NEURO

DEVELOPMENTAL
DISORDERS
Childhood Disorders
◦ A group of disorders in which the development of the central nervous system is
disturbed.
◦ This can include developmental brain dysfunction, which can manifest as
neuropsychiatric problems or impaired motor function, learning, language or non-
verbal communication
◦ The disorder typically manifest early in developmental, often before the child enter
grade school.
I. Intellectual Disabilities
◦ Intellectual Disability (Mental Retardation or
Intellectual Development Disorder)
◦ Global Developmental Delay
Content
II. Communication Disorders
◦ Language Disorder (Expressive and Mixed III. Motor Disorders (Motor Skills
Receptive-Expressive Language Disorders) Disorders)
◦ Speech Sound Disorder (Phonological Disorder)
◦ Developmental Coordination Disorder
◦ Childhood-Onset Fluency Disorder/Stuttering
◦ Stereotypic Movement Disorder
◦ Social (pragmatic) Communication Disorder
IV. Tic Disorders
◦ Autism Spectrum Disorder (Pervasive
Developmental Disorder / Autistic Disorder / ◦ Tourette’s Disorder
Mindblindedness)
◦ Persistent (Chronic) Motor or Vocal Tic
◦ Attention-Deficit/Hyperactivity Disorder
Disorder
◦ Specific Learning Disorder (Learning Disorder)
◦ Provisional Tic Disorder
Intellectual Disabilities
◦ Disability characterized by significant limitations both in intellectual functioning
(reasoning, learning, problem solving) and in adaptive behavior, which covers a
range of everyday social and practical skills.
◦ This disability originates before the age of 18
Causes of neurodevelopmental disorders
◦ During practical periods of development, genetics, substances and toxins,
nutritional deficiencies deprivation trauma, meningitis
Intellectual Giftedness
◦ 130 -144: moderately gifted
◦ 145 – 159: highly gifted
◦ 160 – 179: exceptionally gifted
◦ 180+: profound gifted
◦ Terence Tao: Chinese, IQ of 230
◦ Christopher Herata: Indian, IQ of 225
Two Domains
Externalizing Disorder
◦ Outward-directed
◦ Aggressiveness, noncompliance, overactivity and impulsiveness
Internalizing Disorder
◦ Inward-focused
◦ Depressed, social withdrawal, and anxiety
Intellectual Disability (Mental Retardation or Intellectual Development
Disorder)
◦ Intellectual deficits determined by intelligence testing and broader clinical
assessment
◦ Significant deficits in adaptive functioning relative to the person’s age and cultural
group in one or more of the following areas; communication, social participation,
work or school, independence at home or in the community, requiring the need for
support at school, work, or independent life.
◦ Onset during child development
Common Causes
◦ Genetic Conditions
◦ Problems at Birth and during pregnancy
◦ Lead Poisoning
◦ Health problems
◦ Fetal alcohol syndrome/Hidden disability
When a woman drinks alcohol during pregnancy, she risk giving birth to a child who
will pay the price – in mental and physical deficiencies – for his or her entire life.
Sign and Symptoms
◦ Low birth weight
◦ Small head circumference
◦ Failure to thrive
◦ Developmental delay
◦ Organ dysfunction
◦ Facial abnormalities, including smaller eye openings, flattened cheekbones
◦ Indistinct Philtrum: an underdeveloped groove between nose and upper lip
◦ Epilepsy
◦ Poor coordination/fine motor skills
◦ Poor socialization skills, such as difficulty building and maintaining friendships and relating to
groups
◦ Lack of imagination or curiosity
◦ Learning difficulties, including poor memory, inability to understand concept such as time and
money, poor language comprehension, poor problem-solving skills
◦ Behavioral problems, including hyperactivity, inability to concentrate, social withdrawal,
stubbornness, impulsiveness, and anxiety
Fragile X Syndrome
◦ Inherited causes
Trisomy 21/Down Syndrome/Mongolism
◦ Individual born with an extra 21st chromosome
◦ IQ is below 70
◦ Most common cause
◦ Overly friendly
◦ Smile and laugh
◦ Physical problems of rapid respiration
◦ Simian Crease: Single line that runs across the palm of the hand. People usually
have three creases in their palms
Signs of Intellectual Disability
◦ Sit up, crawl, or walk later than other children;
◦ Learn to talk later, or have trouble speaking
◦ Find it hard to remember things
◦ Not understanding how to pay for things
◦ Have trouble understanding social rules
◦ Have trouble seeing the consequences of their actions
◦ Have trouble solving problems
Levels of Intellectual Disability
Mild/Dull Normal
◦ IQ 50 – 70, educable, Academic potential, Immature in social interactions
Moderate
◦ IQ 35 – 49, Trainable, incapable of learning, trained in nonacademic areas, marked
differences from peers in social and communicative behavior across development.
Severe
◦ IQ 20 – 34, slight words and survival skills, generally has little understanding of
written language or of concepts, requires support for all activities of daily living,
spoken language is quite limited in terms of vocabulary and grammar
Profound
◦ IQ less than 20, require pervasive services and supports, conceptual skills generally
involve the physical world rather than symbolic processes, very limited
understanding of symbolic communication is speech or gesture
Global Developmental Delay (GDD)
◦ Is the general term used to described a condition that occurs during the
developmental period of a child between birth and 18 years
◦ It is usually defined by the child being diagnosed with having a lower intellectual
functioning than what is perceive as ‘normal’
Communication Disorders
◦ Any disorder that affects an individual’s ability to comprehend, detect, or apply
language and speech to engage in discourse effectively with others.
◦ Speech: is the expressive production of sounds and includes an individual’s
articulation, fluency, voice and resonance quality
◦ Language: includes the form, function, and use of conventional system of symbols
in rule-governed manner of communication
◦ Communication: includes any verbal or nonverbal behavior that influences the
behavior, ideas, or attitudes of another individual..
Language Disorder (expressive and mixed receptive-expressive language
disorders)
◦ Difficulties in the acquisition and use of language due to deficits in the
comprehension or production of vocabulary, sentence structure and discourse.
◦ Highly heritable
◦ Onset of symptoms in the early developmental period
◦ Substantially and quantifiably below those expected for age, resulting in functional
limitations in effective communication, social participation, academic achievement,
or occupational performance, individually or in any combination.
◦ When a person has trouble understanding others or sharing thoughts, ideas, and
feelings completely
Speech Sound Disorder (Phonological Disorder) (SSD)
◦ Diagnosed when speech sound production is not what would be expected based on
child’s age and developmental stage
◦ The disturbance causes limitations in effective communication that interfere with
social participation, academic achievement, or occupational performance,
individually or in any combination
Types of Speech Sound Errors
◦ Omission: A child may leave out sounds in words and sentences
Ex: “I re a boo” (I read a book)
◦ Substitution: a child may use an incorrect sound instead of the correct one
Ex: “Wook a the wittle wamb” (Look at the little lamb)
◦ Distortions: a child tries to make the right sound, but cannot produce it clearly
Ex: the /s/ sound may whistle, or the air may come out of the sides of the mouth,
making a “slushy” sound (“lateral lisp”) or, the tongue may push between the teeth
causing the “frontal lisp”
Symptoms of SSD
◦ Repeating sounds (most often seen in people who stutter)
◦ Adding extra sound and words
◦ Elongating words
◦ Making jerky movements while talking (usually involving the head)
◦ Blinking several times while talking
◦ Visible frustration while talking
◦ Taking frequent pauses while talking
◦ Distorting sounds when talking
◦ Hoarseness (raspy and gravely sounding voice)
Childhood-Onset Fluency Disorder/Stuttering
◦ Disturbance of the normal fluency and time patterning of speech that is inappropriate
for the individual’s age
◦ Disturbance causes anxiety about speaking or limitations in effective communication,
social participation, or academic performance, individually or in any combination
◦ The onset of the symptoms is in the early developmental period
◦ Later-onset causes are diagnosed as adult-onset fluency disorder
◦ Monosyllabic whole-word repetitions (ex: why-why-why did he go there?)
◦ Part-word or sound/syllable repetitions
◦ Prolongations of sounds
◦ Audible or silent blocking (filled or unfilled pauses in speech)
◦ Words produced with an access of physical tension or struggle
Social (Pragmatic) Communication Disorder
◦ Characterized by a primary difficulty with pragmatics, or the social use of language and
communication, as manifested by deficits in understanding and following social rules of
verbal and nonverbal communication in naturalistic contexts, changing language according
to needs of the listener or situation and following rules for conversation or story telling
◦ Delay in reaching language milestones
◦ Little interest in social interactions
◦ Going off-topic or monopolizing conversation
◦ Not adapting language to different listeners (Ex: talks the same way to an adult as to a
friend)
◦ Not adapting language to different situations (Ex: speaks the same way in the classroom as
on the playground)
◦ Not giving background information when speaking to an unfamiliar person
◦ Not understanding how to properly greet people, request information or gain attention
◦ Tendency to be overly literal and not understand riddles and sarcasm
◦ Trouble understanding nonverbal communication (Ex: facial expression)
◦ The onset of symptoms is in the early developmental period
Autism Spectrum Disorder (Pervasive Developmental Disorder/Autistic
Disorder/Mindblindedness) (ASD)
◦ Autistic Savant/Savant Syndrome: individuals who score very low IQ tests, while
demonstrating exceptional skills or brilliance in specific areas, such as rapid
calculation (hypercalculia), art, memory, or musical ability
◦ Prodigy: focuses on results or achievement: a child, typically under the age of ten,
who can perform at an adult professional level in a highly demanding culturally
recognized field of endeavor
◦ Onset in early childhood
◦ Symptoms limit and impair functioning
◦ Deficits in social communication and social interactions as exhibited by the following:
◦ Nonverbal behaviors such as eye contact, facial expression, body language
◦ Development of peer relationships appropriate to developmental level
◦ Not cuddly and no fear of real dangers
◦ Social or emotional reciprocity such as not approaching others, not having back-and-forth
conversation, reducing sharing of interest and emotions
◦ Restricted, repetitive behavior patterns, interests, or activities exhibited by at least two of the
following:
◦ Stereotyped or repetitive speech, motor movements, or use of objects (ex: hand flap, head
bang, twirl)
◦ Excessive adherence to routines, rituals in verbal or nonverbal behavior, or extreme resistance
to change
◦ Very restricted interest that are abnormal in focus, such as preoccupation with parts of objects
◦ Hyper- or hyporeactivity to sensory input or unusual interest in sensory environment, such as
fascination with lights or spinning objects.
Forms of Autism (DSM IV)
Asperger’s Disorder
◦ Persistent difficulties with social communication and social interaction and restricted and
repetitive patterns of behaviors, activities or interests since early childhood, to the extent
that these “limit and impair everyday focus on one thing
◦ Tends to obsessively focus on one thing
Childhood Disintegrated Disorder / Heller’s Syndrome / Disintegrated Psychosis /
Regressive Autism
◦ Rare condition characterized by late onset of developmental delays – or stunning
reversals – in language, social function, and motor skills
◦ Researchers have not been successful in finding a cause for the disorder
Rett’s Disorder
◦ Rare genetic neurological and developmental disorder that affects the way the brain
develops, causing a progressive inability to use muscles for eye and body movements
and speech. It occurs almost exclusively in girls
◦ Seem to develop normally at first, but after about 6 months of age, they lose skills they
previously had – such as the ability to crawl, walk, communicate or use their hands
Severity Levels for Autism Spectrum Disorder
Level 1: Requiring Support
◦ Without supports in place, deficits in social communication cause noticeable
impairments
◦ Has difficulty initiating social interactions and demonstrates clear examples of
atypical or unsuccessful responses to social overtures of others. May appear to
have decrease interest in social interactions
◦ Rituals and Repetitive Behaviors (RRB’s) cause significant interference with
functioning in one or more contexts. Resist attempts by others to interrupt RRB’s or
to be redirected from fixated interest
Level 2: Requiring Substantial Support
◦ Marked deficits in verbal and nonverbal social communication skills; social
impairments apparent even with supports in place; limited initiation of social
interactions and reduced or abnormal response to social overtures from others
◦ RRB’s and/or preoccupations or fixated interests appear frequently enough to be
obvious to the casual observer and interfere with functioning in a variety of
contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to
redirect from fixated interest
Level 3: Requiring Very Substantial Support
◦ Severe deficits in verbal and nonverbal social communication skills cause severe
impairments in functioning; very limited initiation of social interactions and minimal
response to social overtures from others.
◦ Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with
functioning in all spheres. Marked distress when rituals or routines are interrupted;
very difficult to redirected from fixated interest or returns to it quickly
Attention-Deficit/Hyperactivity Disorder (ADHD)
◦ Six or more manifestations of inattention present for at least 6 months to a
maladaptive degree and greater than what would be expected given a person’s
developmental level (careless mistakes, not listening well, not following
instructions, easily distracted, forgetful in daily activities, fidgeting, running about
inappropriately, restlessness)
◦ Continue or persist until adulthood
◦ Present before age 12 in two or more setting (home, school, or work)
◦ For people age 17 or older, only five signs of inattention and/or five signs of
hyperactivity-impulsivity are needed to meet the diagnosis
◦ Male > Female 2:1
◦ Key features: hyperactivity, impulsivity, and distractibility (Schizophrenia in adults)
Externalizing Disorders
◦ Predominantly Inattentive Type: Children whose problems are primarily those of
poor attention.
◦ Predominantly Hyperactive-Impulsive Type: Children whose difficulties result
primarily from hyperactivity/impulsive behavior
◦ Combined Type: Children who have both sets of problems
Etiology of ADHD
◦ Genetics Factors
◦ Neurobiological Factors
◦ Perinatal and prenatal Factors
◦ Cocaine, led, alcohol, nicotine all increase dopamine that leads to brain infections
◦ Mother’s use of nicotine: most common cause
◦ Environmental toxins
Specific Learning Disorder (Learning Disorder)
◦ Academic performance that is substantially below what would be expected given
the person’s age, intelligence quotient score, and education for at least 6 months.
◦ Significant interference with academic achievement or activities of daily living
◦ The learning difficulties begin during school-age years but may not become fully
manifest until the demands for those affected academic skills exceed the
individual’s limited capacities.
◦ Dyscalculia: difficulty in numbers or math facts
◦ Dysgraphia: inability to write
◦ Dyslexia: inability to read
◦ Dysorthographia: inability to spell in writing
◦ Dysfluency: inability to speak properly
Motor Disorders (Motor Skills Disorders)
◦ Disorders of the nervous system that cause abnormal involuntary movements.
They can result from damage to the motor system.
Developmental Coordination Disorder (DCD)
◦ Motor skill disorder that affects five to six percent of all school-aged children.
◦ The ratio of boys to girls varies from 2:1 to 5:1 depending on the group studied
◦ By definition, children with DCD do not have an identifiable medical or neurological
condition that explains their coordination problems.
◦ 12 to18 months: a child’s fine motor skills improved steadily. Now she’s physically
ready to grab hold of a crayon and start experimenting
◦ The onset of symptoms is in the early developmental period
◦ DCD occurs when a delay in the development of motor skills, or difficulty
coordinating movements, result in a child being unable to perform common,
everyday task.
◦ Frequently described as “clumsy” or “awkward” by their parent and teachers
◦ Ex: dropping or bumping into objects
◦ Slowness and inaccuracy of performance of motor skills
◦ Ex: Catching an object, using scissors or cutlery, handwriting, riding a bike or
participating in sports
◦ Children with DCD have difficulty mastering simple motor activity
◦ Ex: tying shoes or going down stairs, and are unable to perform age-appropriate
academic and self-care task
◦ Some children may experience difficulties in a variety or area while others may
have problems only with specific activities
◦ Children with DCD usually have normal or above average intellectual abilities.
However, their motor coordination difficulties may impact their academic progress,
social integration and emotional development
◦ Dyspraxia or Clumsy Child Syndrome: inability to coordinate
Stereotypic Movement Disorder
◦ Condition in which a person makes repetitive, purposeless movements
◦ Ex: hand waving, body rocking, or head banging
◦ The movements interfere with normal activity or have the potential to cause bodily
harm
◦ The onset of symptoms is in the early developmental period
Causes of Stereotypic Movement Disorder
◦ Stimulant drugs such as cocaine and amphetamines can cause a severe, short
period of stereotypic movement behavior.
◦ Long-term stimulant use may lead to longer periods of the behavior
◦ Head injuries may also cause stereotypic movements
Tic Disorders
Tourette’s Disorder (TS)
◦ If you have a Tourette’s syndrome, you make unusual repeated, sudden, rapid, non-
rhythmic muscle movements including sound or vocalizations, called TICS
◦ You have little or no control over them
◦ Common tics are throat-clearing and blinking
◦ You may repeat words, spin, or, rarely, blurt out swear words.
◦ TS often report as substantial buildup in tension when suppressing their tics to the
point where they feel that the tic must be expressed against their will
◦ Begin between the ages 2 to 21, and last throughout life
◦ Both multiple motor and one or more vocal tics have been present at some time
during the illness, although not necessarily concurrently
◦ The tics may wax and wane in frequency but have persisted for more than 1 year
since first tic onset
◦ Onset is before 18
Simple
◦ Motor: eye blinking, head jerking, shoulder shrugging, facial grimacing, nose twitching
◦ Vocal: throat clearing, braking noises, squealing, grunting, gulping, sniffing, tongue clicking
Complex:
◦ Motor: jumping, touching other people and things, twirling about, repetitive movements of
the torso and limbs, pulling at clothing and self-injurious actions including hitting or biting
oneself
◦ Vocal: uttering words or phrases
◦ Coprolalia: the involuntary utterance of inappropriate or obscene words
◦ Echolalia: repeating a sound, word or phrase just heard
◦ Palilalia: repeating one’s own words
Causes of Tourette’s Disorder
◦ It is unknown
◦ Most common for boys
◦ The tics usually start in childhood and may be worst in the early teens.
◦ Many people eventually outgrown them
Persistent (Chronic) Motor or Vocal Tic Disorder
◦ It is a condition that involves quick, uncontrollable movements and vocal outburst
(but not both)
◦ Neurotransmitters are chemicals that transmit signals throughout the brain. They
may be misfiring or not communicating correctly. This causes the same “message”
to be sent over and over again. The result is typical tic
◦ Tics usually start at age 5 or 6 and get worse until age 12. they often improve
during adulthood
◦ Chronic motor tic disorder is more common than Tourette syndrome. Chronic tics
may be forms of Tourette syndrome
◦ Both multiple motor and one or more vocal tics have been present at some time
during the illness, although not necessarily concurrently
◦ The tics may wax and wane in frequency but have persisted for more than 1 year
since first tic onset
◦ Onset before 18
Provisional Tic Disorder
◦ It is a temporary condition in which a person makes one or many brief, repeated,
movements or noises (tics). These movements or noises are involuntary
◦ Tics are common in children and may last for less than one year
◦ Onset is before 18 years
◦ Criteria have never been met for Tourette’s disorder or persistent (Chronic) motor
or vocal tic disorder
Causes of Provisional Tic Disorder
◦ The cause of provisional tic disorder can be physical or mental (psychological). It
may be a mild form of Tourette syndrome.
◦ Abnormalities in the brain may also be responsible for tic disorders. Such
abnormalities are the cause of other mental conditions, such as depression and
attention deficit hyperactivity disorder (ADHD)
◦ Some research suggest that transient tic disorder could be linked to
neurotransmitters.