Module 2: Neurodevelopmental Disorders

Neurodevelopmental Disorders

• Begin in the developmental period, often before a child enters school. 

• Caused by differences in brain development or processing.

• Lead to impairments in personal, social, academic, or occupational functioning.

• The severity of difficulties can range from:

  • Specific issues

    • Like trouble learning or controlling attention/executive functions.

  • Global challenges

    • Such as problems with social skills or overall intellectual ability.

DIMENSION | Developmental Onset

Begins early in life, usually before a child enters school.

DIMENSION | Impairments in Functioning

Affects personal, social, academic, or occupational areas.

DIMENSION | Mind Differences

Involves differences or deficits in brain development and processing.

DIMENSION | Executive Function Issues

May include problems with attention, control, or organization.

DIMENSION | Neuro-based Conditions

Rooted in neurological development, not external factors. 

DIMENSION | Spectrum of Severity

Ranges from mild learning issues to major intellectual challenges.

DIMENSION | Individual Variation

No strict boundary; symptoms exist along a continuum.

DIMENSION | Observable Symptom

Diagnosis requires clear symptoms and signs of impairment.

DIMENSION | Not Categorical

Viewed as dimensional rather than distinct categories.

Intellectual Disabilities

• Involve deficits in intellectual and adaptive functioning that affect daily life.

Communication Disorder

• Difficulties in speech, language, or communication that interfere with learning and social interaction.

Autism Spectrum Disorder (ASD)

• Characterized by persistent deficits in social communication and interaction, along with restricted or repetitive behaviors/interests.

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Involves patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development.

Specific Learning Disorder

• Difficulties in learning and using academic skills such as reading, writing, or math, not due to intellectual disability or inadequate schooling.

Motor Disorders

• Involve problems with movement coordination or repetitive, purposeless motor behaviors.

Other Neurodevelopmental Disorders

• Conditions that do not fully meet criteria for specific categories but still show developmental deficits.

• Examples:

  • Other Specified Neurodevelopmental Disorder

  • Unspecified Neurodevelopmental Disorder

Intellectual Developmental Disorders

• A neurodevelopmental disorder with onset during the developmental period, characterized by deficits in intellectual and adaptive functioning across conceptual, social, and practical domains. 

1. Deficits in Intellectual Functioning

• Involves difficulties in:

  • Reasoning and problem solving

  • Planning and abstract thinking

  • Judgement and academic learning

  • Learning from experience

• Confirmed through:

  • Clinical assessment, and

  • Standardized, individualized intelligence testing

• Typically reflected in an IQ score of approximately 65-75 (70 ± 5) or below. 

• Assessment must consider:

  • Cultural and linguistic appropriateness

  • Possible influences such as the Flynn effect and practice effects

  • Use of comprehensive, psychometrically valid tools

Intellectual Deficits

• Problems with reasoning, problem-solving, planning, abstract thinking, judgment, and learning from experience.

  • Confirmed by clinical assessment and standardized IQ testing (≈ IQ 70 ± 5).

Adaptive Deficits

• Impairment in daily functioning and independence.

  • Must show deficits in one or more CSP domains (below).

  • CSP: The Three Adaptive Domains

    • C – Conceptual

      • Academic skills — reading, writing, reasoning, memory.

    • S – Social

      • Communication, empathy, social judgment, relationships.

    • P – Practical

      • Personal care, money use, work, organization, and daily living

Manifestation During Development

• Begins in the developmental period, not acquired later in life

Mild Severity | Conceptual Domain

• For preschool children, there may be no obvious conceptual differences. 

• For school-age children and adults, there are difficulties in learning academic skills involving reading, writing, arithmetic, time, or money, with support needed in one or more areas to meet age-related expectations. 

• In adults, abstract thinking, executive function (i.e., planning, strategizing, priority setting, and cognitive flexibility), and short-term memory, as well as functional use of academic skills (e.g., reading, money management) are impaired. 

• There is a somewhat concrete approach to problems and solutions compared with age-mates.

Mild Severity | Social Domain

• Compared with typically developing age-mates, the individual is immature in social interactions. 

  • For example, there may be difficulty in accurately perceiving peers’ social cues. 

• Communication, conversation, and language are more concrete or immature than expected for age. 

• There may be difficulties regulating emotion and behavior in age-appropriate fashion; these difficulties are noticed by peers in social situations. 

• There is limited understanding of risk in social situations; social judgment is immature for age, and the person is at risk of being manipulated by others (gullibility).

Mild Severity | Practical Domain

• The individual may function age-appropriately in personal care. 

• Individuals need some support with complex daily living tasks in comparison to peers. 

• In adulthood, supports typically involve grocery shopping, transportation, home and child-care organizing, nutritious food preparation, and banking and money management. 

• Recreational skills resemble those of age-mates, although judgment related to well-being and organization and recreation requires support.

• In adulthood, competitive employment is often seen in jobs that do not emphasize conceptual skills. 

• Individuals generally need support to make health care decisions and legal decisions, and to learn to perform a skilled vocation competently. 

• Support is typically needed to raise a family.

Severe Severity | Conceptual Domain

• Attainment of conceptual skills is limited. 

• The individual generally has little understanding of written language or of concepts involving numbers, quantity, time, and money. 

• Caretakers provide extensive support for problem solving throughout life.

Severe Severity | Social Domain

• Spoken language is quite limited in terms of vocabulary and grammar. 

• Speech may be single words or phrases and may be supplemented through augmentative means. 

• Speech and communication are focused on the here and now within everyday events. 

• Language is used for social communication more than for explication. 

• Individuals understand simple speech and gestural communication. 

• Relationships with family members and familiar others are a source of pleasure and help.

Severe Severity | Practical Domain

• The individual requires support for all activities of daily living, including meals, dressing, bathing, and elimination. 

• The individual requires supervision at all times. 

• The individual cannot make responsible decisions regarding well-being of self or others. 

• In adulthood, participation in tasks at home, recreation, and work requires ongoing support and assistance. 

• Skill acquisition in all domains involves long-term teaching and ongoing support. 

• Maladaptive behavior, including self-injury, is present in a significant minority.

Purpose of Vineland Adaptive Behavior Scales (VABS-3)

• Measures adaptive behavior — how an individual copes with everyday life demands.

• Complements IQ testing by assessing Criterion B of ID (Adaptive Functioning)>

• Provides insights into real-world functioning across settings (home, school, community).

VABS | Assessment Procedure

• Conducted via semi-structured interview with parent, caregiver, or teacher familiar with the individual.

• Age-appropriate forms:

  • Parent/Caregiver Form

  • Teacher Form

  • Interview Form

• Responses rated based on frequency and independence of skill performance.

Examples of Motor Disorders

• Developmental Coordination Disorder

• Stereotypic Movement Disorder

• Tic Disorders (e.g., Tourette’s Disorder, Persistent Motor or Vocal Tic Disorder, Provisional Tic Disorder)

Examples of Learning Disorder

• With Impairment in Reading (Dyslexia)

• With Impairment in Written Expression (Dysgraphia)

• With Impairment in Mathematics (Dyscalculia)

Examples of Attention-Deficit/Hyperactivity Disorder

• ADHD, Combined Presentation

• ADHD, Predominantly Inattentive Presentation

• ADHD, Predominantly Hyperactive/Impulsive Presentation

Examples of ASD

• Autism Spectrum Disorder (with varying levels of severity)

Examples of Communication Disorder

• Language Disorder

• Speech Sound Disorder

• Childhood-Onset Fluency Disorder (Stuttering)

• Social (Pragmatic) Communication Disorder

Examples of Intellectual Disabilities

• Intellectual Disability (Intellectual Developmental Disorder)

• Global Developmental Delay

• Unspecified Intellectual Disability

Moderate Severity | Conceptual Domain

• All through development, the individual’s ______ skills lag markedly behind those of peers.

• For preschoolers, language and pre-academic skills develop slowly.

• For school-age children, progress in reading, writing, mathematics, and understanding of time and money occurs slowly across the school years and is markedly limited compared with that of peers.

• For adult, academic skills development is typically at an elementary level, and support is required for all use of academic skills in work and personal life.

• On-going assistance on a daily basis is needed to complete _____ tasks of day-to-day life, and other may take over these responsibilities fully for the individual. 

Moderate Severity | Social Domain

• The individual shows marked differences from peers in social and communicative behavior across development.

• Spoken languages is typically a primary tool for social communication but is much less complex than that of peers.

• Capacity for relationships is evident in ties to family and friends, and the individual may have successful friendships across life and sometimes romantic relations in adulthood.

• Individuals may not perceive or interpret social cues accurately.

• Social judgment and decision-making abilities are limited, and caretakers must assist the person with life decisions.

• Friendships with typically developing peers are often affected by communication or social limitations.

• Significant social and communicative support is needed in work settings for success.

Moderate Severity | Practical Domain

• The individual can care for personal needs involving eating, dressing, elimination, and hygiene as an adult, although an extended period of teaching and time is needed for the individual to become independent in these areas, and reminders may be needed, and on-going supports will typically occur for adult-level performance.

• Independent employment in jobs that require limited conceptual and communication skills can be achieved, but considerable support from co-workers, supervisors, and others is needed to manage social expectations, job complexities, and ancillary responsibilities (e.g., scheduling, transportation, health benefits, and money management).

• A variety of recreational skills can be developed.

• These typically require additional supports and learning opportunities over an extended period of time.

• Maladaptive behavior is present in a significant minority and causes social problems.

Profound Severity | Conceptual Domain

• Conceptual skills generally involve the physical world rather than symbolic processes.

• The individual may use objects in goal-directed fashion for self-care, work, and recreation.

• Certain visuospatial skills, such as matching and sorting based on physical characteristics may be acquired.

• Co-occurring motor and sensory impairments may prevent functional use of objects.

Profound Severity | Social Domain

• The individual has very limited understanding of symbolic communication in speech or gesture.

• He or she may understand some simple instructions or gestures

• The individual expresses his or her own desires and emotions largely through nonverbal, non-symbolic communication

• The individual enjoys relationship with well-known family members, caretakers, and familiar others, and initiates and responds to social interactions through gestural and emotional cues

• Co-occurring sensory and physical impairments may prevent many social activities

Profound Severity | Practical Domain

• The individual is dependent on others for all aspects of daily physical care, health, and safety, although he or she may be able to participate in some of these activities as well

• Individuals without severe physical impairments may assist with some daily work tasks at home, like carrying dishes to the table 

• Simple actions with objects may be the basis of participation in some vocational activities with high levels of on-going support

• Recreational activities may involve, for example, enjoyment in listening to music, watching movies, going out for walks, or participating in water activities, all with the support of others,

• Co-occurring physical and sensory impairments are frequent barriers to participation (beyond watching) in home, recreational, and vocational activities.

• Maladaptive behavior is present in a significant minority