Neurodevelopmental Disorders

Neurodevelopmental disorders

neurologically based disorders that are revealed in clinically significant way during a child’s developing years and typically persist into adulthood

ADHD

a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or developing

How many symptoms are needed to classify as inattention ADHD

6+ symptoms

What are some symptoms of Inattention ADHD?

often fails to give close attention to details or make careless mistakes in schoolwork/at work/during other activities, often has difficulty sustaining attention in tasks or play activities, often does not seem to listen when spoken to directly, often has difficulty organizing tasks/activities, and is often easily distracted by extraneous stimuli 

How many symptoms are needed to classify as Hyperactivity + Impulsivity ADHD

6+ symptoms

What are some symptoms of Hyperactivity + Impulsivity ADHD

often fidgets with/taps/hands/feet/squirms in seat, often runs about/climbs in situations where it is inappropriate, often unable to play or engage in leisure activities quietly, often talks excessively, often blurts out an answer before a question has been completed, and often interrupts/intrudes on others 

ADHD symptoms are present prior to? and present in?

age 12; 2 or more settings

ADHD must have clear evidence that symptoms?

interfere with, or reduce the quality of social, academic, or occupational functioning

ADHD symptoms do not occur? 

exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder 

What are the types of ADHD?

Predominantly inattentive presentation, predominantly hyperactive/impulsive presentation, and combined type

Executive functioning

brains ability to operate in the world effectively; made up of a lot of different skills and capacities and help us move around the world successfully

Examples of executive functioning 

Working memory, flexibility, planning, task initiation, attention, time management, metacognition, and emotional control 

ADHD Prevalence: What is the main takeaway?

Boys are more frequently diagnosed with ADHD across all age groups

ADHD might be underdiagnosed in ____ or overdiagnosed in ____

girls; boys

ADHD course: Symptoms typically appear around ages? 

3 to 4 

____ of children with ADHD continue to have difficulties as ____

Half; adults

Impulsivity ____, but the inattention _____

decreases; remains

ADHD Biopsychosocial Causes: Biological factor 

genetic contributions, neurobiological correlates, and toxins 

Runs in families, smaller brain volume, inactivity of frontal cortex/basal ganglia, abnormal frontal lobe development/functioning, and maternal smoking increase risk 

ADHD Biopsychosocial Causes: Psychological + Social Factors

Children are often viewed negatively by others leading to frequent negative feedback from peers and adults 

Peer rejection and resulting social isolation may lead to low self-esteem 

The goal of ADHD Treatment

reduce impulsivity and hyperactivity, as well as to improve attention

Stimulant medication

ritalin and adderall

Non-stimulation medication 

Strattera 

What are things to know about ADHD Medication

some trial and error is often necessary to find the right medication

medications can improve compliance, decrease unwanted behaviors

medication do not affect learning or academics

benefits of medication do not last after discontinuation

What are other ADHD treatments?

behavioral treatment for children, parent training for children, and cognitive behavioral therapy for adults

When we think about learning disorders, think about: 

academic problems in reading, mathematics, and/or writing 

performance substantially below expected levels based on age and/or demonstrated capacity 

Learning disorder problems persist for?

6 or more months despite targeted intervention

What are the specific learning disorder specifications?

with impairment in reading (word reading accuracy, reading rate or fluency reading comprehension)

with impairment in mathematics (number sense, memorization of arithmetic facts, accurate or fluent calculator, accurate math reasoning)

with impairment in expression (spelling accuracy, grammar and punctuation accuracy, clarity or organization of written expression)

Childhood-Onset Fluency Disorder: Clinical Description 

A disturbance in speech that includes problems with speech, such as: 

• repeating syllables

• prolonging certain sounds 

• making obvious pauses 

• substituting words that are difficult to articulate

Childhood-Onset Fluency Disorder: Statistics

2x as likely in boys

typically begins by age 6 with 98% before the age of 10

80% of children will recover after a year in school

Childhood-Onset Fluency Disorder: Etiology

Multiple brain pathways involved, genetic influences, and may cause symptoms of social anxiety

Childhood-Onset Fluency Disorder: Treatment 

regulated breathing method—take a deep breath when stuttering before proceeding 

self-monitoring 

Language Disorder: Clinical description

limited speech in all situations, expressive language (what is said) is significantly below receptive language (what is understood), and receptive language is usually average

Language Disorder: Statistics

10-15% of children younger than 3 years old

5x as likely in boys

Language Disorder: Etiology 

middle ear infection may be a contributing cause 

Language Disorder: Treatment

may be self-correcting and not require treatment

Social (Pragmatic) Communication Disorder: Clinical Description

Difficulties with the social aspect of verbal and nonverbal communication, including verbosity, excessive switching of topics, and dominating conversations

Social (Pragmatic) Communication Disorder: Statistics 

number of cases are rising 

Social (Pragmatic) Communication Disorder: Etiology

limited information

Social (Pragmatic) Communication Disorder: Treatment

individual social skills training (modeling, role playing) with an emphasis on teaching important rules necessary for carrying conversation with others

Tourette’s Disorder: Clinical Description 

involuntary motor movements (tics), such as head twitching, or vocalizations, such grunts, that often occur in rapid succession, come on suddenly, and happen in idiosyncratic or stereotyped ways 

Tourette’s Disorder: Statistics

usually develops before age 14

high comorbidity between tics + ADHD, and tics + OCD

Tourette’s Disorder: Etiology

genetic component

Tourette’s Disorder: Treatment 

self monitoring, relaxation training, and habit reversal training  

To meet criteria for Autism Spectrum Disorder, two major characteristics are required:

impairment in social communication and social interaction

restricted, repetitive patterns of behaviors, interests, or activities

Impairment in social communication and social interaction: Deficit in social-emotional reciprocity

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

Impairment in social communication and social interaction: Deficits in nonverbal communicative behaviors used for social interactions

from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to total lack of facial expressions and non-verbal communication

Impairment in social communication and social interaction: deficits in developing, maintaining, and understanding relationships

from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play and in making friends; to absence of interest in peers

Restricted, repetitive patterns of behavior, interests, or activities: stereotypes or repetitive motor movements, use of objects, or speech 

lining up toys, echolalia, and idiosyncratic phrases 

Restricted, repetitive patterns of behavior, interests, or activities: Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

extreme distress at small changes, difficulties with transitions, rigid thinking patterns

Restricted, repetitive patterns of behavior, interests, or activities: highly restricted

fixated interests that are abnormal in intensity or focus

Restricted, repetitive patterns of behavior, interests, or activities: hyper or hypo reactivity to sensory input or unusual interest in sensory aspect of the environment

indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement

To meet criteria for ASD: symptoms must be present

in the early developmental period

To meet criteria for ASD: symptoms cause clinically significant

impairment in social, occupational or other important areas of current functioning

To meet criteria for ASD: disturbances not better explained by

intellectual development disorder or global developmental delay (can be comorbid)

Prevalence + Incidence for ASD

pretty significant increase in both the prevalence and incidence of Autism (from 2000-2020)

Prevalence + Incidence: 2000 

1 in 150 children 

Prevalence + Incidence: 2020

1 in 36 children

What are some reasons why Autism appears to be increasing?

increased understanding of autistic experiences, changes in the diagnostic criteria viewing autism as a spectrum, understanding that anyone of any gender/age/race can be autistic, an acknowledgment that autistic people can mask, reduced stigma can encourage more people to seek a diagnosis, and recognizing people can have co-existing conditions

ASD: Biopsychosocial Dimensions

significant genetic component, numerous genes on a number of chromosomes, older parents associated with increased risk, and amygdala larger at birth,

Vaccines or medications ___ ___ cause autism

do not

Autism Diagnostic Observation Schedule (ADOS-2)

semi-structured, play-based observation

Autism Diagnostic Interview-Revised (ADI-R) 

structured caregiver interview 

Social Responsiveness Scale (SRS-2) or Social Communication Questionnaire (SCQ)

screening/questionnaire for social reciprocity and communication

ASD treatment goal

improve communication, social engagement, and adaptive functioning, while reducing behaviors that interfere with learning or daily life

Behavioral interventions for ASD 

applied behavior analysis; uses reinforcement principles to increase desired behaviors and teach new skills

What is the most effective kind of treatment for ASD?

early, intensive, multi-modal, tailored interventions

Intellectual disability

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 for intellectual disability 

deficit in intellectual functions, deficits in adaptive functioning, and onset of intellectual and adaptive deficits during the developmental period

Adaptive functioning can fall within these three areas:

academic, social, and practical

Intellectual Disability: Mild

about 55-70 IQ

Intellectual Disability: Moderate

about 35-55 IQ

Intellectual Disability: Severe

about 20-35 IQ 

Intellectual Disability: Profound

about 25 and below IQ

Severity is based on ___ ___ not __

adaptive functioning; IQ

Adaptive functioning determines? 

service eligibility, educational placement, and treatment goals 

Adaptive skills can ___ with intervention

improve

Cultural and socioeconomic context matters:

what counts as “adaptive” varies across communities

What are the many possible causes of intellectual disability 

genetic influences, chromosomal influences, environmental, prenatal, perinatal, and postnatal