Abnormal Psychology: Neurodevelopmental Disoders

Group of conditions with onset in the developmental period.

Disorders typically manifest early in development.often before the child enter grade schoolcharacterized by developmental deficits that

produce impairments of personal, social, academic or occupational functioning.

Neurodevelopmental Neurodevelopmental DisordersDisorders

Intellectual Disabilities

Reported by: Christian Joy Aboc

• Intellectual Disability is a disorder with onset during the develop-mental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains.

The following criteria must be met:o Deficits in intellectual

functions such as:• reasoning, • problem solving, • planning, • abstract thinking, • judgment, • academic learning,

•and learning from experience

oconfirmed by both clinical assessment and individualized, standardized intelligence testing.

oDeficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility.

oOnset of intellectual and adaptive deficits during the developmental period.

Associated Features Associated Features Supporting DiagnosisSupporting Diagnosis

Intellectual disability is a heterogeneous condition with multiple causes.

Gullibility is often a feature, involving naiveté in social situations and a tendency for being easily led by others.

• Individuals with a diagnosis of intellectual disability with co-occurring mental disorders are at risk for suicide.

Development And Development And CourseCourse

• Onset of intellectual disability is in the Onset of intellectual disability is in the developmental period. developmental period.

• The age and characteristic features at The age and characteristic features at onset depend on the etiology and onset depend on the etiology and severity of brain dysfunction.severity of brain dysfunction.

• When intellectual disability is When intellectual disability is associated with a genetic syndrome, associated with a genetic syndrome, there may be a characteristic there may be a characteristic physical appearance.physical appearance.

• In acquired forms, the onset may In acquired forms, the onset may be abrupt following an illness such be abrupt following an illness such as meningitis or encephalitis or as meningitis or encephalitis or head trauma occurring during the head trauma occurring during the developmental period.developmental period.

• The course may be influenced The course may be influenced by underlying medical or by underlying medical or genetic conditions and co-genetic conditions and co-occurring conditions.occurring conditions.

• Early and ongoing interventions Early and ongoing interventions may improve adaptive may improve adaptive functioning throughout functioning throughout childhood and adulthood.childhood and adulthood.

Genetic and PhysiologicalGenetic and Physiological Prenatal etiologies include genetic

syndromes, inborn errors of metabolism, brain malformations, maternal disease, and environmental influences.

Risk and Prognostic Risk and Prognostic FactorsFactors

Differential Differential DiagnosisDiagnosis

A diagnosis of A diagnosis of intellectual disability intellectual disability should not be should not be assumed because of assumed because of a particular genetic a particular genetic or medical condition.or medical condition.

Differential Differential DiagnosisDiagnosis• Major and mild neuro- Major and mild neuro-

cognitive disordercognitive disorder Intellectual disability is

categorized as a neurodevelopmental disorder and is distinct from the neurocognitive disorders, which are characterized by a loss of cognitive functioning.

• Communication disorder and Communication disorder and specific learning disorderspecific learning disorder

These neurodevelop-mental disorders are specific to the communication and learning domains and do not show deficits in intellectual and adaptive behavior.

Differential Differential DiagnosisDiagnosis• Autism spectrum Autism spectrum

disorderdisorderAssessment of

intellectual ability may be complicated by social-communication and behavior deficits inherent to autism spectrum disorder.

ComorbidityComorbidityCo-occurring mental, Co-occurring mental, neurodevelopmental, neurodevelopmental, medical, and physical medical, and physical conditions are conditions are frequent in intellectual frequent in intellectual disability.disability.

ComorbidityComorbidityAssessment procedures may Assessment procedures may

require modifications because require modifications because of associated disorders, of associated disorders, including: communication including: communication disorders, disorders,

autism spectrum disorder, autism spectrum disorder, and motor, sensory, or and motor, sensory, or other disorders. other disorders.

ComorbidityComorbidityKnowledgeable informants Knowledgeable informants

are essential for identifying are essential for identifying symptoms such as: symptoms such as:

irritability, irritability, mood dysregulation, mood dysregulation, aggression, aggression, eating problems, eating problems, and sleep problems,and sleep problems,

ComorbidityComorbidityThe most common co-occurring The most common co-occurring

mental and neurodevelopmental mental and neurodevelopmental disorders are: disorders are:

attention-deficit/hyperactivity attention-deficit/hyperactivity disorder; disorder;

depressive and bipolar depressive and bipolar disorders; disorders;

anxiety disorders; anxiety disorders;

ComorbidityComorbidityThe most common co-occurring

mental and neurodevelopmental disorders are:

autism spectrum disorder; stereotypic movement disorder

impulse-control disorders; major neurocognitive disorder.

ComorbidityComorbidity• Major depressive

disorder may occur throughout the range of severity of intellectual disability.

ComorbidityComorbidity• Individuals with

intellectual disability may exhibit aggression and disruptive behaviors, including harm of others or property destruction.

Global Global

Developmental Developmental

Delay DelayReserved 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.

Unspecified Intellectual Unspecified Intellectual Disability (Intellectual Disability (Intellectual

Developmental Disorder)Developmental Disorder)Reserved for individuals over the age of

5 years when assessment of the degree of intellectual disability by means of locally available procedures is rendered difficult or impossible.

It is because of associated sensory or physical impairments:

as in blindness or prelingual deafness;

locomotor disability; or presence of severe problem behaviors or co-occurring mental disorder.

Communication Communication DisorderDisorder

Reported by: Christine May Baloria

Language Language Disorder Disorder

• Persistent difficulties in the acquisition and use of language across modalities: -Reduced vocabulary -limited sentence structure -impairments in discourse

• Language abilities are substantially and quantifiably below those expected for age

• Onset of symptoms is in the early developmental period

• The difficulties are not attributable to hearing or other sensory impairment

Associated Associated Features Features Supporting Supporting DiagnosisDiagnosis

• Positive family history is often present

• Individuals can be adept at accommodating to their limited language

Associated Associated Features Features Supporting Supporting DiagnosisDiagnosis

• Affected individuals may prefer to communicate only with significant or familiar people

• Language disorder may occur with speech sound disorder

Development Development And CourseAnd Course

• Language disorders emerges during the early developmental period.

Development Development And CourseAnd Course

• By age 4 years, individual differences in language ability are more stable with better measurement accuracy, and are highly predictive of later outcomes

likely to be stable over time and typically persists into adulthood

• Environmental

Developmental coordination disorder is more common following prenatal exposure to alcohol and in preterm and low-birth-weight children.

Risk and Risk and PrognosPrognos

tic tic FactorsFactors

Genetic and physiologicalImpairments in underlying

neurodevelopmental processes—particularly in visual-motor skills, both in visual-motor perception and spatial mentalizing—have been found and affect the ability to make rapid motoric adjustments as the complexity of the required movement’s increases.

Children with receptive language Children with receptive language impairments have a poorer prognosis impairments have a poorer prognosis than those with predominantly than those with predominantly expressive impairmentsexpressive impairments

Genetic and PhysiologicalGenetic and Physiological

•Normal variations in languagelanguage disorder distinction maybe difficult to make before 4 years of age.

Must be considered:regional -social -cultural/ethnic variations of language (e.g., dialects)

•Hearing or other sensory impairment Hearing impairments needs to be excluded as the primary cause of language difficulties

•Intellectual disability (intellectual developmental disorder)

language delay is often the presenting feature of intellectual disability

•Neurological disorders epilepsy, acquired aphasia,

landau-kleffner syndrome

ComorbidityComorbidity• Language disorder is strongly

associated with other neurodevelopmental disorders, attention-deficit/ hyperactivity disorder, autism spectrum disorder, and developmental coordination disorder.

ComorbidityComorbidityo Also associated with social

(pragmatic) communication disorder

o Positive family history of speech or language disorders is often present.

Speech Sound Disorder

• Persistent difficulty with speech sound production.

• The disturbance causes limitations in the effective communication.

• Onset of symptoms is in the early developmental period.

• The difficulties are not attributable to congenital or acquired conditions.

Associated Associated Features Features

Supporting Supporting DiagnosisDiagnosis

• Language disorder may found to co-occur speech sound disorder.

• A positive family history of speech or language disorder is often present.

Associated Associated Features Features

Supporting Supporting DiagnosisDiagnosis

• Problems in coordinating the articulators. Verbal

Dyspraxia

• Speech may be differentially impaired in certain genetic conditions.

DevelopmentDevelopment And Course And Course

• 3 years old - mastering speech sound production.

• 7 years old - speech sounds and words must be produced and pronounced clearly and accurately.

DevelopmentDevelopment And Course And Course

• "late eight"- (l,r,s,z,th,ch,dzh and zh)

• 8 years - misarticulation limit Lisping (i.e.,

misarticulating sibilants) ([s], [z], [ʒ], [ʃ], [tʃ], [dʒ]).

• The disorder may not be lifelong.

Differential DiagnosisDifferential Diagnosis• Normal variation in speech

Regional, social, or cultural/ ethnic variation of speech should be considered.

• Hearing or other sensory impairment Deficits of speech sound production may be

associated with a hearing impairment, other sensory deficit, or a speech-motor deficit.

Differential DiagnosisDifferential Diagnosis• Structural Deficit

Speech impairment may be due to structural deficit.

- (e.g., cleft palate)

Bilateral complete lip and palate Unilateral complete lip and palate

Incomplete cleft palate

Differential DiagnosisDifferential Diagnosis

Differential DiagnosisDifferential Diagnosis• Dysarthria

Motor disorder, such as cerebral palsy.

• Selective MutismLack of speech in one or more context or settings.

• The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination.

• The onset of symptoms is in the early developmental period.

• The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult, or another medical condition and is not better explained by another mental disorder.

• Fearful anticipation of the problem may develop.

• Childhood-onset fluency disorder may also be accompanied by motor movements.

• It occurs by age 6 for 80%- 90% of affected individuals, with age at onset ranging from 2 to 7 years.

•The onset can be insidious or more sudden.

•Typically, dysfluencies start gradually, with repetition of initial consonants, first words of a phrase, or long words.

•65% - 85% of children recover from these disfluencies.

•8 years- predicted time for recovery or persistency of the disorder.

• Environmental

• Genetic and physiological. The risk of stuttering depends on the significant people surrounding the child.

Differential DiagnosisDifferential Diagnosis• Sensory deficits

Disfluency in speech may be associated with it.

• Normal speech dysfluencies Whole-word or phrase repetitions, incomplete phrases, interjections, unfilled pauses, and parenthetical remarks.

Differential DiagnosisDifferential Diagnosis• Medication side effects

Stuttering

• Adult-onset dysfluencies Onset of dysfluencies during or after

adolescence. Associated with specific neurological

insults and a variety of medical conditions and mental disorders.

Differential DiagnosisDifferential Diagnosis

• Tourette’s disorder Vocal tics and repetitive vocalizations of Tourette's disorder should be distinguishable from the repetitive sounds of childhood-onset fluency disorder by their nature and timing.

• Difficulty with pragmatics

• Deficits in social communication

• Deficits will result to functional limitations

• Diagnosis of social (pragmatic) communication disorder is rare among children younger than 4 years.

• 4 - 5 years - adequate speech and language abilities.

• The outcome of social (pragmatic) communication disorder is variable.

• The early deficits in pragmatics may last and may be associated with problems in written expressions.

• Environmental

• Genetic and physiological A family history of autism spectrum disorder, communication disorders, or specific learning disorder appears to increase the risk for social (pragmatic) communication disorder.

Differential DiagnosisDifferential Diagnosis•Autism spectrum disorder

the primary diagnostic consideration for individuals presenting with social communication deficits

Differential DiagnosisDifferential Diagnosis•Attention-deficit/hyperactivity

disorderPrimary deficits of ADHD may cause impairments in social communication and functional limitations of effective communication, social participation, or academic achievement.

Differential DiagnosisDifferential Diagnosis•Social Anxiety disorder

(social phobia)the symptoms of social communication disorder overlap with those of social anxiety disorder.

Differential DiagnosisDifferential Diagnosis•Intellectual disability and

global developmental delay. social communication skills may be deficient among individuals with global developmental delay or intellectual disability.

Unspecified Unspecified Communication Communication

DisorderDisorder A category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for communication disorder or for a specific neurodevelopmental disorder

Unspecified Unspecified Communication Communication

DisorderDisorderIncludes presentations in which there is insufficient information to make a more specific diagnosis.

Autism Autism SpectrumSpectrum Disorder Disorder

Reported by: Mary Charice CabralReported by: Mary Charice Cabral

Diagnostic Diagnostic CriteriaCriteria • Persistent deficits in

social communication and social interaction across multiple contexts, as manifested by the ff. currently or by history:

1. Deficits in social-emotional reciprocity (e.g., less interest in sharing enjoyments)

Diagnostic Diagnostic CriteriaCriteria2. Deficits in non-verbal

communicative behaviors used for social interactions (e.g., abnormalities in eye contact, body postures, facial expressions)

3. Deficits in developing, maintaining and understanding relationships (e.g., poor in understanding of others feelings, not interested in playing such as a peek-a-boo)

Diagnostic Diagnostic CriteriaCriteria

• Restricted, repetitive patterns of behavior, interests, or activities as manifested by the ff. currently or by history :

1. Stereotyped or repetitive motor movement, used of objects or speech (e.g., echolalia - is the automatic repetition of vocalizations made by another person.

Diagnostic Diagnostic CriteriaCriteria

2.Insistence or sameness, inflexible adherence to routines or ritualized patterns of verbal or non-verbal behavior. (e.g., rigid thinking patterns)

3. Highly restricted, fixated interests, that are abnormal in intensity or focus (e.g., preoccupations with unusual objects)

Diagnostic Diagnostic CriteriaCriteria4. Hyper or hypo

reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., hyperactivity or lacks of aware)

Associated FeaturesAssociated FeaturesSupporting DiagnosisSupporting Diagnosis• Many individuals with ASD also have

intellectual impairment and/or language impairment.

• Even those with average or high intelligence have an uneven profile of abilities.

Associated FeaturesAssociated FeaturesSupporting DiagnosisSupporting Diagnosis

• Motor deficits are often present including odd gaits, clumsiness and other abnormal motor signs. (e.g., walking on tiptoes).

• Some individuals developed catatonic-like behavior (slowing and “freezing” midaction), but these are typically not of the magnitude of a catatonic episode.

Development Development and Courseand Course

• Symptoms are typically recognized during the second year of life (12-24 months of age), but may be seen earlier than 12 months if developmental delays are severe, or noted earlier than 24 months if symptoms are subtle.

Development Development and Courseand Course• First symptoms of ASD frequently

involved delayed language development, often accompanied by lack of social interests or unusual social interactions, odd play patterns and unusual communication.

Development Development and Courseand Course• ASD is not a degenerative disorder and it

is typical for learning and compensation to continue throughout life.

• Symptoms are often marked in early childhood and early school years, with developmental gains typical on later childhood in atleast some areas. (e.g., increased interest in social interaction).

EnvironmentalA variety of nonspecific risk factor may

contribute to risk of Autism Spectrum Disorder. Genetic and physiological

Heritability estimates for ASD have ranged from 37% to higher than 90%, based on twin concordance rates.

• Rett Syndrome Disruption of social

interaction may be observed during the regressive phase of Rett syndrome.

• Selective Mutism The affected child

usually exhibits appropriate communication skills in certain contexts and settings

Language disorders and social (pragmatic) communication disorder When an individual shows impairment in social communication and social interactions but does not show restricted and repetitive behavior or interests, criteria for social (pragmatic) communication disorder, instead of autism spectrum disorder, may be met.

• Intellectual disability (intellectual developmental disorder) without autism spectrum Disorder Individuals with intellectual

disability who have not developed language or symbolic skills also present a challenge for differential diagnosis.

A diagnosis of autism spectrum disorder in an individual with intellectual disability is appropriate when social communication and interaction are significantly impaired

• Stereotypic movement disorder Motor stereotypies are among the

diagnostic characteristics of autism spectrum disorder, so an additional diagnosis of stereotypic movement disorder is not given when such repetitive behaviors are better explained by the presence of autism spectrum disorder.

• Attention-deficit/hyperactivity disorder Abnormalities of attention (overly

focused or easily distracted) are common in individuals with autism spectrum disorder, as is hyperactivity.

• SchizophreniaClinicians must take into account the

potential for individuals with autism spectrum disorder to be concrete in their interpretation of questions regarding the key features of schizophrenia (e.g., "Do you hear voices when no one is there?" "Yes [on the radio]").

ComorbiditComorbidityy

• Autism spectrum disorder is frequently associated with intellectual impairment and structural language disorder (i.e., an inability to comprehend and construct sentences with proper grammar), which should be noted under the relevant specifiers when applicable.

Attention Deficit/Hyperactivity Disorder

Reprted by: Angelica Alyanna D. Abalos

Diagnostic CriteriaDiagnostic CriteriaA. Persistent pattern of inattention and/or

hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities

Diagnostic CriteriaDiagnostic CriteriaNote: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

Diagnostic CriteriaDiagnostic Criteriaa. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

Diagnostic CriteriaDiagnostic Criteriac. Often does not seem to listen when

spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

Diagnostic CriteriaDiagnostic Criteriae. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

Diagnostic CriteriaDiagnostic Criteriaf. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

Diagnostic CriteriaDiagnostic Criteriah. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

a. Often fidgets with or taps hands or feet or squirms in seat.

b. Often leaves seat in situations when remaining seated is expected. (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

c. Often runs about or climbs in situations where it is inappropriate.

(Note: In adolescents or adults, may be limited to feeling restless.)

d. Often unable to play or engage in leisure activities quietly.

e. Often “on the go,” acting as if “driven by a motor”.(e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

f. Often talks excessively.

g. Often blurts out an answer before a question has been completed.(e.g., completes people’s sentences; cannot wait for turn in conversation).

h. Often has difficulty waiting his or her turn.

i. Often interrupts or intrudes on others. (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

B.B. Several inattentive or Several inattentive or hyperactive-impulsive hyperactive-impulsive symptoms were symptoms were present prior to age present prior to age 12 years.12 years.

C.C. Several inattentive or Several inattentive or hyperactive-impulsive hyperactive-impulsive symptoms are symptoms are present in two or present in two or more settings.more settings.

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 psychotic disorder and are not better explained by another mental disorder .

Mild delays in language, motor, or social development are not specific to ADHD but often co occur.

Associated features may include low frustration tolerance, irritability, or mood lability.

Even in the absence of a specific learning disorder, academic or work performance is often impaired.

Inattentive behavior is associated with various underlying cognitive processes, and individuals with ADHD may exhibit cognitive problems on tests of attention, executive function, or memory, although these tests are not sufficiently sensitive or specific to serve as diagnostic indices.

By early adulthood, ADHD is associated with an increased risk of suicide attempt, primarily when comorbid with mood, conduct, or substance use disorders.

As a group, compared with peers, children with ADHD display increased slow wave electroencephalograms, reduced total brain volume on magnetic resonance imaging, and possibly a delay in posterior to anterior cortical maturation, but these findings are not diagnostic.

In the uncommon cases where there is a known genetic cause (e.g.. Fragile X syndrome, 22qll deletion syndrome), the ADHD presentation should still be diagnosed.

ADHD is most ADHD is most often identified often identified during elementary during elementary school years, and school years, and inattention becomes inattention becomes more prominent and more prominent and impairing.impairing.

The disorder is The disorder is relatively stable through relatively stable through early adolescence.early adolescence.

Some individuals have Some individuals have a a worsened course with worsened course with development of development of antisocial behaviors.antisocial behaviors.

In most individuals with In most individuals with ADHD, symptoms of motoric ADHD, symptoms of motoric hyperactivity become less hyperactivity become less obvious in adolescence and obvious in adolescence and adulthood, but difficultadulthood, but difficulties ies with restlessness, with restlessness, inattention, poor planning, inattention, poor planning, and impulsivity persist.and impulsivity persist.

In In PreschoolPreschool – the main – the main manifestation is hyperactivity.manifestation is hyperactivity.

In In Elementary SchoolElementary School – – inattention becomes more inattention becomes more prominentprominent

In In AdolescenceAdolescence – signs of – signs of hyperactivity are less hyperactivity are less commoncommon

In In AdulthoodAdulthood – – inattention and inattention and restlessness, restlessness, impulsivity may remain impulsivity may remain problematic even when problematic even when hyperactivity has hyperactivity has diminisheddiminished

TemperamentalTemperamental ADHD is associated with reduced behavioral ADHD is associated with reduced behavioral inhibition, effortful control, or constraintinhibition, effortful control, or constraint

EnvironmentalEnvironmental ADHD is correlated with smoking during pregnancy. A ADHD is correlated with smoking during pregnancy. A minority of cases may be related to reactions to minority of cases may be related to reactions to aspects of diet.aspects of diet.

Genetic and PhysiologicalGenetic and Physiological ADHD is elevated in the first-degree biological relatives of ADHD is elevated in the first-degree biological relatives of individuals with ADHD. The heritability of ADHD is individuals with ADHD. The heritability of ADHD is substantial.substantial.

Course ModifiersCourse ModifiersFamily interaction patterns in early childhood are unlikely Family interaction patterns in early childhood are unlikely to cause ADHD but may influence its course or contribute to cause ADHD but may influence its course or contribute to secondary development of conduct problemsto secondary development of conduct problems

Oppositional Defiant Disorder individuals may resist work or school

taskstheir behavior is characterized by

negativity, hostility, defiance

Intermittent Explosive DisorderADHD and Intermittent Explosive

Disorder share high levels of impulsive behavior

Specific Learning Disorderchildren with specific

learning disorder may appear inattentive because frustration, lack of interest, or limited ability

Intellectual Disability (intellectual developmental disorder)Symptoms of ADHD are common

among children placed in academic settings that are inappropriate to their intellectual ability

Autism Spectrum Disorderindividuals with ADHD and

those with autism spectrum disorder exhibit inattention, social dysfunction and difficult-to-manage behavior

Reactive Attachment Disorder children with reactive attachment

disorder may show social disinhibition, but not full ADHD symptom cluster, and display other features such as lack of enduring relationships that are not characteristic of ADHD.

Anxiety DisordersADHD shares symptoms of inattention with anxiety disorders.

Restlessness might be seen in anxiety disorders.

Depresive Disordersindividuals with depressive disorders may present with inability to concentrate

Bipolar Disorderindividuals with bipolar

disorder may have increased activity, poor concentration, and increased impulsivity that occurs several days at a time.

Disruptive Mood Dysregulation Disorderis characterized by

pervasive irritability, and intolerance of frustration, but impulsiveness and disorganized attention are not essential features

Substance Use Disordersdifferentiating ADHD from

substance use disorders may be problematic if the first presentation of ADHD symptoms follows the onset of abuse or frequent use

Personality DisordersADHD is not

characterized by fear abandonment, self-injury, extreme ambivalence, or other features of personality disorder

Psychotic DisordersADHD is not diagnosed if

the symptoms of inattention and hyperactivity occur exclusively during the course of a psychotic disorder

Medication-Induced Symptoms of ADHDsymptoms of inattention,

hyperactivity, or impulsivity attributable to the use of medication are diagnosed as other or specified other substance-related disorders

Neurocognitive DisordersEarly major neurocognitive

disorder (dementia) and/or mild neurocognitive disorder are not known to be associated with ADHD but may present with similar clinical features

In clinical settings, comorbid disorders are frequent in individuals whose symptoms meet criteria for ADHD

SpecifiSpecific c LearniLearning ng DisordDisorderer

Reported by: John Louise G. Abit

A. Difficulties learning and using academic skills, as the indicated by the presence of at least one following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties:

1. Inaccurate or slow and effortful word reading.

2. Difficulty understanding the meaning of what is read.

3. Difficulties with spelling.

4. Difficulties with written expression

5. Difficulties mastering number sense, number facts or calculations.

6. Difficulties with mathematical reasoning

B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age and cause significant interference with performance.

C. 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.

D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory.

Specify If:

With impairment in reading:Word reading accuracyReading rate or fluencyReading comprehension

Note: Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities.

With impairment in written expression:

Spelling accuracyGrammar and punctuation accuracyClarity or organization of written

expression

With impairment in mathematics

Number senseMemorization of arithmetic facts

Accurate or fluent calculationsAccurate math reasoning

Note: Dyscalculia is an alternative term used to refer to a pattern of difficulties characterized by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations.

Specify Current SeverityMild: Individual may be able to compensate or function

well when provided with appropriate accommodations or support services, especially during the school years.

Moderate: Individual is unlikely to become proficient without some intervals of intensive and specialized teaching during the school years. At least part of the day at school, in the workplace, or at home may be needed to complete activities accurately and efficiently.

Severe: Individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years. Even with an array of appropriate accommodations or service at home, at school, or in the workplace, the individual may not be able to complete all activities efficiently.

• Specific leaning disorder is frequently but not invariably preceded. An uneven profile abilities is common, such as above-average abilities in drawing, design and other visuospatial skills, but slow, effortful and inaccurate reading and poor reading comprehension and written expression

•Onset, recognition, and diagnosis of specific learning disorder usually occurs during the elementary school years when children are requited to learn to read, spell, write and learn mathematics.

• However, precursors such as language delays or deficits, difficulties on rhyming or counting, etc., commonly occur in early childhood before the start of formal schooling.

•Specific Learning Disorder is lifelong, but the course and clinical expression are variable, in part depending on the interactions among the task demands of the environment, the range and severity of the individual learning difficulties, abilities, comorbidity and available support systems and interventions.

•By contrast, adolescents, may have mastered word decoding, but reading remains slow and effortful, and they are likely show marked problems in reading comprehension and written expression and poor mastery of math facts or mathematical problem solving.

•They may avoid both leisure and work-related activities that demand reading or writing or using alternative approaches to access print.

EnvironmentalEnvironmentalPrematurity or very low birth weight Prematurity or very low birth weight

increases the risk for specific learning disorder, increases the risk for specific learning disorder, as does prenatal exposure to nicotineas does prenatal exposure to nicotine..

Genetic and Physiological Genetic and Physiological Specific learning disorder appears to

aggregate in families, particularly when affecting reading, mathematics and spelling.

Course ModifiersCourse ModifiersMarked problems with inattentive Marked problems with inattentive

behavior in preschool years is predictive of behavior in preschool years is predictive of later difficulties in reading and mathematics later difficulties in reading and mathematics (but not necessarily specific learning (but not necessarily specific learning disorder) and nonresponse to effective disorder) and nonresponse to effective academic interventions. Delay or disorders in academic interventions. Delay or disorders in speech or language, or impaired cognitive speech or language, or impaired cognitive processing in preschool years, predicts later processing in preschool years, predicts later

• Normal variations in academic attainment

Specific learning disorder is distinguished from normal variations in academic attainment due to external factors lack of edu cational opportunity, consistently poor instruction, learning in a second language.

• Intellectual disability (intellectual developmental disorder) Specific learning disorder differs

from general learning difficulties associated with intellectual disability, because the learning difficulties occur in the presence of normal levels of intellectual functioning (i.e., IQ score of at least 70 ± 5).

• Learning difficulties due to neurological or sensory disorders

Specific learning dis order is distinguished from learning difficulties due to neurological or sensory disorders (e.g., pediatric stroke, traumatic brain injury, hearing impairment, vision impairment).

• Neurocognitive disorders Specific learning

disorder is distinguished from learning problems associated with neurodegenerative cognitive disorders.

• Attention-deficit/hyperactivity disorder Specific learning disorder

is distinguished from the poor academic performance associated with ADHD

• Psychotic disorders Specific learning

disorder is distinguished from the academic and cognitive-processing difficulties associated with schizophrenia or psychosis.

• Specific learning disorder commonly co-occurs with neurodevelopmental

EX: ADHD, communication disorders, developmental

coordination disorder, autistic spectrum disor der

• or other mental disorders

EX:anxiety disorders, depressive and bipolar disorders.

• These comorbidities do not necessarily exclude the diagnosis specific learning disorder but may make testing and differential diagnosis more difficult, because each of the co -occurring disorders independently interferes with the execution of activities of daily liv ing, including learning.

Motor Motor DisorDisorderder

Developmental Developmental Coordination Coordination

DisorderDisorder

Diagnostic CriteriaDiagnostic Criteria• The acquisition and execution

of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness as well as slowness and inaccuracy of performance of motor skills.

Diagnostic CriteriaDiagnostic Criteria• The motor skills deficit in Criterion

A significantly and persistently interferes with activities of daily living appropriate to chronological age and impacts academic/school productivity, prevocational and vocational activities, leisure, and play.

• Onset of symptoms is in the early developmental period.

Diagnostic CriteriaDiagnostic Criteria• The motor skills deficits

are not better explained by intellectual disability (Intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement

• Some children with developmental coordination disorder show additional motor activity, such as choreiform movements of unsupported limbs or mirror movements.

• These "overflow" movements are referred to as neurodevelopmental immaturities or neurological soft signs rather than neurological abnormalities

•In both current literature and clinical practice, their role in diagnosis is still unclear, requiring further evaluation.

• Onset is in early childhood. Delayed motor milestones may be the first signs, or the disorder is first recognized when the child attempts tasks such as holding a knife and fork, buttoning clothes, or playing ball games.

• In middle childhood, there are difficulties with motor aspects of assembling puzzles, building models, playing ball, and handwriting, as well as with organizing belongings, when motor sequencing and coordination are required.

• In early adulthood, there is continuing difficulty in learning new tasks involving complex/automatic motor skills, including driving and using tools. Inability to take notes and handwrite quickly may affect performance in the workplace. Co-occurrence with other disorders has an additional impact on presentation, course, and outcome.

EnvironmentalDevelopmental coordination disorder is more common following prenatal exposure to alcohol and in preterm and

low-birth-weight children.

Environmental Developmental coordination disorder is more

common following prenatal exposure to alcohol and in preterm and low-birth-weight children.

Genetic and physiological

Impairments in underlying neurodevelopmental processes—particularly in visual-motor skills, both in visual-motor perception and spatial mentalizing—have been found and affect the ability to make rapid motoric adjustments as the complexity of the required movement’s increases.

Cerebellar dysfunction has been proposed, but the neural basis of developmental coordination disorder remains unclear.

Because of the co-occurrence of developmental coordination disorder with attention-deficit/hyperactivity disorder (ADHD), specific learning disabilities, and autism spectrum disorder, shared genetic effect has been proposed. However, consistent co-occurrence in twins appears only in severe cases.

Course modifiers Individuals with ADHD and with

developmental coordination disorder demonstrate more impairment than individuals with ADHD without developmental coordination disorder.

• Motor impairments due to another medical condition

Problems in coordination maybe associated with visual function impairment and specific neurological disorders. In such cases, there are additional findings on neurological examination.

•Intellectual disability If intellectual disability

is present, motor competences may be impaired in accordance with the intellectual disability

•Intellectual disability if the motor difficulties are in

excess of what could be accounted for by the intellectual disability, and criteria for developmental coordination disorder are met, developmental coordination disorder can be diagnosed as well.

• Attention-deficit/hyperactivity disorder

Individuals with ADHD may fall, bump in to objects, or knock things over. Careful observation across different contexts is required to as certain if lack of motor competence is attributable to distractibility and impulsiveness rather than to developmental coordination disorder.

• Autism spectrum disorderIndividuals with autism spectrum disorder may be uninterested in participating in tasks requiring complex coordination skills, such as ball sports, which will affect test performance and function but not reflect core motor competence. Co-occurrence of developmental coordination disorder and autism spectrum disorder is common.

• Joint hypermobility syndrome

Individuals with syndromes causing hyperextensible joints (found on physical examination; often with a complaint of pain) may present with symptoms similar to those of developmental coordination disorder.

• Disorders that commonly co-occur with developmental coordination disorder include speech and language disorder; specific learning disorder; problems of inattention, including ADHD; autism spectrum disorder; disruptive and emotional behavior problems; and joint hypermobility syndrome.

Diagnostic CriteriaDiagnostic Criteria•Repetitive, seemingly

driven, and apparently purposeless motor behavior

•The repetitive motor behavior interferes with social, academic, or other activities and may result in self injury.

Diagnostic CriteriaDiagnostic Criteria• Onset is in the early

developmental period.

• The repetitive motor behavior is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder.

SpecifierSPECIFY IF

With self-injurious behaviorWithout self-injurious

behavior

SPECIFY CURRENT SEVERITY

Mild: Symptoms are easily suppressed by sensory stimulus or distraction.

Moderate: Symptoms require explicit protective measures and behavioral modification.

Severe: Continuous monitoring and protective measures are required to prevent serious injury.

• Stereotypic movements typically begin within the first 3 years of life.

• Simple stereotypic movements are common in infancy and may be involved in acquisition of motor mastery.

• In children who developed complex motor stereotypies, approximately 80% exhibit symptoms before 24 months of age, 12% between 24 and 35 months, and 8% at 36 months or older.

•In most typically developing children, these movements resolve over time or can be supressed.

• EnvironmentalDevelopmental

coordination disorder is more common following prenatal exposure to alcohol and in preterm and low-birth-weight

children.

Risk and Prognos

tic FactorsGenetic and physiological

• Environmental.

Social isolation is a risk factor for self-stimulation that may progress to stereotypic movements with repetitive self-injury. Environmental stress may also trigger stereotypic behavior. Fear may alter physiological state, resulting in increased frequency of stereotypic behaviors.

• EnvironmentalDevelopmental

coordination disorder is more common following prenatal exposure to alcohol and in preterm and low-birth-weight

children.

Risk and Prognos

tic FactorsGenetic and physiological

• Genetic And Physiological

Streotypic movements are more frequent among individuals with moderate-to-severe/profound intellectual disability, who by virtue of a particular syndrome or environmental factor seem to be at higher risk of stereotypies.

• Normal DevelopmentSimple stereotypic

movements are common in infancy and early childhood. Complex stereotypies are less common in typically developing children and can usually repressed by distraction or sensory stimulation.

• Autism Spectrum DisorderStereotypic movements may be presenting

symptom of autism spectrum disorder and should be considered when repetitive movements and behaviors are being evaluated. When autism spectrum disorder is present, stereotypic movement disorder is diagnosed only when there is self-injury or when the stereotypic behavior are sufficiently severe to become a focus of treatment.

• Tic DisordersStereotypies may involve arms, hands, or the entire body, while tics commonly involve eyes, face, head, and shoulders. Stereotypies are fixed, rhythmic, and prolonged in duration than tics, which, generally are brief, rapid, random, and fluctuating. Tics and stereotypic movements are both reduced by distraction.

• Obsessive-compulsive And Related DisordersStereotypic movement disorder is distinguished from obsessive-compulsive disorder (OCD) by the absence of obsessions, as well as by the nature of the repetitive behaviors.

• Other Neurological And Medical ConditionsThe diagnosis of stereotypic movements requires the exclusion of habits, mannerisms, paroxysmal dyskinesias, and benign hereditary chorea.

Stereotypic movement disorder may occur as a primary diagnosis or secondary to another disorder.

Tic Tic DisordersDisorders

Reported by: Erika May B. Aromin

Both multiple motor and one or more vocal tics have been present at some time during illness, although not necessarily concurrently.

Tourette’s Tourette’s DisorderDisorder

The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset.

Onset is before age 18 years.

The disturbance is not attributable to the physiological effects of a substance.

Single or multiple motor Single or multiple motor or vocal tics have been or vocal tics have been presented during illness, presented during illness, but not both motor and but not both motor and vocal.vocal.

Persistent (Chronic) Persistent (Chronic) Motor or vocal tic Motor or vocal tic

disorderdisorder

The tics wax and wane in The tics wax and wane in frequency but have persisted frequency but have persisted for more than 1 year since 1for more than 1 year since 1stst tic onset.tic onset.

Onset is before age 18 years.Onset is before age 18 years.

disorderdisorder

The disturbance is not The disturbance is not attributable to the attributable to the psychological effects or psychological effects or other medical other medical conditions.conditions.

disorderdisorder

Criteria have never been Criteria have never been met for Tourette’s met for Tourette’s Disorder.Disorder.

disorderdisorder

Single or multiple motor and/or vocal tics.

The tics have been present for less than 1 year since first tic onset.

Onset is before age 18 years.

Provisional Tic DisorderProvisional Tic Disorder

The disturbance is not attributable to the physiological effects of a substance.

Criteria have never been met for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder

Provisional Tic DisorderProvisional Tic Disorder

• Onset of tics is typically between ages 4 and 6 years.

• Peak severity occurs between ages 10 and 12

• Tics wax and wane in severity and change in affected muscle groups and vocalizations over time.

• Tics associated with a premonitory urge may be experienced as not completely ''involuntary" in that the urge and the tic can be resisted.

• The vulnerability toward developing co-occurring conditions changes as individuals pass through the age of risk for various co-occurring conditions.

• TemperamentalTics are worsened by anxiety, excitement, and exhaustion and areare better during calm, focused activities.

• EnvironmentalObserving a gesture or sound in another person may result in an individual with a tic disorder making a similar gesture or sound, which may be incorrectly perceived by others as purposeful

• Genetic and physiologicalGenetic and environmental factors influence tic symptom expression and severity.

• Abnormal movements that may accompany other medical conditions and stereotypic movement disorder.

• Motor stereotypies • Chorea

• Substance-induced and paroxysmal dyskinesias.

• Myoclonus

• Obsessive-compulsive and related disorders

• Many medical and psychiatric conditions have been described as co-occurring with tic disorders, with ADHD and obsessive-compulsive and related disorders being particularly common.

• Individuals with tic disorders can also have other movement disorders movement disorders and other mental disorders.

is used in situations in which the is used in situations in which the clinician chooses to clinician chooses to communicate the specific communicate the specific reason that the presentation reason that the presentation does not meet the criteria for a does not meet the criteria for a tic disorder or any specific tic disorder or any specific neurodevelopmental disorder.neurodevelopmental disorder.

A category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for Tic disorder or for a specific neurodevelopmental disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis.

Unspecified Unspecified Tic DisorderTic Disorder

Thank You!

NueorsNeurodevelopmental Disorders

Aboc, Christian Joy A. – Intellectual Disorder

Baloria Chistine May O.- Communication Disorder

Cabral, Mary Charice and Arizala, Rosemarie DR.- Autism Spectrum Disorder

Abalos, Angelica Alyanna D.-Attention Deficit Hyperactivity Disorder

Abit, John Louise G.-Specific Learning Disodrer

Aromin, Erika May B.- Tic Disorder

Ellimination Disorder

Batotoc, Rocelle- EnuresisAzuma, Mikki- Encopresis

-OSED-USED

ResearchersAmar, Blezary JoyAmutan, AnthonyBagon, Karyn Joy

Powerpoint LayoutAyen, Ella Mae D

Abnormal Psychology: Neurodevelopmental Disoders

Healthcare

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