Neurodevelopmental Disorders

Intellectual Developmental Disorder

Motor disorders
Specific learning disorder
 Intellectual
Developmental Disorder
Intellectual Developmental Disorder
• Intellectual developmental disorder is characterized by 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, including communication,
social participation, academic or occupational functioning, and personal independence
at home or in community settings. Global developmental delay, as its name implies, is
diagnosed when an individual fails to meet expected developmental milestones in several
areas of intellectual functioning. The diagnosis is used for individuals younger than 5
years who are unable to undergo systematic assessments of intellectual functioning, and
thus the clinical severity level cannot be reliably assessed. Intellectual developmental
disorder may result from an acquired insult during the developmental period from, for
example, a severe head injury, in which case a neurocognitive disorder also may be
diagnosed.
Diagnostic Criteria
Intellectual developmental disorder (intellectual disability) is a disorder with onset during
the developmental period that includes both intellectual and adaptive functioning deficits in
conceptual, social, and practical domains. The following three criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving, planning,
abstract thinking, judgment, academic learning, and learning from experience,
confirmed by both clinical assessment and individualized, standardized intelligence
testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and
sociocultural standards for personal independence and social responsibility. Without
ongoing support, the adaptive deficits limit functioning in one or more activities of
daily life, such as communication, social participation, and independent living, across
multiple environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period.
 Severity levels for intellectual developmental disorder
(intellectual disability)

Level Conceptual Domain Social Domain Practical Domain

Mild • Preschool(No clear • Immature social interactions • Personal care: no issues
differences) • Difficulty understanding social cues • Daily tasks: need some help
• School-age(Struggles from peers with complex tasks
with Reading, Writing, • Concrete or immature • Recreation: similar to peers,
Math, Time communication and conversation but need some support
• and Money skills • Work: can succeed in jobs
• Adults(Difficulty with • Struggling to regulate emotions and that don't require strong
Abstract thinking, behavior in a age-appropriate way thinking skills
Planning and • Limited understanding of risk in • Health and legal decisions:
organization, Memory social situations need support
and Using skills in daily • Immature social judgment • Learning a trade or
life (e.g., reading, • Gullibility and vulnerability to profession: need support
managing money) manipulation by others • Parenting: need support
 Severity levels for intellectual developmental disorder (intellectual
disability)

Level Conceptual Domain Social Domain Practical Domain

Moderate • Thinking and problem- • Social and communication skills are • Can learn to care for personal
solving skills are behind significantly different from peers. needs (eating, dressing, etc.) with
those of peers. • Language is less complex than peers. extended teaching and reminders.
• Preschoolers: slow language • Capacity for relationships is present, but • Can participate in household tasks
and pre-academic with limitations. with extended teaching and
development. • May have successful friendships and ongoing support.
• School-age children: slow romantic relationships, but with • Can achieve independent
progress in reading, writing, challenges. employment in jobs with limited
math, and related concepts. • Difficulty interpreting social cues and conceptual and communication
• Adults: limited academic making decisions. demands, but requires significant
skills, need support, and • Need assistance with life decisions and support.
rely on others for help. social situations. • Can develop recreational skills with
• Friendships with peers may be impacted additional supports and learning
by communication limitations. opportunities.
• Significant support needed in work • May exhibit maladaptive behavior
settings for social and that causes social problems (in a
communication success. significant minority of cases).
 Severity levels for intellectual developmental disorder
(intellectual disability)

Level Conceptual Domain Social Domain Practical Domain

Severe • Limited understanding • Limited spoken language • Needs help with daily tasks
of Written language, • Uses simple words and phrases • Requires constant
Numbers and math • Communicates for social supervision
concepts, Time and interaction, not explanation • Can't make decisions
quantity & Money and • Understands simple speech and • Needs support for daily life,
finance gestures recreation, and work
• Requires extensive • Enjoys relationships with family • Learning is slow and needs
support from caretakers and friends ongoing support
for problem-solving • Some may exhibit harmful
throughout life. behaviors
 Severity levels for intellectual developmental disorder
(intellectual disability)

Level Conceptual Domain Social Domain Practical Domain

Profound • Thinking skills are • Limited language understanding • Needs help with daily care
focused on the physical • Understands simple gestures and safety
world, not symbols. • Shows emotions through facial • Can do some tasks with
• Uses objects for expressions/body language help
practical purposes (self- • Enjoys relationships with familiar • Can participate in simple
care, work, recreation). people activities like work and
• May have some visual • Physical limitations affect social recreation with support
skills, like matching and interactions • Physical limitations can
sorting objects. make activities hard
• May have physical and • Some may exhibit harmful
sensory limitations that behaviors
affect ability to use
objects.
 Associated Features Prevalence Comorbidity
Associated challenges may include: § 1% of the global population • Mental health conditions (e.g.,
• Difficulty with social § Middle-income countries: depression, anxiety, bipolar)
decisions and relationships 1.6% • Neurodevelopmental disorders (e.g.,
• Impulse control and self- § High-income countries: 0.9% ADHD, autism)
management § Higher among youth than • Physical conditions (e.g., cerebral
• Motivation in school or work adults. palsy, epilepsy)
• Communicating effectively § Males are more likely to be • Irritability
• Understanding risk and diagnosed with intellectual • Mood swings
danger developmental disorder than • Aggression
Individuals may be more prone to: females. • Eating and sleep problems
• Accidental injuries • For mild cases, males • Self-Harm
• Disruptive and aggressive outnumber females by
behaviors about 1.6 to 1.
• Being taken advantage of or • For severe cases, males
exploited outnumber females by
• Physical and sexual abuse about 1.2 to 1.
They may also experience distress
about their intellectual limitations,
which can impact their well-being.
Development and Course Risk and Prognostic Factors
• Intellectual developmental disorder begins in childhood, • Genetic (e.g., chromosomal disorders, genetic
with symptoms varying based on severity and cause. syndrome)
• Severe cases may be apparent in the first 2 years, while mild • Physiological (e.g., brain malformations, metabolic
cases may not be noticeable until school age. disorders)
• Some children may initially be diagnosed with global • Environmental (e.g., exposure to toxins, maternal
developmental delay, which may later develop into disease during pregnancy)
intellectual developmental disorder. • Prenatal causes:
• Genetic syndromes can have distinct physical and • Genetic issues
behavioral features. • Maternal disease
• Acquired forms can result from illnesses or injuries, with • Environmental factors (e.g., alcohol, drugs,
abrupt onset. toxins)
• While generally nonprogressive, some cases may worsen • Perinatal causes:
over time due to underlying conditions or co-occurring • Labor and delivery complications
disorders. • Postnatal causes:
• Early interventions can improve adaptive functioning, and • Brain injury
in some cases, intellectual functioning may improve enough • Infections
to no longer qualify for the diagnosis. • Seizures
• Assessments must consider the level of support needed for • Social deprivation
daily living skills and whether improvements are due to new • Toxic exposures (e.g., lead, mercury)
skills or ongoing support.
Specific Learning
Disorder
 Diagnostic Criteria
A. Persistent difficulties in learning and using academic skills, such as:
- Inaccurate or slow word reading
- Difficulty understanding what is read
- Spelling difficulties
- Written expression difficulties
- Difficulties with number sense, facts, or calculation
- Difficulties with mathematical reasoning
B. The affected academic skills are significantly below expectations for the individual's age, and interfere with academic or
occupational performance, or daily living activities, as confirmed by standardized measures and clinical assessment.
C. The learning difficulties begin during school-age years, but may not become fully apparent until the demands for those
skills exceed the individual's limited capacities.
D. The learning difficulties are not better explained by:
- Intellectual disabilities
- Uncorrected visual or auditory acuity
- Other mental or neurological disorders
- Psychosocial adversity
- Lack of proficiency in the language of academic instruction
- Inadequate educational instruction.
These criteria aim to identify individuals with significant learning difficulties that are not attributable to other factors, and
that interfere with their academic and daily functioning.
Specification
• Specify if:
With impairment in reading:
– Word reading accuracy
– Reading rate or fluency
– Reading comprehension
With impairment in written expression:
– Spelling accuracy
– Grammar and punctuation accuracy
– Clarity or organization of written expression
With impairment in mathematics:
– Number sense
– Memorization of arithmetic facts
– Accurate or fluent calculation
– Accurate math reasoning
Specify current severity
• Mild: Some difficulties learning skills in one or two academic domains, but of mild
enough severity that the individual may be able to compensate or function well when
provided with appropriate accommodations or support services, especially during the
school years.
• Moderate: Marked difficulties learning skills in one or more academic domains, so that
the individual is unlikely to become proficient without some intervals of intensive and
specialized teaching during the school years. Some accommodations or supportive
services at least part of the day at school, in the workplace, or at home may be needed
to complete activities accurately and efficiently.
• Severe: Severe difficulties learning skills, affecting several academic domains, so that the
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 services at home, at school, or in the workplace, the individual may
not be able to complete all activities efficiently.
 Associated Features Prevalence Comorbidity
1. Difficulty with reading, writing, and • 5%–15% among school-age children 1. Other Specific Learning Disorders
mathematics often co-occur. • Among adults is unknown (e.g., math and reading difficulties)
2. Above-average abilities in visuospatial skills, • More common in males than in 2. Neurodevelopmental disorders
but struggles with reading and writing. females (ratios range from about 2:1 (e.g., ADHD, communication
3. Delays in attention, language, or motor skills • to 3:1) disorders, developmental
may precede Specific Learning Disorder. coordination disorder, autism
4. Poor performance on tests of cognitive spectrum disorder)
processing, including processing speed, are 3. Mental disorders (e.g., anxiety and
common. depressive disorders)
5. Deficits in processing speed and other areas 4. Behavioral problems
are shared across different subtypes of
Specific Learning Disorder.
6. Specific Learning Disorder often co-occurs
with ADHD, autistic spectrum disorder,
communication disorders, and developmental
coordination disorder.
7. Individuals with Specific Learning Disorder
show specific alterations in cognitive
processing and brain function.
8. Genetic differences are evident at the group
level, but genetic testing is not useful for
diagnosis at this time.
 Development and Course Functional Consequences
Onset typically occurs during elementary school years, but precursors may Academic
be present in early childhoood (Manifestations may be behavioral, such as • Lower academic attainment
reluctance to engage in learning or oppositional behavior.) • Higher rates of high school dropout
Specific Learning Disorder is lifelong, but symptoms may change with age. • Lower rates of postsecondary education
Problems with reading, spelling, writing, and numeracy skills often persist Mental Health
into adulthood. • Higher levels of psychological distress
Adults may experience limitations in communication, interpersonal • Poorer overall mental health
interactions, and social and civic life. • Increased risk of suicidal thoughts or behavior
Symptoms may vary by age, including: (especially with co-occurring depressive
qPreschool: lack of interest in language games, trouble learning symptoms)
nursery rhymes, baby talk, mispronunciation. Occupational
qKindergarten: unable to recognize and write letters, trouble breaking • Higher rates of unemployment
down spoken words into syllables. • Underemployment
qElementary school: difficulty learning letter-sound correspondence, • Lower incomes
slow and inaccurate reading, trouble with math facts. Social/Emotional
qMiddle grades: mispronunciation, poor comprehension, trouble • Lower levels of social or emotional support
remembering dates and names. predict poorer mental health outcomes
qAdolescence and adulthood: slow and effortful reading, poor • High levels of social or emotional support
comprehension, spelling mistakes, avoidance of activities requiring predict better mental health outcomes
reading or arithmetic.
 Risk Factors Prognostic Factors
Environmental Risk Factors • Intensive, individualized
• Low socioeconomic status instruction using evidence-
• Exposure to neurotoxicants (e.g., air pollution, nicotine, lead, manganese) based interventions may
• Prenatal or early-life exposure to harmful substances improve or ameliorate learning
Genetic Risk Factors difficulties
• Family history of reading difficulties (dyslexia) or specific learning disorder • Comorbidity with ADHD
• Parental literacy skills predict literacy problems in offspring predicts worse mental health
• High heritability for reading ability and reading disability outcomes
• Covariation between different manifestations of learning difficulties
Other Risk Factors
• Preterm delivery or very low birth weight
• Neurofibromatosis type 1 (up to 75% risk of specific learning disorder)
• Behavioral problems in preschool years (inattentive, internalizing, externalizing)
• Language impairment in preschool years
• Delay or disorders in speech or language
• Impaired cognitive processing (e.g., phonological awareness, working memory,
rapid serial naming)
• ADHD diagnosis in childhood (associated with underachievement in reading and
math in adulthood.
MOTOR DISORDERS

Developmental Coordination Disorder

Stereotypic Movement Disorder
Tic Disorders
 Developmental
Coordination Disorder
Diagnostic Criteria

• The individual has difficulty with motor skills such as walking,

running, balance, handwriting, or using small objects.
• The motor skill difficulties significantly impact the individual's
ability to perform daily activities, such as dressing, eating, or
participating in sports.
• The symptoms of DCD begin in the early developmental period,
typically before age 5.
• The motor skill difficulties are not better explained by another
condition, such as visual impairment, neurological disorder, or
intellectual disability.
Other terms used to describe DCD include:

• Childhood dyspraxia
• Specific developmental disorder of motor function
• Clumsy child syndrome
DCD may affect various motor skills, including:

• Gross motor skills (e.g., walking, running, balance)

• Fine motor skills (e.g., handwriting, using small
objects)
• Daily activities (e.g., dressing, eating, self-care)
Associated Features Prevalence Comorbidity
Neurodevelopmental immaturities The male-to-female ratio ranges 1. Communication disorders
or neurological soft from 2:1 to 7:1, indicating that males 2. Specific learning disorder
signs are more frequently (especially reading and writing)
- Choreiform movements (e.g., affected than females. 3. Attention-Deficit/Hyperactivity
involuntary jerky movements) in Disorder (ADHD) (~50%
unsupported limbs cooccurrence)
-Mirror movements (e.g., 4. Autism Spectrum Disorder
involuntary movements that mirror 5. Disruptive and emotional
intended movements) behavior problems
6. Joint Hypermobility Syndrome

Functional • Reduced participation in team play and sports

• Poor self-esteem and sense of self-worth
Consequences • Emotional or behavioral problems
• Impaired academic achievement
• Poor physical fitness
• Reduced physical activity and obesity
• Poor health-related quality of life.
Development and Course Risk and Prognostic Factors
Onset: Early childhood Risk Factors
Early Childhood Environmental
• Delayed motor milestones • Prematurity
• Difficulty with tasks like holding utensils, buttoning clothes, or • Low birth weight
playing ball games • Prenatal exposure to alcohol
Middle Childhood Genetic and physiological.
• Difficulties with motor aspects of puzzles, building, ball games, • Impairments in neurodevelopmental processes, including:
and handwriting q Visual-motor skills
• Trouble with organizing belongings and motor sequencing q Visual-motor perception
Early Adulthood q Spatial mentalizing
• Difficulty learning new tasks requiring complex/automatic • Cerebellar dysfunction
motor skills (e.g., driving, using tools) Prognostic Factors
• Handwriting and note-taking difficulties may impact workplace • Co-occurrence with other neurodevelopmental disorders, such
performance as:
q Attention-Deficit/Hyperactivity Disorder (ADHD)
q Specific learning disabilities
q Autism Spectrum Disorder
q Shared genetic effects (proposed)
• Severity of symptoms:
q Consistent co-occurrence in twins only in severe cases
q Individuals with ADHD and DCD demonstrate more
impairment than those with ADHD alone
Stereotypic Movement
Disorder
Diagnostic Feature

A. Repetitive, seemingly driven, and apparently purposeless motor

behavior (e.g., hand shaking or waving, body rocking, head banging,
self-biting, hitting own body).
B. The repetitive motor behavior interferes with social, academic, or
other activities and may result in self-injury.
C. Onset is in the early developmental period.
D. 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 (e.g., trichotillomania [hair-pulling disorder], obsessive-
compulsive disorder).
Specification

Specify if:
qWith self-injurious behavior (or behavior that would result in an injury if preventive
measures were not used)
qWithout self-injurious behavior
Specify if:
Associated with a known genetic or other medical condition, neurodevelopmental disorder,
or environmental factor (e.g., Lesch-Nyhan syndrome, intellectual developmental disorder
[intellectual disability], intrauterine alcohol exposure)
Specify current severity:
qMild: Symptoms are easily suppressed by sensory stimulus or distraction.
qModerate: Symptoms require explicit protective measures and behavioral modification.
qSevere: Continuous monitoring and protective measures are required to prevent serious
injury.
 Prevalence Comorbidity
• Simple stereotypic movements (e.g., rocking) 1. Attention-deficit hyperactivity disorder
in Young Developing Children (5%-19%) 2. Motor coordination problems
• Complex stereotypic movements is less 3. Tics/Tourette’s disorder
common (3%-4%) 4. Anxiety
• Individuals with intellectual developmental
disorder (intellectual disability) (4%-16% in
high-income countries)
• Individuals with severe intellectual
developmental disorder
• Individuals with intellectual developmental
disorder living in residential facilities (10%-
15%)
• Repetitive and restricted behaviors and
interests
 Development and Course Risk and Prognostic Factors
Simple stereotypic movements Risk Factors
• Typically begin in infancy (within the first year Environmental
of life) • Social isolation
• May be involved in acquiring motor mastery • Environmental stress
• Usually diminish in severity and frequency over • Fear
time Genetic and physiological
Complex motor stereotypies • Family history of motor stereotypies (suggesting heritability)
• Typically begin before age 24 months • Lower cognitive functioning
(approximately 80% of cases) • Moderate to severe/profound intellectual developmental
• May begin between 24-35 months (12% of disorder
cases) or after 36 months (8% of cases) • Specific neurogenetic syndromes (e.g., Lesch-Nyhan, Rett,
• May persist for years, even in typically Cornelia de Lange)
developing children • Painful medical conditions (e.g., middle ear infection, dental
Stereotypic movement disorder in individuals problems, gastroesophageal reflux)
with intellectual developmental disorder Prognostic Factors
• May persist for years, with changing patterns or • Severity of intellectual developmental disorder
typography of self-injury • Presence of neurogenetic syndromes
• May begin in infancy or later in development • Presence of painful medical conditions
• Lower cognitive functioning (linked to poorer response to
interventions)
Tic Disorders
Diagnostic Features

A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or

vocalization. Tic disorders comprise five diagnostic categories:
• Tourette’s disorder
• Persistent (chronic) motor or vocal tic disorder,
• Provisional tic disorder,
• Other specified tic disorders
• Other unspecified tic disorders.
Types Of Tics

Simple Tic Complex Tic

q Limited involvement of specific q Longer duration

muscle groups q Combination of simple tics
q Short duration q Can appear purposeful
Examples: Examples:
• Motor tics: eye blinks, facial • Motor tics: simultaneous head turning and shoulder shrugging, imitations
of others' movements (echopraxia), sexual or taboo gestures
grimaces, shoulder shrugs,
(copropraxia)
extension of extremities
• Vocal tics: repeating sounds or words (palilalia), repeating last-heard word
• Vocal tics: throat clearing, sniffs, or phrase (echolalia), uttering socially unacceptable words (coprolalia)
chirps, barks, grunting (caused by Note: Coprolalia is a specific type of complex vocal tic characterized by
diaphragm or oropharynx muscle abrupt, sharp utterances lacking prosody, and is distinct from similar
contraction) inappropriate speech in human interactions.
Diagnostic criteria:

A: Presence of motor and/or vocal tics.

B: Tics must be present for at least 1 year.
C: Onset of tics must occur before age 18.
D: Tics cannot be attributed to a substance or medical condition.
E: Previous diagnosis of Tourette's or persistent (chronic) motor or
vocal tic disorder negates other tic disorder diagnoses.
Tourette’s Disorder

A. Both multiple motor and one or more vocal tics have been
present at some time during the illness, although not necessarily
concurrently.
B. The tics may wax and wane in frequency but have persisted for
more than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of
a substance (e.g., cocaine) or another medical condition (e.g.,
Huntington’s disease, postviral encephalitis).
Persistent (Chronic) Motor or Vocal Tic Disorder

A. Single or multiple motor or vocal tics have been present during the illness, but not both
motor and vocal.
B. The tics may wax and wane in frequency but have persisted for more than 1 year since
first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of a substance (e.g.,
cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis).
E. Criteria have never been met for Tourette’s disorder.
Specify if:
With motor tics only
With vocal tics only
Provisional Tic Disorder

A. Single or multiple motor and/or vocal tics.

B. The tics have been present for less than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of
a substance (e.g., cocaine) or another medical condition (e.g.,
Huntington’s disease, postviral
encephalitis).
E. Criteria have never been met for Tourette’s disorder or persistent
(chronic) motor or vocal tic disorder.
 Prevalence Functional Consequence Comorbidity
• Tics are common in childhood. • Social isolation 1. ADHD: Disruptive behavior, social
• Males are 2-4 times more • Interpersonal conflict immaturity, learning difficulties, and greater
commonly affected than • Peer victimization impairment than tic disorder alone.
females (ratio varies). • Inability to work or attend school 2. OCD and related disorders: Earlier age at
• Lower quality of life onset, need for symmetry and exactness,
• Difficulty focusing on work-related forbidden or taboo thoughts (e.g., aggressive,
tasks due to tic suppression sexual, or religious obsessions and related
• Psychological distress and suicidal compulsions).
thoughts 3. Other movement disorders:
• Physical injury (e.g., eye injury, - Sydenham's chorea
orthopedic and neurological injury) - Stereotypic movement disorder
• Disc disease related to forceful 4. Neurodevelopmental and psychiatric
head and neck movements conditions:
- Autism spectrum disorder
- Specific learning disorder
5. Mood, anxiety, or substance use disorders:
Increased risk in teenagers and adults with tic
disorders.
 Development and Course Risk and Prognostic Factors
Simple stereotypic movements Risk Factors
• Typically begin in infancy (within the first year Environmental
of life) • Advanced paternal age
• May be involved in acquiring motor mastery • Pre- and perinatal adverse events:
• Usually diminish in severity and frequency over o Impaired fetal growth, Maternal intrapartum fever,
time Maternal smoking
Complex motor stereotypies o Severe maternal psychosocial stress, Preterm birth
• Typically begin before age 24 months o Breech presentation, Cesarean delivery
(approximately 80% of cases) Genetic and physiological.
• May begin between 24-35 months (12% of • Heritability
cases) or after 36 months (8% of cases) • OCD, ADHD, and other neurodevelopmental disorders,
• May persist for years, even in typically including autism spectrum disorder.
developing children • Immune system and neuroinflammation play important roles
Stereotypic movement disorder in individuals in the pathobiology of tics
with intellectual developmental disorder • Increased risk of autoimmune disorders (e.g., Hashimoto's
• May persist for years, with changing patterns or thyroiditis)
typography of self-injury Prognostic Factors
• May begin in infancy or later in development • Tics are exacerbated by Anxiety, Excitement and Exhaustion
• Tics are improved by Calm, focused activities and Tasks requiring
focused attention and motor control