Lesson 5: Neurodevelopmental Disorders

Neurodevelopmental Disorders

• a group of conditions with onset in the developmental period

• They typically manifest early in development, often before the child enters grade school.

• They are characterized by developmental deficits that produce impairments of: Personal functioning, Social functioning, Academic functioning, Occupational functioning

• these disorders frequently co-occur.

Intellectual Disabilities

• a term used when a person has certain limitations in: Mental functioning, Skills such as communicating, taking care of himself/herself, and social skills

• These limitations cause a child to learn and develop more slowly than a typical child.

• Deficits in Intellectual Functioning

• Not a disease, not a mental illness, has no cure

Adaptive Skills Functioning

Difficulties in daily living activities (self-care, social skills, safety awareness).

Intellectual Functioning

Brain’s ability to learn, think, solve problems, and make sense of the world.

• Measured by IQ tests.

• Average IQ: 100.

• Scores below 70–75 indicate intellectual disability.

Adaptive Behavior

• Skills needed to live independently.

• Professionals compare what a child can do with peers of the same age.

Rosa’s Law

• Until _____(2010), IDEA (Individuals with Disabilities Education Act) used the term mental retardation.

• The law replaced it with intellectual disability, but the definition remained unchanged.

Mild Intellectual disability

IQ: 50–70

1. Can participate in and contribute to family and community.

2. Will have important relationships.

3. May struggle with subtleties of social rules/relationships.

4. May behave awkwardly or inappropriately in social situations.

5. May marry and raise children with support.

6. May hold jobs (open or supported employment).

Moderate Intellectual Disability

IQ: 35–50

1. Will have important and lasting relationships.

2. Enjoys activities with family, friends, acquaintances.

3. May learn to travel independently on regular routes with training but struggles with planning trips and handling money.

4. Great difficulty problem-solving when unexpected events occur.

Severe Intellectual Disability

IQ: 20–35

1. Usually recognizes familiar people and maintains strong relationships with key individuals.

2. Likely to have little or no speech.

3. Relies on gestures, facial expressions, and body language for communication.

Profound Intellectual Disability

IQ: Below 20

• similar to severe, but with greater limitations in functioning and communication

Global Developmental Delay

• Reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood.

• Defined by the child being diagnosed with having a lower intellectual functioning than what is perceived as ‘normal’.

• Usually accompanied by significant limitations in communication.

Treatment of Intellectual Disability

• There is no cure for intellectual disability but services and supports play an important role and can enable the person to thrive throughout their lifetime.

• Services for people with intellectual disabilities and their families are primarily there to provide adequate support to allow for full inclusion in their communities.

• These services touch their daily lives (education, justice, housing, recreational, employment, health care, etc.)

Communication Disorder

• Problems related to speech, language, and auditory processing.

• May range from simple sound repetitions (e.g., stuttering) to misarticulating words, to complete inability to use speech and language (aphasia).

Aphasia

Loss of the ability to produce or comprehend language.

a. Acute → result from stroke or brain injury.

b. Primary progressive → caused by progressive illnesses such as dementia.

Cluttering

a syndrome characterized by a speech delivery rate which is either abnormally fast, irregular, or both.

Esophageal Voice

• involves the patient injecting or swallowing air into the esophagus. Once the patient has forced the air into their esophagus, the air vibrates a muscle and creates esophageal voice.

• tends to be difficult to learn, and patients are often only able to talk in short phrases with a quiet voice.

Lisp

 a speech impediment that is also known as sigmatism. (Coco Martin)

Stuttering

• a speech disorder in which sounds, syllables, or words are repeated or last longer than normal.

• These problems cause a break in the flow of speech (called disfluency).

Language Disorder

a neurodevelopment condition with onset during childhood development, with the core diagnostic features of difficulties in the acquisition and use of language due to deficits in the comprehension or production of vocabulary, sentence structure, and discourse.

DC for Language Disorder

A. Core Issues:
Persistent difficulty with language (spoken, written, or signed) due to:

• Limited vocabulary

• Poor grammar/sentence structure

• Trouble using language in conversation or explanation

B. Impact:
Language skills are well below age level, affecting communication, social life, school, or work.

C. Onset:
Starts in early childhood.

D. Not Due To:
Hearing loss, motor issues, other medical/neurological conditions, intellectual disability, or global developmental delay.

Speech Sound Disorder

• involve impairments in ______________ production and range from mild articulation issues involving a limited number of speech sounds to more severe phonologic disorders involving multiple errors.

• Most children make some mistakes as they learn to say new words.

• occurs when mistakes continue past a certain age.

• Every sound has a different range of ages when the child should make the sound correctly.

• include problems with: Articulation (making sounds), Phonological processes (sound patterns)

• Adults can also have this. Some adults continue to have problems from childhood, while others may develop speech problems after a stroke or head injury. (Cf. apraxia of speech and dysarthria).

Apraxia of speech

A disorder where the brain struggles to plan and sequence the muscle movements needed for clear speech, making speech effortful and inconsistent.

Dysarthria

• Slurred, choppy, or slow speech caused by weak or poorly controlled speech muscles.

• a condition that occurs when problems with the muscles that help you talk make it difficult to pronounce words.

Phonological Process Disorder

involves patterns of sound errors, for example:

• Substituting all sounds made in the back of the mouth (like “k” and “g”) for those in the front (like “t” and “d”).

• Example: saying “tup” for “cup” or “das” for “gas”.

DC for Sound Speech Disorder

A. Core Issue:
Ongoing difficulty producing speech sounds, affecting clarity or ability to communicate.

B. Impact:
Leads to problems in communication, social interaction, school, or work.

C. Onset:
Begins in early childhood.

D. Not Due To:
Other conditions like cerebral palsy, cleft palate, hearing loss, brain injury, or medical issues

Childhood-Onset Fluency Disorder

• The essential feature of stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for the individual’s age.

• This disorder is most commonly diagnosed in childhood.

• At the onset of stuttering, the speaker may not be aware of the problem, although awareness and even fearful anticipation of the problem may develop later.

• Stress or anxiety have been shown to exacerbate this.

• Impairment of social functioning may result from associated anxiety, frustration, or low self-esteem.

• In adults, stuttering may limit occupational choice or advancement.

Motor Movements of Stuttering

• Eye blinks

• Tics

• Tremors of the lips or face

• Jerking of the head

• Breathing movements

• Fist clenching

Phonological disorder and expressive language disorder

occur at a higher frequency in individuals with stuttering than in the general population.

DC for Stuttering

A. Speech Disruptions (happen often, not normal for age):

• Repetitions (sounds, syllables, or whole words)

• Prolongations (stretching sounds)

• Broken words (pauses inside a word)

• Blocking (silent or filled pauses)

• Circumlocutions (substituting words to avoid stuttering)

• Excessive tension when speaking

B. Impact – Causes worry about speaking or problems in school, work, or social life.

C. Onset – Begins in early childhood (later cases = adult-onset fluency disorder).

D. Not due to – Other speech/motor/sensory issues, neurological damage, or medical conditions.

E. Not explained by – Another mental disorder.

Social Communication Disorder

• characterized by difficulty with the use of social language and communication skills (also called by professionals pragmatic communication).

Signs in children/teens:

• Trouble following social rules in communication (verbal & nonverbal)

• Difficulty with storytelling/conversations (e.g., taking turns)

• Problems adjusting language to fit the situation or listener

• Usually identified by age 5, when normal speech and language skills are expected.

DC for Pragmatic Disorder

A. Persistent problems in social use of communication (must have all):

1. Trouble using language for social purposes (e.g., greetings, sharing info)

2. Difficulty changing speech depending on context/listener (e.g., talking to kids vs. adults, classroom vs. playground)

3. Problems following conversation/storytelling rules (e.g., turn-taking, rephrasing, using signals)

4. Struggles with implied/figurative language (e.g., inferences, idioms, humor, metaphors, double meanings)

B. Effects: Causes limitations in communication, social life, relationships, school, or work.

C. Onset: Begins in early development (may show more clearly later as social demands grow).

D. Not due to: Another medical/neurological condition, grammar/word structure issues, autism, intellectual disability, global developmental delay, or another mental disorder.

Autism Spectrum Disorder

• Umbrella term for conditions once diagnosed separately (Autistic disorder, Asperger syndrome, PDD-NOS).

• Merged into ASD in DSM-5 (2013).

• Problems in social interaction

• Verbal & nonverbal communication difficulties

• Repetitive behaviors

• Wide variation in symptoms = “spectrum”

• No cure, but early intervention helps: Educational/Behavioral Interventions,  Medications (for specific symptoms), Other Therapies (Dietary interventions may help some but need careful monitoring)

DC for ASD

A. Social Communication & Interaction Deficits (must have all):

1. Problems with social reciprocity (e.g., abnormal approach, no back-and-forth, limited sharing of interests/emotions).

2. Problems with nonverbal communication (e.g., poor eye contact, gestures, facial expressions).

3. Problems with relationships (e.g., difficulty making/keeping friends, limited imaginative play, little interest in peers).

B. Restricted & Repetitive Behaviors (need ≥ 2):

• Repetitive movements/speech (e.g., echolalia, lining up toys).

• Insistence on sameness/routines (e.g., distress at small changes, rigid behaviors).

• Intense, fixated interests (e.g., unusual focus or attachment to objects).

• Sensory differences (e.g., over/under reaction to sounds, lights, textures, pain).

C. Onset: Symptoms present in early development (may show more later when demands rise).

D. Impact: Must cause significant impairment in social, school, or work functioning.

E. Not explained by: Intellectual disability or global developmental delay (unless social deficits are greater than expected).

Additional Specs

• Severity levels: Requiring support / substantial support / very substantial support.

• With/without: Intellectual impairment or language impairment.

• Associated with: Genetic/medical condition, environmental factor, or another disorder.

• With catatonia: Use additional code F06.1.

Catatonia

a neuropsychiatric syndrome characterized by abnormal psychomotor behaviors, including a lack of movement or excessive movement, abnormal posturing, mutism,

ASD Level 1 - Requiring Support

• Difficulty initiating social interactions.

• Organization and planning problems can hamper (hinder) independence.

ASD Level 2 - Requiring Substantial Support

• Social interactions limited to narrow, special interests.

• Frequent restricted or repetitive behaviours.

ASD Level 3 – Requiring Very Substantial Support

• Severe deficits in verbal and nonverbal social communication skills.

• Great distress or difficulty changing actions or focus.

ADHD

• One of the most common childhood disorders and can continue through adolescence and adulthood.

• Symptoms include: Difficulty staying focused and paying attention, Difficulty controlling behavior, Hyperactivity (over-activity)

• Symptoms are Inattention, Hyperactivity, Impulsivity

• Treatment are medication, psychotherapy, social skills training

Predominantly Hyperactive-Impulsive

• Six or more symptoms are in the hyperactivity-impulsivity categories.

• Fewer than six symptoms of inattention are present (though some inattention may still be present).

Predominantly Inattentive

• Six or more symptoms are in the inattention category.

• Fewer than six symptoms of hyperactivity-impulsivity are present (though some hyperactivity-impulsivity may still be present).

• Children with this subtype are less likely to act out or have difficulties getting along with others. They may sit quietly but are not paying attention, so parents and teachers may overlook ADHD.

Combined Hyperactive-Impulsive and Inattentive

• Six or more symptoms of inattention and six or more symptoms of hyperactivity- impulsivity are present.

• Most children fall into this combined type.

DC for ADHD

A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development: Inattention (≥ 6 symptoms, ≥ 5 if age 17+) for ≥ 6 months , Hyperactivity-Impulsivity (≥ 6 symptoms, ≥ 5 if age 17+) for ≥ 6 months

B. Symptoms present before age 12
C. Symptoms occur in 2+ settings (e.g., home, school, work)
D. Symptoms clearly impair functioning
E. Not explained by schizophrenia or another disorder

Additional Specifications

• Presentations:

  • Combined (both inattentive + hyperactive/impulsive)

  • Predominantly Inattentive

  • Predominantly Hyperactive/Impulsive

• Partial Remission: Past full diagnosis, now fewer symptoms but still impairment

• Severity Levels:

  • Mild → Few symptoms beyond minimum, minor impairment

  • Moderate → Between mild & severe

  • Severe → Many symptoms, very intense, major impairment

Specific Learning Disorder

• diagnosed by: Clinical review of history (developmental, medical, educational, family), Teacher reports & test scores, Response to academic interventions

• Core Difficulties (during school years): Reading (slow/inaccurate, effortful, poor comprehension), Writing (poor expression, lack of clarity), Math (trouble remembering number facts, poor reasoning, inaccurate calculations)

• Diagnostic Criteria: Academic skills well below average on culturally/linguistically appropriate tests,  Problems not explained by neurological, sensory, motor, or developmental disorders, Must interfere significantly with school, work, or daily life

• DSM-5 Notes: Deficits must be unexpected, Specifiers indicate type of deficit (reading, writing, math), Terms like dyslexia (reading) and dyscalculia (math) are used descriptively, not as official diagnoses

DC for SLD

A. Persistent learning difficulties (≥ 6 months, despite interventions):

B. Academic skills are: Below expected level for age, Cause significant interference in school, work, or daily life, Confirmed by standardized tests or clinical assessment (older teens/adults: history of difficulties may suffice)

C. Onset: Begins in school-age years (may appear later when demands increase).

D. Not explained by: Intellectual disability, uncorrected vision/hearing issues, neurological/mental disorders, psychosocial adversity, poor language proficiency, or inadequate teaching.

• Specifiers: Reading (F81.0): word reading accuracy, reading fluency, comprehension (dyslexia) Written Expression (F81.81): spelling, grammar/punctuation, clarity/organization, Mathematics (F81.2): number sense, math facts, calculation, reasoning (dyscalculia)

• Severity Levels: Mild: Some difficulty, manageable with support/accommodation, Moderate: Marked difficulties, needs intensive teaching & accommodations, Severe: Severe, across several domains, requires ongoing individualized support

Motor Neuron Diseases

• Progressive neurological disorders that destroy motor neurons (cells controlling voluntary muscle activity such as speaking, walking, breathing, and swallowing

• Example : Amyotrophic lateral sclerosis (ALS)

• Famous Cases: Stephen Hawking (physicist), David Niven (actor), Lou Gehrig (baseball player – disease often called "Lou Gehrig’s disease")

Motor Neurons

• Pathway of signals:

  1. Upper motor neurons (in the brain) send signals to

  2. Lower motor neurons (in the brainstem & spinal cord), which then send signals to

  3. Muscles to produce movement.

• Roles:

  • Upper motor neurons → direct lower motor neurons to initiate movements (e.g., walking, chewing).

  • Lower motor neurons → directly control muscles of arms, legs, chest, face, throat, and tongue.

• Terminology:

  • Spinal motor neurons = anterior horn cells

  • Upper motor neurons = corticospinal neurons

Developmental Coordination Disorder

• Also known as developmental dyspraxia

• Chronic neurological disorder beginning in childhood

• Affects planning of movements and coordination due to inaccurate brain signaling

• Diagnosis is made in the absence of other motor or sensory impairments such as cerebral palsy, muscular dystrophy, multiple sclerosis, or Parkinson's disease

DC for Developmental Coordination Disorder

A. Motor Skill Deficits: substantially below age expectations, even with practice and learning opportunities.

• Signs include: Clumsiness (dropping things, bumping into objects), Slow/inaccurate motor performance (difficulty catching objects, using scissors or cutlery, poor handwriting, trouble riding a bike, struggles in sports)

B. Interference: 

• Motor skill problems significantly and persistently interfere with age-appropriate activities, such as: Self-care (dressing, eating, hygiene), School productivity (writing, projects), Work-related tasks (in older children/adults), Leisure/play (sports, games)

C. Onset:

• Symptoms begin in the early developmental period (childhood).

D . not better explained by:

• Intellectual disability

• Visual impairment

• Neurological disorders affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative conditions)

Stereotypic Movement Disorder

• A condition marked by repetitive, purposeless movements (e.g., hand-waving, body rocking, head banging) lasting ≥ 4 weeks.

• Movements interfere with daily life or may cause self-injury.

• More common in boys than girls.

• Movements often worsen with stress, frustration, or boredom.

DC for Stereotypic Movement Disorder

A. Repetitive, seemingly driven, and purposeless motor behavior, such as: Hand shaking or waving, Body rocking, Head banging, Self-biting, Hitting own body

B. The repetitive motor behavior:

C. Onset occurs in the early developmental period

D. The behavior is not better explained by: Substance use or neurological condition, Another neurodevelopmental/mental disorder (e.g., OCD, trichotillomania)

• With self-injurious behavior (or would cause injury without protective measures)

• Without self-injurious behavior

• Associated with: Genetic/medical condition, Neurodevelopmental disorder, Environmental factor (e.g., Lesch-Nyhan syndrome, intellectual disability, prenatal alcohol exposure)

• Severity Levels: Mild: Easily suppressed by distraction or sensory stimulus, Moderate: Requires protective measures & behavioral modification, Severe: Continuous monitoring/protective measures needed to prevent serious injury

Tic Disorders

• are involuntary, sudden, rapid, and recurrent movements or vocalizations involving voluntary muscle groups.

• They can sometimes be partially suppressed for a short duration, but suppression often leads to a stronger rebound of tics afterward.

• Common Motor Tics: Eye blinking, Facial grimacing, Nasal flaring, Mouth opening

• Triggers: Stressful situations, Family emergencies, Moving away from a familiar or safe environment

• Simple = brief/purposeless

• Complex = seemingly purposeful actions

• Vocal complex = actual words/phrases

Tics

A sudden, rapid, recurrent, nonrhythmic motor movement or vocalization

Motor Tics

Movements of muscles (eye blink, head jerk)

Vocal Tics

Sounds including humming, grunting, or actual words (sometimes in explosive/spastic fashion, including curses)

Tourette’s

• A neurodevelopmental disorder characterized by the presence of both motor and vocal tics.

• Considered part of a behavioral disorder spectrum that includes:

  • Tics

  • Obsessive-compulsive behavior (OCD)

  • Attention-deficit/hyperactivity disorder (ADHD)

DC for Tourette’s

A. Presence of both multiple motor tics and one or more vocal tics at some time during the illness (not required to occur at the same time).

B. Tics may wax and wane in frequency, but persist for >1 year since first onset.

C. Onset occurs before age 18 years.

D. Not attributable to: Physiological effects of a substance (e.g., cocaine), Another medical condition (e.g., Huntington’s disease, postviral encephalitis)

Persistent (Chronic) Motor or Vocal Tic Disorder

A. Single or multiple motor OR vocal tics (but not both) have been present during the illness.

B. Tics may wax and wane, but have persisted for >1 year since first onset.

C. Onset occurs before age 18 years.

D. Not attributable to: Physiological effects of a substance (e.g., cocaine), Another medical condition (e.g., Huntington’s disease, postviral encephalitis)

E. Criteria for Tourette’s Disorder have never been met.

Provisional Tic Disorder

A. Single or multiple motor and/or vocal tics are present.

B. Tics have been present for < 1 year since first onset.

C. Onset is before age 18 years.

D. Not attributable to:

• Substance effects (e.g., cocaine)

• Another medical condition (e.g., Huntington’s disease, postviral encephalitis)

E. Criteria have never been met for:

• Tourette’s Disorder

• Persistent (Chronic) Motor or Vocal Tic Disorder