Chapter 9 - Neurodevelopmental Disorders

Define pathologization

The process by which behaviours that were previously understood as normal became categorized as symptoms or indicators of deviance or dysfunction

Types of neurodevelopmental disorders

Fetal alcohol spectrum disorder (FASD), intellectual disorders, motor disorders (Tourette’s), communication disorders, genetically determined disorders (Down and Williams syndrome), conditions with traumatic and congenital brain injuries (cerebral palsy)

Two key features of neurodevelopmental disorders

1. At the root of the disorder, is a neurological dysfunction that affects the capacity of the individual for intellectual, social, and sometimes physical development 

2. Individuals diagnosed with these disorders struggle to fit in and be fully included in society 

Attention Deficit Hyperactivity Disorder (ADHD)

A disorder associated with inattentiveness, hyperactivity, and impluse control 

Types of ADHD

• ADHD-I: Inattentive type

• ADHD-H: Hyperactivity and Impulsivity

• ADHD-C: Combined type 

Criteria for diagnosis of ADHD 

6 or more out of 18 symptoms persisted for at least 6 month. Many of the listed criterion are normal child behaviours, it is the frequency and social impact of them that leads to diagnosis 

ADHD-I Diagnosis Criteria A

Six or more of nine symptoms for at least 6 months 

• difficulty with sustained attention, losing objects, forgetfulness, difficulty breaking large projects down, avoidance of tasks requiring sustained attention, distractibility, overlooking details, daydreaming and spacing in conversations, appearing not to listen 

ADHD-H Diagnosis Criteria A

Six or more of nine traits for at least 6 months

• Excessive talking, fidgeting, difficulty sitting still, difficulty with quiet, difficulty engaging in leisure activities, difficulty resting, intruding/interrupting others, restlessness, impatience 

Criteria B

B: Inattentive or hyperactive-impulsive symtpoms were present before age 12c

Criteria C

C: The two setting rule, “Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (home, school, with friends)” 

Criteria D

D: There is clear evidence that the symptoms interfere with or reduce the quality of social, academic or occupational funtioning 

Criteria E

E: The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (mood, anxiety, dissociative, personality disorder, substance intoxication or withdrawal) 

Criticism for criterion for ADHD

Criteria for diagnosis may be explained by immaturity

• the youngest children in a school cohort are more likely to be diagnosed with ADHD and prescribed with medication

Regimented classroom setting may cause children to misbehave then diagnosed with ADHD

Essential feature of Autism

Difficulty understanding the need to be social and managing social interactions 

Autism Spectrum Disorder (ASD)

A neurodevelopmental disorder, is generally understood to include symptoms such as challenges with communication, difficulties with social reciprocation, repetitive behaviours and sensory symptoms. 

• No clear cause and cannot be observed or diagnosed with a brain scan 

Autism Criteria A

Persistent differences in social communication and social interaction across multiple contexts. All 3 subcategories must be present 

1. Differences in social-emotional reciprocity 

2. Differences in nonverbal communication behaviours used for social interaction

3. Differences in developing, maintaining, and understanding relationships 

Autism Criteria B

Restricted, repetitive patterns of behaviour, interests or activities are manifested by at least two of the following 

• Stereotypes or repetitive motor movements, use of objects or speech 

  • Stimming, echolalia, re-using phrases, lining up objects or toys, all of these function to self-soothe

• Insistence on sameness, inflexible adherence to routines or ritualized pattersn of verbal or non verbal behaviour 

  • Secutiry in routines, difficulty with unexpected cahnge

  • particular rituals, deviation from these rituals creates significant distress

Autism Criteria C

Traits must be present in the early developmental period (but may not become fully manifested until social demands exceed limited capacities)

Autism Criteria D

Traits cause clinically signoficant impairment in social, occupational, or other important areas of current functioning 

Autism Criteria E

These disturbances are not better explained by intellectual disability or global developmental delat

Two developments that made ADHD a disorder

1. Terms “hyperkinetic impulse disorder” and “hyperkinetic behaviour syndrome” were coined 

2. Geopolitical context: American losing the brain race with soviets 

What did the GI Bill do

• Helped create the expectation that post-secondary education was necessary for success

• Supported veterans in re-engaging in further education and employment

Emergence of Autism

• Post WWII, pressure for children to be successful in school and children with unusual behaviours were increasingly labeled and pathologized

  • Partially due to narrowing of what was considered “normal” as society and schools changed

Education Reform (Sputnik) 

• Americans fearing they were losing the brain race, viewed the child-centred, hands-on, flexivble approach to childrens education as unsuitable to producing the types of scientists and engineers needed to win the “space race” 

Past beliefs and different explanations for ADHD 

• Initially thought caused by a brain injury or infection 

• food allergies were a suspected cause 

• faulty parenting 

• genetics 

• sleep disruption

• some believe ADHD is not actually a disorder but a social contruct

Critique on ADHD

ADHD is due to aggressive pharmaceutical marketing to parents and school administrators struggling with “problem” children, who may really just be experiencing “poor fit: with educational settings and demands 

Different explanations for Autism 

• Psychoanalytic, behavioural, genetic, dietary, and social theories have all been proposed

• parenting type (cold parenting, refrigerator mothers)

• food allergies and gut health

• Vaccines (no evidence supporting this theory)

• Communicable diseases like measles 

Current findings on cause of Autism

Currently no specific cause of autism has been identified

• genetic explanations for causation are popular but none has yet been found 

Treatment debates on ADHD 

• Ethics of prescribing stimulants to children—lead drug dependency 

• Ritalin is widely available on the illicit market, often misused and diverted, particularly in university settings 

• side effects of ADHD drugs include, insomnia, stunted growth, anorexia, bet-wettinf, irritability, hallucinations, depression, cardiovascular problems

• No studies of effects on brain growth and development 

• little incentive to search for negative effects of medications because pharmaceutical companies fund drug research 

Alternative treatments for ADHD

Dietary approached, educational interventions, therapies including CBT, neurofeedback, mind body, therapy, holistic approaches

Treatment debates on Autism

• There is limited evidence supporting non-phamacological interventions such as Applied Behaviour Analysis and other psychological interventions 

• some interventions have been harmful (chelation and secretin therapies) or are suspected to be useless or harmful (facilitated communication) 

Neurodiversity Movement

A movement that encourages society to view autism, as well as other neurological or psychiatric conditions as variations of “normal” 

Treatment of Autism

There is no medication specifically for autism but medications used to treat other conditions are sometimes prescribed to relieve some of the symptoms and behaviours of autism 

Neurodiversity Movement arguments

• argues that autism and other mental illnesses are not “pathologies” but instead are part of the normal spectrum of human experience and behaviour 

• conditions should not be “cured”, positive part of a person’s identity and experience—encouraging pride in neurodivergent identities 

Critiques of the neurodiversity movement

• It assumes, without adequate evidence or any doubt, that autism is a neurological issue: individuals understand themselves as simply “wired differently”

• Can be seen as an oversimplification or reductionist — casting experiences as homogenous and overlooking diversity

• Most members of the movement tend to be “high-functioning” and successful — it may ignore the needs of people who are less able to participate, for instance, those who are non-verbal

• Nonetheless, this movement challenges our notions of normalcy, development, and mental illness — and draws attention to social conditions and social context