Neurodevelopmental conditions

Question 1

Definition of neurodevelopmental conditions

Answer 1

Lifelong conditions due to an impairment in physical, learning, language, or behaviour areas. Children diagnosed with NDC’s typically need services to address behavioural and developmental challenges

Question 2

Prevalence of NCD’s

Answer 2

17.8%

Question 3

Reasons for disparity between men and women diagnosis

Answer 3

diagnostic material being most appropriate for men

Question 4

Why diagnosis is higher for minority groups

Answer 4

Higher rates of punishment and exclusion for minority children and issues as well with Western criteria being used across the world being generalised to different cultures

Question 5

Neurodevelopmental conditions identified by ICD-11and DSM-5-TR10

Answer 5

Autism spectrum disorder, ADHD, Communication disorders, Learning disorders, motor disorders, Intellectual disabilities

Question 6

Broader definitions of neurodevelopmental conditions might include

Answer 6

Genetic syndromes, congenital brain injury, foetal alcohol spectrum disorder, schizophrenia and OCD

Question 7

Co-morbidity or ADHD and autism

Answer 7

Studies show 22% - 83% of children with ASD have symptoms that satisfy the DSM-IV criteria for ADHD, and 30% - 65% of children with ADHD have clinically significant symptoms pf ASD

Question 8

Where were ‘developmental disorders’ introduced for the first time?

Answer 8

DSM-III for the category that comprised autistic disorder, in 1980

Question 9

When were ‘Neurodevelopmental disorders’ first introduced

Answer 9

As an overarching disorder category in DSM-5 in 2013

Question 10

When did the concept of a ‘developmental disorder’ appear for the first time in psychiatry

Answer 10

1820 in a student textbook by Etienne, a student of Philippe Pinel and Jean-Étienne Esquirol, the pioneers of modern psychiatry based on mental symptoms instead of humoral concepts.

Question 11

Who wrote the classification of mental illnesses and what year was it published

Answer 11

By Pinel after translating William Cullen’s nosology into French in 1785 and publishing the classification in 1801

Question 12

Importance of ‘idiocy’

Answer 12

Was seen as a psychiatric disorder as well as mania, melancholia and dementia. The term ‘idiocy’ is a lack of developmental faculties’ Pinel added that ‘a developmental deficit is not strictly speaking a disease’ and ‘idiots should be classified among monsters’

Question 13

Weikart 1799

Answer 13

Described how sensory stimuli captures the patients attention and divert him from his thought “Each sense can disturb us from out object and draw out attention to something else, of all the senses this occurs most often with hearing and sight’

Question 14

Victor, the wild boy of Averyron (1788-1828)

Answer 14

Found aged 12, taken to physician Jean, Izard, who over 5 years tried to instruct him and repeatedly assessed his sensory, intellectual and affective progress over 5 years. He was likely autistic due to descriptions of him using other tools to satisfy his needs and difficulty initiating and maintaining social relationships, missed the critical period to ever speak fluently

Question 15

Importance of Leo Kanner 1943

Answer 15

Published a paper describing 11 patients who were focused on or obsessed with objects and had a “resistance to (unexpected) change.” He later named this condition “infantile autism.”

Question 16

Importance of Leo Kanner 1949

Answer 16

proclaimed his theory that autism is cause by “refrigerator mother” (parents who are cold and detached) but has been disproved

Question 17

Importance of 1944 Nazi-funded, Austrian paediatrician Asperger

Answer 17

Published a journal of case study of 4 children ages 6-11. Much of his research was rooted in “race hygiene” He noticed some of the children had similar personalities and regard this as a genetic link, foundational the the phased out labels

Question 18

Development of understanding in 1970’s

Answer 18

1970: Psychiatrist Lorna Wing identifies the “triad of impairment,” which includes three areas: social interaction, communication, and imagination.
1975: The Education for All Handicapped Children Act
1977: Susan Folstein, M.D., and professor Michael Rutter publish the first study of twins and autism. The study finds that genetics are an important factor for being autistic.

Question 19

Development of understanding 1980

Answer 19

DSM-III Including criteria for a diagnosis of infantile autism for the first time

Question 20

Development of understanding 1990’s

Answer 20

1990: Autism included as a disability in the Individuals with Disabilities Education Act (IDEA)
1996: Temple Grandin writes ‘Emergence-Labelled Autistic’ account of her life with autism
1998: Andrew Wakefield paper on how MMR vaccine triggers autism
1999: Autism Awareness Puzzle Ribbon

Question 21

How are NDC’s diagnosed

Answer 21

Developmental milestones, family history, multiple reporters, Standardised assessments: self-report, parent-report, teacher-report, observational assessments, structured interviews, cognitive tests, genetic testing, IQ and academic reports.

Question 22

Challenges to intelligence testing in NDC’S

Answer 22

While measuring intelligence in NDC’S the main challenge is more “accessing” intellectual abilities rather than assessing them, persistent in impairments in cognition, mainly issues with attention span, executive functioning and short term memory, also in children with ADHD

Question 23

4 Main challenges to intelligence testing in NDS’s

Answer 23

1. Most measures of assessment are influenced by Spearman’s concepts of “general intelligence” single broad mental capacity accounting for performance on a range of tests
2. Majority of tests are standardised on typically developing countries so a lack of sensitivity
3. Questions about implications of test results in predicting further developmental challenges
4. Tests are long and tedious, could be stressful and overwhelming

Question 24

Social model of NDC’S

Answer 24

disability is a social creation, disabled people are distinguished from non-disabled people. Disabled people are an oppressed group, civil rights are the way to solve the disability problem not charity. Research done by disabled people is most useful e.g., Autistic people may thrive in coding

Question 25

Medical Model of NDC’s

Answer 25

Looks at what is ‘wrong’ with the person not what the person needs. It creates low expectations and leads to people losing independence, choice and control in their lives

Question 26

Further info on sex and gender differences Bolte et al., 2023

Answer 26

Influences how developmental conditions are diagnosed. Sex differences in brain development depend on hormone exposure during foetal and postnatal life. Prenatal sex steroid hormonal exposure is associated with sex-typical play behaviours, gender identity, sexual orientation and some psychological traits inc. empathy. very few of these sex-differential traits have been robustly linked to measurable sex-differential brain features

Question 26

Sex and gender NDC’s Bolte et al., 2023

Answer 26

Sex and gender differences can be more or less pronounced among individuals with neurological, psychiatric and neurodevelopmental conditions. Sex related attributes: X and Y chromosomes, sexed physiology. Gender-related attributes: gender roles and stereotypes.

Question 27

Gender diversity and NDC’S Bolte et al 2023

Answer 27

Studies which used a single item of the Child Behaviour Checklist to approximate gender dysphoria showed 2.5-5.4% of children and adolescents diagnosed with autism, ADHD or intellectual disabilities may have gender minority differences. Estimated autism diagnosis prevalence in gender-minority is 11%

Question 28

Zoom in on autism key points

Answer 28

Affects 1 in 54 children
DSM-5 focuses on: social and communication differences and restricted interests and repetitive behaviours
4:1 ratio male to females, sex differences are inherent
Autistic people may have extreme giftedness, e.g., hyperfocus, honesty, ability to understand systems
Double empathy problem: autistic people have different perspectives not understood by neurotypicals

Question 29

Zoom in on ADHD

Answer 29

13% males, 4% females.
Types: Predominantly hyperactive/impulsive, predominantly inattentive presentation combined presentation.
Thought to be understood as a condition affecting executive functioning ‘control processing’ or the ability to filter and act on past, present and future information.
Links with genetics and brain functional differences
Common treatments: medication and behavioural interventions

Question 30

Zoom in on dyslexia

Answer 30

10% population (spectrum)
Specific learning difficulty affecting reading and writing skills
Difficulty in processing and remembering information they see and hear, which can affect learning and the acquisition of literacy skills
Phonological deficit: impairment in letter-sound conversion and speech processing

Question 31

Zoom in on dyscalculia

Answer 31

6% of people
Only NDC with same sex ration 1:1
Disruptions to brain areas that handle maths and number related skills and understanding
Dominant features of developmental dyscalculia are visuo-spatial working memory, visual spatial short-term memory and inhibitory function impairment, such processes are vital in calculations that need continuous selection and coordination of several processing steps and items in memory.

Question 32

Zoom in on down’s syndrome

Answer 32

Born with extra chromosome
By chance becuase of a change in the sperm or egg birth
The change is not because of the mothers action in pregnancy
1 in 700 births
3 types
Strengths in: peer relationships, sociability, related to skills associated with theory of mind