Neurodevelopmental Disorders

What are the defining characteristics of neurodevelopmental disorders?

1. Typical onset before puberty

2. Clinical course steady in the long term, rather than remitting/relapsing

3. Early onset neurocognitive deficits

4. More commonly diagnosed in males

5. High heritability, aetiology multifactorial

6. High level of overlap

What neurodevelopmental disorders are there, according to the DSM-V?

AD(H)D

Autism

Intellectual Disability

Communication Disorders

Specific Learning Disorders

Motor Disorders (e.g. tic disorders)

What are the “inattention” symptoms found in ADHD?

✦ Inattention to details / makes careless mistakes ✦ Difficulty sustaining attention

✦ Seems not to listen

✦ Fails to finish tasks

✦ Difficulties organizing

✦ Avoids task that require mental effort

✦ Loses things

✦ Easily distracted

✦ Forgetful

What are the “hyperactivity” symptoms found in ADHD?

✦ Blurts out answer before question is finished

✦ Difficulty awaiting turn

✦ Interrupts or intrudes on others

✦ Fidgets

✦ Unable to stay seated

✦ Inappropriate running/climbing (restlessness)

✦ Difficulty in engaging in leisure activities quietly ✦ “On the go”

✦ Talks excessively

What conditions must be met in order for someone to be diagnosed with ADHD?

➡ 6 or more symptoms (5 or more when >16y) ➡ present at least 6 months ✦ Present before age 12 ✦ Present in two or more settings ✦ Interfere with quality of life

How may ADHD be noticed in childhood?

Difficulties at school

Impulsivity

Repetitive failure

ODD

Multiple injuries

How may ADHD be noticed in adolescence?

Underachievement, no high school graduation Carelessness, substance abuse, unwanted pregnancy

Hopelessness, frustration, depression, anxiety

Criminal involvement

Risk taking, accidental injuries

How do the symptoms of ADHD develop over the lifespan?

What is the aetiology of ADHD?

In utero:

• Genetic predisposition

• Fetal exposures and epigenetic changes

After birth:

• Psychosocial influences, chaotic family environments, mismatch with school/work environments

What is the clinical progression of ADHD?

In preschool years: Hyperactivity and rapid speech, motor coordination and language problems

During school years: Co-morbidity, peer rejection, school failure, peer rejection and neurocognitive dysfunction

In adulthood: Inattention persists, hyperactive-impulsive symptoms wane

Substance abuse, low self-esteem and social disability

What is the pathophysiology of ADHD?

What 4 things are impaired in ASD?

Facial / Emotion perception

Theory of mind

Systemizing / Empathizing (Systemizing: Drive to analyse a variable in a system. Empathizing: Drive to understand human emotions and respond appropriately)

Central coherence