neurodevelopmental disorder

Neurodevelopmental Disorders (NDD)

  • Copyright: 2022 Assessment Technologies Institute, L.L.C. All rights reserved.

Learning Objectives

  • Overall Health Impact: Describe the impact neurodevelopmental disorders have on a client’s overall health.

  • Epidemiological and Etiological Factors: Explore epidemiological and etiological risk factors contributing to clients experiencing neurodevelopmental disorders.

  • Clinical Presentation: Differentiate the clinical presentation of clients experiencing neurodevelopmental disorders.

  • Nursing Role: Explore the role of the nurse caring for clients experiencing neurodevelopmental disorders.

  • Application of Nursing Process: Apply the nursing process through the use of clinical judgment functions while providing care to clients experiencing neurodevelopmental disorders.

Overview of Neurodevelopmental Disorders

  • Types of Disorders:

    • Motor and Tic Disorders

    • Intellectual Disabilities (ID)

    • Attention-Deficit/Hyperactivity Disorder (ADHD)

    • Autism Spectrum Disorder (ASD)

    • Language Communication Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD)

Symptoms and Presentation

  • Inattention:

    • Unable to concentrate, easily distracted, short attention span.

    • Inability to follow instructions.

    • Difficulty with organization.

  • Hyperactivity:

    • Inability to sit still, fidgeting.

    • Excessive physical movement, talking, or interrupting.

  • Impulsivity:

    • Acting without thinking, lack of regard for consequences.

    • No sense of danger, leading to frequent injuries.

Etiology

  • Genetics: Strong evidence for heredity contributing to ADHD.

  • Environmental Factors:

    • Low birth weight.

    • Prenatal exposure to alcohol and tobacco.

Comorbidities

  • Common Comorbid Conditions:

    • Learning disabilities (most common)

    • Epilepsy in children

    • Oppositional Defiant Disorder (ODD)

    • Conduct Disorder (CD) in adolescence and adulthood

    • Substance use disorders

    • Sleep disorders

    • Anxiety disorders

    • Somatic conditions (Franke, 2018)

Across the Lifespan

  • Issues related to ADHD may manifest as:

    • Problems with schooling and learning.

    • Relationship difficulties.

    • Employment issues in adulthood.

    • May manifest as anxiety or depression.

Learning Disabilities

Cognitive Signs

  • Characteristics:

    • Inconsistent spelling of the same word within assignments.

    • Difficulty with open-ended questions on tests.

    • Poor reading and language comprehension.

    • Weak memory skills.

    • Challenges in adapting skills across different settings.

    • Slow work pace, inattention to details, excessive focus on details.

    • Frequent misreading/misinterpretation of information.

    • Trouble filling out applications/forms, confusion by instructions.

    • Poor organizational skills, may experience mental health issues such as anxiety or depression (Watson, 2021).

Behavioral Signs

  • Characteristics:

    • Reluctance to attend school.

    • Complaints about teachers and overwhelming workload.

    • Avoidance of reading/writing activities.

    • Expressions of negative self-image, e.g., “I’m dumb.”

    • Disobedience to teacher’s directions, skipping classes.

    • Bullying behavior (Watson, 2021).

Dyslexia

Age-Related Challenges

  • Preschool Age:

    • Recognizing letters and sounds, learning the alphabet.

  • School Age:

    • Reading at grade level, spelling rules, and letter placement.

  • Adolescent and Adult:

    • Challenges with word pronunciation, organizing, time management, learning new skills/languages.

    • Difficulties in summarizing stories.

Autism Spectrum Disorders (ASD)

Overview

  • Deficits:

    • Significant deficits in social, communication, and behavioral abilities.

    • ASD is a group of developmental disabilities with varying severity.

  • Hallmark Signs:

    • Repetitive behaviors: rocking, hand-flapping, spinning.

Levels of Autism Spectrum Disorder

  • Level 1:

    • Requires some support, may seem awkward or anti-social.

    • Thrives with routines; may appear quirky.

  • Level 2:

    • Needs more support; noticeable disability.

    • Limited social engagement and noticeable repetitive behaviors.

  • Level 3:

    • Requires the most support; evident disabilities.

    • Communication is minimal; struggles with routine changes.

Etiology

  • Genetics: Linked to inherited genes and de novo mutations (non-inherited).

  • Environmental Factors: Advanced parental age is a notable contributor, while claims regarding vaccinations lack empirical support.

Comorbidities

  • Common Comorbid Conditions:

    • ADHD

    • Epilepsy

    • Psychiatric/behavioral issues

    • Gastrointestinal disorders

    • Depression

Across the Lifespan

  • Behavioral issues may intensify with age, resulting in unemployment and limited social lives.

Intellectual Disabilities

DSM Definition

  • Definition: Disorder that emerges during the developmental period characterized by both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.

  • Severity Levels:

    • Mild, moderate, severe, or profound.

DSM-5 Criteria

  • Deficits in Intellectual Functions: Reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and experiential learning confirmed through clinical assessment and standardized IQ testing.

  • Deficits in Adaptive Functioning: Resulting in failure to meet developmental and sociocultural standards for personal independence and social responsibility without ongoing support.

  • Onset: Must occur during the developmental period (Wright et al., 2019).

Severity Levels of Intellectual Disabilities

  • Mild:

    • Functional at a 3rd-6th grade level; usually independent living.

  • Moderate:

    • Basic reading/writing skills with assistance required for independence.

  • Severe:

    • Limited reading/writing skills; requires supervision in daily life.

  • Profound:

    • May communicate minimally and requires extensive support with coexisting medical conditions.

Etiology

  • Causes: Genetic disorders (e.g., Fragile X, Down syndrome), genetic mutations, environmental factors including pre/postnatal infections, toxin exposure, and nutritional deficiencies.

Associated Challenges

  • Common Issues:

    • Epilepsy, gastroesophageal reflux, constipation, sensory impairments, injuries/falls.

    • Risks of increased comorbidities with age.

Communication Disorders (CD)

Types

  • Receptive Disorders: Difficulty in understanding and processing information.

  • Social Disorders: Difficulty in using appropriate language in social interactions.

  • Expressive Disorders: Challenges in formulating and sending verbal/nonverbal information.

Etiology

  • Often unknown, with a focus on investigating genetic links.

  • Statistics: Boys are 2-3 times more likely to stutter.

Comorbidities

  • Common Comorbid Conditions:

    • Hearing impairment

    • Intellectual disabilities

    • Developmental disabilities

    • Autism spectrum disorder

    • ADHD

    • Traumatic brain injury

    • Psychological/emotional disorders (Lee, 2020).

Motor Movement Disorders

Types of Movement Disorders

  • Developmental Coordination Disorder (DCD): Involves lack of appropriate motor skills.

  • Stereotypic Movement Disorder: Characterized by repetitive, non-purposeful movements.

  • Tic Disorders: Fast, unanticipated non-rhythmic movements or vocalizations (e.g., throat clearing, echolalia).

Tic Disorders

  • Types:

    • Provisional Tic Disorder: One or more motor and/or vocal tics for less than 1 year prior to age 18.

    • Persistent Tic Disorder: Single or multiple motor/vocal tics greater than 12 months prior to age 18.

    • Tourette Syndrome: Severe form involving multiple motor tics and at least one vocal tic over greater than 12 months before age 18.

Etiology of Movement Disorders

  • DCD Influences: Low birth weight, premature birth, family history, prenatal exposure to drugs/alcohol (NHS, 2019).

  • Tourette Syndrome: Genetic predisposition; maternal stress may play a role (Ueda, 2021).

Comorbidities

  • Common Comorbid Conditions:

    • Learning disorders, ADHD, emotional/behavioral issues, social skills deficits, depression (for DCD).

    • For Tourette Syndrome: ADHD, OCD, depression.

Cognitive Disabilities

  • Confirmed by clinical assessment and standardized intelligence tests showing deficiencies in:

    • Reasoning, problem solving, planning, abstract thinking, judgment, academic learning, experiential learning.

  • Deficits do not meet sociocultural standards for daily functions and social responsibility.

Learning Disorders

  • Definition: Difficulties in learning and using academic skills persisting for at least 6 months; not attributed to other cognitive issues, lack of educational instruction, or sensory impairments.

  • Common Areas of Difficulty:

    • Pronunciation, understanding reading, spelling, mathematical reasoning.

  • Learning difficulties generally emerge during school age but may not be evident until standardized testing.

Autism Spectrum Disorder (ASD)

Key Deficits

  • Deficiencies in social communication and interactions, characterized by difficulties in:

    • Social-emotional reciprocity.

    • Nonverbal communicative behaviors.

    • Developing and maintaining relationships.

    • Restricted, repetitive patterns of behavior/interests.

  • Diagnosis: Must be excluded in the presence of intellectual disability.

ADHD Overview

  • A persistent pattern of inattention and/or hyperactivity-impulsivity lasting at least 6 months affecting social and academic performance.

  • Common Symptoms:

    • Inattention to detail

    • Difficulty maintaining focus

    • Forgetfulness in daily activities

    • Lack of follow-through with tasks

  • Symptoms must be present in two or more settings and apparent before age 12.

Motor Disorders – Stereotypic Movements

  • Definition: Repetitive, driven movements without apparent purpose that interfere with social and academic functioning potentially resulting in self-injury.

  • Onset: Typically occurs during early development.

Tic Disorders – Tourette’s

  • Patients experience multiple motor tics and a vocal tic present for over 12 months before age 18, often not attributable to other medical conditions or medications.

Nurse's Role in Caring for Clients with NDD

Core Functions

  • Develop therapeutic relationships using Peplau’s phases: orientation, working, resolution.

  • Provide holistic, person-centered care.

  • Manage illness while promoting health and well-being.

  • Monitor for abuse and advocate for clients, reducing stigma while focusing on strengths.

  • Educate clients and their families regarding conditions, medications, and care plans.

Role Specific to Conditions

  • Intellectual/Learning Disabilities:

    • Focus on strengths, assist with communication barriers, create alternative strategies.

  • Autism Spectrum Disorder:

    • Appropriate screening, act as a liaison for community resources.

  • ADHD:

    • Advocacy for clients.

  • Tic Disorders:

    • Maintain client dignity and provide education to clients, families, and the public.

Recognize Cues

  • Conduct comprehensive assessments using standardized developmental screenings at well-child visits, tracking developmental milestones.

  • Conduct autism screenings at ages 18 and 24 months or when concerns are raised.

  • Observe mental and physical performance in play and school settings.

  • Consider history of head injury or emotional stress.

Erikson’s Stages of Development (1975)

  • Stages and Associated Virtues:

    • Stage 1: Infancy - Trust vs. Mistrust, Virtue: Hope

    • Stage 2: Early Childhood - Autonomy vs. Shame and Doubt, Virtue: Will

    • Stage 3: Preschool - Initiative vs. Guilt, Virtue: Purpose

    • Stage 4: School Age - Industry vs. Inferiority, Virtue: Competence

    • Stage 5: Adolescence - Identity vs. Confusion, Virtue: Fidelity

    • Stage 6: Young Adult - Intimacy vs. Isolation, Virtue: Love

    • Stage 7: Middle Adult - Generativity vs. Stagnation, Virtue: Care

    • Stage 8: Mature - Integrity vs. Despair, Virtue: Wisdom

Developmental Milestones

Milestones at Different Ages

  • 3 Months:

    • Turns head toward sounds, raises head/chest, shows interest in familiar faces.

  • 6 Months:

    • Shows response to emotions, enjoys games like peek-a-boo, able to sit up, babbles.

  • 1 Year:

    • Stands/walks with support, imitates during play, begins to make simple words.

  • 2 Years:

    • Engages in play, sorts objects, follows simple instructions, makes short sentences.

  • 3 Years:

    • Imitates peers, expresses emotions, runs and navigates stairs.

  • 4 Years:

    • Follows multi-step commands, performs basic life skills, understands colors and counting.

Analyzing Cues and Formulating Hypotheses

  • Recognize that neurodevelopmental disorders may coexist.

  • Consider multiple cues together concerning etiology, abilities, and severity of impairment.

  • Prioritize needs and solutions based on urgency and accessibility.

Generating Solutions

  • Individualization: Solutions should be developmentally appropriate and involve the caregiver's participation.

  • Intervention Strategies: May include behavioral interventions or medical solutions.

Sample Care Plans

Tourette Syndrome

  • Interventions:

    • Teach behavioral techniques to reduce tics.

    • Family therapy for stress management.

    • Consider pharmacological intervention using a second-generation antipsychotic like risperidone (Jordan Halter, 2018).

Autism Spectrum Disorder

  • Interventions:

    • Refer to early intervention programs at school.

    • Educate parents on structure and consistency.

    • Use behavior management strategies with a reward system.

    • Consider necessary therapies (physical, occupational, speech).

    • May include pharmacological interventions with a stimulant like methylphenidate (Jordan Halter, 2018).

Discharge Planning

  • Referrals: For early intervention programs, school services, community resources.

  • Goal-Setting:

    • Short-term goals to increase specific skills.

    • Long-term goals focusing on broader behavioral and developmental improvements for adult independence (Hyman et al., 2020).

Interventions for Managing Behaviors

  • Techniques:

    • Use verbal warnings to prompt self-reflection.

    • Implement time-out for self-control.

    • Provide a quiet room for reduced stimulation.

    • Medications prescribed for symptom relief.

    • Seclusion or restraint procedures as last resort during severe crises.

Evaluating Outcomes

Examples of Desired Outcomes Across Disorders

  • Autism Spectrum Disorder:

    • Improved cooperation with others; shows emotional sensitivity.

  • Attention Deficit Disorder:

    • Improved impulse control, social relationships, effective communication of needs.

  • Intellectual Disability:

    • Engagement in social activities, reduced frustration, management of basic math and reading skills.

  • Tic/Tourette Syndrome:

    • Decreased involuntary facial expressions; improved verbal communication and avoidance of triggering stressors.