1)ADHD

ADHD is characterized by a pattern of behavior, present in multiple settings

(e.g., school and home), that can result in performance issues in social,
educational, or work settings. As in DSM-IV, symptoms will be divided into two
categories of inattention and hyperactivity and impulsivity that include behaviors like failure to pay close attention to details, difficulty organizing tasks and
activities, excessive talking, fidgeting, or an inability to remain seated in
appropriate situations.
Children must have at least six symptoms from either (or both) the inattention
group of criteria and the hyperactivity and impulsivity criteria, while older
adolescents and adults (over age 17 years) must present with five. While the
criteria have not changed from DSM-IV, examples have been included to
illustrate the types of behavior children, older adolescents, and adults with
ADHD might exhibit. The descriptions will help clinicians better identify typical
ADHD symptoms at each stage of patients lives.
Using DSM-5, several of the individuals ADHD symptoms must be present prior
to age 12 years, compared to 7 years as the age of onset in DSM-IV. This change
is supported by substantial research published since 1994 that found no clinical
differences between children identified by 7 years versus later in terms of
course, severity, outcome, or treatment response.
DSM-5 includes no exclusion criteria for people with autism spectrum disorder,
since symptoms of both disorders co-occur. However, ADHD symptoms must not
occur exclusively during the course of schizophrenia or another psychotic
disorder and must not be better explained by another mental disorder, such as a
depressive or bipolar disorder, anxiety disorder, dissociative disorder,
personality disorder, or substance intoxication or withdrawal.

Care Beyond Childhood

The ADHD diagnosis in previous editions of DSM was written to help clinicians
identify the disorder in children. Almost two decades of research conclusively
show that a significant number of individuals diagnosed with ADHD as children
continue to experience the disorder as adults. Evidence of this came from
studies in which individuals were tracked for years or even decades after their
initial childhood diagnosis. The results showed that ADHD does not fade at a
specific age.
Studies also showed that the DSM-IV criteria worked as well for adults as they
did for children but that a lower threshold of symptoms (five instead of six) was
sufficient for a reliable diagnosis.
In light of the research findings, DSM-5 makes a special effort to address adults
affected by ADHD to ensure that they are able to get care when needed.
2)Autism Spectrum Disorder(ASD)
One of the most important changes in the DSM-5 is to autism spectrum disorder
(ASD). The revised diagnosis represents a new, more accurate, and medically
and scientifically useful way of diagnosing individuals with autism-related
disorders.
Using DSM-IV, patients could be diagnosed with four separate disorders: autistic
disorder, Aspergers disorder, childhood disintegrative disorder, or the catch-all

diagnosis of pervasive developmental disorder not otherwise specified.

Researchers found that these separate diagnoses were not consistently applied
across different clinics and treatment centers. Anyone diagnosed with one of the
four pervasive developmental disorders (PDD) from DSM-IV should still meet the
criteria for ASD in DSM-5 or another, more accurate DSM-5 diagnosis. While DSM
does not outline recommended treatment and services for mental disorders,
determining an accurate diagnosis is a first step for a clinician in defining a
treatment plan for a patient.
The Neurodevelopmental Work Group, led by Susan Swedo, MD, senior
investigator at the National Institute of Mental Health, recommended the DSM-5
criteria for ASD to be a better reflection of the state of knowledge about autism.
The Work Group believes a single umbrella disorder will improve the diagnosis of
ASD without limiting the sensitivity of the criteria, or substantially changing the
number of children being diagnosed.
People with ASD tend to have communication deficits, such as responding
inappropriately in conversations, misreading nonverbal interactions, or having
difficulty building friendships appropriate to their age. In addition, people with
ASD may be overly dependent on routines, highly sensitive to changes in their
environment, or intensely focused on inappropriate items. Again, the symptoms
of people with ASD will fall on a continuum, with some individuals showing mild
symptoms and others having much more severe symptoms. This spectrum will
allow clinicians to account for the variations in symptoms and behaviors from
person to person.
Under the DSM-5 criteria, individuals with ASD must show symptoms from early
childhood, even if those symptoms are not recognized until later. This criteria
change encourages earlier diagnosis of ASD but also allows people whose
symptoms may not be fully recognized until social demands exceed their
capacity to receive the diagnosis. It is an important change from DSM-IV criteria,
which was geared toward identifying school-aged children with autism-related
disorders, but not as useful in diagnosing younger children.
The DSM-5 criteria were tested in real-life clinical settings as part of DSM-5 field
trials, and analysis from that testing indicated that there will be no significant
changes in the prevalence of the disorder. More recently, the largest and most
up-to-date study, published by Huerta, et al, in the October 2012 issue of
American Journal of Psychiatry, provided the most comprehensive assessment of
the DSM-5 criteria for ASD based on symptom extraction from previously
collected data. The study found that DSM-5 criteria identified 91 percent of
children with clinical DSM-IV PDD diagnoses, suggesting that
most children with DSM-IV PDD diagnoses will retain their diagnosis of ASD using
the new criteria. Several other studies, using various methodologies, have been
inconsistent in their findings.
3) Major Depressive Disorder and the Bereavement

Exclusion
Major Depressive Disorder (MDD) is a medical illness that affects how you feel,
think and behave causing persistent feelings of sadness and loss of interest in
previously enjoyed activities. Depression can lead to a variety of emotional and

physical problems. It is a chronic illness that usually requires long-term

treatment.
Using DSM-IV, clinicians were advised to refrain from diagnosing major
depression in individuals within the first two months following the death of a
loved one in what has been referred to as the bereavement exclusion. By
advising clinicians not to diagnose depression in recently bereaved individuals,
the DSM-IV bereavement exclusion suggested that grief somehow protected
someone from major depression.
As part of the ongoing study of major depression, the bereavement exclusion
has been removed from DSM. This change from DSM-IV, would be replaced by
notes in the criteria and text that caution clinicians to differentiate between
normal grieving associated with a significant loss and a diagnosis of a mental
disorder. Removing the bereavement exclusion helps prevent major depression
from being overlooked and facilitates the possibility of appropriate treatment
including therapy or other interventions.
While the grieving process is natural and unique to each individual and shares
some of the same features of depression like intense sadness and withdrawal
from customary activities, grief and depression are also different in important
aspects:
In grief, painful feelings come in waves, often intermixed with positive
memories of the deceased; in depression, mood and ideation are almost
constantly negative.
In grief, self-esteem is usually preserved; in MDD, corrosive feelings of
worthlessness and self-loathing are common.
While many believe that some form of depression is a normal consequence of
bereavement, MDD should not be diagnosed in the context of bereavement
since diagnosis would incorrectly label a normal process as a disorder.
Research and clinical evidence have demonstrated that, for some people, the
death of a loved one can precipitate major depression, as can other stressors,
like losing a job or being a victim of a physical assault or a major disaster.
However, unlike those stressors, bereavement is the only life event and stressor
specifically excluded from a diagnosis of major depression in DSM-IV.
While bereavement may precipitate major depression in people who are
especially vulnerable (i.e. they have already suffered a significant loss or have
other mental disorders), when grief and depression co-exist, the grief is more
severe and prolonged than grief without major depression. Despite some overlap between grief and MDD, they are different in important ways, and therefore
they should be distinguished separately to enable people to benefit from the
most appropriate treatment.

Changes to the Bereavement Exclusion

The diagnostic criteria proposed for the manuals next edition includes language
in the criteria for Major Depressive Disorder (MDD) to help differentiate between
normal bereavement associated with a significant loss and a diagnosis of a
mental disorder. DSM-5 will address the misconception that grief symptoms are
identical to those of MDD.
DSM-5 aims to provide an accurate diagnosis for people who need professional
help and no diagnosis for those who do not. Therefore there are several

proposed strategies to help clinicians using DSM-5 differentiate major

depression, normal bereavement and pathological bereavement, including
changes in diagnostic criteria as well as in the text.
The text in DSM-5 seeks to clarify that the normal and expected response to a
significant loss may resemble a depressive episode. The presence of symptoms
such as feelings of worthlessness, suicidal ideas (as distinct from wanting to join
a deceased loved one), and impairment of overall function suggest the presence
of major depression, in addition to the normal response to a significant loss.