NEURODEVELOPMENTAL

DISORDER
DR HILDA PUSPA INDAH, SPKJ
 • sekelompok kondisi yang terjadi dalam masa
perkembangan.
• Gangguan ini biasanya terdiagnosis di awal
NEURODEVELOPMENTAL pengembangan, sebelum anak memasuki
DISORDER
sekolah dasar, dan ditandai dengan defisit
perkembangan yang menimbulkan gangguan
fungsi personal, sosial, akademik, atau
pekerjaan.
1. Intellectual Disabilities
2. Communication Disorders
3. Autism Spectrum Disorders
4. Attention Deficit/Hyperactivity Disorder
5. Specific Learning Disorders
6. Motor Disorders
7. Tic Disorders
INTELLECTUAL DISABILITIES
INTELLECTUAL DISABILITIES

• = mental retardation
• below-average intelligence or mental ability and a lack of skills necessary for day-to-day
living.
• can and do learn new skills, but they learn them more slowly.
• degrees of intellectual disability → from mild to profound.
SOMEONE WITH INTELLECTUAL DISABILITY HAS
LIMITATIONS IN TWO AREAS. THESE AREAS ARE:
• Intellectual functioning → IQ, this • Adaptive behaviors.
refers to a person’s ability to learn,
These are skills necessary for day-to-
reason, make decisions, and solve
day life, such as being able to
problems.
communicate effectively, interact with
others, and take care of oneself.
• There are many different signs of intellectual disability in children. Signs may
appear during infancy, or they may not be noticeable until a child reaches school
age. It often depends on the severity of the disability.
• Signs of intellectual disability are:
✓ Rolling over, sitting up, crawling, or walking late
✓ Talking late or having trouble with talking
✓ Slow to master things like potty training, dressing, and feeding himself or
herself
✓ Difficulty remembering things
✓ Inability to connect actions with consequences
✓ Behavior problems such as explosive tantrums
✓ Difficulty with problem-solving or logical thinking
ETIOLOGY
• Genetic conditions → Down syndrome, fragile X syndrome
• Problems during pregnanycy → fetal brain development include alcohol or drug use,
malnutrition, certain infections, or preeclampsia
• Problems during childbirth → deprived of oxygen during childbirth or born extremely
premature
• Illness or injury → Infections like meningitis, whooping cough, or the measles can lead
to intellectual disability. Severe head injury, near-drowning, extreme malnutrition,
infections in the brain, exposure to toxic substances such as lead, and severe neglect or
abuse can also cause it.
• None of the above. In two-thirds of all children who have intellectual disability, the cause
is unknown
• Three things factor into the diagnosis of intellectual disability:
✓interviews with the parents
✓observation of the child
✓testing of intelligence and adaptive behaviors.
• After a diagnosis of intellectual disability is made, a team of professionals will
assess the child’s particular strengths and weaknesses. This helps them
determine how much and what kind of support the child will need to succeed at
home, in school, and in the community.
TYPES OF INTELLECTUAL DISABILITIES DSM V :
• Mild (IQ of 50-55 to 70)
❖85% of people with intellectual disabilities have a mild disability.
❖Conceptual domain: mildly affected abstract thinking, functional abilities, cognitive
flexibility and short-term memory.
❖Social domain: immature social interactions, which puts them at risk for
manipulation.
❖Practical domain: requiring supervision, guidance and assistance when carrying
out daily life tasks. This help is very important particularly in stressful situations.
❖They often seem no different than children without this disability until they get older.
 MODERATE (IQ OF 35-40 TO 50-55)
❖10% are moderate disabilities.
❖Conceptual domain: requiring continuous assistance to complete daily activities.
Sometimes it is even necessary for other people to take over some of their responsibilities.
With moderate supervision, they are able to learn skills related to their own personal care.
They can perform unskilled or semi-skilled jobs, but always with supervision.
❖Social domain: when communicating verbally, their language is less rich and complex than
people without disabilities. This means that they cannot interpret certain social subtleties
correctly and that they have problems making new relationships.
❖Practical domain: with support and continuous instruction they can develop certain skills
and abilities.
SEVERE (IQ OF 20-25 TO 35-40)
❖3-4% of people with an intellectual disability have a severe disability.
❖Conceptual domain: very limited, especially with numerical concepts. They need
constant support in many areas.
❖Social domain: their oral language is very elementary, their sentences are
grammatically simple and they have a limited vocabulary. They communicate very
simply and are limited to the present.
❖Practical domain: requiring constant supervision for all everyday tasks.
PROFOUND (IQ OF 20-25)
❖Although they are a minority (1% -2%), most are related to an identified neurological
disease.
❖Conceptual domain: clearly impacted. They only think about the physical world and non-
symbolic processes. With instruction, they can acquire certain skills like pointing.
Associated motor and sensory difficulties often prevent the functional use of objects.
❖Social domain: precarious understanding of verbal and gestural communication. They
express themselves in a very basic, simple and mostly non-verbal way.
❖Practical domain: they are totally dependent in all areas. Only if they have no motor or
sensory impairments can they participate in certain basic activities.
ALAT UKUR

• To measure a child’s adaptive behaviors, a

• IQ (intelligence quotient) → IQ test. specialist will observe the child’s skills and
The average IQ is 100, with the compare them to other children of the same
majority of people scoring between age.
85 and 115. A person is considered ✓ Things that may be observed include how
intellectually disabled if he or she has well the child can feed or dress himself or
an IQ of less than 70 to 75. herself;
✓ how well the child is able to communicate
with and understand others

✓ how the child interacts with family, friends,

and other children of the same age.
AUTISM SPECTRUM DISORDERS
• Autism spectrum disorder (ASD) is a developmental disorder that

affects communication and behavior. Although autism can be

diagnosed at any age, it is said to be a “developmental disorder”

because symptoms generally appear in the first two years of life.

ACCORDING TO THE DSM V

• Difficulty with communication and interaction with other people

• Restricted interests and repetitive behaviors
• Symptoms that hurt the person’s ability to function properly in school, work, and other
areas of life
• Autism → “spectrum” disorder → there is wide variation in the type and severity of
symptoms people experience.
• ASD occurs in all ethnic, racial, and economic groups.
• Although ASD can be a lifelong disorder, treatments and services can improve a
person’s symptoms and ability to function.
SOCIAL COMMUNICATION / INTERACTION BEHAVIORS
MAY INCLUDE :
• Making little or inconsistent eye contact
• Tending not to look at or listen to people
• Rarely sharing enjoyment of objects or activities by pointing or showing things to others
• Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to
gain attention
• Having difficulties with the back and forth of conversation
• Often talking at length about a favorite subject without noticing that others are not interested or
without giving others a chance to respond
• Having facial expressions, movements, and gestures that do not match what is being said
• Having an unusual tone of voice that may sound sing-song or flat and robot-like
• Having trouble understanding another person’s point of view or being unable to predict or
understand other people’s actions
RESTRICTIVE / REPETITIVE BEHAVIORS MAY
INCLUDE:

• Repeating certain behaviors or having unusual behaviors. For example, repeating

words or phrases, a behavior called echolalia
• Having a lasting intense interest in certain topics, such as numbers, details, or
facts
• Having overly focused interests, such as with moving objects or parts of objects
• Getting upset by slight changes in a routine
• Being more or less sensitive than other people to sensory input, such as light,
noise, clothing, or temperature
• People with ASD may also experience sleep problems and irritability. Although
people with ASD experience many challenges, they may also have many
strengths, including:
• Being able to learn things in detail and remember information for long periods of
time
• Being strong visual and auditory learners
• Excelling in math, science, music, or art
CAUSES AND RISK FACTORS
• While scientists don’t know the exact causes of ASD, research suggests that genes
can act together with influences from the environment to affect development in
ways that lead to ASD.
• Risk factors include:
✓ Having a sibling with ASD
✓ Having older parents
✓ Having certain genetic conditions—people with conditions such as Down syndrome,
fragile X syndrome, and Rett syndrome are more likely than others to have ASD
✓ Very low birth weight
TREATMENTS AND THERAPIES

• Treatment for ASD should begin as soon as possible after diagnosis.

• Early treatment for ASD is important as proper care can reduce individuals’
difficulties while helping them learn new skills and make the most of their
strengths.
• The wide range of issues facing people with ASD means that there is no single
best treatment for ASD.
MEDICATION
• A doctor may use medication to treat some symptoms that are common with ASD.
With medication, a person with ASD may have fewer problems with:
✓ Irritability
✓ Aggression
✓ Repetitive behavior
✓ Hyperactivity
✓ Attention problems
✓ Anxiety and depression
• Behavioral, psychological, and educational therapy
• People with ASD may be referred to doctors who specialize in providing
behavioral, psychological, educational, or skill-building interventions. These
programs are typically highly structured and intensive and may involve parents,
siblings, and other family members. Programs may help people with ASD:
• Learn life-skills necessary to live independently
• Reduce challenging behaviors
• Increase or build upon strengths
• Learn social, communication, and language skills
ATTENTION DEFICIT/HYPERACTIVITY
DISORDER
• Attention deficit hyperactivity disorder (ADHD) is a brain disorder
that affects how you pay attention, sit still, and control your behavior. It
happens in children and teens and can continue into adulthood.
• most commonly diagnosed mental disorder in children
• Boys > girls.
• It’s usually spotted during the early school years, when a child begins to
have problems paying attention.
ADHD SYMPTOMS IN CHILDREN

• Inattentive ✓ Has problems organizing daily tasks

✓ Is easily distracted ✓ Doesn’t like to do things that require

sitting still
✓ Doesn't follow directions or finish tasks
✓ Often loses things
✓ Doesn't seem to be listening
✓ Tends to daydream
✓ Doesn't pay attention and makes
careless mistakes
✓ Forgets about daily activities
HYPERACTIVE-IMPULSIVE
• Often squirms, fidgets, or bounces when • Has trouble waiting for their turn
sitting
• Blurts out answers
• Doesn't stay seated
• Interrupts others
• Has trouble playing quietly
• Is always moving, such as running or
climbing on things (In teens and adults,
this is more often described as
restlessness.)
• Talks excessively
SYMPTOMS IN ADULTS → MAY CHANGE AS A PERSON
GETS OLDER

• Often being late or forgetting things • Procrastination

• Anxiety • Easily frustrated
• Low self-esteem • Often bored
• Problems at work • Trouble concentrating when reading
• Trouble controlling anger • Mood swings
• Impulsiveness • Depression
• Substance misuse or addiction • Relationship problems
• Trouble staying organized
CAUSES
• Genes
• Chemicals
• Brain changes. Areas of the brain that control attention are less active in children with ADHD.
• Poor nutrition, infections, smoking, drinking, and substance abuse during pregnancy
• Toxins
• A brain injury or a brain disorder → the frontal lobe, can cause problems controlling impulses
and emotions
ADHD TREATMENT

✓Amphetamine
✓Dexymethylphenidate
✓Dextroamphetamine
✓Lisdexamfetamine
✓Methylphenidate
THERAPY

• These treatments focus on changing behavior.

• Special education helps a child learn at school. Having structure and a routine can
help children with ADHD a lot.
• Behavior modification→ teaches ways to replace bad behaviors with good ones.
• Psychotherapy (counseling) can help someone with ADHD learn better ways to
handle their emotions and frustration. It could help improve their self-esteem.
Counseling may also help family members better understand a child or adult with
ADHD.
• Social skills training can teach behaviors, such as taking turns and sharing.
TIC DISORDERS
TIK

• → gerakan yang tiba-tiba dan cepat dari berbagai kelompok otot dengan atau
tanpa ucapan vokal, yang terjadi tanpa disengaja.
• terjadi secara singkat, berulang, tidak berirama.
• Dapat diklasifikasikan menurut derajat kompeksitasnya yaitu single atau kompleks
serta kualitasnya yaitu motor atau vokal.
 Tik motorik Tik Vokal
• Mengedipkan mata • Batuk

• Memutar bola mata • Membersihkan tenggorokan

• Menyeringai • Menghirup

• Menggelengkan kepala • Bersiul

• Menyentakan bahu • Mendengkur

• Menyentakan badan dan panggul • Suara binatang

• Menyentakan perut • Mengucapkan suku kata

• Menggerakan tangan dan lengan • Mengucapkan kata

• Menggerakan kaki dan tungkai • Berteriak-teriak

KRITERIA DIAGNOSIS TIK MENURUT DSM-V

• Catatan : tik itu tiba-tiba, cepat, berulang, gerakan motorik dan vokalisasi nonritmik.
• Tourette’s Disorder 307.23 (F95.2)
A. Ada dua-duanya tik motorik dan 1 atau lebih tik vokal yang ada bersama-sama
selama sakit, walaupun tidak selalu bersamaan.
B. Tik mungkin bertambah dan berkurang frekuensinya tetapi menetap untuk lebih dari
1 tahun sejak onset tik pertama kali.
C. Onset sebelum 18 tahun
D. Gangguan tidak disebabkan oleh efek fisiologis dari suatu zat (misal kokain) atau
kondisi medis lainnya (misal Huntington’s disease, postviral encephalitis)
• Persistent (Chronic) Motor or Vocal Tic Disorder (F95.1 )
A. Tik vokal atau motorik single atau multiple yang ada selama sakit, tapi tidak
keduanya motorik dan vokal.
B. Tik mungkin bertambah dan berkurang frekuensinya tetapi menetap untuk
lebih dari 1 tahun sejak onset tik pertama kali.
C. Onset sebelum 18 tahun
D. Gangguan tidak disebabkan oleh efek fisiologis dari suatu zat (misal kokain)
atau kondisi medis lainnya (misal Huntington’s disease, postviral encephalitis).
E. Kriteria tidak pernah memenuhi gangguan Tourette.

Spesifikasi jika :
• Dengan hanya tik motorik
• Dengan hanya tik vokal
• Provisional Tic Disorder (F95.0)
A. Tik vokal dan/ atau motorik single atau multiple
B. Tik mungkin bertambah dan berkurang frekuensinya tetapi menetap untuk
lebih dari 1 tahun sejak onset tik pertama kali.
C. Onset sebelum 18 tahun
D. Gangguan tidak disebabkan oleh efek fisiologis dari suatu zat (misal kokain)
atau kondisi medis lainnya (misal Huntington’s disease, postviral encephalitis).
E. Kriteria tidak pernah memenuhi gangguan Tourette atau persistent
(chronic) motor or vocal tic disorder
Gangguan psikiatri yang sering dikaitkan dengan
gangguan Tik :

Gangguan komorbid %

ADHD 40-60

OCD 40-70

Gangguan cemas 25-40

Gejala depresi Sekitar 50

Gangguan tidur 12-44

TERAPI
Farmakoterapi :
• Sebelum diberikan obat dlakukan pemeriksaan : tes fungsi liver, level prolaktin, EKG, EEG
pemeriksaan fisik dan neurologis.
• Haloperidol satu-satunya obat resmi yang disetujui untuk pengobatan gangguan tic di Eropa
(dari usia tiga tahun). Haloperidol memiliki anti dopaminergik kuat dan hasil dalam
pengurangan tics di sekitar 80% dari kasus. Namun efek samping seperti sindrom
ekstrapiramidal cukup sering terjadi dimana membuat haloperidol tidak menjadi pengobatan
pilihan yang pertama.
• Risperidone sebagai SGA dengan afinitas tinggi terhadap reseptor D2 dan 5-HT2. Efikasinya
hampir = haloperidol dengan efek samping yang lebih kecil.
• Aripiprazole →pasien yang tidak berespon terhadap obat lain.
TERAPI UNTUK TIK DENGAN KOMORBID
ADHD :
• Psikostimulan (metilfenidat)
• Atomoxetin dan klonidin
• Risperdione
• Risperidon+metilfenidat
Gangguan emosional → Sulpiride
OCD → SSRI
Tik yang berat → SSRI + antipsikotik
 NONFARMAKOTERAPI

Psikoedukasi
• Psikoedukasi yang diberikan biasanya meliputi orangtua dan guru. Informasi yang
diberikan yaitu tentang gangguannya dan pilihan pengobatan. Informasi yang diberikan
guru dapat sebagai rekomendasi bila anak ujian diperbolehkan ujian sendiri atau boleh
meninggalkan kelas untuk waktu yang singkat untuk melepaskan tik nya.
Psikoterapi
• Metode cognitive behavioral → paling efektif untuk intervensi psikoterapi.
Latihan relaksasi
• dapat membantu mengurangi tik karena intensitas tik sering meningkat ketika stres dan
cemas. Latihan relaksasi meliputi relaksasi otot, pernapasan dalam.
TERIMA KASIH