Neurodevelopmental Disorders Lecture - PDF

Neurodevelopmental disorders Dr Jimoh A.O Paediatrician/Assoc. Prof College of Medicine and Allied Health Sciences, Bingham University/ Bingham University Teaching Hospital, Jos. Plateau state. Expected learning...

Neurodevelopmental disorders Dr Jimoh A.O Paediatrician/Assoc. Prof College of Medicine and Allied Health Sciences, Bingham University/ Bingham University Teaching Hospital, Jos. Plateau state. Expected learning outcomes At the end of lecture, students should be able to: define and explain neurodevelopmental disorders, demonstrating an understanding of their diverse nature and the impact on paediatric patients. recognize and describe the causes, risk factors, clinical manifestations, and diagnostic criteria associated with prevalent neurodevelopmental disorders in children. highlight the significance of early identification, intervention, and a multidisciplinary approach in comprehensive care of paediatric patients with neurodevelopmental disorders Outline Introduction: definition and types Epidemiology: risk factors Common neurodevelopmental disorders Management conclusion Q/A Introduction Behavioural and cognitive disorders that arise during the developmental period, that involves significant difficulties in the acquisition and execution of specific intellectual, motor, language or social functions –ICD 11 Often manifest before the child starts school. Characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning. Introduction They include: Intellectual disability Communication disorders (language disorder, speech sound disorder, social communication disorder, childhood onset fluency disorder) Learning disorders Autism spectrum disorder Attention deficit/Hyperactivity disorder Specific learning disorder Motor disorders (developmental motor coordination disorder, stereotypic disorder and tic disorder) Epidemiology Prime determinants involve: Genetic/metabolic abnormalities and aberrant CNS abnormalities Prematurity, LBW, perinatal complications Chronic physical health conditions, Exposure to environmental hazardous substances Compromised family settings Low SEC Families of children with ADHD have been found to have higher rates of alcoholism, other drug abuse, depression, delinquency, learning disabilities than controls Intellectual disability (intellectual developmental disorder, formerly mental retardation) Characterized by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience, and in adaptive functioning for the individual’s age-, gender-, and sociocultural setting. 10-year-old having challenges in dressing independently, tying shoelaces, or practicing personal hygiene routines. Can also manifest as difficulty expressing needs, limited vocabulary, and challenges in understanding and responding appropriately to others Communication disorder Language disorder: persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production These difficulties arise from deficits either in understanding language (comprehension) or in producing language (expression). Children with a language disorder may struggle with the foundational aspects of language, such as vocabulary, grammar, sentence structure, and the ability to convey thoughts or ideas effectively in any communicative format. When the teacher gives a multi-step direction, the child might have difficulty processing the information and following through with the tasks or struggle with forming grammatically correct sentences Communication disorder Speech sound disorder: persistent difficulty with speech sound production. A child with a speech sound disorder may substitute the "r" sound with a "w" sound, saying "wabbit" instead of "rabbit.“ A child might distort the "s" sound, making it sound more like a "th" sound in words like "sun."  Childhood-onset fluency disorder (stuttering): disturbances of normal fluency and time patterning of speech, including sound and syllable repetitions, sound prolongation of consonants as well as vowels, broken words, audible or silent blocking, circumlocutions, words produced with an excess of physical tension. Repetitions: saying "b-b-b-ball," or repeat entire words, like saying "go- go-go home." Prolongations: saying "ssssstop" for "stop," with an extended hissing sound. Blocks: might experience a block while trying to say their name, resulting in a noticeable pause. Secondary behaviours: such as eye blinking, facial tension, or foot tapping Social (Pragmatic) Communication Disorder (SCD) Persistent difficulties in the social use of verbal and nonverbal communication. Individuals struggle in understanding and using the rules of social communication, such as turn-taking in conversation, understanding implicit social cues, and adapting communication based on the context. Unlike autism spectrum disorder, children with SCD do not exhibit repetitive behaviours or restricted interests. Autistic Spectrum Disorder ASD includes the former autistic disorder, Asperger’s syndrome, and PDD not otherwise specified (PDD-NOS) Diagnostic criteria for ASDs are Deficits in social communication and social interaction, and Restrictive repetitive behaviour, interests and activity Autistic disorder: A child with autistic disorder, may exhibit significant challenges in social interactions, communication, and display repetitive behaviours. For instance, he might have difficulty maintaining eye contact, struggle with using language to express needs, and engage in repetitive hand-flapping. Asperger's Syndrome: A child with Asperger's syndrome, may have strong language skills but struggle with social interactions. She might have difficulty understanding nonverbal cues, maintaining reciprocal conversations, forming friendships, and might also show intense interest in specific topics. Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS): A child diagnosed with PDD-NOS, may display some characteristics of autism but not fully meet the criteria for autistic disorder or Asperger's syndrome. For instance, he might have challenges in social communication or repetitive behaviours that don't fit neatly into the specific criteria for the other subtypes. Attention-deficit/hyperactivity disorder (ADHD) A disorder of childhood and adolescence characterized by extreme persistent patterns of inattention, impulsivity, and hyperactivity that significantly impact daily functioning. Worldwide prevalence in children ≤18 years is estimated at 5.3%; & 5.4-8.7% in Africa. Boys are more affected. Individuals with ADHD may exhibit these symptoms to varying degrees. The disorder is often chronic, with 1/3-1/2 of those affected retaining the condition into adulthood Inattention: 1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities. 2. Often has difficulty sustaining attention in tasks or play activities. 3. Often does not seem to listen when spoken to directly. 4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions). 5. Often has difficulty organizing tasks and activities. 6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework). 7. Often loses things necessary for tasks and activities (e.g., toys, school assignments, pencils, books, or tools). 8. Is often easily distracted by extraneous stimuli. 9. Is often forgetful in daily activities. Hyperactivity and Impulsivity: 1.Often fidgets with or taps hands or feet or squirms in seat. 2.Often leaves seat in situations when remaining seated is expected. 3.Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). 4.Often unable to play or engage in activities quietly. 5.Is often "on the go," acting as if "driven by a motor." 6.Often talks excessively. 7.Often blurts out an answer before a question has been completed. 8.Often has difficulty waiting his or her turn. 9.Often interrupts or intrudes on others' conversations or games. Diagnostic criteria for ADHD I. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (six or more symptoms for children up to age 16, or five or more for adolescents 17 and older and adults) II. Several inattentive or hyperactive-impulsive symptoms present prior to age 12 years. III. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities). IV. There must be clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. V. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal). Specific Learning Disorders Specific deficits in an individual’s learning and academic skills to perceive or process information efficiently and accurately. Dyslexia (Reading Disorder): difficulty accurately decoding and recognizing words. They struggle with recognizing sight words, understanding phonetic patterns, and reading fluently. Dyscalculia (Mathematics Disorder):challenge in grasping mathematical concepts. They might struggle with basic arithmetic, have difficulty understanding mathematical symbols, and encounter challenges with tasks involving numbers and calculations. Specific Learning Disorders contd. Dysgraphia: struggle to organize thoughts and ideas in writing. They might have difficulty with spelling, grammar, and expressing themselves coherently in written assignments. Auditory Processing Disorder: difficulty processing and interpreting auditory information. This could result in challenges understanding spoken instructions, following lectures, or discriminating between similar sounds. Executive Functioning Deficits: struggle with organization, planning, and time management. They might find it challenging to initiate and complete tasks, leading to difficulties in meeting deadlines and managing academic responsibilities. Management of NDD Similar to evaluating a child with neurological disorder, but special attention to specific areas. Developmental history: Reports from different settings Adaptive history: ability to perform activities of daily living. (Vineland Adaptive Behaviour Scale can be used) pattern of development-developmental regression, loss of milestone, areas more affected. Eg- motor delay-CP or neuromuscular disorders, language delays-hearing disorder Antenatal and birth history: exposures to hazarodous substances-drugs/medications perinatal complications and resuscitations, postnatal respiratory support, etc Management of NDD Social history: to elicit possible aetiological factors- psychological stressors like trauma, neglect leading to social dysregulation, heightened responses to perceived negative stimuli, executive dysfunction. These children have increased risk of ADHD, anxiety, to assess emotional and financial support that may be needed. To assess social functioning of child: interaction with friends, missed school days, being bullied, social isolation. Family history: can give clue to aetiology. E.g: ADHD and dyslexia have strong genetic aspects, Fragile X syndrome may have maternal relations with ADHD, anxiety or depression Management of NDD contd. Physical examination: observe child’s behaviour in unstructured environment. Provide toys and opportunities for child to play. For older children, engage them in conversation- ask about social life, interests Important things to note: ability of child to make eye contact, ability to respond to his/her name, ability to follow directions with/ without demonstrations, and the level of engagement with the examiner. Look for features of dysmorphism, neurocutaneous disorders and features of metabolic disorders Management of NDD contd. Investigations should be individualized Care requires multidisciplinary approach: neurologists, psychiatrists, developmental paediatricians, neuropsychologists, education specialists, behaviour specialists, occupational therapists, physical therapists, speech and language therapists and social workers. Management of NDD contd. Treatment of Inborn errors of metabolism - show the most favourable outcome if diagnosed at birth and treated early with enzyme replacement. LADDERS model for treatment of Autism-(Learning And Developmental Disabilities Evaluation and Rehabilitation Services), a multidisciplinary program has been used for diagnosis and management of Autism and other neurodevelopmental disorder patients. Pharmacotherapy- depending on underlying cause and symptoms, e.g.- neuroleptic medications are often used for behaviour management Gene therapy is promising and shows some degree of success Conclusion NDD is an umbrella term for a heterogeneous group of disorders as a result of abnormal neurological development It is multifactorial, with a wide range of symptoms depending on the part of the nervous system involved. Compared with healthy peers, children with NDD have significant challenges that can affect their quality of life.  Questions Clarifications Contributions Assignment