Neurodevelopmental Disorder

The neurodevelopmental disorders are a group of conditions with onset in

the developmental period. The disorders typically manifest early in
development, often before the child enters grade school, and are
characterized by developmental deficits that produce impairments of
personal, social, academic, or occupational functioning.

Intellectual Disabilities

Intellectual Disability (Intellectual Developmental Disorder)

Diagnostic Criteria:

Intellectual disability (intellectual developmental disorder) is a disorder with

onset during the developmental period that includes both intellectual and
adaptive functioning deficits in conceptual, social, and practical domains.
The following three criteria must be met:

A. Deficits in intellectual functions, such as reasoning, problem solving,

planning, abstract thinking, judgment, academic learning, and learning from
experience, confirmed by both clinical assessment and individualized,
standardized intelligence testing.

B. Deficits in adaptive functioning that result in failure to meet

developmental and socio-cultural standards for personal independence and
social responsibility. Without ongoing support, the adaptive deficits limit
functioning in one or more activities of daily life, such as communication,
social participation, and independent living, across multiple environments,
such as home, school, work, and community.

C. Onset of intellectual and adaptive deficits during the developmental

period.

Diagnostic Features

The essential fèatures of intellectual disability (intellectual developmental

disorder) are deficits in general mental abilities (Criterion A) and impairment
in everyday adaptive functioning, in comparison to an individual's age-,
gender-, and socioculturally matched peers (Criterion B). Onset is during the
developmental period (Criterion C). The diagnosis of intellectual disability is
based on both clinical assessment and standardized testing of intellectual
and adaptive functions.
Criterion A refers to intellectual functions that involve reasoning, problem
solving, planning, abstract thinking, judgment, learning from instruction and
experience, and practical understanding.

Deficits in adaptive functioning (Criterion B) refer to how well a person

meets community standards of personal independence and social
responsibility, in comparison to others of similar age and sociocultural
background.

Criterion B is met when at least one domain of adaptive functioning—

conceptual, social, or practical—is sufficiently impaired that ongoing support
is needed in order for the person to perform adequately in one or more life
settings at school, at work, at home, or in the community.

Criterion C, onset during the developmental period, refers to recognition that

intellectual and adaptive deficits are present during childhood or
adolescence.

Global Developmental Delay

This diagnosis is reserved for individuals under the age of 5 years when the
clinical severity level cannot be reliably assessed during early childhood. This
category is diagnosed when an individual fails to meet expected
developmental milestones in several areas of intellectual functioning and
applies to individuals who are unable to undergo systematic assessments of
intellectual functioning, including children who are too young to participate in
standardized testing. This category requires reassessment after a period of
time.

Unspecified Intellectual Disability (Intellectual Developmental

Disorder)

This category is reserved for individuals over the age of 5 years when
assessment of the degree of intellectual disability (intellectual
developmental disorder) by means of locally available procedures is
rendered difficult or impossible because of associated sensory or physical
impairments, as in blindness or prelingual deafness; locomotor disability; or
presence of severe problem behaviors or co-occurring mental disorder. 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 individual's articulation, fluency, voice, and resonance quality. Language
includes the form, function, and use of a conventional system of symbols
that influences the behavior, ideas, or attitudes of another individual.

Diagnostic Criteria:

A. Persistent difficulties in the acquisition and use of language across

modalities (i.e.,spoken, written, sign language, or other) due to deficits in
comprehension or production that include the following

1. Reduced vocabulary (word knowledge and use).

2. Limited sentence structure (ability to put words and word endings together
to form sentences based on the rules of grammar and morphology).

3. Impairments in discourse (ability to use vocabulary and connect sentences

to explain or describe a topic or series of events or have a conversation).

B. Language abilities are substantially and quantifiably below those expected

for age, resulting in functional limitations in effective communication, social
participation, academic achievement, or occupational performance,
individually or in any combination.

C. Onset of symptoms is in the early developmental period

D. The difficulties are not attributable to hearing or other sensory

impairment, motor dysfunction, or another medical or neurological condition
and are not better explained by intellectual disability (intellectual
developmental disorder) 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 comprehension or
production of vocabulary, sentence structure, and discourse. The language
deficits are evident in spoken communication, written communication, or
sign language. Language learning and use is dependent on both receptive
and expressive skills. Expressive ability refers to the production of vocal,
gestural, or verbal signals, while receptive ability refers to the process of
receiving and comprehending language messages. Language skills need to
be assessed in both expressive and receptive modalities as these may differ
in severity. For example, an individual's expressive language may be
severely impaired, while his receptive language is hardly impaired at all.

Speech Sound Disorder

Diagnostic Criteria

A. Persistent difficulty with speech sound production that interferes with

speech intelligibility or prevents verbal communication of messages.

B. The disturbance causes limitations in effective communication that

interfere with social participation, academic achievement, or occupational
performance, individually or in any combination.

C. Onset of symptoms is in the early developmental period.

D. The difficulties are not attributable to congenital or acquired conditions,

such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain
injury, or other medical or neurological conditions.

Diagnostic Features

A speech sound disorder is diagnosed when speech sound production is not

what would be expected based on the child's age and developmental stage
and when the deficits are not the result of a physical, structural, neurological,
or hearing impairment. Among typically developing children at age 4 years,
overall speech should be intelligible, whereas at age 2 years, only 50% may
be understandable.

Childhood-Onset Fluency Disorder (Stuttering)

Diagnostic Criteria

A. Disturbances in the normal fluency and time patterning of speech that are
inappropriate for the individual’s age and language skills, persist over time,
and are characterized by frequent and marked occurrences of one (or more)
of the following:

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”).

B. The disturbance causes anxiety about speaking or limitations in effective

communication, social participation, or academic or occupational
performance, individually or in any combination.

C. The onset of symptoms is in the early developmental period. (Note: Later-

onset cases are diagnosed as 307.0 [F98.5] adult-onset fluency disorder.)

D. The disturbance is not attributable to a speech-motor or sensory deficit,

dysfluency associated with neurological insult (e.g., stroke, tumor, trauma),
or another medical condition and is not better explained by another mental
disorder.

Diagnostic Features

The essential feature of childhood-onset fluency disorder (stuttering) is a

disturbance in the normal fluency and time patterning of speech that is
inappropriate for the individual's age. This disturbance is characterized by
frequent repetitions or prolongations of sounds or syllables and by other
types of speech dysfluencies, including broken words, audible or silent
blocking, circumlocutions, words produced with an excess of physical
tension, and monosyllabic whole-word. The disturbance in fluency interferes
with academic or occupational achievement or with social communication.
The extent of the disturbance varies from situation to situation and often is
more severe when there is special pressure to communicate Dysfluency is
often absent during oral reading, singing, or talking to inanimate objects or
to pets.

Social (Pragmatic) Communication Disorder

Diagnostic Criteria

A. Persistent difficulties in the social use of verbal and nonverbal

communication as manifested by all of the following:

1. Deficits in using communication for social purposes, such as greeting and

sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or
the needs of the listener, such as speaking differently in a classroom than on
a playground, talking differently to a child than to an adult, and avoiding use
of overly formal language.

3. Difficulties following rules for conversation and storytelling, such as taking

turns in conversation, rephrasing when misunderstood, and knowing how to
use verbal and nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g., making

inferences) and nonliteral or ambiguous meanings of language (e.g., idioms,
humor, metaphors, multiple meanings that depend on the context for
interpretation).

B. The deficits result in functional limitations in effective communication,

social participation, social relationships, academic achievement, or
occupational performance, individually or in combination.

C. The onset of the symptoms is in the early developmental period (but

deficits may not become fully manifest until social communication demands
exceed limited capacities).

D. The symptoms are not attributable to another medical or neurological

condition or to liabilities in the domains of word structure and grammar, and
are not better explained byautism spectrum disorder, intellectual disability
(intellectual developmental disorder), global developmental delay, or another
mental disorder.

Diagnostic Features

Social (pragmatic) communication disorder is characterized by a primary

difficulty with pragmatics, or the social use of language and communication,
as manifested by deficits in understanding and following social rules of
verbal and nonverbal communication in naturalistic contexts, changing
language according to the needs of the listener or situation, and following
rules for conversations and storytelling. The deficits in social communication
result in functional limitations in effective communication, social
participation, development of social relationships, academic achievement, or
occupational performance. The deficits are not better explained by low
abilities in the domains of structural language or cognitive ability.
Unspecified Communication Disorder

This category applies to presentations in which symptoms characteristic of

communication disorder that cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for communication disorder or
for any of the disorders in the neurodevelopmental disorders diagnostic
class. The unspecified communication disorder category is used in situations
in which the clinician chooses not to specify the reason that the criteria are
not met for communication disorder or for a specific neurodevelopmental
disorder and includes presentations in which there is insufficient information
to make a more specific diagnosis.

Autism Spectrum Disorder

Diagnostic Criteria

A. Persistent deficits in social communication and social interaction across

multiple contexts, as manifested by the following, currently or by history
(examples are illustrative, not exhaustive; see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from

abnormal social approach and failure of normal back-and-forth conversation;
to reduced sharing of interests, emotions, or affect; to failure to initiate or
respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction,

ranging, for example, from poorly integrated verbal and nonverbal
communication; to abnormalities in eye contact and body language or
deficits in understanding and use of gestures: to a total lack of facial
expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships,

ranging, for example, from difficulties adjusting behavior to suit various
social contexts; to difficulties in sharing imaginative play or in making
friends; to absence of interest in peers.

Specify current severity:

Severity is based on social communication impairments and restricted,

repetitive patterns of behavior (seeTable 2).
B. Restricted, repetitive patterns of behavior, interests, or activities, as
manifested by atleast two of the following, currently or by history (examples
are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech

(e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia,
idiosyncratic phrases).

2. Insistence on sameness, inflexible adherence to routines, or ritualized

patterns of verbal or nonverbal behavior (e.g., extreme distress at small
changes, difficulties with transitions, rigid thinking patterns, greeting rituals,
need to take same route or eat same food every day).

3. Highly restricted, fixated interests that are abnormal in intensity or focus

(e.g.,strong attachment to or preoccupation with unusual objects,
excessively circumscribed or perseverative interests).

4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory

aspects of the environment (e.g., apparent indifference to pain/temperature,
adverse response to specific sounds or textures, excessive smelling or
touching of objects, visual fascination with lights or movement).

Specify current severity:

Severity is based on social communication impairments and restricted,

repetitive patterns of behavior (see Table 2).

C. Symptoms must be present in the early developmental period (but may

not become fully manifest until social demands exceed limited capacities, or
may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational,

or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability

(intellectual developmental disorder) or global developmental delay.
Intellectual disability and autism spectrum disorder frequently co-occur; to
make comorbid diagnoses of autism spectrum disorder and intellectual
disability, social communication should be below that expected for general
developmental level.

Diagnostic Features
The essential features of autism spectrum disorder are persistent impairment
in reciprocal social communication and social interaction (Criterion A), and
restricted, repetitive patterns of behavior, interests, or activities (Criterion B).
These symptoms are present from early childhood and limit or impair
everyday functioning (Criteria C and D). The stage at which functional
impairment becomes obvious will vary according to characteristics of the
individual and his or her environment. Core diagnostic features are evident in
the developmental period, but intervention, compensation, and current
supports may mask difficulties in at least some contexts. Manifestations of
the disorder also vary greatly depending on the severity of the autistic
condition, developmental level, and chronological age; hence, the term
spectrum. Autism spectrum disorder encompasses disorders previously
referred to as early infantile autism, childhood autism, Kanner's autism, high-
functioning autism, atypical autism, pervasive developmental disorder not
otherwise specified, childhood disintegrative disorder, and Asperger's
disorder.

ATTENTION – DEFICIT/HYPERACTIVITY DISORDER

Attention-deficit/hyperactivity disorder is a neurodevelopmental condition

that affects focus, impulse control, and activity regulation. Individuals with
this disorder may struggle with sustained attention, organization, and
completing tasks, often appearing distracted or forgetful. They may also
exhibit excessive physical activity or restlessness and have difficulty
delaying actions or considering long-term consequences.

Diagnostic Criteria

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that

interferes with functioning or development, as characterized by (1) and/or
(2):

1. Inattention: Six (or more) of the following symptoms have persisted for
at least 6 months to a degree that is inconsistent with developmental level
and that negatively impacts directly on social and academic/occupational
activities:
a. Often fails to give close attention to details or makes careless mistakes
in schoolwork, at work, or during other activities (e.g., overlooks or misses
details, work is inaccurate).

b. Often has difficulty sustaining attention in tasks or play activities (e.g.,

has difficulty remaining focused during lectures, conversations, or lengthy
reading).

c. Often does not seem to listen when spoken to directly (e.g., mind
seems elsewhere, even in the absence of any obvious distraction).

d. Often does not follow through on instructions and fails to finish

schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly
loses focus and is easily sidetracked).

e. Often has difficulty organizing tasks and activities (e.g., difficulty

managing sequential tasks; difficulty keeping materials and belongings in
order; messy, disorganized work; has poor time management; fails to meet
deadlines).

f. Often avoids, dislikes, or is reluctant to engage in tasks that require

sustained mental effort (e.g., schoolwork or homework; for older adolescents
and adults preparing reports, completing forms, reviewing lengthy papers).

g. Often loses things necessary for tasks or activities (e.g., school

materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile
telephones).

h. Is often easily distracted by extraneous stimuli (for older adolescents

and adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running errands;
for older adolescents and adults, returning calls, paying bills, keeping
appointments).

2. Hyperactivity and impulsivity: Six (or more) of the following symptoms

have persisted for at least 6 months to a degree that is inconsistent with
developmental level and that negatively impacts directly on social and
academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behavior,

defiance, hostility, or a failure to understand tasks or instructions. For older
adolescents and adults (age 17 and older), at least five symptoms are
required.

a. Often fidgets with or taps hands or feet or squirms in seat.

b. Often leaves seat in situations when remaining seated is expected

(e.g., leaves his or her place in the classroom, in the office or other
workplace, or in other situations that require remaining in place).

c. Often runs about or climbs in situations where it is inappropriate.

(Note: In adolescents or adults, may be limited to feeling restless.)

d. Often unable to play or engage in leisure activities quietly.

e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to

be or uncomfortable being still for extended time, as in restaurants,
meetings; may be experienced by others as being restless or difficult to keep
up with).

f. Often talks excessively.

g. Often blurts out an answer before a question has been completed (e.g.,
completes people’s sentences; cannot wait for turn in conversation).

h. Often has difficulty waiting his or her turn (e.g., while waiting in line).

i. Often interrupts or intrudes on others (e.g., butts into conversations,

games, or activities; may start using other people’s things without asking or
receiving permission; for adolescents and adults, may intrude into or take
over what others are doing).
B. Several inattentive or hyperactive-impulsive symptoms were present
prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two

or more settings (e.g., at home, school, or work; with friends or relatives; in
other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the
quality of, social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia

or another psychotic disorder and are not better explained by another
mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder,
personality disorder, substance intoxication or withdrawal).

Diagnostic Features

Inattention

Inattention in ADHD involves difficulty staying focused, frequent task-

switching, and disorganization. Individuals with inattention may wander off-
task, fail to complete activities, and struggle with sustained mental effort.
These behaviors are not due to defiance or a lack of comprehension but
reflect a persistent challenge in maintaining focus.

Hyperactivity

Hyperactivity refers to excessive physical or verbal activity that is

inappropriate for the situation, such as fidgeting, tapping, or constant
talking. In children, it often appears as running or climbing in unsuitable
settings, while adults may experience extreme restlessness. These behaviors
can be exhausting for others and are persistent rather than situational.
Impulsivity

Impulsivity in ADHD manifests as acting without forethought, often leading to

risky or harmful situations, such as darting into traffic. It is driven by
difficulty delaying gratification and a preference for immediate rewards over
long-term considerations. This impulsiveness may result in social
intrusiveness, like interrupting others, or hasty decisions with significant
consequences.

Attention-deficit/hyperactivity disorder often occurs with mild delays in

language, motor, or social development, as well as low frustration tolerance,
irritability, and mood swings. Academic or work performance is frequently
impaired, even without a specific learning disorder, and individuals may
show cognitive challenges in attention, memory, or executive function,
though these are not reliable for diagnosis. There is no biological marker for
the disorder, but research shows differences in brain activity, size, and
development in affected children. Rare genetic conditions, like Fragile X
syndrome, may include attention-deficit/hyperactivity disorder symptoms,
which should still be diagnosed separately.

SPECIFIC LEARNING DISORDER

Specific learning disorder is a condition characterized by significant

difficulties in reading, writing, or mathematics, despite having average
intelligence and appropriate education. These difficulties are not due to
external factors like lack of instruction or other developmental issues. The
disorder can affect academic performance and daily functioning, requiring
tailored interventions for support.

Diagnostic Criteria
A. Difficulties learning and using academic skills, as indicated by the
presence of at least

One of the following symptoms that have persisted for at least 6 months,
despite the

Provision of interventions that target those difficulties:

1. Inaccurate or slow and effortful word reading (e.g., reads single words
aloud incorrectly or slowly and hesitantly, frequently guesses words, has
difficulty sounding out words).

2. Difficulty understanding the meaning of what is read (e.g., may read

text accurately but not understand the sequence, relationships, inferences,
or deeper meanings of what is read).

3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or

consonants).

4. Difficulties with written expression (e.g., makes multiple grammatical

or punctuation errors within sentences; employs poor paragraph
organization; written expressikn of ideas lacks clarity).

5. Difficulties mastering number sense, number facts, or calculation (e.g.,

has poor understanding of numbers, their magnitude, and relationships;
counts on fingers to add single-digit numbers instead of recalling the math
fact as peers do; gets lost in the midst of arithmetic computation and may
switch procedures).

6. Difficulties with mathematical reasoning (e.g., has severe difficulty

applying mathematical concepts, facts, or procedures to solve quantitative
problems).
B. The learning difficulties are much lower than expected for the person's
age and significantly affect school, work, or daily life, as confirmed by
standardized tests and a thorough assessment. For individuals 17 and older,
a history of learning difficulties can replace the standardized test.

C. The difficulties start during school years but may not be fully noticeable
until academic demands become too challenging, like during timed tests or
when handling complex assignments with tight deadlines.

D. The learning problems are not better explained by intellectual disabilities,

poor vision or hearing, other mental or neurological issues, personal
struggles, language barriers, or poor education.

Diagnostic Features

Specific learning disorder can be categorized based on the primary area of

difficulty:

1. Reading (Dyslexia): Challenges with reading accuracy, fluency, and

comprehension.

2. Written Expression: Difficulties with spelling, grammar, organizing ideas,

and writing clearly.

3. Mathematics (Dyscalculia): Problems with number sense, arithmetic

calculation, and mathematical reasoning.

These categories help specify the type of academic skills affected while
recognizing the underlying neurodevelopmental basis of the disorder. These
challenges are not due to lack of instruction, intellectual disabilities, or
sensory issues but stem from how the brain processes information. The
disorder significantly affects academic, work, or daily life, with persistent
difficulties lasting at least six months despite extra help. Diagnosis is based
on standardized tests or assessments, and the condition may become more
noticeable as academic demands increase.

MOTOR DISORDERS

Developmental Coordination Disorder:

Developmental Coordination Disorder makes it hard for people to coordinate

their movements, affecting tasks like writing or playing sports. It is not
caused by physical or brain problems but is specific to motor skill difficulties.
This disorder usually shows up in childhood and can impact daily activities
and schoolwork.

Diagnostic Criteria

A. The acquisition and execution of coordinated motor skills is substantially

below that expected given the individual’s chronological age and opportunity
for skill learning and use. Difficulties are manifested as clumsiness (e.g.,
dropping or bumping into objects) as well as slowness and inaccuracy of
performance of motor skills (e.g., catching an object, using scissors or
cutlery, handwriting, riding a bike, or participating in sports).

B. The motor skills deficit in Criterion A significantly and persistently

interferes with activities of daily living appropriate to chronological age (e.g.,
self-care and self-maintenance) and impacts academic/school productivity,
prevocational and vocational activities, leisure, and play.

C. Onset of symptoms is in the early developmental period.

D. The motor skills deficits are not better explained by intellectual disability
(intellectual developmental disorder) or visual impairment and are not
attributable to a neurological condition affecting movement (e.g., cerebral
palsy, muscular dystrophy, degenerative disorder).

Diagnostic Features

Developmental Coordination Disorder (DCD) is diagnosed through a clinical

evaluation that includes medical history, physical exams, and standardized
tests. The disorder affects motor coordination, with symptoms varying by
age; in young children, it may delay milestones like walking or using zippers,
while older children and adults may struggle with tasks like handwriting,
typing, or playing sports. The disorder significantly impacts daily activities,
including self-care, schoolwork, and social participation, especially tasks
requiring speed and precision. The symptoms must begin in early childhood
and cannot be explained by other conditions, such as visual impairment or
neurological disorders. DCD can affect either gross motor skills (like running
or jumping) or fine motor skills (like writing or using scissors).

Stereotypic Movement Disorder:

Stereotypic Movement Disorder is characterized by repetitive, nonfunctional

body movements, such as hand-flapping, rocking, or head-banging, that
persist over time. These movements are not associated with any other
medical or developmental condition and are often performed in response to
boredom, excitement, or stress. The movements can interfere with daily
activities or cause physical harm, and they may become more noticeable in
early childhood. In some cases, these behaviors can be reduced or managed
with therapy, but they are persistent and may continue into adulthood.

Diagnostic Criteria

A. Repetitive, purposeless movements (e.g., hand-shaking, body rocking,

head-banging, self-biting).

B. These movements interfere with daily activities and may cause harm.

C. The behavior starts in early childhood.

D. The behavior is not caused by drugs, a medical condition, or another

disorder (e.g., hair-pulling or obsessive-compulsive disorder).

Specify if:

- With self-injury (or could cause injury without prevention)

- Without self-injury

Specify if:

- Related to a medical condition, genetic disorder, or environmental

factor (e.g., Lesch-Nyhan syndrome, intellectual disability, alcohol exposure
in pregnancy).

Coding note: Use an additional code to identify any associated medical

condition, genetic disorder, or neurodevelopmental disorder.

Specify current severity:

- Mild: Symptoms can be managed with sensory input or distractions.

- Moderate: Symptoms need specific protective measures and behavioral

changes.
- Severe: Constant monitoring and protection are needed to prevent serious
harm.

Diagnostic Features

Stereotypic movement disorder involves repetitive, purposeless movements

like rocking, hand flapping, or head banging. These behaviors can be non-
injurious or cause self-injury, such as biting or eye poking. They often occur
when a person is stressed, bored, or excited and may interfere with daily
activities or social interactions. The movements are usually present from an
early age and vary in how often and how long they last. The disorder is
diagnosed when these behaviors aren’t caused by another medical or
neurological condition.

Tic Disorders:

Tic disorders involve repetitive, involuntary movements or sounds, such as

blinking, grunting, or head jerking. These tics can be motor (physical) or
vocal (sounds) and usually begin in childhood. They often worsen with stress
and may interfere with daily activities or social interactions. Common types
include Tourette syndrome and chronic motor or vocal tic disorder.

Tourette’s Disorder

A. Both motor tics and vocal tics are present at some point, but not
necessarily at the same time.

B. Tics may change in frequency but have lasted more than 1 year since they
first appeared.

C. Onset is before age 18.

D. The tics are not due to substance use or another medical condition.

Persistent (Chronic) Motor or Vocal Tic Disorder

A. Only motor or only vocal tics are present, not both.

B. Tics may change in frequency but have lasted more than 1 year.
C. Onset is before age 18.

D. Tics are not due to substance use or another medical condition.

E. The criteria for Tourette’s Disorder have never been met.

Specify if:

- With motor tics only

- With vocal tics only

Provisional Tic Disorder

A. One or more motor or vocal tics.

B. The tics have been present for less than 1 year.

C. Onset is before age 18.

D. The tics are not due to substance use or another medical condition.

E. The criteria for Tourette’s or Persistent Tic Disorder have never been met.