Part One of Neurodevelopmental Disorders!

What classifies a disorder as neurodevelopmental?

Neurodevelopmental disorders are characterized by “intellectual and adaptive deficits” that begin during early development and hinder the individual’s “personal, social, academic, and/or occupational functioning” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Symptoms of neurodevelopmental disorders must be present in the early developmental period; they must disrupt how the individual functions in more than one area of life, such as school, home, or work; and, they must not be better explained by another disorder.  These requirements are typically described in the last diagnostic criteria for each disorder. Click HERE to read the introduction to this blog series, Mental Health Diagnoses!, which covers how diagnosis using the Diagnostic and Statistical Manual- 5 (DSM-5) works.

Intelligence and Intellectual Deficits

Intellectual functioning, or intelligence, is the capacity to learn, reason, problem solve, and so forth.  Intellectual deficits include, but are not limited to, difficulties learning due to experience, planning, solving problems, abstract thinking, and academic learning.

What is adaptive behavior?

The American Association on Intellectual and Developmental Disabilities defines adaptive behavior as “the collection of conceptual, social, and practical skills that all people learn in order to function in their daily lives” (Diagnostic Adaptive Behavior Scale).  Examples of these “adaptive skills include:

• Conceptual Skills: language and literacy; money, time, and number concepts; and self-direction
• Social Skills: interpersonal skills, social responsibility, self-esteem, gullibility, social problem solving, and the ability to follow rules/obey laws and to avoid victimization
• Practical Skills: activities of daily living, occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone”

(Definition of Intellectual Disability, n.d.).

Names of the Disorders within the Class

*We will not cover the unspecified or other specified disorders in this blog.

We have filibustered enough! Here are the specifics!

Attention Deficit/Hyperactivity Disorder

Most of us know someone who exhibits the characteristics of Attention Deficit/Hyperactivity Disorder, or ADHD.  We are sometimes quick to call a friend or even a child showing high energy in the store ADHD.  However, simply having high energy does not qualify someone for the diagnosis.

The DSM-5 characterizes Attention Deficit/Hyperactivity Disorder as a “persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  This interference has to disrupt the individual in more that one area of their life.  Someone would need to be impulsive and/or hyperactive during play, while at home, and/or at work.

Criteria for Diagnosis

There are known milestones and developmental patterns that set a standard for ‘normal’ behavior.  It is normal for a toddler to run around, open and close cabinet doors, and throw temper tantrums.  This is why symptoms of inattention along with hyperactivity and impulsivity must be inconsistent with the individual’s developmental level.  In addition, the symptoms must be present prior to the age of twelve, they must be persistent for at least six months, and they must also negatively impact the individual in multiple settings, such as social, academic, or occupational (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Symptoms of inattention include, but are not limited to, maintaining attention during activities, being easily distracted, trouble organizing, and not completing series of instructions.  Talking excessively, interrupting conversation, and fidgeting are symptoms that describe hyperactivity and impulsivity.

Autism Spectrum Disorder

Television shows like ABC’s The Good Doctor and Boston Legal, and Netflix’s Atypical depict a main character that is on the autism spectrum.  While each of these show’s main characters describe themselves as having Asperger’s Syndrome, it is no longer a separate diagnosis, but is now included as part of the autism spectrum.

Individuals with Autism Spectrum Disorder have “persistent deficits in social communication and social interaction across multiple contexts”, and they exhibit “restricted, repetitive patterns of behavior, interests, or activities” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  It appears like the person is having difficulty carrying a conversation forward, or having the inability to shift behavior in different social situations, or trouble combining verbal and nonverbal communication.

Criteria for Diagnosis

There are five criterions for diagnosis with Autism Spectrum Disorder.  The first criterion for Autism Spectrum Disorder involves deficits in social communication and social interactions.  These deficits must be seen in three specific areas.  One: nonstandard back and forth conversation, and failure to begin or failure to respond to social interactions; two: “poorly integrated verbal and nonverbal communication”, which ranges from inconsistent eye contact and misunderstanding hand gestures to “a total lack of facial expressions”; and third: “deficits in developing, maintaining, and understanding relationships” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

The second criterion involves limited, “repetitive patterns of behavior, interests, or activities” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  The DSM-5 describes four examples of these patterns.  An individual only needs to exhibit two of the four in order to meet this criterion.   These include: repeating the same movements, having habitual verbal and nonverbal patterns, incredibly fixated interests, and abnormal “interest in sensory aspects of the environment” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

The last three criteria are as mentioned in the introduction of neurodevelopmental disorders.  The symptoms must be present during early development; they must cause functional limitations in more than one area of life; and, they must not be better explained by another disorder. 

Global Developmental Delay

Global Developmental Delay is considered the failure to “meet expected developmental milestones in several areas of intellectual functioning” specifically in children who are five years and younger (Diagnostic and Statistical Manual of Mental Disorders, 2013).

The Centers for Disease Control have a checklist of milestones for children from two months to five years old.  Click HERE to check out their .pdf. (You will be leaving Collaborative Means’ webpage and directed to an extension of http://www.cdc.gov).

Criteria for Diagnosis

Diagnosis of Global Developmental Delay is reserved for individuals five years old and younger.  Assessment of children this age and younger is not considered reliable; therefore, this diagnosis is given until the severity of their symptoms can be more accurately determined.  It is expected that the individual be reassessed as they age.

Intellectual Disability

Intellectual Disability is one of the most stigmatized mental health diagnoses.  It has undergone multiple name changes in an effort to transform the public’s perspective of this disorder.  In fact, referring to an individual as ‘mentally retarded’, which was one of Intellectual Disability’s former names, is now considered both offensive and taboo.

Intellectual Disability, which is sometimes referred to as Intellectual Developmental Disorder, is characterized by “both intellectual and adaptive functioning deficits in conceptual, social, and practical domains” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Criteria for Diagnosis

There are three diagnostic criteria for Intellectual Disability.  First, the individual must have deficits in typical mental abilities such as abstract thinking, learning from experience, reasoning, and problem solving (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Second, these deficits or impairments must inhibit the individual’s adaptive functioning.  It is important to note that the degree of hindrance is based upon the “individual’s age, gender, and [culture]” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Finally, the onset of this disorder is in the developmental period, which is a criterion for all of the neurodevelopmental disorders.

Specific Learning Disorder

Dyslexia, dysgraphia, and dyscalculia are disorders that seem to be ‘common place’.  Instead of having their own DSM-5 diagnoses, their characteristics are described as criteria for Specific Learning Disorder.

Specific Learning Disorder can be generalized as an individual having difficulties learning academics.  These include trouble spelling, writing, and solving math problems.  At some point in life, we all had difficulties in one or more of those areas, but the difference between having short-term issues with a subject and Specific Learning Disorder are great.

Criteria for Diagnosis

There are four diagnostic criteria for Specific Learning Disorder.  First, the individual must experience at least one of six symptoms for at least six months, and persistently.  These symptoms are difficulties with spelling, mastering sequences, writing, reading comprehension, mathematical reasoning, and “inaccurate or slow and effortful word reading” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Second, the individual must be performing significantly below what is expected for their level of development and in the academic area that is affected.  It is important to note that the level of performance must be based on the results of a test or assessment.  Third, the symptoms begin while the person is in early education.  Sometimes the symptoms are not present until the individual has been challenged academically, which can delay diagnosis.  Fourth, the learning difficulties must not be better explained by other neurodevelopmental disorders.

Up Next!

Part Two of Neurodevelopmental Disorders!

References

Definition of Intellectual Disability. (n.d.). Retrieved January 2, 2018, from http://aaidd.org/intellectual-disability/definition#.WmO8rSgx9SV

Diagnostic Adaptive Behavior Scale. (n.d.). Retrieved January 22, 2018, from https://aaidd.org/intellectual-disability/diagnostic-adaptive-behavior-scale#.WmZ4aKinHIU

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 6 January 2018]. dsm.psychiatryonline.org