Ch13 Concepts: Neurodevelopmental Disorders

What’s a neurodevelopmental disorder, and how is age & environment important for diagnosis?

• Neurologically based disorder revealed in a clinically significant way during a child’s developing years 🧒

• Age & environment is important; you must understand when symptoms appeared and where/how they manifest in the child’s daily life.

Communication/Motor Disorder: Childhood Onset Fluency

1. Previously “stuttering”: major speech problems (pauses, substitutes words)

2. Gender: 2x more males than females ♂

3. Onset: by age 6 🧒

4. Course: 80% stop stuttering after 1-2 years in school

5. Causes: multiple brain pathways and possible genetic influences

6. Behavioral treatment: teach regulated breathing method; deep breath if start to stutter 🫁

   1. Electronic auditory feedback to improve speech

   2. Self-monitoring to modify your own speech with difficult words (what letters set you off? Is it a T or S sound?)

What’s a neurodevelopmental disorder, and how is age & environment important for diagnosis?

• Neurologically based disorder revealed in a clinically significant way during a child’s developing years 🧒

• Age & environment is important; you must understand when symptoms appeared and where/how they manifest in the child’s daily life.

Communication/Motor Disorder: Childhood Onset Fluency

1. Previously “stuttering”: major speech problems (pauses, substitutes words)

2. Gender: 2x more males than females ♂

3. Onset: by age 6 🧒

4. Course: 80% stop stuttering after 1-2 years in school

5. Causes: multiple brain pathways and possible genetic influences

6. Behavioral treatment: teach regulated breathing method; deep breath if start to stutter 🫁

   1. Electronic auditory feedback to improve speech

   2. Self-monitoring to modify your own speech with difficult words (what letters set you off? Is it a T or S sound?)

Communication/Motor Disorder: Language Disorder

• Limited speech in all situations, but normal understanding of speech. Restrictions: decreased vocab and sentence structure.

• Diagnosis: before 3 (10-15%)

• Gender: 5x more males than females ♂

• Causes: middle ear infection affects hearing 👂

• Treatment: may be self-corrected and do not require treatment

Communication/Motor Disorder: Social (Pragmatic) Communication Disorder

• Difficulties with the social aspects of verbal and non-verbal communication

• Symptoms:

  • Problems: Social aspects of communication (dominates conversation, switches topics excessively)

  • Functional limitations: decreased understanding of non-explicit speech, like inferences

  • Lacks other autism features: like restricted behaviors

• Causes & prevalence: unknown

• Treatment: individualized social skills training (modeling, roleplaying), increased appropriate communication strategies

Communication/Motor Disorder: Tourette’s Disorder

• Symptoms: involuntary movements and vocalization (twitches, grunts); rapid and sudden succession. Idiosyncratic or stereotypic ways. Tics often include repetitions of obscenities.

• Statistics: 1-10 out of 1,000 people have Tourette’s

• Onset: before age 14

• High Comorbidity: with tics, ADHD, and OCD

• Causes: multiple vulnerability genes that affects form and severity of tics

• Treatment: self-monitoring, relaxation training, habit reversal

Statistics: ADHD 🧒

1. Prevalence: 5% of all kids report with 1 or another form of ADHD

2. Onset: as early as 3 or 4 (often not diagnosed until age 7)

3. ADHD children to adults: not clear, but adults have half the rate!

4. Gender: 3x more males than females ♂

5. Cultural factors: consistent across cultures, but diagnosed more in US

Biological Causes: ADHD

1. Genetics: runs in families. Dopamine transporter gene (DAT1) decreases dopamine transport to next neuron, impacting ability to stay focused 🧬

2. Neurobiological correlates: smaller brain size or volume, lower activity in frontal cortex and basal ganglia, abnormal frontal lobe development and functioning 🧠

3. Toxins/poisons: food additives (dyes, very little role), maternal smoking increases risk 🚬🤰

Psychosocial Causes: ADHD

1. Negative social interactions 🗣 ❌

2. Viewed negatively by others due to frequent negative feedback by peers and adults 😥

3. Peer rejection increases risk of social isolation and withdrawal

4. Decreased self-esteem and self-worth results 🔽

Medical Treatments: ADHD

1.  Goals: increase focus and attention, decrease impulsivity and hyperactivity ✅

2. Stimulants: 4 million (Ritalin)

   1. Low doses: increase focus and attention 🔼

   2. Later substance abuse may increase later substance use/abuse

3. Effectiveness: increases compliance and obedience, decrease negative attention-seeking behaviors

   1. Genes may affect medication response: some trial and error 🧬

   2. Other medications (anti-hypertensives): limited effect 💊❌

   3. Benefits: Not long lasting if discontinued

   4. No direct effect on learning and academic performance: increase attention and focus 🔼

Psychological Treatment: ADHD

•  Behavioral therapy: Reinforcement programs

  • Increase appropriate behaviors: sit quietly, pay attention

  • Decrease inappropriate: fidgeting, bothering others

  • Parent training, token economies: set up “reward” system for doing things 🪙

• Combining medications and behavioral therapy is often recommended; it’s better than those two alone, but more research is needed.

DSM-5 Subtypes: ADHD

1. Predominantly inattentive: Quiet, withdrawn; daydreams💤

1. Predominantly hyper-active impulsive: Seeks attention, higher energy 🐶

2. Combined: both predominantly inattentive and hyper-active impulsive

Symptoms + Settings: ADHD

Greater than or equal to 6 months of increased inattention, overactivity, and impulsivity

1. Inattention: greater than or equal to 9 symptoms of difficulty focusing, easily distracted

2. Hyperactivity/impulsivity: greater than or equal to 6 of 9 symptoms of fidgeting, talking excessively, bothering others

3. Major Impairments: poor grades, peer rejection, difficulty focusing 📉

4. Settings: 2 or more = true ADHD 🏠

Statistics: Specific Learning Disorders

• Prevalence: 6 million

• Demographics: More African Americans (3%) than Whites (1%)

• Low SES: increase learning disorder problems 📉

• High SES: are able to be tested and diagnosed more through support services 💵

• Most common learning disorder is reading: 4-10% 📚

• Negative school experience: more dropout, unemployment, suicidal thoughts and attempts 🏫🔽

Biological/Psychological Causes: Specific Learning Disorders

1. Genetic and neurobiological issues: runs in families, specific “types” not inherited 🧬

   1. “Subtle” neurological difficulties: decreased functioning in certain brain areas 🧠🔽

2. Psychosocial issues

   1. SES and cultural factors: parental expectations; helps with HW 📚

   2. Child management practices: desk to study, HW before TV/video games 🕹

   3. Types of school support available: tutoring, special room for testing

Treatment: Specific Learning Disorders

1. Intense educational interventions 📚

   1. Remediation: basic processing issues (writing clearer letters and numbers)

   2. More cognitive and other skills to compensate for weaknesses

2. Effectiveness: Positive outcomes! ✅

   1. FMRI study: changes in brain processing showed that Learning disorder students’ post-treatment show similar processing to non-LD students

Subtype Impairments: Specific Learning Disorders

1. Reading: accuracy, comprehension 📚

2. Written expression: spelling, grammar ✍

3. Math: number sense, math reasoning ➕

Symptoms: Specific Learning Disorders

Last for greater than 6 months: math, reading, or writing problems and performance is well below expected levels

Statistics: Autism Spectrum Disorders

• Gender: 4x more males than females

• Prevalence: as high as 1 in 50

Symptoms: Autism Spectrum Disorders

1. Persistent/pervasive problems that affects multiple life functions/areas: often decrease language, socialization, cognition skills 🔽

2. Major impairment areas

   1. Deficits in communication and social interaction

      1. Lacks communication or has unusual communication: 25% lack effective speech

      2. Lacks interest in others or unaware of others’ identities: Lacks joint attention (shared/common focus with others)

   2. Restricted behaviors, interests, activities

      1. Maintenance of sameness: often must stick to strict schedules/routines

      2. Stereotyped and ritualistic behaviors (stimming): repetitive movements (rocking, hand flipping)

Biological Causes: Autism Spectrum Disorders 🧬

1. Genetic contribution: risk of having a 2^nd ASD child is 20x, which is 100x higher risk than for the general population

2. Multiple genes/chromosomes: oxytocin receptor genes contribute to bonding and social memory. Having decreased oxytocin lowers social bonding, trust, and social memory

3. Older parents at birth: gives you a higher ASD risk 👵

4. Amygdala: Larger size at birth increases cortisol, thus more anxiety and fear. More withdrawal from social experiences occur.

5. Vaccinations (mercury): NO SUPPORT TOWARDS THIS IDEA!

   1. Lancet: Retracts 1998 Wakefield’s article, who was paid $647k by lawyers to sue vaccine makers. Some people had ASD before vaccines, others never had ASD. Wakefield was fired from the university and his medical license revoked!

Psychological/Social Causes: Autism Spectrum Disorders

1. Historical views: not supported ❌

   1. Poor parenting: cold, aloof, rejecting

   2. Lack of self-awareness

2. Unusual speech and behavioral patterns

   1. Refers to self in third person

   2. Echolalia: repeats/mimics others’ words

   3. Self-injurious behavior: head banging, biting

Prognosis: Autism Spectrum Disorders

• Depends on IQ Level

• Intellectual disabilities: 38%

• Higher IQ and stronger language skills: better long-term prognosis

Childhood Disorders: Autism Spectrum Disorders

1. Childhood Disintegrative Disorder

2. Rett disorder

3. Asperger’s syndrome

4. High Functioning ASD (must assess from low to high functioning)

Psychosocial Treatment: Autism Spectrum Disorders 🗣

• Mostly behavioral therapy

• Increase socialization, social skills building, communication and language training, and naturalistic teaching strategies (teaching in many settings to generalize skills)

• Decrease self-harm problem behaviors 🔪🔽

• Early intervention is critical to normalize the functioning of the developing brain! 🧠

Biological/Integrated Treatment: Autism Spectrum Disorders 💊

• Medications have little effect on core dysfunction, but some meds (SSRIs) decrease agitation

• Integrated treatments

  • Preferred model: multidimensional and comprehensive

  • Increase family education and support, communication/social skills in special education, and with increased age, increase community integration and independence 👨‍👩‍👦 🩷

3 domains (DSM-5) w/ several conditions/levels: Intellectual Disability

1. Conceptual skills: language, memory 💭

2. Social skills: social judgment, friendships 🗣

3. Practical skills: self-care, job skills 🧼

Statistics: Intellectual Disability

• Prevalence: 2%; 90% have a mild IQ of 50-70

• Onset: identified in early childhood 🧒

• Course: pervasive and chronic even with treatment 😢

• Prognosis: highly varied. Those with mild intellectual disability are more independent with support and resources through skills training and minor supervision.

• Symptoms show below average intellectual functioning, with a typical IQ of less than 70-75. Functional impairment can vary!

Biological - Genetics & Mutation Causes: Intellectual Disability 🧬

1. Chromosomal disorders: Down Syndrome (extra 21 chromosome)

2. Single gene disorders: Mutated/recessive gene (Lesch-Nyhan Syndrome for males only); recessive allele on X chromosome

   1. Symptoms: intellectual disorder, cerebral palsy, self-injurious behaviors (bites off lips/fingers)

3. Multiple genetic mutations: abnormalities in many genes

4. De Novo disorders: mutation in the sperm, egg, or post-fertilization 🥚

5. Most IDD cases have NO identified or known causes.

Cultural & Familial Causes: Intellectual Disability 👪

1. Milder forms of intellectual disorders are mostly caused by environmental factors

2. Social-environmental factors 🌏

   1. Major illnesses or diseases increase social isolation or withdrawal 😷

   2. Interaction between Biological and Environmental factors increase negative social response (abuse/neglect, orphaned) ❌

Environmental - Neonatal & Early Natal Causes: Intellectual Disability 🧒

1. Prenatal (pre-birth, fetus in womb): exposed to disease or drugs through mom (Fetal Alcohol Syndrome) 🍺

2. Perinatal (during birth process): labor or delivery problems (Anoxia or lack of oxygen) 🫁

3. Postnatal (post birth): Environmental factors, accidents (head injury, lead poisoning from paint, malnutrition) 💀

Down’s Syndrome: Intellectual Disability Disorder

• #1 chromosomal cause

• Higher maternal age increases risk 👵

Fragile X Syndrome (mostly male): Intellectual Disability Disorder

• #1 single-gene cause

• Symptoms: learning disability, short attention, hyperactivity, elongated face, large ears 👂🔼

• Girls with Fragile X: have milder symptoms due to an extra healthy X chromosome ♀

Phenylketonuria (PKU): Intellectual Disability Disorder

• At birth, have normal brain functioning 🧠

• Lacks enzyme to break down phenylalanine. More phenylalanine in the brain causes permanent brain damage.

• Testing needed at birth; diets without phenylalanine decrease risk of brain damage 🔽

Specific treatments for Intellectual Disability?

First, assess level of support: intermittent, limited, extensive, pervasive

1. Behavioral interventions to increase:

   1. Basic life skills: personal hygiene, dressing 🧼👕

   2. Practical skills: paying bills, finding a job 💵

   3. Social skills: communication, friendships 🗣

2. Treatment depends on Intellectual Disorder level

   1. Mild: similar to learning disability (LD)

   2. Severe: similar to Autism Spectrum Disorder (ASD)

   3. Goals: similar across severity levels. Figure out the required level of assistance and support.