Neurodevelopmental Disorders

Autism Spectrum Disorder (ASD)

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 Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association used to diagnose mental disorders, people with ASD have:

• 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 is known as a “spectrum” disorder because 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. The American Academy of Pediatrics recommends that all children be screened for autism. All caregivers should talk to their doctor about ASD screening or evaluation.

People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. The list below gives some examples of the types of behaviors that are seen in people diagnosed with ASD. Not all people with ASD will show all behaviors, but most will show several.

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

Specific Learning Disorder

Specific learning disorder (often referred to as learning disorder or learning disability, see note on terminology) is a neurodevelopmental disorder that begins during school-age, although it may not be recognized until adulthood. Learning disabilities refer to ongoing problems in one of three areas, reading, writing, and math, which are foundational to one’s ability to learn. An estimated 5 to 15 percent of school-age children struggle with a learning disability. An estimated 80 percent of those with learning disorders have reading disorders in particular (commonly referred to as dyslexia). One-third of people with learning disabilities are estimated to also have attention-deficit hyperactivity disorder (ADHD).

Other specific skills that may be impacted include the ability to put thoughts into written words, spelling, reading comprehension, math calculation, and math problem-solving. Difficulties with these skills may cause problems in learning subjects such as history, math, science, and social studies and may impact everyday activities.

Learning disorders, if not recognized and managed, can cause problems throughout a person’s life beyond having lower academic achievement. These problems include increased risk of greater psychological distress, poorer overall mental health, unemployment/under-employment, and dropping out of school.

Types of Learning Disorders (classified by APA):

Dyslexia

Dyslexia is a term that refers to the difficulty with reading. People with dyslexia have difficulty connecting letters they see on a page with the sounds they make. As a result, reading becomes a slow, effortful, and not a fluent process for them. Problems in reading begin even before learning to read, for example when children have trouble breaking down spoken words into syllables and recognizing words that rhyme. Kindergarten-age children may not be able to recognize and write letters as well as their peers. People with dyslexia may have difficulty with accuracy and spelling as well. It’s a common misconception that all children with dyslexia write letters backward or those who write letters backward all have dyslexia.

People with dyslexia, including adolescents and adults, often try to avoid activities involving reading when they can (reading for pleasure, reading instructions). They often gravitate to other mediums such as pictures, video, or audio.

Learning disorder can vary in severity:

• Mild: Some difficulties with learning in one or two academic areas, but may be able to compensate

• Moderate: Significant difficulties with learning, requiring some specialized teaching and some accommodations or supportive services

• Severe: Severe difficulties with learning, affecting several academic areas and requiring ongoing intensive specialized teaching

Intellectual Disability

Intellectual disability involves problems with general mental abilities that affect functioning in two areas:

• intellectual functioning (such as learning, problem-solving, judgment)

• adaptive functioning (activities of daily life such as communication and independent living)

Intellectual disability affects about one percent of the population, and of those about 85 percent have mild intellectual disability. Males are more likely than females to be diagnosed with intellectual disability.

Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

• Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.

• Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.

• Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have a high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD. In preschool, the most common ADHD symptom is hyperactivity.

It is normal to have some inattention, unfocused motor activity, and impulsivity, but for people with ADHD, these behaviors:

• are more severe

• occur more often

• interfere with or reduce the quality of how they function socially, at school, or in a job

Inattention:

People with symptoms of inattention may often:

• Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities

• Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading

• Not seem to listen when spoken to directly

• Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked

• Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines

• Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers

• Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones

• Be easily distracted by unrelated thoughts or stimuli

• Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Hyperactivity-Impulsivity:

People with symptoms of hyperactivity-impulsivity may often:

• Fidget and squirm in their seats

• Leave their seats in situations when staying seated is expected, such as in the classroom or the office

• Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless

• Be unable to play or engage in hobbies quietly

• Be constantly in motion or “on the go,” or act as if “driven by a motor”

• Talk nonstop

• Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in a conversation

• Have trouble waiting for his or her turn

• Interrupt or intrude on others, for example in conversations, games, or activities

Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12.

Other Neurodevelopmental Disorders include:

Communication Disorders

This type of disorder appears when language development does not follow the expected pattern or significant deficits occur in any of its aspects. The linguistic characteristics of each disorder vary depending on its severity and the age of the child.

Expression disorder

The ability for oral expression is substantially below the appropriate level for a child's mental age. Difficulties may occur in verbal as well as body language.

Its main characteristics are

•  quantitatively limited speech, limited vocabulary, 

• difficulty acquiring new words, vocabulary errors or errors recalling words, 

• excessively short sentences, simplified grammar, 

• limited use of grammatical structures and types of sentences, 

• omissions of critical parts of sentences, 

• using an unusual word order and deceleration in language development.

Comprehension disorder

The ability for comprehension is markedly below the appropriate level for a child's mental age. Expression is also significantly affected (this condition is commonly called "mixed receptive-expressive language disorder") because the development of expressive language is derived from the acquisition of receptive skills. Apart from the characteristics of expression disorder mentioned above, in this disorder difficulty is seen in understanding words, phrases, or specific types of words. There can also be a deficit in different areas of auditory processing (sound discrimination, sound-symbol association, retention, recall, and sequencing).

Speech disorder (Dislalia)

• Its main characteristic is the inability to use the sounds of speech that are developmentally appropriate given a child’s age and language.

• It may involve errors in the production, use, representation, or organization of sounds, such as substitution of one sound for another or omission of sounds.

• Stuttering

• It is the disruption of normal fluency and temporal structure of speech given a patient’s age.

• It is characterized by frequent repetitions or prolongations of sounds or syllables. There may also be interjections, word fragmentation, blockage (audible or silent), circumlocutions, words produced with an excess of physical tension, and repetition of monosyllables.

• It does not usually occur during oral reading, singing, or talking to inanimate objects or animals.