Chapter 11: Neurodevelopmental Disorders

How are hereditary factors related to childhood-onset psychiatric disorders?

Hereditary factors are implicated in many childhood-onset psychiatric disorders, but not all genetically vulnerable children develop them.

What factors may limit the development of mental disorders in genetically vulnerable children?

Resilience, intelligence, and a supportive environment can help prevent the onset of mental disorders.

what happens to synapses during childhood?

synapses peak at age 5, then decline in number as the brain matures

How does myelination affect brain functioning in children and adolescents?

Myelination increases processing speed, improves nerve impulse conduction, and allows faster reactions.

How does emotional and behavioral control change throughout adolescence?

It is low in early adolescence but typically increases over time.

What is temperament in the context of child development?

Temperament refers to a child's habitual mood, behavior, and coping style in response to environmental demands.

When do temperament traits begin to appear, and how do they change?

They appear in infancy and are shaped by maturation, and develop within the social environment

Why is the “fit” between parent and child temperament important?

Poor fit can lead to insecure attachment, developmental problems, and future mental disorders.

What are examples of temperament traits that may predict future problems?

Shyness, aggressiveness, and rebelliousness may increase the risk of substance use.

What are external risk factors for adolescent substance use?

Peer or parental substance use and legal issues like truancy or vandalism

What are protective factors that help prevent adolescent drug use?

Self-control, parental monitoring, academic achievement, antidrug-use policies, and strong neighborhood attachment.

What is resilience in children and adolescents?

Resilience is the ability to recover quickly from difficulties and adapt well to adversity

What internal and external factors influence resilience?

Self-concept, future expectations, social competence, problem-solving skills, and family/school/community support.

Why are children more vulnerable to environmental stress than adults?

Children are highly dependent on caregivers and family for safety, modeling behavior, and shaping their worldview.

How can poor parenting affect child development?

Abusive, rejecting, or overly controlling parenting can cause developmental trauma and increase the risk of psychiatric disorders.

What does a mentally healthy child believe about the world and others?

they trust others and view the world as safe an supportive

How does a mentally healthy child interpret their environment?

They correctly perceive reality and understand their ability to influence it through actions (self-determination).

How does a mentally healthy child behave socially?

They act in developmentally appropriate ways that do not violate social norms

What kind of self-image does a mentally healthy child have?

A positive, realistic self-concept and a developing identity.

How does a mentally healthy child respond to anxiety and stress?

They cope adaptively using age-appropriate behaviors

What is the mentally healthy child’s attitude toward learning and challenges?

they learn and master developmental tasks and new situations

How does a mentally healthy child express themselves?

through spontaneous and creative behaviors

what kind of relationships does a mentally healthy child maintain?

they develop and maintain satisfying relationships with others

what are neurodevelopment disorders?

a group of conditions with onset in the developmental period, typically manifesting early and involving developmental deficits that impair personal, social, or occupational functioning.

what are the six major types of neurodevelopmental disorders?

• Communication disorders

• Motor disorders

• Specific learning disorder

• Intellectual disability

• Autism spectrum disorder (ASD)

• Attention-deficit/hyperactivity disorder (ADHD)

what are communication disorders?

Deficits in language, speech, and communication that impair academic achievement, socialization, or self-care.

Why must cultural and language context be considered in communication disorder assessment?

To avoid misdiagnosis, especially in children from bilingual families

What are the four main types of communication disorders?

• Language disorder

• Speech sound disorder

• Childhood-onset fluency disorder (stuttering)

• Social (pragmatic) communication disorder

What is a language disorder?

difficulty in acquiring and using language due to deficits in understanding (receptive) or producing (expressive) language

What are signs of expressive language problems?

trouble finding words, forming clear sentences, or using proper verbal and nonverbal cues

what are signs of receptive language problems?

difficulty understanding language or following directions

which has a poorer prognosis: expressive or receptive impairment?

receptive impairment

what are potential causes of language disorder?

hearing loss, neurological issues, intellectual diability, drug misuse, brain injury, cleft palate/lip, or unknown causes

when does language disorder typically present?

before age 3

what is a speech sound disorder?

Difficulty producing speech sounds correctly, leading to problems with articulation and communication.

What are common speech sound errors?

Distorting, adding, or omitting sounds (e.g., “no” for “snow,” “wabbit” for “rabbit”).

What areas of functioning can speech sound disorder affect?

Social participation, academic achievement, and occupational performance.

What characterizes childhood-onset fluency disorder?

Hesitations and repetitions in speech that impair communication

Do most children with stuttering recover?

es, most recover from mild or transient dysfluency.

What is social (pragmatic) communication disorder?

Difficulty using verbal and nonverbal communication in social interactions, including writing.

What must be ruled out before diagnosing social communication disorder

Autism spectrum disorder.

What services are typically included in the treatment plan?

Hearing test followed by therapy with a speech or language pathologist

what are the key features of developmental coordination disorder?

• Impaired motor skill development

• Coordination below developmental age

• Interference with academic achievement or ADLs

What are symptoms of developmental coordination disorder?

Delayed sitting/walking, difficulty jumping, tying shoes, or avoidance of drawing and sports.

What treatments are used for developmental coordination disorder?

Early diagnosis, physical therapy, and occupational therapy

What characterizes stereotypic movement disorder?

Repetitive, purposeless movements for 4+ weeks (e.g., hand-waving, head-banging, rocking).

Which population is most affected by stereotypic movement disorder?

Boys and individuals with intellectual disabilities

What interventions are used for stereotypic movement disorder?

• Safety precautions (e.g., helmets)

• Behavioral therapy (habit reversal)

• Naltrexone to block euphoric effects of behaviors

what are tics?

Sudden, nonrhythmic, rapid motor movements or vocalizations

what is an example of motor tics?

Head jerking, hopping, squatting, twirling, tongue protrusion, touching

what are examples of verbal tics?

sniffing, barking, grunting, coughing, spontaneous words

what is provisional tic disorder?

motor or vocal tics lasting less than 1 year

what is persistent motor or vocal tic disorder?

motor OR vocal tics (not both) lasting more than 1 year

What is Tourette’s disorder?

Multiple motor tics + at least one vocal tic for more than 1 year.

What is the typical onset and progression of tic disorders?

Begin before age 18 (usually age 4–6), peak in adolescence, often improve in adulthood

What is CBIT and how does it help tic disorders?

Comprehensive Behavioral Intervention for Tics – teaches awareness of tic urges and uses competing muscular responses.

Which FDA-approved antipsychotics are used to treat tics?

• Haloperidol

• Pimozide

• Arpiprazole

Which antipsychotic is commonly used but not FDA-approved for tics?

Risperidone (Risperdal)

what alpha 2-adrenergic agonists are used to treat tics?

• Guanfacine (Tenex, Intuniv)

• Clonidine (Kapvay, Catapres)

What are common side effects of guanfacine?

Somnolence, lethargy, dizziness, insomnia, nausea, hypotension, abdominal pain.

What are common side effects of clonidine?

Somnolence, fatigue, nightmares, irritability, dry mouth, constipation, respiratory symptoms

What is clonazepam (Klonopin) used for in tic disorders?

As a supplemental treatment to reduce anxiety and tics.

How is Botox used in tic disorders?

Injected into muscles to reduce tic movement.

What is deep brain stimulation (DBS) and when is it used?

A device that delivers electrical impulses to the brain; used in severe, treatment-resistant cases.

what is a specific learning disorder?

A condition where a child shows persistent difficulty in reading (dyslexia), math (dyscalculia), and/or writing (dysgraphia) despite normal intelligence and education.

When are specific learning disorders usually identified?

During the school years, when academic demands increase.

What must be true for a diagnosis of a specific learning disorder?

The child’s performance is significantly below age- and grade-level expectations, confirmed by multiple assessments, including formal psychological evaluations.

What is dyslexia?

A specific learning disorder in reading.

What is dyscalculia?

A specific learning disorder in written expression.

Why is early screening for learning disorders important?

It allows for early interventions, which are crucial to academic and personal success.

What type of educational plan is created for children with learning disorders?

An Individualized Education Program (IEP).

What does an IEP typically include?

• Individualized treatment plan

• Progress monitoring

• Special education services

• Educational and emotional support strategies

What are risk factors for specific learning disorders?

• Low family education

• Poverty

• Male gender

What are potential negative outcomes without proper intervention?

• Low self-esteem

• Poor social skills

• Higher school dropout rates

• Employment difficulties

• Poorer adult social adjustment

What are the three major areas of impairment in intellectual disability?

• Intellectual functioning

• Social functioning

• Daily functioning

What does intellectual functioning include?

Deficits in reasoning, problem-solving, planning, judgment, abstract thinking, and academic ability.

What does social functioning include?

Impairments in communication and language, interpreting and acting on social cues, and emotion regulation.

What does daily functioning include?

Deficits in age-appropriate daily activities, functioning at school/work, and performing self-care tasks.

When do impairments in intellectual disability typically begin?

During childhood development.

What are the possible causes (etiologies) of intellectual disability?

• Heredity

• Pregnancy/perinatal problems

• Environmental influences

• Medical conditions

What are some environmental causes of intellectual disability?

• Social neglect

• Lack of linguistic stimulation

• Absence of a nurturing relationship

Intellectual disability can co-occur with which other mental disorder?

Autism spectrum disorder

How is the severity of intellectual disability measured?

By the person’s level of dependence on others for ongoing care and support.

lack of responsiveness or interest in others, empathy, or sharing

• Impaired socialization

• Impaired caregiver–child attachment

• Risk for impaired parenting

• Risk for social isolation

Lack of cooperation or imaginative play with peers

• Lack of play activity

• Situational low self-esteem

• Impaired socialization

Language delay or absence; stereotyped or repetitive use of language

Impaired child development

Inability to feed, bathe, dress, or toilet self at age-appropriate level

• Impaired child development

• Self-care deficit

Head banging, face slapping, hand biting

• Impaired impulse control

• Risk for injury

• Self-destructive behavior

Frequent disregard for bodily needs

• Risk for situational low self-esteem

• Self-care deficit

What is Autism Spectrum Disorder (ASD)?

A complex neurodevelopmental disorder that impairs social interaction and communication, appearing within the first 3 years of life and ranging from mild to severe.

What are the core symptom domains of ASD according to DSM-5?

• Deficits in social communication and interaction

• Restricted, repetitive patterns of behavior, interests, or activities

What are examples of deficits in social communication (DSM-5 Criteria A)?

• Deficits in social-emotional reciprocity

• Deficits in nonverbal communication (e.g., eye contact, body language)

• Deficits in developing, maintaining, and understanding relationships

What are examples of restricted and repetitive behaviors

• Stereotyped motor movements or speech (e.g., echolalia)

• Insistence on sameness or rituals

• Fixated interests with abnormal intensity

• Hyper- or hyporeactivity to sensory input

What criteria must be met for an ASD diagnosis?

• Symptoms must be present in early development (C)

• Must impair everyday functioning (D)

• Not better explained by intellectual disability or global delay (E)

What is savant syndrome?

A rare condition where an individual with ASD has exceptional skills in specific areas such as music, memory, or math, despite overall low IQ.

What improves outcomes for children with ASD?

Early, intensive intervention—it can enhance social, academic, and daily functioning.

What are the three DSM-5 levels of Autism Spectrum Disorder?

• Level 1 – Requires support

• Level 2 – Requires substantial support

• Level 3 – Requires very substantial support

What is typical of a child with Level 1 ASD?

Milder symptoms; may need support for transitions, social-emotional reciprocity, and routine changes. Expected to participate more with appropriate supports.

What is typical of a child with Level 2 ASD?

Substantial impairments in social and communication skills; requires substantial support for daily functioning.

What is typical of a child with Level 3 ASD?

Severe impairments; often nonverbal, needs extensive assistance with ADLs, and relies heavily on caregivers.