1.1 Understanding and working with neurodevelopmental complexity (E)

Reading 1:

1. Traditional umbrella terms, like ADHD or autism, assume that one of these conditions is the primary diagnosis and that comorbidity is not common.

2. The text argues that it's illogical to categorize psychiatric problems as "neuropsychiatric" because all psychiatric issues have their origins in the brain and should be considered as "neuro."

3. The term "neurodevelopmental problems" is criticized for implying that these issues only exist during the developmental stage.

4. ESSENCE, as a concept, acknowledges that comorbidity is common, that symptoms of different diagnostic categories may overlap in early childhood, and that it's not always possible to definitively determine which diagnosis applies.

5. ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) is a more comprehensive approach.

6. ESSENCE recognizes that a child's presentation may change over time, with one condition like ADHD becoming more salient at a later age, even if autistic symptoms persist.

7. ESSENCE is described as a neutral term that doesn't align with either neuropsychiatry or neurodevelopment but instead emphasizes the link between early-onset symptomatic conditions and clinical examinations.

   Understanding ESSENCE in Child Neurodevelopment

1. Application of ESSENCE:

   • ESSENCE emphasizes examining every child with autistic or ADHD symptoms for other problems.

   • It suggests early assistance for children and families through a cohesive team of professionals.

   • This team includes doctors, psychologists, nurses, educators, speech and language therapists, and other

     specialists.

   • ESSENCE helps provide tailored support and treatment.

2. Developmental Issues and ESSENCE:

   Intellectual disability (ID) and autism (ASD) can cause long-term problems.

○ Early-onset issues like ADHD symptoms can lead to social difficulties and psychiatric problems in teenagers.
Various early developmental disorders increase the risk of mental health issues, school failure, social isolation, and criminal activity in adulthood.

3. ESSENCE Concept:
   ESSENCE challenges traditional diagnostic terms:

   • □  It believes all psychiatric problems originate in the brain and should be considered "neuro."

   • □  It doesn't agree with the term "neurodevelopmental problems" as it implies issues only exist

     during development.

   • □  ESSENCE assumes that comorbidity (having more than one condition) is common.

   • □  It recognizes that symptoms may overlap in young children, making it hard to assign a single

     diagnosis.

   • □  ESSENCE believes that ADHD or autism can be more noticeable at different ages.

4. ESSENCE Neutrality:

   • ESSENCE doesn't take sides between neuropsychiatry and neurodevelopment.

   • It simply highlights the link between early symptoms and clinical examinations.

5. Development of ESSENCE:

   Researchers have been working on ESSENCE worldwide for 45 years. ○ This involves:

   Using new methods (like questionnaires and diagnostic interviews).

   • §  Studying genetics, brain chemistry, and brain imaging.

   • §  Finding common ground on how different conditions should be grouped.

   • §  ESSENCE helps explain how early symptoms affect lifelong outcomes like school and job success, mental health, drug use, and criminal behavior.

   • §  Effective treatments based on scientific research and experience have been developed.

   • §  The Gillberg Neuropsychiatry Centre at the University of Gothenburg and collaborators worldwide

     have been at the forefront of this effort.

     Prevalence of ESSENCE:

1. The total rate of early diagnosable ESSENCE (child neuropsychiatric or neurodevelopmental disorders/impairments/variations) is approximately 10% of the population.

2. This prevalence is estimated to be higher in boys, with around 13% of all boys and 7% of all girls affected.

3. In many countries, roughly half of these children, approximately 8% of all boys and 2% of all girls, have sought medical attention before the age of 10.

4. They are examined by healthcare professionals like doctors, psychologists, or speech and language therapists.

5. The initial diagnoses for these children often include terms like "language disorder," "developmental delay," or "autism."

6. Sometimes, the conclusion at an early age is that there is an unspecified abnormality in the child's development, but no specific diagnosis is provided.

7. In other cases, parents may receive reassurances, such as being told "it's not autism," with no further action recommended, or they may be advised to "wait and see."

8. The remaining half of affected children are identified as "problematic cases" before reaching adulthood.

9. These cases are often given diagnoses such as ADHD, depression, "anxiety," or "family relationship problems."

10. Families are rarely informed from the outset that the child may have a complex set of problems that partially or wholly meet the criteria for multiple neurodevelopmental diagnoses found in healthcare diagnostic manuals, such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) or ICD-11 (International Classification of Diseases, 11th edition).

    When to Suspect ESSENCE:

1. ESSENCE should be suspected in children displaying signs of abnormal development, behavioral disorders, or significant mood swings or problems.

2. These issues are severe enough to raise concerns among parents or others in the child's environment.

3. The symptoms and concerns have been present for an extended period, typically many months.

4. In some cases, these problems may appear suddenly, evolving rapidly over just a few days, even in children who initially exhibited completely "normal" development.

5. The text emphasizes that all children with long-term or extremely acute-onset problems falling within the categories listed in Table 1.2 should undergo some form of developmental evaluation.

6. This assessment is essential to determine the presence and nature of any ESSENCE-related problems and to provide appropriate support and intervention

Outcome of ESSENCE:

1. Long-term follow-up of children diagnosed with autism, language disorder, intellectual disability, learning problems, or ADHD reveals that fundamental problems outlined in these diagnoses persist into adulthood in many cases.

2. These problems encompass difficulties in social interaction, communication, learning, reading and writing (dyslexia), motor coordination, and attention.

3. Even in cases where individuals no longer meet the full diagnostic criteria, these challenges endure.

4. Despite these difficulties, it's noteworthy that the mortality rate among those with ESSENCE is elevated, although the majority will live to old age.

   Prevalence in Adulthood:

   5. Approximately 5% of the adult population still exhibits diagnosable ESSENCE-related problems in adulthood.

5. Additional individuals, constituting several more percentage points, grapple with underlying issues that continue to impede their functioning.

   Comorbid Conditions:

6. Most adults with ESSENCE also meet criteria for additional diagnoses:

• Depression.

• Anxiety.

• Pain disorder.

• Personality disorders (e.g., antisocial, avoidant, borderline).

• Drug addiction.

  Functional Implications:

7. significant portion of those affected end up on early retirement, unemployment benefits, or welfare.

8. A notable percentage of individuals with ADHD, approximately 20%, become involved in the criminal justice system.

9. Criminal involvement often results from impulsive violent crimes or drug-related offenses.

10. It's worth noting that a significant portion of inmates (30–70%) in correctional facilities may have ADHD.

    Positive Outcomes:

11. Positive outcomes can occur in cases of autism and Tourette's syndrome, particularly when families receive early diagnosis, information, and subsequent support.

12. Many individuals in these groups exhibit artistic aptitude, creative thinking, and the ability to "think outside the box."

13. In some cases, individuals with extreme impulsivity (e.g., ADHD and Tourette's syndrome) or extreme compulsiveness (e.g., autism) can, with tailored support, develop into:

• Entrepreneurs.

• Various kinds of artists.

• Scientific researchers.

  Comorbidity in ESSENCE:

1. Pure" cases, where only one syndrome is present, are rare.

2. For example, approximately 85% of school children with ADHD meet the criteria for at least one other ESSENCE

   diagnosis.

3. Preschool children with autism typically meet the criteria for at least one other learning/communication, psychiatric, neurological, or medical disorder diagnosis.

4. It's common for individuals with ESSENCE to have multiple co-occurring conditions.

   Gender Differences: 8. Most conditions within the ESSENCE group are more commonly observed in boys.

5. However, many girls are either overlooked or misdiagnosed during their early childhood years, highlighting a potential gender bias in diagnosis and recognition.