NEURODEVELOPMENTAL DISORDERS

 Onset in developmental period.

 Typically, manifest early in development, often before the child enters
grade school.
 Characterized by developmental deficits that produce impairments of
personal, social, academic or occupational functioning.
 Neurodevelopmental disorders frequently co-occur or are comorbid.
E.g; individuals with ASD often have ID.

RISK FACTORS:
 GENETIC INFLUENCES: GENE DAMAGE
1. Fragile X Syndrome – FMR1 gene of X chromosome narrows, breaks,
or otherwise becomes mutated
 Less common in females. Why?
 Leads to certain brain changes
 Hyperactivity
 Self-stimulatory & self-injurious behavior
 Aggression
 Poor social skills
 Perseveration (?)
 Bizarre language
 Intellectual Disability
 2. Phenylketonuria (PKU)
 Genetic mutation on chromosome 12
 Body’s inability to break down phenylalanine, an amino acid
 Excess – damage to liver and brain
 Awkward gait
 Severe language delay
 Learning disorders
 Intellectual disability

3. Sickle cell disease

 Damaged red blood cells
 Slow blood movement
 Less oxygenation
 Leading to brain damage
 Intellectual disability

GENETIC INFLUENCES:
 Concordance rates of Autism – 60-92% in identical twins
 Autism & learning disorders (especially reading disorders) run in
families.

CHROMOSOMAL ABBERATION:
- DOWN-SYNDROME: An extra #21 chromosome.

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PRENATAL AND PERINATAL PROBLEMS:
 TERATOGENS: Conditions that negatively impact physical
development of a child during;
1. Prenatal – Before birth or
2. Perinatal – During birth periods.
 Lead to many structural changes.

PRENATAL TERATOGENS:
1. Infections
2. Maternal Diseases (e.g. HIV, High BP, Chronic Kidney problems) and
toxins (such as lead and mercury)
3. Excessive maternal stress
a. Increase adrenaline and limit oxygen to fetus
4. Malnutrition
5. Exposure to X-Rays
6. Alcohol & Drug use

PERINATAL TERATOGENS:
1. Premature birth
2. Low birth weight
3. Respiration issues (Hypoxia)
4. Trauma to head
5. Severe Jaundice

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POST-NATAL CAUSES
1. Malnutrition
2. Infections (e.g. Meningitis, Encephalitis)
3. Repeated fits
4. Trauma/Injury to brain
5. Environmental influences

BRAIN CHANGES:
 Problems in:
 Closure of neural tube (linking spinal cord to the brain)
 Proper development of the forebrain
 Completion of the corpus callosum
 Cell growth and distribution
 Leading to underdevelopment of brain areas

ENVIRONMENTAL FACTORS:
1. Poor language stimulation
2. Neglect of Educational needs
3. Inconsistent parenting
4. Accidents or Traumas leading to brain damage
 Severe ‘shaking’ of children due to frustration
 Car accidents
 Poisoning from lead or cleaners
 Neurological damage from diseases such as meningitis

TREATMENTS FOR NEURODEVELOPMENTAL DISORDERS:

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 1. LANUAGE TRAINING:
 Receptive ability through improving eye contact and attention
 Expressive speech through Shaping (?)
 Speech Imitation
 Sign language

2. SOCIALIZATION TRAINING:
 Performing and using social skills
 Eye contact
 Appropriate conversations
 Playing and cooperating with others
 Expressing affection
 Imitation & Observational learning
 Social play groups – rewarded for playing with peers instead of solitary
play

3. SELF-CARE SKILLS TRAINING:

 Task analysis
 Chaining (Forward & Backward) (?)
 Feedback & Reinforcement

4. ACADEMIC SKILLS TRAINING:

 Phonetic approach – breaking down the sounds of words
 Individualized teaching
 Special educational facilities
 Technology

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 ADDRESSING PROBLEM BEHAVIOURS:
 Time-Out
 Token Economy
 Restitution & positive overcorrection
 Punishment/Restraint

INTELLECTUAL DISABILITY (ID)

DIAGNOSTIC CRITERIA FOR INTELLECTUAL DISABILITY (DSM-5)

 The DSM-5 outlines the following criteria for diagnosing Intellectual
Disability (ID), which is characterized by deficits in general mental
abilities and impaired functioning in daily life:

1. Deficits in Intellectual Functioning:

 This includes reasoning, problem-solving, planning, abstract thinking,
judgment, academic learning, and experiential learning.
 These deficits are confirmed by clinical assessment and standardized
intelligence testing.
 (typically an IQ score approximately two standard deviations or more
below the population mean, i.e., an IQ score of around 70 or below).

2. Deficits in Adaptive Functioning:

 These deficits result in a failure to meet developmental and
sociocultural standards for personal independence and social
responsibility.

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  Without ongoing support, the deficits limit functioning in one or more
activities of daily life, such as communication, social participation, and
independent living, across multiple environments (e.g., home, school,
work, community).

3. Onset During the Developmental Period:

 These deficits begin during childhood or adolescence.

DIFFERENTIAL DIAGNOSIS FOR INTELLECTUAL DISABILITY:

 Differential Diagnosis The diagnosis of intellectual disability should be
made whenever Criteria A, B, and C are met.
 A diagnosis of intellectual disability should not be assumed because of
a particular genetic or medical condition.
 A genetic syndrome linked to intellectual disability should be noted as
a concurrent diagnosis with the intellectual disability.
1. Major and mild neurocognitive disorders.
 Intellectual disability is categorized as a neurodevelopmental disorder
and is distinct from the neurocognitive disorders, which are
characterized by a loss of cognitive functioning.
 Major neurocognitive disorder may co-occur with intellectual disability
(e.g., an individual with Down syndrome who develops Alzheimer’s
disease, or an individual with intellectual disability who loses further
cognitive capacity following a head injury).
 In such cases, the diagnoses of intellectual disability and
neurocognitive disorder may both be given.

2. Communication disorders and specific learning disorder.

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  These neurodevelopmental disorders are specific to the
communication and learning domains and do not show deficits in
intellectual and adaptive behavior. They may co-occur with intellectual
disability.
 Both diagnoses are made if full criteria are met for intellectual
disability and a communication disorder or specific learning disorder.

3. Autism spectrum disorder.

 Intellectual disability is common among individuals with autism
spectrum disorder.
 Assessment of intellectual ability may be complicated by social-
communication and behavior deficits inherent to autism spectrum
disorder, which may interfere with understanding and complying with
test procedures.
 Appropriate assessment of intellectual functioning in autism spectrum
disorder is essential, with reassessment across the developmental
period, because IQ scores in autism spectrum disorder may be
unstable, particularly in early childhood.

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AUTISM SPECTRUM DISORDER (ASD)

The Diagnostic Criteria for Autism Spectrum Disorder (ASD):

A. Persistent Deficits in Social Communication and Social Interaction

These deficits must be present in multiple contexts and include the
following, currently or by history:
1. Deficits in Social-Emotional Reciprocity:
 Examples include abnormal social approach and failure of
normal back-and-forth conversation; reduced sharing of
interests, emotions, or affect; failure to initiate or respond to
social interactions.
2. Deficits in Nonverbal Communicative Behaviors Used for Social
Interaction:
 Examples include poorly integrated verbal and nonverbal
communication; abnormalities in eye contact and body
language; deficits in understanding and using gestures; a total
lack of facial expressions and nonverbal communication.
3. Deficits in Developing, Maintaining, and Understanding
Relationships:
 Examples include difficulties adjusting behavior to suit various
social contexts; difficulties in sharing imaginative play or in
making friends; absence of interest in peers.
B. Restricted, Repetitive Patterns of Behavior, Interests, or Activities
At least two of the following must be present, currently or by history:
1. Stereotyped or Repetitive Motor Movements, Use of Objects, or
Speech:

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  Examples include simple motor stereotypies, lining up toys or
flipping objects, echolalia, idiosyncratic phrases.
2. Insistence on Sameness, Inflexible Adherence to Routines, or
Ritualized Patterns of Verbal or Nonverbal Behavior:
 Examples include extreme distress at small changes, difficulties
with transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day.
3. Highly Restricted, Fixated Interests that are Abnormal in Intensity or
Focus:
 Examples include strong attachment to or preoccupation with
unusual objects, excessively circumscribed or perseverative
interests.
4. Hyper- or Hypo reactivity to Sensory Input or Unusual Interest in
Sensory Aspects of the Environment:
 Examples include apparent indifference to pain/temperature,
adverse response to specific sounds or textures, excessive
smelling or touching of objects, visual fascination with lights or
movement.
C. Symptoms Must Be Present in the Early Developmental Period
 These symptoms may not become fully manifest until social demands
exceed limited capacities, or they may be masked by learned
strategies later in 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 Developmental Disorder) or Global Developmental Delay.
 Intellectual Disability and Autism Spectrum Disorder frequently co-
occur; to make comorbid diagnoses of Autism Spectrum Disorder and
Intellectual Disability, social communication should be below that
expected for general developmental level.

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DIFFERENTIAL DIAGNOSIS FOR (ASD):
1. Rett Syndrome:
 Rett syndrome is a genetic disorder that primarily affects
females
 It includes a period of normal development followed by loss of
purposeful hand skills, development of stereotyped hand
movements, and severe psychomotor retardation.
 Unlike ASD, Rett syndrome includes specific medical and
neurological features.
2. Selective Mutism:
 Selective mutism involves consistent failure to speak in specific
social situations despite speaking in other situations.
 Unlike ASD, selective mutism does not include deficits in social
communication and interaction or restricted and repetitive
behaviors.
3. Language Disorders and Social (Pragmatic) Communication Disorder:
 Language disorders involve difficulties in language
comprehension and production, whereas social (pragmatic)
communication disorder involves difficulties with social use of
verbal and nonverbal communication.
 These conditions do not include the restricted, repetitive
patterns of behavior typical of ASD.
4. Intellectual Disability (Intellectual Developmental Disorder) without
ASD:
 Intellectual disability involves global developmental delays in
intellectual and adaptive functioning.
 ASD is diagnosed in individuals with intellectual disability only if
social communication and interaction are below the expected
level for their developmental stage.

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 5. Stereotypic Movement Disorder:
 This disorder is characterized by repetitive, non-functional
motor behavior (e.g., hand-flapping, body rocking) that
interferes with normal activities.
 If these behaviors are associated with other symptoms of ASD,
the diagnosis of ASD should be given instead.
6. Attention-Deficit/Hyperactivity Disorder (ADHD):
 ADHD involves patterns of inattention, hyperactivity, and
impulsivity.
 While these symptoms can co-occur with ASD, they do not
include the social communication deficits or restricted,
repetitive behaviors seen in ASD.
7. Schizophrenia:
 Schizophrenia, typically diagnosed in adolescence or adulthood,
involves hallucinations, delusions, and disorganized thinking.
 Early onset of schizophrenia might be confused with ASD;
however, the primary symptoms of schizophrenia are psychotic
features, which are not present in ASD.

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ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

DIAGNOSTIC CRITERIA – DSM-5:

A. Inattention
Six (or more) of the following symptoms have persisted for at least six
months to a degree that is inconsistent with developmental level and that
negatively impacts directly on social and academic/occupational activities:
1. Often fails to give close attention to details or makes careless mistakes
in schoolwork, at work, or during other activities.
2. Often has difficulty sustaining attention in tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions).
5. Often has difficulty organizing tasks and activities.
6. Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework).
7. Often loses things necessary for tasks or activities (e.g., school
materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses,
mobile phones).
8. Is often easily distracted by extraneous stimuli.
9. Is often forgetful in daily activities.
B. Hyperactivity and Impulsivity
Six (or more) of the following symptoms have persisted for at least six
months to a degree that is inconsistent with developmental level and that
negatively impacts directly on social and academic/occupational activities:
1. Often fidgets with or taps hands or feet or squirms in seat.

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 2. Often leaves seat in situations when remaining seated is expected
(e.g., leaves his or her place in the classroom, in the office or other
workplace, or in other situations that require remaining in place).
3. Often runs about or climbs in situations where it is inappropriate (in
adolescents or adults, may be limited to feeling restless).
4. Often unable to play or engage in leisure activities quietly.
5. Is often "on the go," acting as if "driven by a motor" (e.g., is unable to
be or uncomfortable being still for extended time, as in restaurants,
meetings; may be experienced by others as being restless or difficult
to keep up with).
6. Often talks excessively.
7. Often blurts out an answer before a question has been completed
(e.g., completes people's sentences; cannot wait for turn in
conversation).
8. Often has difficulty waiting his or her turn (e.g., while waiting in line).
9. Often interrupts or intrudes on others (e.g., butts into conversations,
games, or activities; may start using other people's things without
asking or receiving permission; for adolescents and adults, may
intrude into or take over what others are doing).
Additional Criteria
1. Several inattentive or hyperactive-impulsive symptoms were present
before age 12 years.
2. Several inattentive or hyperactive-impulsive symptoms are present in
two or more settings (e.g., at home, school, or work; with friends or
relatives; in other activities).
3. There is clear evidence that the symptoms interfere with, or reduce
the quality of, social, academic, or occupational functioning.
4. The symptoms do not occur exclusively during the course of
schizophrenia or another psychotic disorder and are not better
explained by another mental disorder (e.g., mood disorder, anxiety

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 disorder, dissociative disorder, personality disorder, substance
intoxication or withdrawal).

DIFFERENTIAL DIAGNOSIS FOR ADHD – DSM 5:

1. Oppositional Defiant Disorder (ODD):
 Children with ODD may exhibit defiant, disobedient, and hostile
behaviors towards authority figures, which can overlap with
ADHD symptoms, particularly impulsivity. However, the primary
issue in ODD is a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness.
2. Intermittent Explosive Disorder:
 This disorder involves episodes of aggressive outbursts that are
disproportionate to the situation. Unlike ADHD, which includes a
pattern of pervasive inattentiveness and hyperactivity,
intermittent explosive disorder is characterized by impulsive
aggression without the other ADHD symptoms.
3. Specific Learning Disorder:
 Children with specific learning disorders may struggle
academically and show signs of inattention due to frustration
and difficulty in learning specific skills. However, their attention
issues are typically limited to academic tasks and do not extend
to other areas of life, as in ADHD.
4. Intellectual Disability (Intellectual Developmental Disorder):
 Individuals with intellectual disability may show inattentive or
hyperactive behaviors, but these are better explained by a
general developmental delay. ADHD should be diagnosed only if
the attentional and hyperactivity symptoms are excessive for the
developmental level.
5. Autism Spectrum Disorder (ASD):

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  ASD can involve difficulties in social interaction, communication,
and repetitive behaviors, which might be confused with ADHD.
However, ASD includes significant social communication deficits
and restricted, repetitive behaviors that are not core symptoms
of ADHD.
6. Reactive Attachment Disorder (RAD):
 Children with RAD may display inattention and hyperactivity due
to severe neglect or lack of stable attachment figures. RAD is
characterized by disturbed and developmentally inappropriate
social relatedness, which differentiates it from ADHD.
7. Anxiety Disorders:
 Anxiety can cause inattention due to worry and distraction.
Children with anxiety disorders might also appear restless.
However, the inattention in anxiety is typically related to specific
worries or fears rather than the pervasive patterns seen in
ADHD.
8. Depressive Disorders:
 Depression can lead to difficulties concentrating and a lack of
motivation, which might be mistaken for ADHD. The
distinguishing feature is the presence of a persistent sad or
irritable mood and other symptoms of depression.
9. Bipolar Disorder:
 Bipolar disorder can present with episodes of increased activity,
impulsivity, and distractibility during manic episodes, similar to
ADHD. However, bipolar disorder includes distinct mood
episodes (mania/hypomania and depression) that are not
characteristic of ADHD.
10. Disruptive Mood Dysregulation Disorder (DMDD):
 DMDD is characterized by severe temper outbursts and chronic
irritability. Unlike ADHD, the primary issue in DMDD is mood

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 dysregulation, which does not include the persistent pattern of
inattention and hyperactivity.
11. Substance Use Disorders:
 Substance use can cause symptoms of inattention and
hyperactivity, either through the effects of the substance or
withdrawal. A careful history is needed to differentiate ADHD
from substance-related issues.
12. Neurodevelopmental Disorders:
 Other neurodevelopmental disorders, such as communication
disorders or motor disorders, may also present with symptoms
that overlap with ADHD. Each of these disorders has specific
criteria and symptom patterns that help differentiate them from
ADHD.
13. Psychotic Disorders:
 Conditions such as schizophrenia can involve disorganized
thinking and behavior that might be confused with ADHD.
Psychotic disorders include hallucinations and delusions, which
are not features of ADHD.
14. Medical Conditions:
 Certain medical conditions (e.g., thyroid dysfunction, sleep
disorders, seizure disorders) can present with symptoms that
mimic ADHD. A thorough medical evaluation is necessary to rule
out these conditions.

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