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Mental disorders diagnosed in childhood are usually first diagnosed in infancy, childhood, or adolescence, as laid out in the DSM-5^[1] and in the ICD-10 ^[2] These disorders often co-occur with each other or with other disorders. Deficits may arise in academic, personal, social or occupational functioning. These disorders begin early in life and may produce lifelong functional impairments. Essential features of any diagnosis include recognition of severity, duration, time of onset of symptoms and the extent to which the individual is impaired by them.^[1]

Mental disorders diagnosed in children are called Neurodevelopmental Disorders in the DSM-5. These disorders are divided into seven subcategories: Intellectual disability, Communication disorder, Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder, Specific Learning Disorder (see Learning disability), Motor disorder and Other Neurodevelopmental Disorders.^[1]

Intellectual disability is defined as generalized deficits in mental abilities. Some examples of mental abilities which may be affected are: reasoning, judgement, problem solving, planning, abstract reasoning and learning. In order to be severe enough for diagnosis, these deficits must impede a person’s daily life. Global developmental delay is a type of intellectual disability diagnosed when an individual fails to meet expected life milestones but for whom formal testing can not occur (for example, in individuals too young for standardized testing). Intellectual disability can be caused by traumatic brain injury as well, in which case it may also be diagnosed at a neurocognitive disorder. ^[1]

The following three symptoms must be present for a diagnosis of intellectual disability according to the DSM-5:

A. Deficits in intellectual functioning in areas such as reasoning, planning, abstract thinking.

B. Deficits in adaptive functioning that result in a failure to meet developmental and socio-cultural standards for personal responsibility and social functioning.

C. The onset of these symptoms must be during the developmental period. ^[1]

The diagnosis can be either mild, moderate, severe or profound depending on level of the patient’s adaptive functioning. The role of adaptive functioning rather than IQ to determine level of severity is used for two reasons. Firstly, it is adaptive functioning that determines the level of support an individual will need. Second, IQ measures are less valid on the extremities of the scale. ^[1]

A communication disorder is that which affects verbal and nonverbal language production and comprehension. Examples of this type of disorder include language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering) and social (pragmatic) communication disorder. The cause of Communication Disorders in children are usually biological, developmental or environmental. These causes include abnormalities in brain development, exposure to certain toxins during pregnancy, or genetic factors.^[3]

The criterion required to diagnose a child with a language disorder are as follows:

A. Persistent problems in the acquisition of language (be it spoken, written or signed language) due to deficits in the comprehension or production of language including:

1. Limited vocabulary.

2. Limited sentence structure.

3. Difficulty engaging in conversation.

B. Language ability is significantly and measurably below norm for individual’s age range.

C. Onset of symptoms is very early in the child’s development.

D. The difficulties are not otherwise better accounted for (by example, not attributable to hearing or other sensory or neurological impairment). ^[1]

Children who have difficulty understanding language often have more difficulties correcting this deficits than do children with primarily productive impairments due to the nature of the disorders. Speech and language therapists are often very reliable for helping children with communication disorders. ^[4] Language disorders are often seen to be heritable and it is not uncommon to find multiple members of a family with communication disorders. ^[1]

The diagnostic criteria for speech sound disorder are:

A. Persistent difficulty producing sound in an intelligible manner.

B. As a result of (A), the individual experience social and academic deficits.

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

D. The difficulty in speech production is not caused by another disorder or disability.^[1]

Typically, children who are developing normally produce intelligible speech at a rate of 50% at age 2, and at a rate of 100% at age 4. ^[1]

Childhood-onset fluency disorder (see stuttering) is diagnosed when an individual:

A. Exhibits improper fluency and pattern of speaking for their age, as characterized by one or more of the following:

1. Sound and syllable repetitions.

2. Sound prolongation of consonants and vowels.

3. Marked pauses in the middle of a word.

4. Pauses in speech, may or may not fill these pauses with audible sounds.

5. Substituting a word for an easier one (circumlocutions).

6. Words produced are noted to have used excessive effort (tension).

7. Monosyllabic whole word repetition

B. The individual experiences anxiety as a result of symptoms described in (A).

C. The onset is early in developmental period (adults may be diagnosed with adult-onset fluency disorder).

D. The disturbances are not attributable to another deficit, disorder or injury. ^[1]

Stuttering shows a high genetic component, in fact, individuals with a first-degree relative with the disorder are three times more likely than the general population to develop this. Typically 65%-85% of children who stutter speak normally as adults. ^[1]

To be diagnosed with social (pragmatic) communication disorder (see Pragmatic language impairment) an individual must display the following symptoms:

A. Persistent difficulty with verbal and nonverbal aspects of communication when in social situations. These difficulties should be seen to manifest as all of the following:

1. Inability to use communication for social ends, such as making a proper salutation.

2. Inability to change communication style to appropriately suit circumstance, context or environment.

3. Difficulty following socially ascribed rules of conversation, such as taking turns speaking.

4. Difficulty understanding what is “in between the lines”, for example interpreting humour, metaphors, references that are context dependant and not explicitly stated.

B. These deficits result in social limitations at work, school, social situations or otherwise.

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

D. These symptoms are not better accounted for by any other condition.

The diagnosis of social (pragmatic) communication disorder may be suitable for some individuals who were diagnosed with autism spectrum disorder under a previous version of the DSM. The presence of this disorder may arise in individual who are otherwise cognitively and linguistically normal. ^[1]

Additionally, the DSM-5 provides opportunity for a diagnosis of unspecified communication disorder, which is given to an individual who exhibits marked and impairing deficits which only partially meet any of the above criteria. ^[1]

Autism spectrum disorder is characterized by persistent and broad deficits in socialization. In addition to social deficits, to qualify for diagnosis, the individual must exhibit restrictive and repetitive behaviours or interests. Diagnosing autism is made complicated by the fact that symptoms change over the course of development and by compensatory mechanisms used by the individual. In the DSM-5, the diagnosis of Asperger’s syndrome has been brought under the umbrella of autism spectrum disorder. ^[1]

In order to be diagnosed with autism spectrum disorder, an individual must exhibit the following symptoms:

A. Persistent and broad social deficits, as characterized by these or similar examples:

1. Deficits in socia-emotional reciprocity as shown by, for example, difficulty sharing interests, emotions in addition to or when experiencing difficulty maintaining social interactions.

2. Nonverbal expressive difficulties. These may manifest as poorly understood or produced verbal and nonverbal expression, abnormal body language or eye contact, lack of facial expression.

3. Difficulty or lack of interest in developing or maintaining social relations.

B. At least two of the following restricted and repetitive patterns of behaviour:

1. Stereotypical patterns of motor or speech.

2. Rigid insistence of keeping same routine or pattern of action. For example, distress at small changes.

3. Abnormal degree of interest or focus in topics of interest.

4. Hyper- or hyporeactivity to sensory input.

C. Symptoms must be present in early development, even if they do not become apparent until later.

D. Symptoms cause clinically significant social, occupational, academic or other life impairment.

E. The symptoms are not better explained by anything else. ^[1]

The clinician should specify the severity of symptoms and whether the individual exhibits catatonia. Individuals diagnosed with autism, Asperger’s or pervasive developmental disorder who exhibit only the communication deficits of the current criteria should be reassessed for social (pragmatic) communication disorder. The prevalence of autism is estimated to be around 1% of the U.S. population, however the frequency of diagnosis is on the rise. Many experts speculate that this may be due to an increase in awareness and hence increase in screening. ^[1]

ADHD is characterized by an activity which increases inattention, disorganization and activity. Individuals with ADHD have may show marked deficits in school or occupation and also show social deficits. ADHD comes in three forms, primarily hyperactive (more common in males); primarily inattentive (more common in females); and combination. ^[1] ADHD is one of the most commonly diagnosed disorders in childhood. The causes are often studied, yet still inconclusive. Research shows that ADHD has a strong genetic component, as a result it often runs in families. ^[5] Children exposed to lead at a young age will also have an increased chance of developing ADHD. Brain injuries could cause ADHD, yet only a small number of children diagnosed fit into this category. Researchers have looked into sugar intake as the cause of ADHD, but have found little to support that theory.^[6] To date, there are not any biological markers which are considered sufficient evidence for diagnosis. ^[1] In order to be diagnosed with ADHD an individual must show:

A. A persistent pattern of at least six symptoms from list (1) and/or (2) over a period of at least 6 months:

1. Inattention (note, for older individuals, at least 5 from this category are required for diagnosis).

a. Individual fails to give close attention to details when completing tasks resulting in ‘careless mistakes.

b. Difficulty sustaining attention for period equal to their peers in tasks or play (difficulty during long readings or lectures, for example).

c. Appears absent-minded even when spoken to directly.

d. Easily sidetracked, often fails to finish tasks as a result of this.

e. Organizational problems in life and/or task completion (for example, is characterized as messy, poor at managing own time).

f. Often avoid, dislikes or is reluctant to start a task the individual knows will require sustained mental effort.

g. Often loses objects.

h. Is easily distracted, even by own thoughts.

i. Is forgetful, resulting in neglecting recurring activities or chores.

1. Hyperactivity and impulsivity (note, for older individuals, at least 5 from this category are required for diagnosis).

a. Often can not sit completely still (toe or hand tapping, squirming in seat).

b. Often leaves seat when social/ occupational/academic expectations dictate the individual should remain seated.

c. Often runs or climbs when inappropriate (for older individuals, may be limited to feeling restless).

d. Often unable to play quietly.

e. Is often “on the go” as if “driven by a motor”

f. Often talks excessively.

g. Often blurts out an answer prematurely, before the question has been completed hence interrupting speaker.

h. Often has difficulty waiting their turn.

i. Often interrupts or intrudes upon others.

B. Several symptoms from (1) and/or (2) were present before age 12.

C. Several symptoms from (1) and/or (2) are present in multiple environments (occupational, home, with friends or relatives; other).

D. The symptoms are not better explained by another disorder. ^[1]

Diagnostician should specify whether symptoms are mild, moderate or severe according to the level of disturbance experience by the individual. The prevalence of ADHD is about 5% in children and about half that in adults according to survey data. Clinicians should take care to differentiate ADHD from substance use disorders by making sure that symptoms are present before and independant of substance use.^[1]

Specific learning disability occurs when perception and processing information efficiently and accurately is impossible. Specific learning disability is most commonly diagnosed when an individual fails to maintain expected level of functioning in reading, writing and/ or math. The individual’s performance in the field is well below average or acceptable level for that age. Specific learning disabilities may occur in individuals of any intellectual ability. Specific learning disability may only manifest during certain circumstances or tasks (eg. testing). ^[1]. For further reading, see Reading disorder, Mathematics disorder and Disorder of written expression.

Learning disorders are believed to be caused by a nervous system abnormality. The abnormality could either be in the structure of the brain or in the functioning of chemicals in the brain. Because of this, he individual has problems receiving, processing or communicating information normally. Some causes of the nervous system abnormality include problems during pregnancy, birth or early infancy, brain trauma at a young age, exposure to toxins, and prematurity.^[7]

The criteria for diagnosing a specific learning disability according to the DSM-5 are:

A. (at least 1 of the following over a period of 6 months or more)

1. Laborious and inaccurate word reading.

2. Difficulty comprehending meaning of text.

3. Difficulty spelling.

4. Displays poor written expression.

5. Difficulty with number sense or calculation.

6. Difficulty with mathematical reasoning.

B. The affected area is significantly below expected ability for the individual’s educational level. The deficits cause interference with individual’s life, as confirmed separately by standardized academic assessment (for individuals above school age, a documented history of impairment may be substituted for formal assessment).

C. The learning disability began during school age.

D. The deficits are not better accounted for by another explanation. ^[1]

The severity can be either mild, moderate or severe depending on the number of areas affected and by amount of support needed. Prevalence rates in children are estimated at between 5-%15%, whereas the prevalence is unknown in adults but is expected to be near 4%. ^[1]

Neurodevelopmental motor disorders is a category which includes developmental coordination disorder, stereotypic movement disorder and tic disorders. Developmental coordination disorder is characterized by by deficits in the mastery of motor skills and manifests as clumsiness, accuracy or slowness that is severe enough to impact daily completion of tasks. Stereotypic movement disorder is characterized by repetitive series of a small amount of movements performed by the individual, for example head banging, hand flapping, body rocking, self biting or hitting. Tic disorders are those disorders characterized by the presence of motor or vocal tics. A tic is categorized as sudden, rapid, nonrhythmic, recurrent vocal or motor activities. Tic disorders may be further specified to Tourette’s disorder, persistent (chronic) motor or vocal tic disorder, provisional, other or unspecified tic disorder.

In order to be diagnosed with developmental coordination disorder, an individual must have the following symptoms:

A. Acquisition of target skills is well below the norm for the individual’s cohort.

B. The deficit described in (A) causes consistent and significant impact on the individual’s daily life.

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

D. The deficit is not better explained by another disability or disorder. ^[1]

Other terms used to describe developmental coordination disorder are childhood dyspraxia, specific developmental disorder of motor function and clumsy child syndrome. The prevalence of this disorder is 5% in children aged 6-11. Males are two-to-seven-times more likely to be affected than females. ^[1]

In order to qualify for a diagnosis of stereotypic movement disorder an individual should show the following symptoms:

A. Repetitive, seemingly automatic and senseless pattern of movement (hand shaking, rocking, head banging or other).

B. The action in (A) caused social and/or physically harmful to the individual.

C. Onset is early in the developmental period.

D. The action in (A) is not otherwise better accounted for by another condition. ^[1]

The diagnosing clinician should specify if the individual is or is not injuring themselves due to the behaviour and whether there are also other factors present (such as environmental factors or another disorder also present). Simple versions of this are common in developing children (eg. babies rocking themselves), however, complex stereotypical movements occur in only about 3%-4% of the population. This occurs more frequently in children with intellectual disability, at a rate of about about 5%-15% . ^[1]

Another type of movement disorder is tic disorder. Tic disorders come in three main forms:

Tourette syndrome is diagnosed when:

A. An individual experiences (single or multiple) motor and vocal tics, though not necessarily at the same time.

B. The tics may vary in frequency but have been present for at least one year.

C. Onset is before age 18.

D. The tics are not attributable to substance abuse or other condition (eg. Huntington’s disease). ^[1]

Persistent (chronic) motor or vocal tic disorder (see tic and tic disorder) is diagnosed when:

A. Either (single or multiple) motor or vocal tics are present, but not both.

B. The tics may vary in frequency but have been present for at least one year.

C. Onset is before age 18.

D. The tics are not attributable to substance abuse or other condition (eg. Huntington’s disease). ^[1]

A diagnosis of provisional tic disorder is given when:

A. Either (single or multiple) motor or vocal tics are present, but not both.

B. The tics may vary in frequency but have been present for less than one year.

C. Onset is before age 18.

D. The tics are not attributable to substance abuse or other condition (eg. Huntington’s disease).

E. The criteria for Tourette’s syndrome or persistent (chronic) motor or vocal tic disorder have not been met. ^[1]

For any of the above, the clinician should specify whether the type of tic is motor, vocal or both. It has been shown that an individual’s tics are affected by external stimuli such as temperament and environment. Tics are often notably worse when an individual is exhausted, anxious or excited. Often, a person with tic disorder will mimic another sound, which may be perceived as purposeful mimicry, which is especially troublesome with authorities such as teachers or police. ^[1]

The DSM-5 gives clinicians two ways to give a diagnosis to a child who does not fully qualify for any of the above disorders, yet still experiences deficits which are significant enough to impact the individual’s life. The child may be diagnosed as having a specific neurodevelopmental disorder. This is done when the clinician wishes to communicate that the child does not meet another diagnosis for a specific reason, for example due to prenatal exposure to alcohol. Alternatively, the category of unspecified neurodevelopmental disorder may be diagnosed. This happens when a clinician notes than an individual suffers deficits, yet the symptoms do not provide sufficient information for a more specific diagnosis. ^[1]

The International Statistical Classification of Diseases and Related Health Problems was published in 1990 by the World Health Organization and is in use in its member states. The reviewed version, ICD-11 is anticipated to be released in 2018. ^[2]

• (F90.0) Disturbance of activity and attention
  • Attention-deficit hyperactivity disorder
  • Attention deficit syndrome with hyperactivity
• (F90.1) Hyperkinetic conduct disorder
• (F90.8) Other hyperkinetic disorders
• (F90.9) Hyperkinetic disorder, unspecified

• (F91.0) Conduct disorder confined to the family context
• (F91.1) Unsocialized conduct disorder
• (F91.2) Socialized conduct disorder
• (F91.3) Oppositional defiant disorder
• (F91.8) Other conduct disorders
• (F91.9) Conduct disorder, unspecified

• (F92.0) Depressive conduct disorder
• (F92.8) Other mixed disorders of conduct and emotions
• (F92.9) Mixed disorder of conduct and emotions, unspecified

• (F93.0) Separation anxiety disorder of childhood
• (F93.1) Phobic anxiety disorder of childhood
• (F93.2) Social anxiety disorder of childhood
• (F93.3) Sibling rivalry disorder
• (F93.8) Other childhood emotional disorders
  • Identity disorder
  • Overanxious disorder
• (F93.9) Childhood emotional disorder, unspecified

• (F94.0) Elective mutism
• (F94.1) Reactive attachment disorder of childhood
• (F94.2) Disinhibited attachment disorder of childhood
• (F94.8) Other childhood disorders of social functioning
• (F94.9) Childhood disorder of social functioning, unspecified

• (F95.0) Transient tic disorder
• (F95.1) Chronic motor or vocal tic disorder
• (F95.2) Combined vocal and multiple motor tic disorder (de la Tourette)
• (F95.8) Other tic disorders
• (F95.9) Tic disorder, unspecified

• (F98.0) Nonorganic enuresis
• (F98.1) Nonorganic encopresis
• (F98.2) Feeding disorder of infancy and childhood
• (F98.3) Pica of infancy and childhood
• (F98.4) Stereotyped movement disorders
• (F98.5) Stuttering (stammering)
• (F98.6) Cluttering
• (F98.8) Other specified behavioural and emotional disorders with onset usually occurring in childhood and adolescence
  • Attention deficit disorder without hyperactivity
  • Excessive masturbation
  • Nail-biting
  • Nose-picking
  • Thumb-sucking
• (F98.9) Unspecified behavioural and emotional disorders with onset usually occurring in childhood and adolescence