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Neurodevelopmental Disorders
Intellectual Disability
Three main criteria: •
Significant limitations in intellectual .1
functioning;
Significant limitations in adaptive .2
functioning;
Before the age of 18. .3
Intellectual functioning: •
Refers to the ability to reason, plan, think, and •
communicate. These abilities allow us to solve
problems, to learn, and to use good judgment.
One measure of intelligence is called the
intelligence quotient, or IQ.
Adaptive functioning: •
Three basic skill sets: •
Conceptual skills: language, reading, writing, math, .1
reasoning, knowledge, and memory.
Social skills, these skills help us to get along well with .2
others. These skills include empathy, social judgment,
interpersonal communication skills, the ability to
make and retain friendships, and similar capacities.
Practical life skills, these are the skills needed to .3
perform the activities of daily living. This includes
feeding, bathing, dressing, occupational skills, and
navigational skills.
Prevalence
Formerly 2.5% scored 70 or below. •
Now 1%. •
Causes
Can be grouped into 4 major categories:
Medical Conditions; .1
Brain Damage; .2
Genetic Conditions; .3
Psychiatric Conditions. .4
Most common is autism, Down syndrome •
and Fragile X syndrome, Fetal Alcohol
Syndrome (FAS).
Specific Learning Disorders
A biologically based, neurodevelopmental •
disorder that affects a person’s ability to take
in, process, and/or communicate information.
Lagging academic achievement that results •
from visual or auditory problems or poor or
inappropriate academic instruction is not
indicative of a specific learning disorder.
Diagnostic Criteria
Persistent difficulty acquiring academic skills despite •
adequate instruction is a primary feature of the disorder.
Students with specific learning disorder struggle to learn in •
at least one academic domain.
In addition, academic performance in the affected •
academic domain must be confirmed by a “comprehensive
clinical assessment” (including a standardized test of
achievement) to be “substantially and quantifiably” lower
than expected given the individual’s age and to result in
“significant interference” with school, work performance,
or daily living.
Prevalence
Specific learning disorder affects •
approximately 5%-15% of school-age children.
Co-occurring Disorders
Specific learning disorder can occur alongside •
other disorders. A study by Margari et al. (2013)
revealed that 33% of patients with specific
learning disorder also show signs of attention
deficit hyperactivity disorder (ADHD), indicating
that common biological mechanisms are at play
in both specific learning disorder and ADHD.
Additionally, this study suggested that other
disorders, such as anxiety disorders, depressive
disorders and developmental coordination
disorder, may tend to co-occur with specific
learning disorder.
Causes
Are not entirely understood. •
Examples: •
Preterm infants have higher risk. .1
Low birth weight have higher risk. .2
Chemicals – such as pesticides, dioxins, and .3
other organic toxins – that damage
hormones of the endocrine gland are
associated with learning disabilities.
Disruptive Behavior Disorders
Characterized by problems in emotional and •
behavioral self-control.
Includes two disorders: •
Oppositional defiant disorder. .1
Conduct disorder. .2
Prevalence
2% to 16% of youth have an ODD. •
The prevalence of CD is 6% to 9% and is more •
commonly diagnosed in boys.
Etiology
Biological: •
Parent with a diagnosis of: Alcohol Dependence, .1
Antisocial Personality Disorder, Attention
Deficit/Hyperactivity Disorder, Conduct Disorder,
Schizophrenia.
Sibling with a Disruptive Behavior Disorder. .2
Maternal smoking during pregnancy. .3
Environmental risk factors: •
Parental rejection/neglect.
Inconsistent parenting/multiple caregivers.
Abuse.
Exposure to violence.
.1
.2
.3
.4
Oppositional Defiant Disorder
Diagnostic criteria: •
Loses temper –
Arguing with adults –
Easily annoyed –
Spiteful –
Blames others for mistakes –
Deliberately annoys others –
Conduct Disorder
Diagnostic criteria: •
Exhibits a pattern of behavior that violates the –
rights of others or disregards age-specific social
norms.
Deliberately break rules –
Aggressive toward people or animals –
Destructive of property –
Lying and theft –
Violation of rules –
ODD can progress into CD. •
Predisposing factors include: •
Greater severity and early onset of oppositional –
behavior, frequent physical fighting, parental
substance abuse and low socio-economic status.
ADHD is frequently co morbid with these •
disorders.
ADHD
ADHD is a neurodevelopmental disorder •
affecting both children and adults. It is
described as a “persistent” or on-going
pattern of inattention and/or hyperactivityimpulsivity that gets in the way of daily life or
typical development.
There are three presentations of ADHD:
Inattentive
Hyperactive-impulsive
Combined inattentive & hyperactive-impulsive
•
•
•
•
Could be: •
Mild –
Moderate –
Severe –
Based on how many symptoms a person has •
and how difficult those symptoms make daily
life.
Diagnosis
Children still should have six or more •
symptoms of the disorder. In people 17 and
older the DSM-5 states they should have at
least five symptoms.
Inattentive presentation
Fails to give close attention to details or makes careless
mistakes.
Has difficulty sustaining attention.
Does not appear to listen.
Struggles to follow through on instructions.
Has difficulty with organization.
Avoids or dislikes tasks requiring a lot of thinking.
Loses things.
Is easily distracted.
Is forgetful in daily activities.
•
•
•
•
•
•
•
•
•
Hyperactive-impulsive
presentation
Fidgets with hands or feet or squirms in chair.
Has difficulty remaining seated.
Runs about or climbs excessively in children; extreme
restlessness in adults.
Difficulty engaging in activities quietly.
Talks excessively.
Blurts out answers before questions have been completed.
Difficulty waiting or taking turns.
Interrupts or intrudes upon others.
•
•
•
•
•
•
•
•
Combined inattentive &
hyperactive-impulsive presentation
Has symptoms from both of the above •
presentations.
5) Autism Spectrum Disorder
ADS
vs.
Pervasive Developmental Disorders
PDD
Until recently, the types of ASD have been determined by guidelines
in the diagnostic manual (DSM - IV) of the American Psychiatric
Association. According to the CDC, the three main types of ASD are:
1- Asperger's syndrome
2- Pervasive developmental disorder, not otherwise specified (PDDNOS)
3- Autistic disorder
The DSM -IV also included two rare but severe autistic-like conditions
Rett syndrome and childhood disintegrative disorder.
The new diagnostic manual has made some major changes in this list
of disorders. It's unclear, though, how these changes will affect the
way health professionals define exactly what is an autistic spectrum
disorder.
A table provided in DSM-5 in the neurodevelopmental disorders
chapter (Ref. 1, pp 34 – 6) provides examples of the different
levels of severity.
for example, in the absence of intellectual
impairment, the DSM-5 diagnosis for a person
with a DSM-IV diagnosis of Asperger’s disorder
is autism spectrum disorder without intellectual
impairment and without structural language
impairment.
5) Autism Spectrum Disorder
ADS
• Definition: group of conditions that involve problems
with social skills, language, and behaviors.
• Impairment is noticeable at early age of life and
involves multiple areas of development (social,
cognitive, and communicative).
• include:
1. Autistic disorder.
2. Asperger disorder.
3. PDD not otherwise specific (NOS).
4. Childhood disintegrative disorder.
5. Rett disorder.
List of symptoms
1. Problems with social interaction : •
- Impairment in nonverbal behaviors (facial expression, gestures, etc.)
- Failure to develop peer relationships
- Failure to seek sharing of interests or enjoyment with others
- Lack of social/emotional reciprocity
2. Impairments in communication
- Lack of or delayed speech
- Repetitive use of language
- Lack of varied, spontaneous play, and so on
3. Repetitive and stereotyped patterns of behavior and activities
- Inflexible rituals
- Preoccupation with parts of objects, and so on
Autism
Dx & Definition
(by DSM-IV)
Epidemiology*
Etiology
Treatment
At least 6 symptoms must be present by age 3, from the following categories:
1. Problem with social interaction (at least 2)*
2. Impairments in communication (at least 1)
3. Repetitive & stereotype patterns of behavior & activities (at least 1)
0.02 – 0.05% children*.
Boys 3-4x
Apparent at early age due to delayed developmental milestones
70% of them meet criteria for mental retardation (IQ <70)
 Some associate with FXS, tuberous sclerosis, MR & seizures
Multi-factorial..
1. Prenatal neurological insults
2. Genetics factors
3. Immunological & biochemical factors
No cure ! –but to help manage symptoms &
improve social skills:
 Remedial education
 Behavioral therapy
 Antipsychotic drugs.
 Antidepressants/ stimulants*
Asperger Syndrome
Dx & DSM-IV
Criteria
1. Impaired social interaction (at least 2)
2. Restricted / stereotype behaviors, interest or activities
3. Have a normal language acquisition and cognitive
devalopment
Epidemiology
Incidence : unknown
Boys > girls
Etiology
Unknown, may involve genetic, infectious, or perinatal
factors
Treatment
 Supportive as autisim
 Social training & behavioral modification techniques
Childhood Disintegrative Disorder
Dx & DSM-IV
Criteria
 Normal development in the first 2 years of life
 Loss of previously acquired skills (at least 2) by age 10 years :
(Language, Social skill or adaptive behavior, Bowel/ bladder control, Play,
Motor skills)
 At least 2 of :
-Impaired social interaction
-Impaired use of language
-Behaviors & interest (restricted, repetitive & stereotype)
- Bowel or bladder control
- Play
- Motor skills
Epidemiology
 Rare: 1/100000, onset : 2-10 years old
 Boys 4-8x !
Etiology
unknown
Treatment
Supportive
Rett Disorder
Characteristics 1.
2.
3.
4.
5.
6.
7.
8.
Epidemiology
Normal prenatal & perinatal development.
Normal psychomotor development during the first 5 months
Normal HC (but then ↓ between 5-48 months old)
Loss of previously learned purposeful hand skills (5-30m) 
development of stereotype hand movement “hand wringing, hand
washing)
Early loss social interaction usually followed by subsequent
improvement
Impaired language & psychomotor retardation.
Problems with gait and trunk movements.
Seizures, Cyanotic spells
Rare: 1/15000 & 1/22000 female, onset : age 5-48 months old, Girls
predominantly
Boys : variable phenotype, dev. delay, many die in utero
Genetic testing is available
Etiology
MECP2 gene mutation on X chromosome
Treatment
Supportive
6- Tourette Disorder
Tics: sudden, repetitive, nonrythmic, stereotyped involuntary movements &
vocalization
Tourette disorder: most severe tic disorder
vocal tics may 1st appear many years after motor tics
Motor tics : most common –face & head (e.g eyes blinking)
Vocal tics : Coprolalia & Echolalia
Dx & DSM-IV Multiple motor & vocal tics (both must present !) that are not attributable to
Criteria
CNS disease.
Tics : occur many time a day, almost every day for >1 year (no tic-free period >3
months)
Change in anatomic location and character of tic over time
Onset prior to age 18 years
Epidemiology  0.05% of children
 Onset : 7-8 y/o, Boys 3x !
 High co-morbidity with OCD & ADHD
Etiology
 Genetics factors
 Neurochemical factors mpaired regulation of dopamine in the caudate
nucleus
Treatment
Pharmacotherapy (haloperidol, pimozide)
Supportive psychotherapy
7- ELIMINATION DISORDERS
Enuresis
Urinary continence : normally established before age 4
Enuresis : involuntary voiding of urine (bedwetting), r/o MD conditions
Primary—child never established urinary continence.
Secondary—manifestation occurs after a period of urinary continence,
most commonly between ages 5 and 8.
Diurnal—includes daytime episodes
Nocturnal—includes nighttime episodes
Dx & DSM-IV •Involuntary voiding of urine after age 5
Criteria
•Occurs at least 2x a week for 3 consecutive months or
with marked impairment
Epidemiology 5% of 5 years old, prevalence ↓ with age
Boys > girls
May be associated with other psychiatric disorders; e.g.
conduct disorder.
Etiology
 Genetic predisposition
 Small bladder/ low nocturnal levels of ADH
 Psychological stress
Treatment
o Behavioral modification
o Pharmacotherapy – antidiuretics, TCAs
Encopresis
Bowel control : normally achieved by age of 4
Bowel incontinence: result in rejection by peers & impairment of social
development.
Must r/o metabolism abnormalities, lower GI problems & dietary factors.
Dx & DSM-IV
Criteria
Involuntary/ intentional passage of feces in inappropriate places
At least 4 years of age
At least 1x a month for 3 months
Epidemiology  1% of 5-year-old children
 Incidence ↓ with age
 Associated with other psychiatric condition (e.g conduct disorder
& ADHD)
Etiology
 Psychosocial stressors
 Lack of sphincter control
 Constipation with overflow incontinence
Treatment
Therapy (psycho, family, behavioral)
Stool softener (if constipate)
8 – Other Disorders
- Selective Mutism
- Separation Anxiety disorder
- Child Abuse
Selective Mutism
 Rare condition
 Girls > boys
 Refusal to speak in certain situations ( such as in school)
for at least 1 month, despite the ability to comprehend and
use language.
 Onset : 2-5 years old, often not noticed until time of entry
to school.
 Maybe preceded by stressful life event
 Treatment : psychotherapy , behavior therapy, and
management of anxiety.
Separation Anxiety disorder
Excessive fear of leaving one’s parents or other major attachment figures
for ≥ 4 weeks.
May refuse to go to school (avoid it by complain of physical symptoms,
refuse to sleep alone
Become extremely distressed & worry excessively about losing their
parents forever.
 4% of school-age children
 Equal boys-girls
 Onset : around age 7, may be preceded by stressful life event.
 Treatment : Family therapy, cognitive behavioral therapy, and low-dose
antidepressant
Child Abuse
Physical, emotional, sexual & neglect
Doctors are legally required to report all cases of suspected child
abuse.
The majority of substantiate cases are cases of neglect.
↑ risk of anxiety disorders, depressive disorders, dissociative
disorders, self-destructive behaviors, substance abuse disorders, and
posttruamatic stress disorder
↑ risk of abusing their own children.
Children may be admitted to the hospital without parental consent
in order to protected them
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