment in several contexts e. DSM-5 has revised this to "several inattentive or hyperactive-impulsive symptoms are present in two or more settings". This is less demanding too, and increases the chance to receive a full ADHD diagnosis, thus raising the percentage of the population who meets the diagnostic criteria.

Presentations: In DSM-5, subtypes have been substituted by presentation specifiers that correspond to the former subtypes in order to employ terms that accord with the change and fluidity that the disorder may display in a given patient across time. DSM-5 defines three presentations of ADHD according to the presence or absence of specific symptoms: hyperactive-Impulsive presentation, inattentive presentation, and combined presentation.

New requirement to specify severity: DSM-5 requires the severity of the disorder to be graded in the affected person, since ADHD symptoms impact each individual in varying degrees. It must also be recognized that the degree of severity and how ADHD manifests itself can vary during the patient's lifespan, which implies the chance of a partial remission of ADHD.

New categories for persons not meeting full criteria. The Other Specified category is employed when full the criteria are not reached, the clinician is able to determine the reason why full criteria were not met and the symptoms that do appear impair functioning in a clinically significant way. Comorbid diagnosis with ASD.

This new disposition will pave the way for a more scientific approach to the overlap of these disorders, as well as enable a more appropriate clinical treatment of these children. The modifications introduced will probably raise the prevalence of ADHD, particularly in adolescents and adults, and perhaps also in children [ 49 ]. However, those changes are supported by clinical and epidemiological data and are unlikely to result in over-diagnosis [ 48 ].

In the field of psychiatric disorders there has been a traditional delay in the systematic research dealing with infants and preschoolers 0 to 5-year-old children in comparison with that studying school-age children, adolescents, and adults.

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To facilitate research on the preschool and infant ages, the development of clear and specific diagnostic criteria that can be confidently utilized within standardized measurements across a variety of samples is essential. In —, an independent research committee elaborated the first Research Diagnostic Criteria-Preschool Age RDC-PA , with the aim of promoting systematic study of psychiatric disorders in younger children [ 50 ]. Therefore, in young children, it is very important to recognize changes that may occur in the early stages of learning, especially in language acquisition and behavioral symptoms, which could already be identified as prodromal symptoms, followed by a correct differential diagnosis of these entities.

The development of both language and communication is an intricate process affected by multiple genetic and environmental factors. Diagnostic criteria for NDDs e. These complex disorders are polygenic with a relevant genetic contribution to both types of skills. Language acquisition is the process by which human beings acquire the capacity to perceive, comprehend, produce, and use words and sentences to communicate.

Humans' the early years, beginning at birth, are critical to future development of the skills required. Language acquisition needs to be stimulated in every way to generate a solid base to build upon as the child develops. There have been numerous investigations in this area, and several models for learning language have been developed based on neural networks, computational models, and other connectionist approaches [for review see 52—55].

Subject literature provides guidelines for when age-specific language features are acquired on average, but different authors cite different milestone dates, depending on where they conducted their research. Therefore, it is important to note that dates, in terms of specific linguistic milestones, are not concrete and can vary slightly from child to child. In accordance with published data, we can identify six basic stages of language acquisition occurring between ages 0 to 5 years, which coincide with the preschool stage.

These ages are divided into two cycles: first cycle, between 0 and 3 years in toddlers ; and a second cycle, ranging from 3 to 5 or 6 years old, prior to the start of mandatory education. Prelingual stage mo : Occurs before the use, acquisition, or development of language. Infants practice the pragmatic component of language use e. The "normal" child concentrates on the center of the face, or the region of the eyes.

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In NDD, there is a continuous and general deficiency in reciprocal social interaction. A notable disability in a myriad of nonverbal forms of social interaction and communication may occur e. Babbling and canonical babbling stage 6—12 mo : Babbling also known as twaddling is a stage of language acquisition during development when the child seems to be exploring their capability to produce articulate sounds, but still not being able to utter recognizable words.


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Syllable patterns start to emerge. Infants begin to distinguish between the different sounds, from vowels V to consonant and vowel CV syllables. This phase is considered to be the beginning of the canonical stage. During the canonical stage, babbling consists of repeated sounds containing alternations of consonants and vowels, progressing through such syllable types as VCV, VC, and redup of syllables CVCV and variegated syllables; children start to acquire the phonemes of the language.

Two-word utterances approx. Telegraphic stage 2—3 years : When children have acquired and start to use multiple-word utterances. At this stage, some of the children's utterances are grammatically correct. By about 5—6 years of age, children have acquired almost normal speech, with good command of syntax and semantics.

In later stages, development of vocabulary and pragmatics takes place. Pragmatic development highlights children's motivation to acquire language in the first place, as it serves different purposes and functions.

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Pragmatics are not acquired immediately, nor does it take a short period of time for a child to acquire them. This process is on-going until the age of approximately 10 years. As already mentioned, developmental milestones and particularly social communication abilities, language acquisition, and proper speech occur at different age ranges amongst children, therefore diagnosis of pathology at early ages can be hindered.

In AD, there may be either total absence or a delay in the development of speech.

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The classical criteria for AD require abnormal functioning in communication skills, which has been one of the reasons that AD was not usually diagnosed until the second cycle of preschool age. In the new classification of ASD, communication verbal and nonverbal skills is excluded; by removing this requirement, possibility of diagnosis before the age of 3 is increased. At 6 months, ASD prodromal symptoms include a reduced capability to spontaneously pay attention to people and their activities [56—59]. However, many of these symptoms described for ASD can also occur in children with ADHD or intellectual deficit, so caution is needed before a definitive diagnosis [ 69 ].

Sociocultural and individual factors influence body language, facial expressions and eye contact, and social communication behaviors in preschoolers and there is an ample spectrum of norms that are considered acceptable within and across cultures, families, and individuals [ 70 ]. Children diagnosed with pragmatic language impairment may be placed within a continuum between individuals with social communication deficits associated with ASD and those presenting with the specific language impairment [ 16 ].

The criteria for PDD-NOS diagnosis according to DSM-IV required the presence of impaired reciprocal social interaction and either deficient communication skills or stereotyped behavior, activities, and interests.

Additional research is necessary to discern the consequences that pragmatic language impairments and SCD have on neuropsychiatric disorders, problematic behaviors, and the acquisition of academic skills. To reliably diagnose SCD, children must have already acquired suitable language and speech capabilities i. Therefore, samples from preschool- and school-age children should be employed in future research to establish a baseline for symptom manifestations. Although autism tends to appear during the first 1—2 years of life, ADHD is nearly impossible to diagnose along this period.

Hyperactivity and inattentiveness are features shown by almost all toddlers, thus making ADHD very difficult to diagnose reliably until early childhood although it is often possible during the preschool period [ 71 ]. Children demonstrate dramatic gains in control processes between the ages of 3 and 6.