Week2 D3#1

Order Description
Part 1:
The presenting symptoms or functioning skills can at times be representative of different disorders. For example, both intellectual disability disorder and dementia describe significant deficits in everyday functioning. Behavior disorders from an everyday point of view are also a difficult area to define. One of the challenges with evaluating children is the influence of several factors such as social, cognitive, and motor development as well as environmental factors.
Describe the diagnostic criteria for intellectual disability disorder and dementia based on the current DSM. Explain the major differences between the two disorders. Describe some of the ways in which a person may be diagnosed with intellectual disability disorder. Describe some of the ways a person may be diagnosed with dementia.
Describe the main types of behavior disorders in children and explain how these disorders can be differentiated from a child that may be exhibiting disruptive behaviors for other reasons.
Part 2:
Somatic symptom disorder has a long history. Sigmund Freud described a case of Anna, who displayed several physical conditions (e.g., pain, dizziness, numbness, and visual disturbances) with no apparent medical cause. Also, schizophrenia is not actually one single disorder but a spectrum of disorders that fall along a continuum of symptoms and functioning levels.
Describe somatic symptom disorder, and if the disorder can be diagnosed if the person has an actual physical illness.
Describe the basic criteria for schizophrenia based on the current DSM criteria. Explain the differences between negative and positive symptoms.
Explain the prognosis of an individual diagnosed with schizophrenia based on age and gender factors.
Reading for above assignment By Topics
Disorders Common in Childhood
Disorders first observed in childhood can be much harder to diagnose than adult disorders for several reasons:
Traits that would be considered abnormal in adulthood can often be considered normal developmental behaviors in a child, including grandiosity and egocentrism.

Characteristics of adult disorders can appear different in children. For example, depression often exhibits in children as agitation or aggression, but it is more likely to exhibit in adulthood as lethargy.
Many times childhood disorders are not diagnosed until the person has reached adulthood, so information necessary for meeting diagnostic criteria must be gathered from friends’ and family’s memories, as opposed to currently observable behaviors or self-reports.
One of the major changes that came with the DSM-5 is the removal of the mulitaxial system of diagnosis. In its place, consideration was given to gender and cultural considerations as well as developmental and life-span considerations. The life-span consideration is important to consider in the change in diagnostic criteria when it comes to mental disorders diagnosed in children. Many mental disorders now have specific criteria particular for childhood onset. The following disorders are a specific set of disorders that begin in childhood (American Psychiatric Association, 2013b):
Intellectual disabilities
Communication disorders
Language disorder
Autism spectrum disorder
Attention-deficit/hyperactivity disorder (ADHD)
Specific learning disorder
Motor disorders
Developmental coordination disorder
Stereotypic movement disorder
Tic disorders
Tourette’s disorder
Other neurodevelopmental disorders

It is important to remember that children can suffer from the same disorders (with the exception of personality disorders) as adults. However, this lecture focuses on disorders in which the symptoms must be present in childhood to have been diagnosed. In addition, remember that children often exhibit behavioral and emotional problems that don’t necessarily meet formal diagnostic criteria yet are troubling to parents and teachers. For example, children may have nightmares or normal enuresis or exhibit lying or noncompliance.
Let’s focus on what is arguably one of the most hotly debated disorders in the DSM: ADHD.

ADHD
ADHD centers on chronic inattention. It is a good example of a disorder that is often diagnosed for the first time in adulthood. It is very common to find college students whose ADHD is undetected until they are in college because they are so intelligent. In college, when they are required to manage their time and be
self-disciplined, their symptoms of ADHD are suddenly quite distressing. Sometimes, they go to the counseling center not understanding why they are not succeeding in school. The clinician must ascertain from the college student and parents or guardians whether or not there were symptoms of ADHD present earlier in the student’s life.
People with ADHD can appear very different from one another depending on the symptoms that accompany the inattention. The following graphic describes the symptoms of ADHD:
ADHD Diagnosis and Treatment
Issues Surrounding Diagnosis and Treatment of ADHD
Before discussing issues surrounding ADHD treatment, keep in mind that many scientists and clinicians disagree on the usefulness of labeling children as having any disorders. Research and debate on ADHD have truly brought this disagreement to the forefront of the media. Arguments abound as to whether or not ADHD exists as a disorder or whether it is a label for children that previous generations would have called active or undisciplined. Some of this debate has been settled by very recent brain imaging studies, which have identified brain processing differences between those diagnosed with ADHD and those not.
Another debate has centered on the psychopharmacology of ADHD: Are physicians overeager to medicate children and adults with ADHD? Is ADHD truly as prevalent in our schools as it seems? Although the DSM reports that the prevalence rate for ADHD hovers between 1 and 7 percent of all children, there are theorists who believe that there are much higher rates of students who are taking medications or receiving accommodations for ADHD.
The affect of ADHD on children or adults can be mediated with behavioral strategies. However, medication seems to be the more effective yet controversial treatment. Most of the medications are stimulant-based. (There is an exception, but the therapeutic efficacy of the non stimulant-based medications seems to be much lower than that of the stimulant-based medications.) The use of a stimulant to treat a disorder centered on distractibility and hyperactivity seems counterintuitive to many people. However, if you understand the biology of ADHD, it makes perfect sense.
The brain requires a minimum level of stimulation in order to function optimally. For individuals with ADHD, their brains are actually producing a less-than-minimum amount of stimulation—they are under-stimulated. Their distractibility or hyperactivity is their brains’ way of compensating by seeking out additional stimulation (either from the environment or through motor movement) to obtain that minimum level necessary for functioning. Therefore, when given stimulant medications, their brains get what they need. The brain no longer needs to compensate, so the individual is actually able to relax. Therefore, a person who legitimately has ADHD will seem calmer, better able to concentrate, or better able to sleep after taking a stimulant. However, the person without ADHD will have more energy, have less need for sleep, or be more agitated after taking a stimulant. Therefore, you can use a person’s response to stimulant medications as a discriminator between those with ADHD and those without ADHD.
Two important notes to keep in mind as we conclude this discussion:
Stimulant medications are highly addictive and are often sought by non-ADHD individuals who desire their side-effects (such as weight loss or ability to “pull all-nighters” or a single night of total sleep deprivation). For this reason, they are classified as Schedule II drugs (which are drugs having a high potential for abuse) and prescriptions for them must be renewed monthly in attempts to limit abuse.
Some clinicians currently hypothesize that there is a second type of ADHD—an adult onset type. This is a relatively new area of research.
Now let’s discuss disorders associated with later life, specifically cognitive disorders.
Autism Spectrum Disorder
For the DSM-5, there were significant changes to pervasive developmental disorders (PDDs). PDDs were a set of disorders that occur due to delays in development. Prior to DSM-5, the different PDDs included autism, Asperger’s syndrome, Rett syndrome, childhood disintegrative disorder, and PDD Not Otherwise Specified (NOS). According to the American Psychiatric Association (2013a), research has shown that the different diagnoses weren’t applied consistently and many of the symptoms were similar. Several disorders were eliminated and merged into one called autism spectrum disorder.
The main features of autism spectrum disorder include (American Psychiatric Association, 2013b):
Deficits in social communication
Social interactions
Non-verbal communication skills
Understanding relationships
Restrictive repetitive behaviors
Repetitive motor movements
Ritualized behaviors
Strong interests in unusual objects
Heightened sensitivity to sensory stimulation

Autism Spectrum Disorder
For the DSM-5, there were significant changes to pervasive developmental disorders (PDDs). PDDs were a set of disorders that occur due to delays in development. Prior to DSM-5, the different PDDs included autism, Asperger’s syndrome, Rett syndrome, childhood disintegrative disorder, and PDD Not Otherwise Specified (NOS). According to the American Psychiatric Association (2013a), research has shown that the different diagnoses weren’t applied consistently and many of the symptoms were similar. Several disorders were eliminated and merged into one called autism spectrum disorder.
The main features of autism spectrum disorder include (American Psychiatric Association, 2013b):
Deficits in social communication
Social interactions
Non-verbal communication skills
Understanding relationships
Restrictive repetitive behaviors
Repetitive motor movements
Ritualized behaviors
Strong interests in unusual objects
Heightened sensitivity to sensory stimulation

Schizophrenia Spectrum
Schizophrenia is the most severe of the psychotic disorders. What differentiates it from other psychotic disorders is the combination and severity of the symptoms. While there are several classifications of schizophrenia, all of the schizophrenic disorders share the following basic core symptoms:
Delusions: These are beliefs not based in reality. The most common delusion in the U.S. is the belief that one is Jesus Christ or that Jesus Christ or God is speaking to them. Often individuals will interpret innocuous stimuli as being direct signs or messages from God.
Hallucinations: These are sensory experiences that are not grounded in reality. The individual sees, hears, or feels something that does not actually exist.

For the individual with schizophrenia, these thoughts or experiences are as real as the computer screen you are reading is to you—the individual does not perceive them to be imaginary.
The typical onset of symptoms for schizophrenia in women is in late adolescence, while for men it comes a bit later, typically in the early to mid-twenties. It is not uncommon for individuals to be in college when they experience their first delusion or hallucination. These often terrifying experiences can drastically and quickly affect the function of the individual. Because the experiences are so real to the person, it is not typically the delusion or hallucination that brings the person into counseling. Instead, it is some associated experience. Let’s look at the following case to learn how:
Content on this page requires a newer version of Adobe Flash Player.
Get Adobe Flash player
Clients such as Mary do not perceive their perceptions or thoughts to be out of touch with reality, so they can function undetected for some time without intervention or treatment.
Dissociative Disorders
Dissociative disorders are centered on the separation of an individual’s identity, memories, or consciousness. In almost all cases of dissociation, the individual has experienced some type of trauma. What is important to note is that dissociation can be a symptom of several stress disorders (as we will see in future lectures). When dissociation is a symptom of another disorder, such as posttraumatic stress disorder (PTSD) or acute stress disorder, it is not diagnosed on its own. Also, it is important to note that in order to be diagnosed with a dissociative disorder, the dissociation cannot be the result of an organic cause (such as brain trauma) or substance use (such as alcohol).
For most clients, dissociation is a protective measure—when emotions become too intense, the individual checks out of the current reality. Working with trauma victims can provide frequent examples of dissociation, which are not dissociative disorders by definition.
Many times, law enforcement officers express the belief that a victim is lying about a crime because the victim is not emotionally demonstrative or distressed. In such cases, you have to educate the officers about dissociation. It is common for individuals who have experienced some form of trauma to have found a way to separate themselves from the experience. For example, victims may relate the details of the crime as if they were a bystander or they were reporting a story. Victims will often demonstrate a flat (a complete lack of emotion) affect and report feeling numb or indifferent. While officers can sometimes interpret this as a lack of genuineness, it is typically a form of dissociation. Similarly, when victims are re-interviewed days after their experience, it is not uncommon for them to have “blacked out” on many of the details they may have remembered immediately following the trauma. This is another type of dissociation.

The disorders in the dissociation class are more severe versions of these types of common experiences. The most severe of the dissociative disorders is dissociative identity disorder (previously called multiple personality disorder).
Let’s now discuss somatic symptom and related disorders.

Week2 D3#1

Order Description
Part 1:
The presenting symptoms or functioning skills can at times be representative of different disorders. For example, both intellectual disability disorder and dementia describe significant deficits in everyday functioning. Behavior disorders from an everyday point of view are also a difficult area to define. One of the challenges with evaluating children is the influence of several factors such as social, cognitive, and motor development as well as environmental factors.
Describe the diagnostic criteria for intellectual disability disorder and dementia based on the current DSM. Explain the major differences between the two disorders. Describe some of the ways in which a person may be diagnosed with intellectual disability disorder. Describe some of the ways a person may be diagnosed with dementia.
Describe the main types of behavior disorders in children and explain how these disorders can be differentiated from a child that may be exhibiting disruptive behaviors for other reasons.
Part 2:
Somatic symptom disorder has a long history. Sigmund Freud described a case of Anna, who displayed several physical conditions (e.g., pain, dizziness, numbness, and visual disturbances) with no apparent medical cause. Also, schizophrenia is not actually one single disorder but a spectrum of disorders that fall along a continuum of symptoms and functioning levels.
Describe somatic symptom disorder, and if the disorder can be diagnosed if the person has an actual physical illness.
Describe the basic criteria for schizophrenia based on the current DSM criteria. Explain the differences between negative and positive symptoms.
Explain the prognosis of an individual diagnosed with schizophrenia based on age and gender factors.
Reading for above assignment By Topics
Disorders Common in Childhood
Disorders first observed in childhood can be much harder to diagnose than adult disorders for several reasons:
Traits that would be considered abnormal in adulthood can often be considered normal developmental behaviors in a child, including grandiosity and egocentrism.

Characteristics of adult disorders can appear different in children. For example, depression often exhibits in children as agitation or aggression, but it is more likely to exhibit in adulthood as lethargy.
Many times childhood disorders are not diagnosed until the person has reached adulthood, so information necessary for meeting diagnostic criteria must be gathered from friends’ and family’s memories, as opposed to currently observable behaviors or self-reports.
One of the major changes that came with the DSM-5 is the removal of the mulitaxial system of diagnosis. In its place, consideration was given to gender and cultural considerations as well as developmental and life-span considerations. The life-span consideration is important to consider in the change in diagnostic criteria when it comes to mental disorders diagnosed in children. Many mental disorders now have specific criteria particular for childhood onset. The following disorders are a specific set of disorders that begin in childhood (American Psychiatric Association, 2013b):
Intellectual disabilities
Communication disorders
Language disorder
Autism spectrum disorder
Attention-deficit/hyperactivity disorder (ADHD)
Specific learning disorder
Motor disorders
Developmental coordination disorder
Stereotypic movement disorder
Tic disorders
Tourette’s disorder
Other neurodevelopmental disorders

It is important to remember that children can suffer from the same disorders (with the exception of personality disorders) as adults. However, this lecture focuses on disorders in which the symptoms must be present in childhood to have been diagnosed. In addition, remember that children often exhibit behavioral and emotional problems that don’t necessarily meet formal diagnostic criteria yet are troubling to parents and teachers. For example, children may have nightmares or normal enuresis or exhibit lying or noncompliance.
Let’s focus on what is arguably one of the most hotly debated disorders in the DSM: ADHD.

ADHD
ADHD centers on chronic inattention. It is a good example of a disorder that is often diagnosed for the first time in adulthood. It is very common to find college students whose ADHD is undetected until they are in college because they are so intelligent. In college, when they are required to manage their time and be
self-disciplined, their symptoms of ADHD are suddenly quite distressing. Sometimes, they go to the counseling center not understanding why they are not succeeding in school. The clinician must ascertain from the college student and parents or guardians whether or not there were symptoms of ADHD present earlier in the student’s life.
People with ADHD can appear very different from one another depending on the symptoms that accompany the inattention. The following graphic describes the symptoms of ADHD:
ADHD Diagnosis and Treatment
Issues Surrounding Diagnosis and Treatment of ADHD
Before discussing issues surrounding ADHD treatment, keep in mind that many scientists and clinicians disagree on the usefulness of labeling children as having any disorders. Research and debate on ADHD have truly brought this disagreement to the forefront of the media. Arguments abound as to whether or not ADHD exists as a disorder or whether it is a label for children that previous generations would have called active or undisciplined. Some of this debate has been settled by very recent brain imaging studies, which have identified brain processing differences between those diagnosed with ADHD and those not.
Another debate has centered on the psychopharmacology of ADHD: Are physicians overeager to medicate children and adults with ADHD? Is ADHD truly as prevalent in our schools as it seems? Although the DSM reports that the prevalence rate for ADHD hovers between 1 and 7 percent of all children, there are theorists who believe that there are much higher rates of students who are taking medications or receiving accommodations for ADHD.
The affect of ADHD on children or adults can be mediated with behavioral strategies. However, medication seems to be the more effective yet controversial treatment. Most of the medications are stimulant-based. (There is an exception, but the therapeutic efficacy of the non stimulant-based medications seems to be much lower than that of the stimulant-based medications.) The use of a stimulant to treat a disorder centered on distractibility and hyperactivity seems counterintuitive to many people. However, if you understand the biology of ADHD, it makes perfect sense.
The brain requires a minimum level of stimulation in order to function optimally. For individuals with ADHD, their brains are actually producing a less-than-minimum amount of stimulation—they are under-stimulated. Their distractibility or hyperactivity is their brains’ way of compensating by seeking out additional stimulation (either from the environment or through motor movement) to obtain that minimum level necessary for functioning. Therefore, when given stimulant medications, their brains get what they need. The brain no longer needs to compensate, so the individual is actually able to relax. Therefore, a person who legitimately has ADHD will seem calmer, better able to concentrate, or better able to sleep after taking a stimulant. However, the person without ADHD will have more energy, have less need for sleep, or be more agitated after taking a stimulant. Therefore, you can use a person’s response to stimulant medications as a discriminator between those with ADHD and those without ADHD.
Two important notes to keep in mind as we conclude this discussion:
Stimulant medications are highly addictive and are often sought by non-ADHD individuals who desire their side-effects (such as weight loss or ability to “pull all-nighters” or a single night of total sleep deprivation). For this reason, they are classified as Schedule II drugs (which are drugs having a high potential for abuse) and prescriptions for them must be renewed monthly in attempts to limit abuse.
Some clinicians currently hypothesize that there is a second type of ADHD—an adult onset type. This is a relatively new area of research.
Now let’s discuss disorders associated with later life, specifically cognitive disorders.
Autism Spectrum Disorder
For the DSM-5, there were significant changes to pervasive developmental disorders (PDDs). PDDs were a set of disorders that occur due to delays in development. Prior to DSM-5, the different PDDs included autism, Asperger’s syndrome, Rett syndrome, childhood disintegrative disorder, and PDD Not Otherwise Specified (NOS). According to the American Psychiatric Association (2013a), research has shown that the different diagnoses weren’t applied consistently and many of the symptoms were similar. Several disorders were eliminated and merged into one called autism spectrum disorder.
The main features of autism spectrum disorder include (American Psychiatric Association, 2013b):
Deficits in social communication
Social interactions
Non-verbal communication skills
Understanding relationships
Restrictive repetitive behaviors
Repetitive motor movements
Ritualized behaviors
Strong interests in unusual objects
Heightened sensitivity to sensory stimulation

Autism Spectrum Disorder
For the DSM-5, there were significant changes to pervasive developmental disorders (PDDs). PDDs were a set of disorders that occur due to delays in development. Prior to DSM-5, the different PDDs included autism, Asperger’s syndrome, Rett syndrome, childhood disintegrative disorder, and PDD Not Otherwise Specified (NOS). According to the American Psychiatric Association (2013a), research has shown that the different diagnoses weren’t applied consistently and many of the symptoms were similar. Several disorders were eliminated and merged into one called autism spectrum disorder.
The main features of autism spectrum disorder include (American Psychiatric Association, 2013b):
Deficits in social communication
Social interactions
Non-verbal communication skills
Understanding relationships
Restrictive repetitive behaviors
Repetitive motor movements
Ritualized behaviors
Strong interests in unusual objects
Heightened sensitivity to sensory stimulation

Schizophrenia Spectrum
Schizophrenia is the most severe of the psychotic disorders. What differentiates it from other psychotic disorders is the combination and severity of the symptoms. While there are several classifications of schizophrenia, all of the schizophrenic disorders share the following basic core symptoms:
Delusions: These are beliefs not based in reality. The most common delusion in the U.S. is the belief that one is Jesus Christ or that Jesus Christ or God is speaking to them. Often individuals will interpret innocuous stimuli as being direct signs or messages from God.
Hallucinations: These are sensory experiences that are not grounded in reality. The individual sees, hears, or feels something that does not actually exist.

For the individual with schizophrenia, these thoughts or experiences are as real as the computer screen you are reading is to you—the individual does not perceive them to be imaginary.
The typical onset of symptoms for schizophrenia in women is in late adolescence, while for men it comes a bit later, typically in the early to mid-twenties. It is not uncommon for individuals to be in college when they experience their first delusion or hallucination. These often terrifying experiences can drastically and quickly affect the function of the individual. Because the experiences are so real to the person, it is not typically the delusion or hallucination that brings the person into counseling. Instead, it is some associated experience. Let’s look at the following case to learn how:
Content on this page requires a newer version of Adobe Flash Player.
Get Adobe Flash player
Clients such as Mary do not perceive their perceptions or thoughts to be out of touch with reality, so they can function undetected for some time without intervention or treatment.
Dissociative Disorders
Dissociative disorders are centered on the separation of an individual’s identity, memories, or consciousness. In almost all cases of dissociation, the individual has experienced some type of trauma. What is important to note is that dissociation can be a symptom of several stress disorders (as we will see in future lectures). When dissociation is a symptom of another disorder, such as posttraumatic stress disorder (PTSD) or acute stress disorder, it is not diagnosed on its own. Also, it is important to note that in order to be diagnosed with a dissociative disorder, the dissociation cannot be the result of an organic cause (such as brain trauma) or substance use (such as alcohol).
For most clients, dissociation is a protective measure—when emotions become too intense, the individual checks out of the current reality. Working with trauma victims can provide frequent examples of dissociation, which are not dissociative disorders by definition.
Many times, law enforcement officers express the belief that a victim is lying about a crime because the victim is not emotionally demonstrative or distressed. In such cases, you have to educate the officers about dissociation. It is common for individuals who have experienced some form of trauma to have found a way to separate themselves from the experience. For example, victims may relate the details of the crime as if they were a bystander or they were reporting a story. Victims will often demonstrate a flat (a complete lack of emotion) affect and report feeling numb or indifferent. While officers can sometimes interpret this as a lack of genuineness, it is typically a form of dissociation. Similarly, when victims are re-interviewed days after their experience, it is not uncommon for them to have “blacked out” on many of the details they may have remembered immediately following the trauma. This is another type of dissociation.

The disorders in the dissociation class are more severe versions of these types of common experiences. The most severe of the dissociative disorders is dissociative identity disorder (previously called multiple personality disorder).
Let’s now discuss somatic symptom and related disorders.

Week2 D3#1

Order Description
Part 1:
The presenting symptoms or functioning skills can at times be representative of different disorders. For example, both intellectual disability disorder and dementia describe significant deficits in everyday functioning. Behavior disorders from an everyday point of view are also a difficult area to define. One of the challenges with evaluating children is the influence of several factors such as social, cognitive, and motor development as well as environmental factors.
Describe the diagnostic criteria for intellectual disability disorder and dementia based on the current DSM. Explain the major differences between the two disorders. Describe some of the ways in which a person may be diagnosed with intellectual disability disorder. Describe some of the ways a person may be diagnosed with dementia.
Describe the main types of behavior disorders in children and explain how these disorders can be differentiated from a child that may be exhibiting disruptive behaviors for other reasons.
Part 2:
Somatic symptom disorder has a long history. Sigmund Freud described a case of Anna, who displayed several physical conditions (e.g., pain, dizziness, numbness, and visual disturbances) with no apparent medical cause. Also, schizophrenia is not actually one single disorder but a spectrum of disorders that fall along a continuum of symptoms and functioning levels.
Describe somatic symptom disorder, and if the disorder can be diagnosed if the person has an actual physical illness.
Describe the basic criteria for schizophrenia based on the current DSM criteria. Explain the differences between negative and positive symptoms.
Explain the prognosis of an individual diagnosed with schizophrenia based on age and gender factors.
Reading for above assignment By Topics
Disorders Common in Childhood
Disorders first observed in childhood can be much harder to diagnose than adult disorders for several reasons:
Traits that would be considered abnormal in adulthood can often be considered normal developmental behaviors in a child, including grandiosity and egocentrism.

Characteristics of adult disorders can appear different in children. For example, depression often exhibits in children as agitation or aggression, but it is more likely to exhibit in adulthood as lethargy.
Many times childhood disorders are not diagnosed until the person has reached adulthood, so information necessary for meeting diagnostic criteria must be gathered from friends’ and family’s memories, as opposed to currently observable behaviors or self-reports.
One of the major changes that came with the DSM-5 is the removal of the mulitaxial system of diagnosis. In its place, consideration was given to gender and cultural considerations as well as developmental and life-span considerations. The life-span consideration is important to consider in the change in diagnostic criteria when it comes to mental disorders diagnosed in children. Many mental disorders now have specific criteria particular for childhood onset. The following disorders are a specific set of disorders that begin in childhood (American Psychiatric Association, 2013b):
Intellectual disabilities
Communication disorders
Language disorder
Autism spectrum disorder
Attention-deficit/hyperactivity disorder (ADHD)
Specific learning disorder
Motor disorders
Developmental coordination disorder
Stereotypic movement disorder
Tic disorders
Tourette’s disorder
Other neurodevelopmental disorders

It is important to remember that children can suffer from the same disorders (with the exception of personality disorders) as adults. However, this lecture focuses on disorders in which the symptoms must be present in childhood to have been diagnosed. In addition, remember that children often exhibit behavioral and emotional problems that don’t necessarily meet formal diagnostic criteria yet are troubling to parents and teachers. For example, children may have nightmares or normal enuresis or exhibit lying or noncompliance.
Let’s focus on what is arguably one of the most hotly debated disorders in the DSM: ADHD.

ADHD
ADHD centers on chronic inattention. It is a good example of a disorder that is often diagnosed for the first time in adulthood. It is very common to find college students whose ADHD is undetected until they are in college because they are so intelligent. In college, when they are required to manage their time and be
self-disciplined, their symptoms of ADHD are suddenly quite distressing. Sometimes, they go to the counseling center not understanding why they are not succeeding in school. The clinician must ascertain from the college student and parents or guardians whether or not there were symptoms of ADHD present earlier in the student’s life.
People with ADHD can appear very different from one another depending on the symptoms that accompany the inattention. The following graphic describes the symptoms of ADHD:
ADHD Diagnosis and Treatment
Issues Surrounding Diagnosis and Treatment of ADHD
Before discussing issues surrounding ADHD treatment, keep in mind that many scientists and clinicians disagree on the usefulness of labeling children as having any disorders. Research and debate on ADHD have truly brought this disagreement to the forefront of the media. Arguments abound as to whether or not ADHD exists as a disorder or whether it is a label for children that previous generations would have called active or undisciplined. Some of this debate has been settled by very recent brain imaging studies, which have identified brain processing differences between those diagnosed with ADHD and those not.
Another debate has centered on the psychopharmacology of ADHD: Are physicians overeager to medicate children and adults with ADHD? Is ADHD truly as prevalent in our schools as it seems? Although the DSM reports that the prevalence rate for ADHD hovers between 1 and 7 percent of all children, there are theorists who believe that there are much higher rates of students who are taking medications or receiving accommodations for ADHD.
The affect of ADHD on children or adults can be mediated with behavioral strategies. However, medication seems to be the more effective yet controversial treatment. Most of the medications are stimulant-based. (There is an exception, but the therapeutic efficacy of the non stimulant-based medications seems to be much lower than that of the stimulant-based medications.) The use of a stimulant to treat a disorder centered on distractibility and hyperactivity seems counterintuitive to many people. However, if you understand the biology of ADHD, it makes perfect sense.
The brain requires a minimum level of stimulation in order to function optimally. For individuals with ADHD, their brains are actually producing a less-than-minimum amount of stimulation—they are under-stimulated. Their distractibility or hyperactivity is their brains’ way of compensating by seeking out additional stimulation (either from the environment or through motor movement) to obtain that minimum level necessary for functioning. Therefore, when given stimulant medications, their brains get what they need. The brain no longer needs to compensate, so the individual is actually able to relax. Therefore, a person who legitimately has ADHD will seem calmer, better able to concentrate, or better able to sleep after taking a stimulant. However, the person without ADHD will have more energy, have less need for sleep, or be more agitated after taking a stimulant. Therefore, you can use a person’s response to stimulant medications as a discriminator between those with ADHD and those without ADHD.
Two important notes to keep in mind as we conclude this discussion:
Stimulant medications are highly addictive and are often sought by non-ADHD individuals who desire their side-effects (such as weight loss or ability to “pull all-nighters” or a single night of total sleep deprivation). For this reason, they are classified as Schedule II drugs (which are drugs having a high potential for abuse) and prescriptions for them must be renewed monthly in attempts to limit abuse.
Some clinicians currently hypothesize that there is a second type of ADHD—an adult onset type. This is a relatively new area of research.
Now let’s discuss disorders associated with later life, specifically cognitive disorders.
Autism Spectrum Disorder
For the DSM-5, there were significant changes to pervasive developmental disorders (PDDs). PDDs were a set of disorders that occur due to delays in development. Prior to DSM-5, the different PDDs included autism, Asperger’s syndrome, Rett syndrome, childhood disintegrative disorder, and PDD Not Otherwise Specified (NOS). According to the American Psychiatric Association (2013a), research has shown that the different diagnoses weren’t applied consistently and many of the symptoms were similar. Several disorders were eliminated and merged into one called autism spectrum disorder.
The main features of autism spectrum disorder include (American Psychiatric Association, 2013b):
Deficits in social communication
Social interactions
Non-verbal communication skills
Understanding relationships
Restrictive repetitive behaviors
Repetitive motor movements
Ritualized behaviors
Strong interests in unusual objects
Heightened sensitivity to sensory stimulation

Autism Spectrum Disorder
For the DSM-5, there were significant changes to pervasive developmental disorders (PDDs). PDDs were a set of disorders that occur due to delays in development. Prior to DSM-5, the different PDDs included autism, Asperger’s syndrome, Rett syndrome, childhood disintegrative disorder, and PDD Not Otherwise Specified (NOS). According to the American Psychiatric Association (2013a), research has shown that the different diagnoses weren’t applied consistently and many of the symptoms were similar. Several disorders were eliminated and merged into one called autism spectrum disorder.
The main features of autism spectrum disorder include (American Psychiatric Association, 2013b):
Deficits in social communication
Social interactions
Non-verbal communication skills
Understanding relationships
Restrictive repetitive behaviors
Repetitive motor movements
Ritualized behaviors
Strong interests in unusual objects
Heightened sensitivity to sensory stimulation

Schizophrenia Spectrum
Schizophrenia is the most severe of the psychotic disorders. What differentiates it from other psychotic disorders is the combination and severity of the symptoms. While there are several classifications of schizophrenia, all of the schizophrenic disorders share the following basic core symptoms:
Delusions: These are beliefs not based in reality. The most common delusion in the U.S. is the belief that one is Jesus Christ or that Jesus Christ or God is speaking to them. Often individuals will interpret innocuous stimuli as being direct signs or messages from God.
Hallucinations: These are sensory experiences that are not grounded in reality. The individual sees, hears, or feels something that does not actually exist.

For the individual with schizophrenia, these thoughts or experiences are as real as the computer screen you are reading is to you—the individual does not perceive them to be imaginary.
The typical onset of symptoms for schizophrenia in women is in late adolescence, while for men it comes a bit later, typically in the early to mid-twenties. It is not uncommon for individuals to be in college when they experience their first delusion or hallucination. These often terrifying experiences can drastically and quickly affect the function of the individual. Because the experiences are so real to the person, it is not typically the delusion or hallucination that brings the person into counseling. Instead, it is some associated experience. Let’s look at the following case to learn how:
Content on this page requires a newer version of Adobe Flash Player.
Get Adobe Flash player
Clients such as Mary do not perceive their perceptions or thoughts to be out of touch with reality, so they can function undetected for some time without intervention or treatment.
Dissociative Disorders
Dissociative disorders are centered on the separation of an individual’s identity, memories, or consciousness. In almost all cases of dissociation, the individual has experienced some type of trauma. What is important to note is that dissociation can be a symptom of several stress disorders (as we will see in future lectures). When dissociation is a symptom of another disorder, such as posttraumatic stress disorder (PTSD) or acute stress disorder, it is not diagnosed on its own. Also, it is important to note that in order to be diagnosed with a dissociative disorder, the dissociation cannot be the result of an organic cause (such as brain trauma) or substance use (such as alcohol).
For most clients, dissociation is a protective measure—when emotions become too intense, the individual checks out of the current reality. Working with trauma victims can provide frequent examples of dissociation, which are not dissociative disorders by definition.
Many times, law enforcement officers express the belief that a victim is lying about a crime because the victim is not emotionally demonstrative or distressed. In such cases, you have to educate the officers about dissociation. It is common for individuals who have experienced some form of trauma to have found a way to separate themselves from the experience. For example, victims may relate the details of the crime as if they were a bystander or they were reporting a story. Victims will often demonstrate a flat (a complete lack of emotion) affect and report feeling numb or indifferent. While officers can sometimes interpret this as a lack of genuineness, it is typically a form of dissociation. Similarly, when victims are re-interviewed days after their experience, it is not uncommon for them to have “blacked out” on many of the details they may have remembered immediately following the trauma. This is another type of dissociation.

The disorders in the dissociation class are more severe versions of these types of common experiences. The most severe of the dissociative disorders is dissociative identity disorder (previously called multiple personality disorder).
Let’s now discuss somatic symptom and related disorders.