What is neurodevelopmental disorders
a group of condition with onset in the developmental period. Typically manifest early in development, often before grade school. produce impairment of personal, social, academic, or occupational functioning.
List the neurodevelopmental disorders
- Intellectual disability
- developmental delay
- communication disorders - language disorder, speech sound disorder, social (pragmatic) communication disorder and childhood-onset fluency disorder
- Autism spectrum disorder
- Motor disorders (developmental coordination dis, stereotypic movement disorder, and tic )
- Specific learning disorder
Intellectual Disability (Intellectual developmental disorder)
Onset during developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domain
Must meet the 3 criteria
1. Deficits in intellectual functions - reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience (confirmed by clinical assessment and individualized standardized intelligence testing).
2. Deficits in adaptive functioning - resulting in failure to meet developmental and sociocultural standards for personal independence and social responsibility. w/o ongoing support deficits limit functioning in one or more activities of daily life i.e communication, social participation and independent living, across multiple settings.
3. Onset of intellectual and adaptive deficits during the developmental period.
What determines levels of serverity for InD
Adaptive functioning, and not IQ scores b/c it is the adaptive functioning that determines the level of supports required. IQ measures are also less valid in the lower end of the IQ range.
Social (Pragmatic) Social Communication Disorder
Persistent difficulties in the social use of verbal and nonverbal communication.
Social Pragmatic Communication Disorder (Diagnostic Criteria)
A 1. Deficits in using communication for social purposes (i.e., greeting, sharing information in an appropriate manner for the social context)
2. Impairment of the ability to change communication to match the context or needs of the listener (i.e., speaking differently in classroom vs. playground or speaking to an adult vs. a child or avoiding the use of overly formal language.)
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (making inferences) and nonliteral or ambiguous meanings of language idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
B. The Deficits results in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination
C. The onset of the symptoms is in the arly developmental period (but deficits may ot become fully manifest until social communication demands exceed limited capacities)
D. The symptoms are attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (Intellectual developmental disorder) global developmental delay, or another mental disorder.
What is the Differential Diagnosis Between:
ADS and Social Communication Disorder?
- The two can be differentiated by the presence in ADS of restricted/repetitive patterns of behavior interests, or activities
- and their absence in social (pragmatic) communication disorder.
Note: persons w/ ASD may only display the restricted/repetitive patterns of behavior, interests, and activities during the early developmental period, so a comprehensive history should be obtained. Current absence of Sympotom would not preclude a diagnosis of ASD, if the restricted interests and repetitive behaviors were present in the past.
A diagnosis of social (Pragmatic communication disorder should be considered only if the developmental hx fails to reveal any evidence of any restricted/repetitive patterns of behavior, interests, or activities.
What is the differentiating feature for social anxiety disorder and social communication disorder?
The differentiating feature is the timing of the onset of symptoms. In social (pragmatic ) communication Disorder, the individual has never had effective social communication; in social anxiety disorder, the social communication skills developed appropriately but are not utilized because of anxiety, fear or distress about social interactions.
Autism Spectrum Disorder (Diagnostic Criteria)
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following (currently or by history)
- 1 Deficits in social-emotional reciprocity
- 2. Deficits in nonverbal communicative behaviors used for social interaction
- 3. Deficits in developing, maintaining and understanding relationships (range- difficulty adjusting behavior to suit various social contests; to difficulties in sharing imaginative play or making friends; to absence of interest in peers
B. Restricted, repetitive patterns of behavior, interest, or activities, as manifested by at least two of the following (currently or by history)
- 1. stereotyped or repetitive motor movements, use of objects, or speech (e.g. simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases)
- 2. Insistence on sameness, inflexiblie adherence to routines, or ritualized patters of verbal or nonverbal behaviors (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food everyday
- 3. highly restricted, fixed interest that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests.)
- 4. Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., 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 (but not become fully manifest until social demands exceed limited capacities, or many 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 or global developmental delay. Ind and ASD frequently co-occur to make comorbid diagnoses of diagnoses of ASD and InD.
Note: individuals who do not otherwise meet criteria for ASD, should be evaluated for social pragmatic communication disorder
What are the ASD specifiers
- With or without accompanying intellectual impairment
- with or without accompanying language impairment
- Associated with a known medical or genetic condition or environmental factor
- Associated with another neurodevelopmental, mental or behavioral disorder
- With catatonia
What is Specific Learning Disorder different from ADHD
Children with SLD may appear inattentive because of frustration, lack of interest, or limited ability. However, inattention in individuals with a specific learning disorder who does not have ADHD is no impairing outside of academic work.
What is the Diagnostic Criteria For
A. Persistent pattern of inattention and /or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2)
1. Inattention 6(or more) symptoms for at least 6 months - in way that is inconsistent with developmental level and that negatively impact directly on social and academic/occupational activities
- a. Often fails to give close attention to details or make careless mistakes in schoolwork, at work or during other activities
- b. often has difficulty sustaining attention in task or play activities (lectures, conversations or lengthy reading)
- c. often does not seem to listen when spoken to directly (mind seems else where)
- d. often does not follow through on instructions and fails to finish schoolwork, chores or duties in workplace (easily side tracked, quicly loses focus)
- e. often has difficulty organizing tasks and activities
- f. often avoids, dislkes, or is reluctant to engage in tasks that require sustained mental effort (school work , homework, preparing reports).
- g. often loses ting necessary for task or activities
- h. is often easily distracted by extraneous stimuli
- I is often forgetful in daily activities (doing chores, running errands, keeping appointments, paying bills)
2 Hyperactivity and impulsivity 6 (or more) of the following symptoms have persisted for at least 6 months in a way that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. 5 or more for adults (not due to oppositional behavior are a failure to understand tasks and instructions)
- a. often fidgets with or taps hands or feet or squirms in seat.
- b. often leaves seat in situation when remaining seated I expected
- c. Often runs about or climbs in situation where it is inappropriate
- d. often unable to play or engage in leisure activities quietly.
- e. often on the go, acting as if "driving by a motor"
- d. often talks excessively
- g. often blurts out an answer before a question has been completed
- h. often has difficulty waiting his or her turn
- often interrupts or intrudes on others.
B. Severe inattentive or hyperactive-impulsive symptoms were present prior to age 12
C. Several inattentive or hyperactive-impulsive symptoms are present in two to ore settings (home, school, work, with friends or relative)
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic or occupational functioning .
E. the symptoms do not occur exclusively during the course of schizophrenia or another mental disorder
What is the differential diagnosis between ODD and ADHD
Individual with ODD may resist work or school tasks that require self application because they resist conforming to other's demands. Behaviors are characterized by negativity, hostility and defiance.
Must be differentiated from aversion to school or mentally demanding task due to difficulty in sustaining mental effort, forgetting instructions and impulsivity individuals with ADHD.
Some individuals with ADHD may develop secondary oppositional attitudes toward such tasks and devalue their importance.