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Diagnostic Statistical Manual of Mental Disorders (DSM) is publised by the American Psychiatric Association (APA) as a tool to diagnose mental disorders. DSM 5th edition was published in 2013 and its DSM-5 text revision (DSM-5-TR) was published in 2021 as an addendum to DSM-5 and includes additional content and updated diagnostic codes.

The International Classification of Diseases, Eleventh Revision (ICD-11), is a diagnostic manual for medical conditions, including mental and behavioural disorders. It is produced by the World Health Organization (WHO) and is intended to be used by healthcare professionals worldwide. The ICD-11 includes many updates and changes from the previous version, the ICD-10, including changes to the classification and diagnostic criteria for mental and behavioural disorders. Some of the changes in the ICD-11 include the addition of new disorders, such as gaming disorder and prolonged grief disorder, and the removal of others, such as Asperger’s syndrome.

The DSM is primarily used in the United States and Canada, focuses on symptom-based diagnosis, and includes a large number of mental disorders. The ICD, on the other hand, is used globally for both medical and public health purposes, classifies disorders based on their underlying causes, and includes a vast array of medical and mental health conditions. Overall, there are some notable differences between DSM-5-TR and ICD-11 in terms of functional impairments, duration criteria, and the classification of certain disorders such as Prolonged Grief Disorder (PGD) and attenuated psychotic symptoms. However, both systems have introduced harmonised time course criteria and dimensional assessments.

A disability is a functional limitation of our physical (including blindness, deaf, handicapped), neurological (autism spectrum disorder, attention deficit-hyperactive disorder, developmental delay) or psychological (including anxiety disorder, panic disorder, post-traumatic stress disorder, depression, bipolar disorder, schizophrenia) structure that causes us a lack of ability to perform routine activity within the range considered as normal. 

A disorder is a medical condition that mainly relates to mental health (neurological and psychological). The DSM-5-TR defines “disorder” as “a syndrome characterised by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning“. 

Commonly known mental disorders are autism spectrum disorder (ASD), attention deficit-hyperactive disorder (ADHD), dyslexia, dyscalculia, dysgraphia, dyspraxia, eating disorder, depression, anxiety disorder, dissociative disorder, obsessive compulsive disorder (OCD), oppositional defiant disorder (ODD), conduct disorder (CD), antisocial personality disorder, (ASPD), paranoia, neuroses, psychoses, Alzheimer’s disease, Parkinson disease and schizophrenia etc. Many rare disorders also vary from mild to severe, which warrants for different types and intensity of treatment and therapy.

A disease is construed as a medical condition associated with specific symptoms and signs that affects the structure or function of all or part of our body organism, not caused by physical injury. Most people understand a disease to be caused by pathogens (bacteria, virus, fungi and microorganisms) that maybe infectious. However, not all diseases are caused by pathogens and not all of them are infectious. Autoimmune diseases, cardiovascular disease, cancer, diabetes, Alzheimer’s disease, Parkinson’s disease and Huntington’s disease etc., are non-communicable.

A difficulty is often known as a phase of struggle or challenge or in the condition of being difficult. It impedes a person encountering it from achieving a goal or aim. When the aim is redundant, the struggle in achieving the aim becomes less apparent. The disability, disorder and disease the person has encountered may inherently create a difficulty and prevent him or her to achieve a desired result. In the context of academic learning, the United Kingdom’s National Health Service defines a ‘learning difficulty’ as ‘a type of Special Education Needs, which affects areas of learning, such as reading, writing, spelling, mathematics etc‘.  

A neurological disorder impairs the functions of neurons and the brain systems. In other words, genetic variants have caused impairment of the protein synthesis in the neurons affecting how the neurons synapse with each other. The neurological disorder has three components: neurodevelopmental disorder, neurodegenerative disorder and neurocognitive disorder. Examples of neurodevelopmental disorders are autism spectrum disorder (ASD), attention deficit hyperactive disorder (ADHD), dyslexia, down syndrome and mental retardation etc. Examples of neurodegenerative disorders are Alzheimer’s disease, parkinson disease, multiple sclerosis and motor neuron disease etc. Genetic variants are heritable in nature and/or could be caused by environmental toxicity relating to radioactivity, existence of heavy mental in food and pollution etc.

A psychological disorder is an ongoing dysfunctional pattern of thought, feeling & emotion, and behaviour that causes significant distress, and that is considered deviant in that person’s culture or society (Butcher, Mineka, & Hooley, 2007). Individual with the psychological disorder will find his/ her daily functions impaired, family life disrupted and have to face unfriendly social environment leading to social withdrawal. Examples of psychological disorders are anxiety disorders, depression, bipolar disorder, paranoia, post-traumatic stress disorder (PTSD), conduct disorder (CD), oppositional defiant disorder (ODD), various personality disorders. These psychological disorders could be treated with psychotherapy and counseling, as alternative to pharmacological treatment.

The neurodevelopmental and psychological disorders have varying degree of severity and are not mutually exclusive. They could cause learning difficulties in a child due to the impairment in memory, language, motor skills, speech, behaviour, cognitive abilities, social skills, emotion regulation skills. Intervention programs drawn up by a qualified educational therapist will effectively assist the child to overcome the learning difficulties.

Neurocognitive disorders refer to a broad range of conditions such as delirium, traumatic brain injury, infections, vascular disorders and exposure to toxins, that impair cognitive functions, including memory, attention, perception, and problem-solving, including but not limited to neurodegenerative diseases.

Neurodegenerative disorders are a type of neurological disease that involve the progressive loss and death of neurons, which can lead to cognitive, motor, and sensory functions impairment. Examples of neurodegenerative disorders include Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and Amyotrophic lateral sclerosis (ALS). 

By DSM-5-TR definition, ADHD is characterised by predominant symptoms of inattention, hyperactive and impulsivity. It affects about 5% of the children and adolescents worldwide. Other common comorbidity disorders associated with ADHD include intellectual disability, anxiety disorders and learning difficulties as well as functional impairment such as low educational attainment, high unemployment and peer rejection etc. More than 60% of these can also be persisted into adulthood. 

ADHD could be both caused by heritable genetic factors and/ or linked to inadequacy in care provision given at the early years of the person diagnosed with it. The inadequate care provision at the early years could have caused growth stunting and developmental delay leading to neurodevelopmental impairment at the prefrontal lobe and limbic system, especially the amygdala. Impairment at the prefrontal lobe leads to inattention and self-control, leading to impulsivity and hyperactive traits of the child. Impairment in the limbic system leads to both disinhibited social engagement traits, oppositional defiant disorder (ODD) and conduct disorder (CD).   

Various pharmacological medications are available to treat ADHD in reducing the core symptoms, mainly by improving brain circuits in targeting the neurotransmitters pathways. Counseling for family including guiding the parents the techniques in improving family interactions & implementing behavioural techniques, and social learning based approach have positive effect on conduct problems, challenging behaviours and social skills of ADHD.

By DSM-5-TR definition, disruptive behaviour disorders are a group of mental health conditions that involve patterns of defiant and hostile behaviours that persist for at least six months and cause significant impairment in social, academic, and/or occupational functioning. These behaviours often violate the rights of others, and can involve aggression, destruction of property, or rule-breaking. Here are some of the most common disruptive behaviour disorders:

1. Oppositional Defiant Disorder (ODD): Children with ODD display a persistent pattern of angry and irritable mood, argumentative and defiant behaviour, and vindictiveness towards authority figures like parents, teachers, and other adults. This behaviour can cause significant distress for the child and their family and can lead to impaired social and academic functioning. 

2. Conduct Disorder (CD): Conduct disorder involves persistent patterns of aggressive and antisocial behaviour, including physical violence, theft, and deceitfulness. Children with CD may disregard the rights and feelings of others, violate rules and laws, and engage in risky behaviours such as substance abuse or sexual activity. CD can lead to significant impairment in social and academic functioning, and may progress to more serious behavioural and legal problems in adulthood.

3. Intermittent Explosive Disorder (IED): IED is characterized by sudden episodes of uncontrollable anger or aggression that are disproportionate to the situation. These outbursts may involve physical violence, destruction of property, or verbal aggression, and can cause significant distress and impairment in social and occupational functioning. 

4. Disruptive Mood Dysregulation Disorder (DMDD): DMDD is a relatively new diagnosis that involves severe and persistent irritability and temper outbursts that are disproportionate to the situation. These behaviours may occur frequently and can cause significant impairment in social and academic functioning.

5. Pyromania: Pyromania involves a persistent and intense fascination with fire and setting fires, which can cause significant harm to self, others, or property. Pyromania is a rare diagnosis and is often associated with other mental health conditions like ADHD, depression, or conduct disorder. 

6. Kleptomania: Kleptomania is a mental health disorder where the affected person experiences difficulty in controlling their emotions or behaviour. It involves a persistent and recurrent urge to steal objects that are not needed for personal use or monetary gain. Kleptomania is a rare diagnosis and is often associated with other mental health conditions like depression and anxiety disorders.

By DSM-5-TR definition, Autism Spectrum Disorder (ASD) recognises three persistent deficits in three core behavioural symptoms: (1) impairment in verbal and non-verbal communication; (2) deficit in social reciprocity; (3) highly restricted, fixated interests and repetitive motor movements. The main cause for such the high heterogeneous neurodevelopmental disorder is genetic factors, such as Asperger Syndrome, Phelan McDermid Syndrome, Rett Syndrome, Pervasive Developmental Disorder, Heller Syndrome etc. It is also highly prevalent in people who are diagnosed with Fragile X Syndrome, Tuber Sclerosis, Cohen, Smith Magenis Syndrome, Angelman Syndrome etc. ASD affects close to 2% of the population worldwide. Males have four times more of a prevalent rate than females. It is also considered as highly heritable, running in the family as high as 80% to family history of genetic disorder conditions.

These genetic disorders substantially affect the functional structure of the neurons and their synapses between the neurons. It is highly likely that the genes implicated in ASD overlaps and comorbid with other neurodevelopmental disorders such as intellectual disabilities, ADHD, speech and language impairment, oppositional defiant disorder and epilepsy etc. 

ASD is a lifelong diagnosis. There is no specific medication to treat ASD and its symptoms. An accurate and comprehensive psychoeducational diagnostic assessment (PDA) at the early onset of the ASD is essential to understand in depth the varying degree in severity of the condition the child is encountering before individualising any learning and treatment programs. Some children with milder symptoms can learn how to manage the disorder more effectively than others. Hence, appropriate early intervention programs (EIP) conducted by an educational therapist is beneficial and could benefit from the greater brain plasticity at the younger age of the child and is more effective in reducing a developmental trajectory towards ASD effectively. EIP or different types of therapies become the prevalent and effective frontline treatment for ASD. They are able to modify atypical ASD related behaviours during development. Improved social interaction between the caregiver and the infant has resulted in raising infant attentional flexibility. Both early diagnosis and intervention programs display higher efficacies.

Well established parenting training also has efficacy for children with ASD. As it has therapeutic effects for the parents as it reduces parenting stress resulting from the ASD children’s disruptive behaviours. The parenting training also improves their capacity to cope and improve interactions with the ASD children. The child with ASD in turns benefits from the reduction of parental stress and effectively improves their disruptive behaviours and anxiety.