Neurodevelopmental Disorders Notes
Neurodevelopmental Disorders
Prepared by: Sherwin Galzote-Maputol, RN, MAN
Nurse Educator
Date: 5/23/2025
Types of Neurodevelopmental Disorders
Autism Spectrum Disorder (ASD)
Social (Pragmatic) Communication Disorder
Specific Learning Disorder
Attention-Deficit/Hyperactivity Disorder (ADHD)
Intellectual Disability (Intellectual Developmental Disorder)
Autism Spectrum Disorder (ASD)
A neurological and developmental disorder affecting interaction, communication, learning, and behavior.
Characterized by an inability to communicate and interact socially.
Best known of the pervasive developmental disorders.
More prevalent in boys; identified usually by 18 months, no later than 3 years of age.
Causes:
Unknown
Genetic link
Exposure to hazardous chemicals
Savants: Some children excel in areas like arts, music, memory, mathematics, perceptual skills.
Diagnostic Criteria for 299.00 Autism Spectrum Disorder (DSM-5)
Persistent deficits in social communication and interaction across multiple contexts, evidenced by:
Deficits in social-emotional reciprocity (e.g., abnormal social approach, reduced sharing of interests, failure to respond to social interactions).
Deficits in nonverbal communicative behaviors (e.g., poorly integrated verbal/nonverbal communication, abnormal eye contact, lack of facial expressions).
Deficits in developing, maintaining, and understanding relationships (e.g., difficulties adjusting behavior, sharing imaginative play, or lack of interest in peers).
Restricted, repetitive patterns of behavior, interests, or activities, evidenced by at least two of the following:
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., motor stereotypes, lining up toys, echolalia).
Insistence on sameness, inflexible adherence to routines (e.g., distress at small changes, rigid thinking, need for sameness).
Highly restricted, fixated interests abnormal in intensity (e.g., preoccupation with unusual objects).
Hyper- or hyporeactivity to sensory input (e.g., indifference to pain, adverse response to sounds, fascination with lights).
Severity is based on social communication impairments and restricted, repetitive behaviors, described in 3 levels:
Level 3: Requires very substantial support.
Level 2: Requires substantial support.
Level 1: Requires support.
Symptoms must be present in the early developmental period.
Symptoms cause clinically significant impairment in social, occupational, or other areas of functioning.
These disturbances are not better explained by intellectual disability or global developmental delay. Comorbid diagnoses are possible if social communication is below expectations for general development.
Note: Individuals with previous DSM-IV diagnoses (autistic disorder, Asperger’s disorder) should be diagnosed with autism spectrum disorder.
Specify if:
With or without intellectual impairment
With or without language impairment
Associated with a known medical or genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia
Manifestations of ASD
Little eye contact and few facial expressions.
Limited gestures to communicate.
Limited capacity to relate to peers or parents.
Lack of spontaneous enjoyment.
Express no moods or emotional affect.
Cannot engage in play or make-believe with toys.
Little intelligible speech.
Engage in stereotyped motor behaviors.
Features of ASD
Extreme autistic aloneness: Loner, lack of interest in others.
Language abnormalities: Repeat words (echolalia).
Repetitive behaviors: Concentration, preserves sameness of environment.
Treatment for ASD
Goals:
Reduce behavioral symptoms
Promote learning and development
Methods:
Special education: Individual learning, structured programs, focus on communication & social skills, behavioral support, sensory-friendly environments, early intervention, inclusion
Language therapy: Comprehensive communication focus, individualized goals, verbal & non-verbal skills, augmentative communication, social skills training, collaboration
Pharmacology:
Antipsychotics: Haloperidol (Haldol), Risperidone (Risperdal)
Other meds: naltrexone (ReVia), clomipramine (Anafranil), clonidine (Catapres)
Interventions for ASD
Determine child’s routines, habits, and preferences; maintain consistency.
Determine specific communication methods and use them.
Avoid placing demands on the child.
Implement safety precautions for self-injurious behaviors.
Initiate referrals to special programs.
Provide support to parents.
Asperger’s Disorder
Pervasive developmental disorder with impairments in social interaction and restricted stereotyped behaviors, but without language or cognitive delays.
A mild form of autism with higher mental functioning (DSM IV).
More common in boys, generally lifelong effects.
Manifestations of Asperger’s Disorder
No cognitive delay.
Average or above-average IQ.
Need for high stimulation.
Overdeveloped use of imagination.
Fewer language deficits.
More social & willful behavior.
Able to progress in school.
Social (Pragmatic) Communication Disorder (SCD)
Persistent difficulty with verbal and nonverbal communication for social purposes, not explained by low cognitive ability.
Leads to impairments in effective communication, social participation, maintaining relationships, and academic/occupational performance.
DSM 5 Diagnostic Criteria for Social (Pragmatic) Communication Disorder (SCD)
Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
Difficulties understanding what is not explicitly stated (e.g. - making inferences) and nonliteral or ambiguous meanings of language (e.g. - idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability, global developmental delay, or another mental disorder.
Treatment for SCD
Behavioral interventions/techniques.
Speech therapy on social interaction.
Educational Accommodation to support the individual.
Specific Learning Disorder (SLD)
A biologically based, neurodevelopmental disorder affecting information processing and communication abilities.
Characterized by persistent impairment in at least one of three major areas: reading, written expression, and/or math.
Abnormalities in the brain's ability to accurately and efficiently perceive and process information.
Difficulties in learning foundational academic skills, such as reading accuracy, fluency and comprehension; spelling and written expression; and arithmetic calculation and mathematical reasoning.
Difficulties arise in learning more complex subjects, causing academic achievement to lag.
Lagging academic achievement from visual/auditory problems or poor instruction is not indicative of SLD.
Diagnostic Criteria for SLD
Meet four criteria:
Difficulties in at least one of the following areas for at least six months despite targeted help:
Difficulty reading (e.g., inaccurate, slow, and effortful).
Difficulty understanding the meaning of what is read.
Difficulty with spelling.
Difficulty with written expression (e.g., problems with grammar, punctuation, or organization).
Difficulty understanding number concepts, number facts, or calculation.
Difficulty with mathematical reasoning (e.g., applying math concepts or solving math problems).
Have academic skills that are substantially below what is expected for the child’s age and cause problems in school, work or everyday activities. Difficulties start during school-age.
The difficulties start during school age even if some people don’t experience significant problems until adulthood (when academic, work and day-to-day demands are greater).
Learning difficulties are not due to other conditions, such as intellectual disability, vision or hearing problems, a neurological condition (e.g., pediatric stroke), adverse conditions such as economic or environmental disadvantage, lack of instruction, or difficulties speaking/understanding the language.
Types of Specific Learning Disorders:
Dyslexia, Dysgraphia, and Dyscalculia
Three separate learning disorders merged into one diagnostic category.
Requires three different specifiers to identify the area(s) of academic weakness:
With impairment in reading (dyslexia)
With impairment in written expression (dysgraphia)
With impairment in mathematics (dyscalculia)
Dyslexia:
"With impairment in reading" is added when a person demonstrates significant impairment in one or more of the reading subskills including word reading accuracy, reading rate or fluency, and/or reading comprehension.
Refers to problems with word reading fluency or word reading accuracy, decoding, and spelling.
Problems in reading may begin even before learning to read:
Children with dyslexia may have trouble with breaking down spoken words into syllables and or recognizing words that rhyme.
People with dyslexia often have difficulty connecting letters they see on a page with the sounds they make.
Reading becomes slow and effortful.
Difficulty with writing accuracy and spelling.
Dysgraphia:
An impairment in writing skills is assigned to the specifier “with impairment in written expression”
Refers to those children with impaired spelling and problems with writing that can include difficulties with accuracy, grammar, and punctuation accuracy, and/or clarity or organization of written expression.
Children with impairment in written expression may not be able to recognize and write letters as well as their peers.
Problems in reading begin even before learning to read. For example, children may have trouble breaking down spoken words into syllables and recognizing words that rhyme.
Dysgraphia is the term used to describe difficulties with putting one’s thoughts on to paper.
Kindergarten-age children with impairment in written expression may not be able to recognize and write letters as well as their peers.
Dyscalculia:
"With impairment in mathematics" is for individuals who demonstrate significantly below average skills in number sense, memorization of arithmetic facts, accurate or fluent calculation, and/or accurate math reasoning.
The term “dyscalculia” is used to describe difficulties with learning number number-related concepts, with processing numerical information, with learning arithmetic facts or with using the symbols and functions to perform accurate or fluent math calculations.
Degree of Severity of SLD
Mild:
Some difficulties with learning in one or two academic areas, but may be able to compensate with appropriate accommodations or support services.
Moderate:
Significant difficulties with learning, requiring some specialized teaching and some accommodations or supportive services may be needed in school, in the workplace, or at home for activities to be completed accurately and efficiently.
Severe:
Severe difficulties with learning, affecting several academic areas, and requiring ongoing intensive specialized teaching for most of the school years. Even with accommodations, an individual with a severe SLD may not be able to perform academic tasks with efficiency.
Treatment of Specific Learning Disorder
NO “CURE”! Early intervention is key for people with a SLD
Remediation for specific learning disorder: Special Education- often involves specialized instruction provided by a special education teacher.
Often part of a comprehensive individualized education plan (IEP) that may include classroom or test- taking accommodations (e.g. quite learning environment, extra test taking time, etc.) to compensate for the impact of cognitive inefficiencies on academic performance.
Special education teachers are uniquely qualified to provide special teaching to help students overcome learning difficulties.
Impairment in reading are structured and targeted strategies that address phonological awareness, decoding skills, comprehension and fluency.
Treatments for writing problems are in two general areas: the process of writing and the process of composing written expression.
Treatment for dyscalculia often includes multisensory instruction to help kids understand math concepts. Accommodations, like using manipulative and assistive technology, may also help kids with dyscalculia.
improving math ability in adolescents with intellectual disabilities that involved the use of computer software called Math Garden assist teaching basic arithmetic operations (Jansen, De Lange, & Van der Molen, 2013).
computer software been shown to successfully to ameliorate deficits in reading comprehension skills (Saine, Lerkkanen, Ahonen, Tolvanen, & Lyyttinen, 2011).
Neurofeedback, which involves the use of electroencephalography to monitor brain activity, has been shown to significantly increase reading comprehension skills (Nazari, Mosanezhad, Hashemi, & Jahan, 2012).
These finding suggest that computer-based education and neurofeedback may be of benefit to individuals with a broad range of learning problems.
traditional psychotherapy does not directly address specific learning disorder, it is known to effectively treat depressive disorders and anxiety disorders that frequently occur as a result of the impact that specific learning disorders can have on an individual’s life.
psychotherapy may be an important competent of comprehensive treatment.
Attention Deficit Hyperactivity Disorder (ADHD)
Characterized by inattentiveness, overactivity, and impulsiveness.
Common, especially in boys, accounts for more child mental health referrals than any other single disorder.
Etiology of ADHD
Unknown
Environmental toxins
Prenatal influences
Heredity
Damage to brain structure
DSM-5 Criteria for ADHD
Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Inattention: Six or more symptoms (children up to 16), five or more (adolescents 17+ and adults) present for at least 6 months and inappropriate for developmental level.
Fails to give close attention to details or makes careless mistakes.
Trouble holding attention on tasks or play activities.
Does not seem to listen when spoken to directly.
Does not follow through on instructions and fails to finish tasks.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time
Loses things necessary for tasks.
Easily distracted.
Forgetful in daily activities.
Hyperactivity and Impulsivity: Six or more symptoms (children up to 16), five or more (adolescents 17+ and adults) present for at least 6 months, disruptive and inappropriate for developmental level.
Fidgets or taps hands/feet, or squirms in seat.
Leaves seat when remaining seated is expected.
Runs/climbs when inappropriate (restlessness in adolescents/adults).
Unable to play quietly.
"On the go," acting as if "driven by a motor."
Talks excessively.
Blurts out answers before questions are completed.
Trouble waiting their turn.
Interrupts or intrudes on others.
Additional conditions:
Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
Several symptoms are present in two or more settings.
Clear evidence that symptoms interfere with social, school, or work functioning.
The symptoms are not better explained by another mental disorder.
Types (Presentations) of ADHD:
Combined Presentation: Symptoms of both inattention and hyperactivity-impulsivity present for the past 6 months.
Predominantly Inattentive Presentation: Symptoms of inattention present, but not hyperactivity-impulsivity, for the past six months.
Predominantly Hyperactive-Impulsive Presentation: Symptoms of hyperactivity-impulsivity present, but not inattention, for the past six months.
Inattentive Behaviors
Misses details
Makes careless mistakes
Has difficulty sustaining attention
Doesn’t seem to listen
Doesn’t follow through on chores or homework
Has difficulty with organization
Avoids tasks requiring mental effort
Often loses necessary things
Is easily distracted by other stimuli
Is often forgetful in daily activities
Hyperactive/impulsive behaviors
Fidgets
Often leaves seat (during meal)
Runs or climbs excessively
Can’t play quietly
Is always on the go; driven
Talks excessively
Blurts out answer
Interrupts
Can’t wait for turn
Is intrusive with siblings/playmates
Treatment for ADHD
Combines pharmacotherapy with behavioral, psychosocial, and parental education & special educational assistance.
Pharmacotherapy:
methylphenidate (Ritalin)
amphetamine compound
Atomoxetine (Strattera)
Goal of Treatment:
Managing symptoms
Reducing hyperactivity and impulsivity
Increasing the child’s attention
Interventions for ADHD
Ensuring the child’s safety and that of others:
Stop unsafe behavior.
Provide close supervision
Give clear directions about acceptable & unacceptable behavior
Improved role performance:
Give positive feedback for meeting expectations.
Manage environment (e.g., provide a quiet place free of distractions for task completion)
Simplifying instructions/directions:
Get child’s full attention.
Break complex tasks into small steps.
Allow breaks.
Stimulant medications may be prescribed; possible S/E include appetite suppression & weight loss, nervousness, tics, insomnia, & increased BP.
Instruct the child & parents about medication administration & the need for regular follow-up.
Structured daily routine:
Establish a daily schedule.
Minimize changes.
Client/family education & support:
Listen to parent’s feelings & frustrations.
Include parents in planning & providing care
Refer parents to support groups
Focus on child’s strengths as well as problems
inform parents that the child is eligible for special school services
Teach accurate administration of medication & possible side effects
Assist parents to identify behavioral approaches to be used at home
Help parents achieve a balance of praising child and correcting child’s behavior.
Emphasize the need for structure & consistency in child’s daily routine and behavioral expectations
Intellectual Disability (Intellectual Developmental Disorder)
"Mental retardation" is an outdated term.
The preferred terminology is "intellectual disability" or "developmental disability."
Essential feature: Below-average intellectual functioning (intelligence quotient [IQ] less than 70) accompanied by significant limitations in intellectual and adaptive functioning.
IQ < 70
Adaptive functioning includes communication skills, self-care, home living, social skills, use of community resources, self-direction, academic skills, work, leisure, and health and safety.
Degree of Intellectual Disability
Mild: IQ 50 to 70
Moderate: IQ 35 to 50
Severe: IQ 20 to 35
Profound: IQ less than 20
WAIS Classification
Profound: Below 20 (Idiot).
Severe: 20–34 (Imbecile).
Moderate: 35–49 (Moron).
Mild: 50–69.
Borderline: 70–79.
Levels of Intellectual Disability and Their Implications
Mild Intellectual Disability:
IQ Range: IQ scores typically range from 50 to 70.
Adaptive Behavior: Individuals with mild intellectual disability may have relatively mild impairments in adaptive behavior, particularly in areas such as academic skills, social skills, and independent living skills.
Implications: With appropriate support and interventions, individuals with mild intellectual disability can often learn practical skills and live semi-independently. They may benefit from special education services, vocational training, and community support programs.
Moderate Intellectual Disability:
IQ Range: IQ scores typically range from 35 to 49.
Adaptive Behavior: Individuals with moderate intellectual disability often have significant limitations in adaptive behavior, including challenges with communication, self-care, and social interaction.
Implications: While individuals with moderate intellectual disability may require more intensive support and supervision, they can still learn basic skills and may be able to work in supported employment settings or participate in structured day programs.
Severe Intellectual Disability:
IQ Range: IQ scores typically range from 20 to 34.
Adaptive Behavior: Individuals with severe intellectual disability have profound impairments in adaptive behavior, requiring significant assistance with activities of daily living and often having limited communication abilities.
Implications: Individuals with severe intellectual disability may require constant supervision and support for all aspects of daily life. They may benefit from specialized educational programs, residential care, and assistive technology to enhance communication and independence to the extent possible.
Profound Intellectual Disability:
IQ Range: IQ scores are typically below 20.
Adaptive Behavior: Individuals with profound intellectual disability have severe impairments in adaptive behavior, often requiring total assistance with all activities of daily living and having limited or no communication skills.
Implications: Individuals with profound intellectual disability have significant care needs and may require full-time support and assistance for all aspects of life. They may benefit from specialized residential care facilities, adaptive equipment, and a highly structured and supportive environment.
Causes of Intellectual Disability
Hereditary conditions
Early alterations in embryonic development
Pregnancy or perinatal problems
Medical conditions of infancy
Environmental influences
Manifestations of Intellectual Disability
Deficits in cognitive skills & level of adaptive functioning.
Delays in fine & gross motor skills
Speech delays
Decreased spontaneous activity
Poor eye contact during feeding
Passive and dependent; others are aggressive and impulsive.
Interventions for Intellectual Disability
Medical strategies focused on correcting structural deformities & treating associated behaviors.
Implement community & educational services, using a multidisciplinary approach.
Promote care skills as much as possible
Assist with communication & socialization skills.
Facilitate appropriate playtime.
Initiate safety precautions as necessary.
Assist the family with decisions regarding care.
Provide information regarding support services & community agencies.