NEURODEVELOPMENTAL DISORDERS • Pica, Rumination Disorder, and Feeding

Disorder of Infancy or Early Childhood →

Neurodevelopmental Disorders in the DSM
Feeding and Eating Disorders
DSM-I: • Separation Anxiety Disorder and Selective
Mutism → Anxiety Disorders
-childhood disorders were subsumed under
• Reactive Attachment Disorder → Trauma-and
Mental Deficiency, transient situational
Stressor-Related Disorders
personality disturbances, adjustment
reaction of infancy, adjustment reaction of -all of these disorders belonged to one just one
adolescence, and adjustment reaction of category prior to the DSM-5, but were later
childhood classified into different categories as there were
plenty of different symptoms and manifestations
DSM-II:
Neurodevelopmental Disorders
-there was the introduction of Mental
Retardation, behavior disorders of • Intellectual Disabilities
childhood and adolescence
-Intellectual Developmental Disorder
DSM-III:
-Global Developmental Delay
-there was an introduction now of Pervasive
-Unspecified Intellectual Disability
Developmental Disorders, Disorders Usually
First Diagnosed in Infancy, Childhood, or • Communication Disorders
Adolescence
-Language Disorder
DSM-IV:
-Speech Sound Disorder
-this version introduced Disorders Usually
First Diagnosed in Infancy, Childhood, or -Childhood Onset Fluency Disorder
Adolescence (Stuttering)

Changes in the DSM-5: -Social (Pragmatic) Communication Disorder

-placement of the Neurodevelopmental -Unspecified Communication Disorder

Disorders as first class in the DSM-5 • Autism Spectrum Disorder
-Mental Retardation has been replaced by -Autism Spectrum Disorder
Intellectual Disability (Intellectual
Developmental Disorder) • Attention-Deficit/Hyperactivity Disorder

-in the US in 2010, the Rosa’s Law -Attention Deficit Hyperactivity Disorder
removed the terms Mental
• Specific Learning Disorder
Retardation, as there are other
terms more appropriate, and the -Specific Learning Disorder
term “Mental Retardation” is too
stigmatizing. • Motor Disorders

-the term Intellectual -Developmental Coordination Disorder

Developmental Disorder is -Stereotypic Movement Disorder
consistent with the ICD-11
• Tic Disorders
-Autism Spectrum Disorder as an omnibus
category -Tourette’s Disorder

-Learning Disorders are changed into

Specific Learning Disorders and the types of
learning disorder are now single disorder
with coded specifiers

Movements in the DSM-5

• Oppositional Defiant Disorder and Conduct

Disorder → Disruptive Impulse-Control and
Conduct Disorders
• Encopresis and Enuresis → Elimination
Disorders
 Intellectual Disability: Criteria • Practical Domain

-learning and self-management across life

settings: personal care, job responsibilities,
money management, recreation, self-
management of behavior, and school and
• Criterion A: work task organization
-deficits in general mental disabilities Intellectual Disability: Global Developmental Delay
Diagnosis Criteria
• Criterion B:
-under the age of five
-impairment in everyday adaptive
functioning in comparison to the -individuals fails to meet expected developmental
individual's age, gender, and socioculturally milestones in several areas of intellectual
matched peers functioning
• Criterion C: -individuals who are unable to undergo systematic
assessments of intellectual functioning
-with onset in the developmental period
Ex: children who are too young to
-in the past, the only basis for diagnosis of mental
participate in standardized testing
retardation was the IQ or Intelligence
-requires assessment and reassessment as the child
Intelligence- general mental ability that
grows
involves reasoning, problem solving,
planning, etc. Intellectual Disability: Unspecified Intellectual
Disability Diagnosis Criteria
-in knowing signs of declines in intelligence
(intellectual disability), the computation -it is used in persons over age five years
would be:
-individual who has significant intellectual or
Mean: 100 | SD: 15 | MoE: 5 points general developmental delay or disability who
cannot be reliably assessed
IQ: 65-75
Intellectual Disability: Etiology and Treatment
-in the present, in does not only include the IQ but
as well as the adaptive functioning Etiology:
-assessment for this disability will not just -present in only 1-2% of the population
be IQ/standardized tests but also clinical
-maybe caused by injury to the brain or
assessment
factors affecting normal growth and
Adaptive Functioning- it is how well an development
individual copes with the common tasks of
-Down Syndrome is the most common
everyday life in three general domains and
chromosomal cause of mental retardation
how well an individual meets the standards
of personal independence and social -Fragile X Syndrome is the most common
responsibility expected for similar ages heritable form of intellectual disability
Ex: communication, social -it can also be caused by maternal
participation, functioning at malnutrition, substance abuse (exposure to
home/school/work, etc. mutagens such as radiation), maternal
illnesses (diabetes, toxemia, rubella),
Three Domains in Adaptive Functioning
maternal abuse and neglect, or traumatic
• Conceptual (Academic) Domain deliveries

-it involves memory, language, reading, Treatment:

writing, math reasoning, acquisition of
-biological treatment is currently not a
practical knowledge, problem-solving, and
viable option
judgement in novel situations
-Learning Interventions: specific learning
• Social Domain
deficits are identified and addressed to help
-involves awareness of others’ feelings, thoughts, and the individual improve skills such as reading
experiences; empathy; interpersonal communication and writing
skills; friendship abilities, social judgement
 -Task Analysis: people are taught each part -may also include articulation, fluency, and
in succession until they can perform the voice production
whole scale of basic self-care
-it may cause limitations in effective communication
-Communication Training: making their which interferes with social participation, academic
needs and wants known for personal achievement, or occupational performance
satisfaction and participation in social
-the difficulties are not attributable to congenital or
activities
acquired conditions (cerebral palsy, cleft palate,
-early intervention is recommended deafness, etc.)

Communication Disorders -this disorder often coexists with language disorder,

intellectual disability (IDD), and neurological
Language Disorder: Criteria
condition like Landau-Kleffner syndrome
Before: Expressive and Mixed Receptive-Expressive
Speech Sound Disorder: Etiology and Treatment
Language Disorder
Etiology: it is idiopathic (still unknown) unless it is
Criterion A: persistent disturbance in the
caused by structural abnormalities
acquisition and use of spoken language, written
language, or sign language that is due to deficits in Treatment: Speech Therapy
comprehension or production
Childhood Onset Fluency Disorder: Criteria
-reduced vocabulary
Before: Stuttering (it is still retained but only inside
-limited sentence structure a parenthesis)

-impairments in discourse -it is a disturbance in speech fluency that includes a

number of problems with speech:
Criterion B: language abilities are substantially and
quantifiably below those expected for age -repeating syllables or words

-it affects socialization, effective -prolonging certain sounds

communication, academic achievement, or
-making obvious pauses
occupational performance
-substituting words to replace one that are
Criterion C: symptom onset is in the early
difficult to articulate
developmental.
Childhood Onset Fluency Disorder: Etiology and
Criterion D: Other disorders must be ruled out as a
Treatment
cause of language difficulties
Etiology:
-examples would be intellectual disability,
IDD, hearing impairment, motor -abnormalities in speech motor control
dysfunction, etc.
-brain structure/or process produce less
Language Disorder: Etiology and Treatment blood flow to the frontal lobe of the brain
Etiology: -genetic abnormalities
-an unfounded psychological explanation Treatment:
could be because of the lack of
communication between the children and -parental involvement
the parents -regulated breathing method
-a biological theory stipulates that the -altered auditory feedback
middle ear infection is a contributory cause
off language disorder -speech therapy

Treatment: may be self-correcting and may not Social Pragmatic Communication Disorder: Criteria
require special intervention -there are deficits in using communication for social
Speech Sound Disorder: Criteria purposes: greeting and sharing information
(appropriate for the social context)
Before: Phonological Disorder
Ex: not able to change the manner of
-there are persistent difficulties in speech speaking to an adult (if they are younger)
production that are developmentally inappropriate
-there is also impairment of the ability to change Autism Spectrum Disorder: Criteria
communication to match the context or the needs
Criterion A: persistent deficits in reciprocal social
of the listener
communication,
-there are difficulties following rules for
-deficits in nonverbal communicative
conversation and storytelling (taking turns in
behaviors used for social interaction
conversation, rephrasing, etc.)
-deficits in developing, managing, and
-there are also difficulties in understanding what is
understanding relationships
not explicitly stated and nonliteral or ambiguous
meanings of language (idioms, humor, metaphors)

-there are also other problems such as: Criterion B: restricted, repetitive patterns of
behavior, interests, or activities
-Verbosity- using more words than needed
-stereotyped or repetitive motor
-Prosody- use of stress, intonation, and
movements, use of objects, or speech
rhythm
-insistence of sameness, inflexible
-excessive switching of topics
adherence to routines, or ritualized
-dominating conversations patterns of verbal or nonverbal behavior

Social Pragmatic Communication Disorder: Etiology -highly restricted, fixated interests that are
and Treatment abnormal in intensity or focus

Etiology: Limited information as this disorder is new -hyper- or hypoactivity to sensory input or
in the DSM-5 unusual interest in sensory aspects of the
environment
Treatment:
Autism Spectrum Disorder: Specifiers
-individualized social skills training,
emphasizing on teaching important rules -with or without accompanying intellectual
necessary for carrying on conversations impairment
with others
-with or without accompanying language
Ex: modeling, role-playing, etc. impairment

Autism Spectrum Disorder: Development -associated with unknown medical or genetic

condition or environmental factor
Leo Kanner (1948)- he was the one who introduced
the syndrome of social communication deficits -associated with another neurodevelopmental,
combined with repetitive and stereotyped mental, or behavioral disorder
behaviors and as having an onset in early childhood
-with catatonia
DSM-III- this syndrome was then called Infantile
Autism Spectrum Disorder: Etiology and Treatment
Autism Pervasive Developmental Disorders
Etiology:
DSM-III-R and DSM-IV- in these versions, the
stipulation of Rett’s Disorder, childhood -genetic influences
disintegrative disorder, Asperger's disorder, and
pervasive developmental disorder happened -neurobiological influences: fewer neurons
in the larger amygdala, lower levels of
Rett’s Disorder- primarily foreseen in oxytocin in the blood
females, rather than males and is the more
complex form of ASD Treatments:

Childhood Disintegrative Disorder (Heller’s -Behavioral Treatment: teach language

Syndrome)- the symptoms of this form of through imitation/shaping and
ASD usually come out when the child is discrimination
older than three years old -tranquilizers and Selective Serotonin
Asperger’s Syndrome- it is a high- Reuptake Inhibitor
functioning ASD (no language delays, no -interpersonal social rhythm therapy
severe symptoms, but produce the same as
other ASD like repetitive word usage, lack of
prosocial behaviours, etc.)
 Attention-Deficit Hyperactivity Disorder (ADHD): Attention-Deficit Hyperactivity Disorder (ADHD):
Development Etiology and Treatment

DSM-II- it was called Hypokinetic Reaction of Etiology:

Childhood
-genetic factors
DSM-III- there already was an operational
-neurochemical influences: Dopamine,
diagnostic criteria and emphasize deficits in
GABA
attention, impulsivity, and hyperactivity
-environmental factors: mother’s smoking
-but it also included a category for those
during pregnancy
without hyperactivity
Treatments:
DSM-IV- its focus was of inattention and
hyperactivity/impulsivity -Behavioral Interventions that focus on
increasing the amount of time the child
-Onset: before 7 years old
remains seated, number of math papers
DSM-5- it was changed from onset of impairing completed, or appropriate play with peers
symptoms by age 7 to onset of symptoms by age 12
-Parental Educational Programs to teach
-adults could have 5 symptoms out of the families how to respond constructively to
12 criteria, compared to the 6 symptoms their child's behavior and how to structure
required for children the child's day to help prevent difficulties

Attention-Deficit Hyperactivity Disorder (ADHD): -Social Skills Training which includes

Criteria teaching them how to interact
appropriately with their peers
-the DSM-5 differentiates 2 categories of the
symptoms of ADHD, inattention, and hyperactivity -Cognitive Behavioral Therapy for adults to
and impulsivity reduce distractibility and improve
organizational skills
Inattention- may be manifested as
wandering off task, lacking persistence, -Stimulant Medications: Methylphenidate
having difficulty sustaining focus, and being (Ritalin), Amphetamine (Adderall)
disorganized
-intake of these medications have
-it is not caused by defiance or lack side effects such as addiction, sleep
of comprehension disturbances, and heart problems

Hyperactivity- refers to the excessive motor Attention-Deficit Hyperactivity Disorder (ADHD):

activity when it is not appropriate (ex: Reason for Stimulants
excessive fidgeting, tapping, or
-the most common problem in ADHD is on
talkativeness, running about)
executive function (impulsivity, inattention, etc.)
-hyperactivity in adults may
Low Arousal Theory- in ADHD, the brains are under
manifest as extreme restlessness or
aroused and needs aid from stimulants to increase
wearing others out to their activity
arousal
Impulsivity- refers to hasty actions that
-the dopamine, being highly involved in the
occur in the movement without
feelings of being granted rewards, has two
forethought and have high potential for
types that largely play in how stimulants
harm to the individual
work for people with ADHD
-it may reflect a desire for
Tonic Dopamine- dopamine
immediate rewards or an inability
available in the synaptic cleft
to delay gratification
(normally enough for people
-it may also manifest as social without ADHD)
intrusiveness
Phasic Dopamine- short bursts (or
release) of dopamine which is
produced when doing things that
stimulate an individual

-normally, when people have a high level of

Tonic Dopamine, there is a lesser need for
 Phasic Dopamine, having enough dopamine -Neurobiological Influences:
to enjoy normal feelings of stimulation
• Dyslexia- Broca’s Area (affecting
-however, in people with ADHD, there is articulation and word analysis
low Tonic Dopamine, which is why they
-area in the left parietotemporal
seek out stimulation (through their
lobe (affecting word analysis)
behavior) to satisfy the Phasic Dopamine
-area in the left occipitotemporal
-with this said, the stimulants given to people with
area (affecting the recognition of
ADHD come in play to inhibit the reuptake of
word form)
Dopamine, ensuring enough Tonic Dopamine in the
synaptic cleft • Dyscalculia- intraparietal sulcus
Dopamine Reuptake- if there is enough (important for the development of a
dopamine in the synaptic cleft, and the post sense of numbers; implicated in
synaptic neuron has received this mathematics disorder)
dopamine, the pre-synaptic neuron will • Impairments in Written Expression- no
reuptake the excess dopamine current evidence for specific deficits

-in people with ADHD, when there is -Environmental Influences: home learning
already low dopamine, while also habits of the family
experiencing dopamine reuptake, there will Treatment:
be lesser dopamine present, resulting in
lesser stimulation and under -Biological (Drug) Treatment is typically
restricted to those individuals who may also
Specific Learning Disorder: Criteria have comorbid ADHD
-it is characterized by persistent difficulties in -Specific Skills Instruction including
learning and using academic skills, with onset during instruction and vocabulary, finding the main
the developmental period idea, and finding facts in reading
-it is a clinical diagnosis based on a synthesis of the -Strategy Instruction which includes efforts
person's medical, developmental, educational, and to improve cognitive skills through decision
family history making and critical thinking
Ex: history of learning difficulty, impact on Motor Disorders
academic, occupational, or social
functioning, school reports, scores on Developmental Coordination Disorder-
standardized educational or characterized by deficits in the acquisition and
neuropsychological testing execution of coordinated motor skills

Specific Learning Disorder: Specifiers -manifested by clumsiness and slowness or

inaccuracy of performance of motor skills
Impairment with Reading: Dyslexia- this may that can cause interference with activities
include word reading accuracy, reading rate fluency, of daily living
and reading comprehension
Stereotypic Movement Disorder- it is diagnosed
Impairment with Written Expression- it may when an individual has repetitive, seemingly driven,
include spelling accuracy, grammar and punctuation and apparently purposeless motor behaviors (ex:
accuracy, and clarity or organization of written hand flapping, body rocking, headbanging, self-
expression biting, or hitting)
Impairment in Mathematics: Dyscalculia- this may -these movements interfere with social,
include number sense, memorization of arithmetic academic, or other activities
facts, accurate or fluent calculation, and accurate
math reasoning -if behaviors cause self-injury, it should be
specified as part of the diagnostic
Specific Learning Disorder: Etiology and Treatment description
Etiology: Tic Disorders- characterized by the presence of
-Genetic Factors: specifically in genes motor or vocal tics, which are sudden, rapid,
located on chromosomes 1, 2, 3, 6, 11, 12, recurrent, nonrhythmic, stereotype motor
15, and 18 movements or vocalizations
 -the duration, presumed etiology, and
clinical presentation define the specified tic
disorder being diagnosed:

-Tourette’s Disorder- it is the

persistent (chronic) motor or vocal
tic disorder

-it is diagnosed when the

individual has multiple
motor and vocal tic present
for at least 1 year and have
a waxing-waning symptom
course

-provisional tic disorder

-other specified tic disorder and

unspecified tic disorder

Motor Tics: eye blinking, facial twitches,

shoulder shrugging

Verbal Tics: grunting, coprolalia, tongue

clicking

Motor Disorders: Etiology and Treatment

Etiology - Developmental Coordination Disorder:

-Sensory Integrative dysfunction- it is when

the child is unable to integrate sensory or
perceptual-motor information in order to
produce skilled movements

-Automatization Hypothesis- it is when

children have difficulty making motor
behaviors automatic

-the lack of authorization becomes

particularly challenging when the
secondary task is introduced
because the child does not have the
attentional resources to attend to
more than one thing at a time

Etiology – Stereotypic Movement Disorder:

-the cause of stereotypic movement

disorder is unknown, but the movements
tend to increase if the person is stressed,
frustrated, or bored

Etiology – Tic Disorders:

-there are likely multiple vulnerability genes

that influence the form and severity of tics

Treatment:

-physical or occupational therapy to help

maintain or restore ability to control
movements

-self-monitoring, relaxation training, and

habit reversal