NEURODEVELOPMENTAL

DISORDERS

Samia Mazhar
Neurodevelopmental Disorders
■ The neurodevelopmental disorders are a group of
conditions with onset in the developmental period.

■ The disorders typically manifest early in development,

often before the child enters grade school, and are
characterized by developmental deficits that produce
impairments of personal, social, academic, or
occupational functioning.

■ The range of developmental deficits varies from very

specific limitations of learning or control of executive
functions to global impairments of social skills or
intelligence.
■ The neurodevelopmental disorders frequently co-occur; for
example, individuals with autism spectrum disorder often
have intellectual disability (intellectual developmental
disorder), and many children with
attention-deficit/hyperactivity disorder (ADHD) also have a
specific learning disorder.

■ For some disorders, the clinical presentation includes

symptoms of excess as well as deficits and delays in
achieving expected milestones.
Neurodevelopmental Disorders
1. Intellectual Disabilities.

2. Communication Disorders

3. Autism Spectrum Disorder

4. Attention-Deficit/Hyperactivity Disorder

5. Specific Learning Disorder

6. Motor Disorders

7. Other Neurodevelopmental Disorders

1. INTELLECTUAL
DISABILITIES (IDD)
Intelligence and Intellectual Disability (ID)

■ Deficits in general mental abilities, such as reasoning, problem

solving, planning, abstract thinking, judgment, academic
learning, and learning from experience.

■ The deficits result in impairments of adaptive functioning, such

that the individual fails to meet standards of personal
independence and social responsibility in one or more aspects of
daily life,

 communication,

 social participation,

 academic or occupational functioning,

 personal independence at home or in community settings.

Specific Examples of Adaptive Behavior Skills
Diagnostic Criteria for
Intellectual Disability
Severity Level: Mild

■ About 85% of persons with ID

■ Typically not identified until early elementary years/ some times
identified as slow learners.
■ Overrepresentation of minority group members
■ Develop social and communication skills
■ Live successfully in the community as adults with appropriate
supports
Severity Level: Moderate

■ About 10% of persons with ID

■ Usually identified during preschool years
■ Applies to many people with Down syndrome
■ Benefit from vocational training
■ Can perform supervised unskilled or semiskilled work in adulthood
Severity Level: Severe

■ About 3%-4% of persons with ID

■ Often associated with organic causes
■ Usually identified at a very young age
– Delays in developmental milestones and visible physical features
are seen
■ May have mobility or other health problems
– Need special assistance throughout their lives
– Live in group homes or with their families
Severity Level: Profound

■ About 1%-2% of persons with ID

■ Identified in infancy due to marked delays in development and
biological anomalies
■ Learn only the rudimentary communication skills
■ Require intensive training for:
– Eating, grooming, toileting, and dressing behaviors
■ Require lifelong care and assistance
Examples of Support Areas
 CLASSIFICATION OF INTELLECTUAL DISABILITY, STRATIFIED
BY THREE AGE GROUPS

0 to 5 years 6 to 20 years 21 years and older

Maturation and development Training and education Social and vocational
adequacy
Degree: General develop communicative Can learn up to 4th/5th Is capable of acquiring social
Mild and social skills. primary school grade skills and work skills for integration
May not be distinguishable until when reaching the ages of into the work force at minimum
beginning school. 18 or 19 years. wage.
Can be integrated into
society.
Degree: Can speak or learn to Difficulty meeting 2nd May be able to partially
Moderate communicate. Some difficulties primary school grade maintain oneself economically
with motor skills. academic objectives. in manual work under protected
conditions
Degree: Marked limitations in motor skills. Can speak or learn to Can partially contribute to
Severe Minimal language ability. communicate. Can learn maintaining oneself
elemental self-care and economically under total
health habits. supervision.

Degree: Significant delay, minimal Some motor and language

Profound functional ability in sensorimotor development. Can learn very
areas. Needs basic care. limited personal care skills.
 Global Developmental Delay

■ Diagnosed when an individual fails to meet expected developmental

milestones in several areas of intellectual functioning.
■ The diagnosis is used for individuals who are unable to undergo
systematic assessments of intellectual functioning, including children
who are too young to participate in standardized testing.
■ Intellectual disability may result from an acquired insult during the
developmental period, for example, a severe head injury, in which
case a neurocognitive disorder also may be diagnosed.
■ Reserved for individuals under the age of 5 years when the clinical
severity level cannot be reliably assessed during early childhood.
■ Diagnosed when an individual fails to meet expected developmental
milestones in several areas of intellectual functioning.
■ Applies to individuals who are unable to undergo systematic
assessments of intellectual functioning.
Prevalence

■ Approximately 1-3% of population (depending on cutoff)

■ Twice as many males as females among those with mild cases
 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 40 Neurodevelopmental Disorders genetic
or medical condition. A genetic syndrome linked to intellectual disability
should be noted as a concurrent diagnosis with the intellectual disability
(down syndrome, Fragile, angel X etc).

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.
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
Comorbidity
■ some conditions (e.g., mental disorders, cerebral
palsy, and epilepsy) three to four times higher
than in the general population
■ attention-deficit/hyperactivity disorder; / ADD.
■ depressive and bipolar disorders;
■ anxiety disorders;
■ autism spectrum disorder;
■ stereotypic movement disorder (with or without
self-injurious behavior);
■ impulse-control disorders;
■ major neurocognitive disorder.
Motivation

■ Many children with mild ID are able to learn and attend regular
schools
■ susceptible to feelings of helplessness and frustration in their learning
environments
■ Children who have mild ID are able to stay on task and develop goal-
directed behavior
– With stimulating environments and caregiver support
Causes

Prenatal, Perinatal, and Postnatal Causes

■ Prenatal: genetic disorders and accidents in the womb
■ Perinatal: prematurity and anoxia
■ Postnatal: meningitis and head trauma
 Causes
Risk Factors (cont'd.)
 Genetic and Constitutional Factors
■ Chromosome abnormalities
– Down syndrome
– Fragile-X syndrome
– Prader-Willi and Angelman syndromes

Neurobiological Influences

■ Adverse biological conditions

– Examples: infections, traumas, and accidental poisonings during
infancy and childhood
■ Fetal Alcohol Spectrum Disorder (FASD)
– Estimated to occur in one-half to two per 1000 live births
■ Teratogens increase
Social and Psychological
Dimensions
■ Environmental influences account for 15-20% of ID
– Deprived physical and emotional care and stimulation of the
infant
– Other mental disorders accompanied by ID, such as autism
■ Parents are critically important
Prevention, Education, and
Treatment
■ Child’s overall adjustment is a function of:
– Parental participation, family resources, social supports, level of
intellectual functioning, basic temperament, and other specific
deficits
■ Treatment involves a multi-component, integrated strategy
– Considers children’s needs within the context of their individual
development, their family and institutional setting, and their
community
Prenatal Education and
Screening
■ ID related to fetal alcohol syndrome, lead poisoning, rubella) can be
prevented if precautions are taken
■ Prenatal programs for parents caution about use of alcohol, tobacco,
drugs, and caffeine during pregnancy
Psychosocial Treatments

■ Early intervention
– One of the most promising methods for enhancing the intellectual
and social skills of young children with developmental disabilities
– Carolina Abecedarian Project provides enriched environments
from early infancy through preschool years
– Optimal timing for intervention is during preschool years
Behavioral Approaches

■ Initially seen as a means to control or redirect negative behaviors

■ Association for Behavior Analysis (ABA) Task Force advocates that:
– Each individual has the right to the least restrictive effective
treatment and the right to treatment that results in safe and
meaningful behavior change
Cognitive-Behavioral Therapy

■ Self-instructional training and metacognitive training

■ Verbal instructional techniques
■ Teaching the child to be strategical and metastrategical
Family-Oriented Strategies

■ Help families cope with the demands of raising a child with ID

■ Some ID children and adolescents benefit from residential care or out-
of-home placement
■ The inclusion movement integrates individuals with disabilities into
regular classroom settings
– Curriculum is adapted to individual needs
 Intellectual Disability
Further Considerations

• Parental mental health issues

– Always check how parents are coping
– Depression in mothers is common
• Severe marital discord/ domestic violence/recent divorce
– Raising a child with ID is hard, are parents working
together?
– Often one parent blames the other and/or
withdraws
• Child abuse or neglect
• Severe bullying or exclusion by peers
• Severe deprivation or poverty
PSYCHOTHERAPY
• Specific psychotherapeutic approaches that have been shown to be
effective include behavioural (in particular, applied behaviour analysis
models), cognitive-behavioural, psychodynamic, psychoeducational, and
skills training (e.G., Coping skills, social skills) approaches.

•Behavioural therapies are demonstrably effective in managing many

maladaptive behaviours, particularly aggression and self-injury, in persons
with intellectual disability.

• Psychoanalytic approaches, focusing on developmental theories, to

improve emotional expression, enhance self-esteem, increase personal
independence, and broaden social interactions.

• Group therapy can be an important part of a treatment program for

persons with intellectual disability, particularly in the area of social skills
building.
BEHAVIOUR THERAPY
• Impairment in adaptive behaviour may be either a deficit behaviour or an
excess behaviour.

• 5 major steps in implementation of behaviour modification programme: i.

Identification of problem behaviour. Ii. Defining the target behaviour. Iii.
Behaviour recording – baseline & after treatment.

• Questions about behavioral function (qabf) iv. Functional analysis. V.

Treatment procedures & evaluation

Skill training

Urban area: • special schools •

vocational training centres • child guidance clinic in general hospital.

Rural area: • village level worker equipped with skills in home training of id
people.
Skill training steps:
1. Each training activity should be divided into small steps and
demonstrated properly.
2. Repeated training in each activity.
3. Train regularly and systematically.
4. Parental counseling : patience
PARENT COUNSELING
• It is an important step in management of id patients.
■ Sincerity, reassurance, effective communication & enhancing
emotional stability are the important measures.
■ The stages of counseling are:
1. Imparting information regarding the condition of the id child.
2. Helping the parent to develop right attitude towards their
disabled child.
3. Creating awareness in the parent regarding their role in training
their id child.
ETIOLOGY-BASED EDUCATIONAL
APPROACHES
• Child's etiology of intellectual disability influence his/her behaviour.
• Individuals with each syndrome differ from others in maladaptive
behaviour and psychopathology, as well as in relative strengths (or
weaknesses) in language, versus other abilities.
• Such etiology-related profiles may eventually lead to aetiology-related
interventions.
• Etiology-related interventions have adopted the approach of “playing to
strengths” as opposed to ameliorating weaknesses.
Example: ETIOLOGY-BASED
EDUCATIONAL APPROACHES
• Most children with down syndrome show particular difficulties in
linguistic grammar, expressive language, and articulation, but their
abilities in visual short-term memory appear to be relatively strong.
• Thus, when asked to recall a series of hand movements, these children
perform better than when recalling a series of spoken numbers or words.
• Using this visual-over-auditory profile, various researchers have
become interested in teaching children with down syndrome to read.
MANAGEMENT IN CASE OF PSYCHOSOCIAL DEPRIVATION

• A variety of verbal, sensory stimulation should be provided.

• Introduction of new, pleasurable & useful skills to increase child’s
knowledge.
• Frequent play therapy sessions.
• Extra & special coaching in small group to cover up for social & cultural
deprivation.
Rehabilitation
• Depending upon their learning potential & assests, prevocational &
vocational training needs to be provided.
• Vocational services include:
• counseling of the trainers & their families.
• Supported employment including job placement.
• For multiple physical disability: physical rehabilitation.
• Physiotherapy
• orthopedic services.
• Sensory disability: special training
SOCIAL INTERVENTION

• One of the most prevalent problems among persons who are

intellectually disabled is a sense of social isolation and social skills
deficits.
• Thus, improving the quantity and quality of social competence is a
critical part of their care.
• Special olympics international is the largest recreational sports
program geared for this population.
• In addition to providing a forum to develop physical fitness, special
olympics also enhances social interactions, friendships, and (it is hoped)
general self-esteem.
So……….