Clinical exam: Neurodevelopmental Disorders

Neurodivergent Definition

Differing neurological function from what is typical

Neuro-atypical

refers to people whose neurological structure does not fit the medical community version of normal

Paradigm shift

Neurodiverse thinking should be treated as a normal variation of the human experience

Neurodiversity

OCD, Schizophrenia, Tourette’s, Dyslexia, Depression

Gabor Mate

ADHD is a response to early childhood/uterine stress . When paired with genetics can cause brain disruption in areas like self-regulation. ADHD then becomes a survival strategy.

DSM-5: ADHD Adult

For a diagnosis symptoms must show up before 12. Pairs and self-reporting can indicate ADHD. Functional impact and co-morbidity. Must be present for at least 6 month

DSM-5 ADHD Child

Academic performce; Standardized rating scales by clinician; observation assessment; development and behavior history. Prior to age 12 and for 6 months

Types of ADHD

Predominantly inattentive, predominantly hyperactive/impatient and combined

Multimodal ADHD: Medical and lifestyle

Stimulants and non stimulants. Sleep, hygiene, exercise, mindfulness, feedback, psychoeducation, IEPs and routines Medication is more effective than therapy but has more of an effect when done together.

Multimodal ADHD: Therapy and behavior

CBT, DBT (Dialectical behavior), MBCT(mindfulness, cognitive ), Coaching, social skills, Parent management training (PMT)

Inattention

Forgetful, Mistakes, distracted, dislikes mental tasks, organization. But they also can be hyper focused, meticulous, good at multitasking

Hyperactive and Impuslive

Fidgets, talks a lot, loud, does not wait turn and moves inappropriately. But also brave, Passionate, fun, honest, fast thinkers, resourceful, active

DSM: Autism Definition

Persistent challenges in social interaction and restrictive repetitive behaviors/interest

Neurodiversity Affirmative Perspective

Autism is not a disorder to fix. Promote environmental adaptions and not personality changes. Use of identity empowering language like autistic instead of someone with ASD.

DSM-5: Diagnosis for social/interaction

• Social emotional reciprocity: Deficit in back and forth communication

• Nonverbal communication: Challenges in interpreting body/facial expressions

• Relationships: Struggles to develop, maintain and understand age appropriate friendships

• May only appear when social demands exceed capacity but was there from childhood

DSM-5 Inte

Sensory sensitivities, restricted interest, insistence on sameness, repetitive movements

Support Needs by Leavel

Level 1: 50-60% can function independently but require mild support with communication and change

Level 2: 35-30% Need help in daily routines and require more support with communication and change

Level 3: 10-15% Require intensive support because of high behavior and communication challenges

Disorder or Difference?

Both. A balance approach is needed for inclusivity, individualized support and adaptive skills.

Double Empathy

It emphasizes that communication breakdowns are not just the autistic persons’ fault but also the neurotypicals’ failure to understand the autistic persons’ perspective.

Assessment for Autism

Interviews especially collateral ones, history, standardized rating scales, collateral questionnaires, observations, cognition test, adaptive behavior scales (daily living), co-morbid ADHD and language disorders.

Treatment or Support

Lifelong support is needed but hard for adults and poorer people. Treatment needs to be careful of stigmatization and must be inidvidualized to that persons needs as many co-morbid disorders require compilcated approaches.

ABA

Used to teach how behavior works and changes. Critics argue it causes stress, anxiety and loss of autonomy because it promotes compliance and masking.