Neurodevelopmental Disorders of Childhood + Adolescence

Attention Deficit Hyperactivity Disorder (ADHD)

  • most frequent disorder diagnosed in preschool and school-aged children

  • A) a persistent pattern of inattention + hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2)

    • 1 - inattention

      • 6 or more of the following symptoms persistent for at least 6 months to a degree that is inconsistent with developmental level + that negatively impacts directly on social and academic/occupational activities

        • fails to pay attention to details or makes careless mistakes in schoolwork, work, or with other activities

        • has difficulty sustaining attention on tasks at school or during play

        • does not seem to listen when spoken to directly

        • does not follow through on instructions or finish tasks

        • has difficulty organizing tasks and activities

        • avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort over a long period of time

        • often loses things necessary for school tasks or activities

        • is easily distracted by external stimuli

        • is forgetful in daily activities

      • note: symptoms are not solely a manifestation of oppositional behavior, defiance, or a failure to understand directions; 17+ yo → 5 symptoms required

    • 2 - hyperactivity/impulsivity

      • often fidgets with hands or feet or squirms in seat

      • often leaves seat in situations where remaining seated is expected

      • often runs about or climbs excessively where such activity is inappropriate

      • has difficulty playing or engaging in leisure activities quietly

      • often on the go, acting as if “driven by a motor”

      • often talks excessively

      • often blurts out answers before questions are completed

      • often has difficulty awaiting turn

      • often interrupts or intrudes on others

  • B) symptoms were present prior to age 12

  • C) clear evidence that symptoms interfere with or reduce quality of social, academic, or occupational functioning

  • D) symptoms are not better explained by something else (e.g., another psychological disorder)

ADHD (DSM-5-TR) Specifiers

  • presentation

    • primarily inattentive; primarily hyperactive/impulsive; combined presentation

  • remission status

    • in partial remission: fewer than the full criteria have been met for the last 6 months, symptoms still result in impairment

  • current severity

    • mild: fewer symptoms in excess of those required for diagnosis are present, and their effect on daily functioning is minor

    • moderate: the severity of the person’s ADHD falls between the “mild” and “severe” categories

    • severe: many symptoms are present beyond those required for diagnosis, or several symptoms are especially severe. this significantly affects the person’s daily functioning

When can we diagnose ADHD?

  • remember - symptoms must be present prior to age 12

  • hard to distinguish symptoms from highly variable normative behaviors before age 4

  • most often diagnosed in elementary school

ADHD Etiology - Biological

  • 80% heritable

  • prenatal/birth

    • exposure to smoking + alcohol

    • premature birth

    • low birth weight

    • lead exposure

  • one of the first psychological disorders to be associated with neurotransmitters

    • norepinephrine (low levels)

      • sustained attention/alertness

      • response to environmental stimuli

      • attention

    • dopamine (low levels)

      • working memory

      • behavior

      • motivation

      • attention

ADHD Etiology - Psychological + Social

  • not the result of sugar or video games

  • poverty, family stress, family conflict are correlated with ADHD diagnosis

  • difficulty with peer interactions - might be the result of symptoms rather than a contributing factor

ADHD Etiology - Sociocultural

  • who gets diagnosed with ADHD?

    • boys more than girls

      • more noticeable symptoms

      • doctors are more likely to diagnose boys than girls, regardless of symptoms

    • younger children in the class more than older children (birthdays in the last 3rd of the year)

ADHD Treatment - Biological

  • stimulant medication (e.g. Adderall, Ritalin, etc.)

  • Guanfacine + Wellbutrin - nonstimulants

ADHD Treatment - Psychological

  • parent education, classroom management strategies, behavioral rewards, or self-management training

  • parent education + training could be the first line of treatment for preschoolers

  • environmental modifications

  • moderate physical activity - reduce impulsivity + hyperactivity

  • mixed martial arts interventions → improved cognitive control

Autism Spectrum Disorder (ASD)

  • autism rates are rising, but in all age groups

  • A) persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

    • deficits in social-emotional reciprocity

    • deficits in nonverbal communicative behaviors used for social interaction

    • deficits in developing, maintaining, and understanding relationships

  • B) restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following, currently or by history:

    • stereotyped or repetitive motor movements, use of objects, or speech

    • insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

    • highly restricted, fixated interests that are abnormal in intensity or focus

    • hyper- or hypoactivity to sensory input or unusual interest in sensory aspects of the environment

  • C) symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)

  • D) symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

  • E) these disturbances are not better explained by intellectual disability (intellectual development disorder) or global developmental delay

What if someone only has persistent deficits in social communication and social interaction?

  • consider diagnosis of social (pragmatic) communication disorder

Diagnosing ASD

  • American Academy of Pediatrics recommends that health care providers screen all children between 19 and 24 months of age

  • evaluation involves Autism screening inventories, observations by medical professionals, parent interviews, developmental histories, communication assessment, and psychological testing

Early Signs of Possible Autism Spectrum Disorder

  • 6-12 Months:

    • limited or no eye contact

    • minimal or no smiling or joyful responses to people or reciprocal sharing of sounds

    • limited or atypical babbling or communicating by pointing, reaching, or waving

    • limited response when someone speaks to the child

  • 9-12 Months:

    • emerging repetitive behaviors such as spinning or lining up objects

    • atypical play behavior or unusual visual or tactile focus on toys

  • 12-18 Months:

    • not using any words

    • no use of gestures such as pointing

    • lack of pretend play

    • limited attention to interpersonal interaction

  • 15-24 months

    • limited, atypical, or no use of meaningful two-word phrases

  • any age

    • parental or caregiver concerns about possibility of ASD

    • loss of previously acquired skills, including reduced frequency or loss of social behaviors or communication skills

ASD Etiology - Biological

  • genetics: 62-75% (identical twins)

  • abnormalities in brain development

    • thinner temporal cortex, thicker frontal cortex

  • not vaccines

  • not bad parenting

  • primarily seen as having biological etiology

ASD Treatment

  • early intervention is impactful

  • improving reciprocal social interaction, developing communication skills through imitation, reinforcing behavioral improvement, and social skills training