Neurodevelopmental

 and  
Neurocognitive  Disorders  
ATTENTION-­‐DEFICIT/  HYPERACTIVITY  DISORDER  

•   Persistent  pattern  of  inattention  and/or  hyperactivity  that  interferes  with  functioning  or  
development  
•   Subtypes  
•   Combined  presentation  -­‐  Six  or  more  symptoms  of  inattention  and  hyperactivity-­‐
impulsivity  
•   Predominantly  inattentive  presentation  -­‐  Six  or  more  symptoms  of  inattention  
but  less  than  six  of  hyperactivity-­‐impulsivity  
•   Predominantly  hyperactive/impulsive  presentation  -­‐  Six  or  more  symptoms  of  
hyperactivity-­‐  impulsivity  less  than  six  symptoms  of  inattention  
•   Age  limit  for  the  onset  of  symptoms  -­‐  12  years  
•   Occurs  in  more  than  one  setting  such  as  school  and  home  
Factors  Contributing  to  ADHD  
Biological  
•   Cerebral  cortex  is  smaller  in  volume  
•   Less  connectivity  between  frontal  areas  of  the  cortex  and  areas  of  the  brain  that  influence  
motor  behavior,  memory  and  attention  
•   Abnormal  functioning  of  catecholamine  neurotransmitters  
•   Genetic  factors  
•   Prenatal  birth  complications  
•   Diet  
Psychosocial  
•   Aggressive  and  hostile  behavior  from  parents  
•   Parents  with  a  problem  of  substance  abuse  
 
Treatments  for  ADHD  

•   Stimulant  drugs  increase  levels  of  dopamine  -­‐Ritalin,  dexedrine,  and  adderall  
•   Non  stimulant  drugs  affect  the  levels  of  norepinephrine  -­‐  Atomoxetine,  clonidine,  and  
guanfacinechumba  
•   Behavioral  therapies  -­‐  Focus  on  reinforcing  attentive,  goal-­‐directed,  and  prosocial  
behaviors  and  extinguishing  impulsive  and  hyperactive  behaviors  
•   Combination  of  stimulant  therapy  and  psychosocial  therapy  is  best  
 
AUTISM  SPECTRUM  DISORDER  
•   Deficits  in  social  interactions  and  communications    
•   Autism:  Interactions  with  parents  which  is  characterized  by  reciprocal  
adoration  
•   Echolalia:  Echoing  what  one  hears  rather  than  generating  ones  own  
words  
•   Deficits  in  restricted,  repetitive  patterns  of  behaviors,  interests,  and  activities  
•   Self-­‐stimulatory  behaviors  
•   Pervasive  developmental  disorders(PDDs)  
 
Diagnostic  Criteria  for  Autism  Spectrum  Disorder  
•   Presence  of  two  symptoms  of  social  impairment  and  one  symptom  each  of  
communication  problems  and  repetitive/stereotyped  behaviors  
 

Persistent  deficits  in  social  communication  and  social  interaction  across  multiple  contexts  with  
deficits  in:  

A   •   Social-­‐emotional  reciprocity  

•   Nonverbal  communicative  behaviors  

•   Developing,  maintaining,  and  understanding  relationships  

Restricted,  repetitive  patterns  of  behavior,  interests,  or  activities  as  manifested  by:  

•   Stereotyped  or  repetitive  motor  movements  

•   Insistence  on  sameness,  inflexible  adherence  to  routines,  or  ritualized  patterns  of  behavior  
B  
•   Highly  restricted,  fixated  interests  that  are  abnormal  in  intensity  or  focus  

•   Hyper-­‐  or  hyporeactivity  to  sensory  input  or  unusual  interest  in  sensory  aspects  of  
environment  

C   Symptoms  must  be  present  in  the  early  developmental  period  

Symptoms  cause  clinically  significant  impairment  in  social,  occupational,  or  other  important  areas  of  
D  
current  functioning  

 
INTELLECTUAL  DISABILITY  
Deficits  in  the  ability  to  function  in  three  broad  domains  of  daily  living  

•   Conceptual  domain  
•   Social  domain  
•   Practical  domain  
DSM-­‐5  Criteria  for  Intellectual  Disability  (Intellectual  Developmental  Disorder)  

A   Deficits  in  intellectual  functions  

Deficits  in  adaptive  functioning  that  result  in  failure  to  meet  developmental  and  
B  
sociocultural  standards  for  personal  independence  and  social  responsibility  

C   Onset  of  intellectual  and  adaptive  deficits  during  the  developmental  period  

 
Causes  of  Intellectual  Disability  

•   Genetic  contributions  
•   Brain  damage  
o   Fetal  alcohol  syndrome  
o   Infectious  diseases  
o   Severe  head  trauma  
•   Sociocultural  factors  
LEARNING,  COMMUNICATION,  AND  MOTOR  DISORDERS  
Deficits  or  abnormalities  in  specific  skills  or  behaviors  
Specific  learning  disorder:  Deficits  in  one  or  more  academic  skills  

•   Reading  
•   Written  expression  
•   Mathematics  
Communication  Disorders    

•   Language  disorder  
•   Speech  sound  disorder  
•   Childhood-­‐onset  fluency  disorder  or  stuttering  
•   Social  communication  disorder  
Causes  and  Treatment  of  Learning  and  Communication  Disorders  
 •   Genetic  factors  -­‐  Abnormalities  in  brain  structure  and  functioning  
o   Broca’s  area  
•   Environmental  factors    
o   Lead  poisoning  
o   Birth  defects  
o   Sensory  deprivation  
o   Low  socioeconomic  status  
Treatment  -­‐  Therapies  designed  to  build  missing  skills  
 
Motor  Disorders  

•   Tic  disorders:  Sudden,  rapid,  recurrent,  non  rhythmic  motor  movements  or  vocalizations  
o   Tourette’s  disorder  
o   Persistent  motor  or  vocal  tic  disorder  
o   Stereotypic  movement  disorder  
All  three  motor  disorders  begin  in  childhood  and  increase  in  adolescence  and  decline  in  
adulthood  
Treated  with  a  behavioral  therapy  called  habit  reversal  therapy  

•   Developmental  coordination  disorder  -­‐  Treated  with  physical  or  occupational  therapy  
Criteria  for  Motor  Disorders  

Tourette’s  disorder   Multiple  motor  and  at  least  one  vocal  tic  that  have  been  
present  at  some  time  during  the  illness,  but  not  necessarily  
concurrently  

Persistent  motor  or  vocal  tic   Motor  or  vocal  tics,  persistent  for  at  least  1  year,  and  with  
disorder   onset  before  age  18  

Stereotypic  movement   Repetitive,  seemingly  driven,  and  apparently  purposeless  

disorder   motor  behavior  causing  clinically  significant  distress  or  
impairment  

Developmental  coordination   Motor  performance  that  is  substantially  below  expected  

disorder   levels,  given  the  person’s  chronologic  age  and  previous  
opportunities  for  skill  acquisition  

 
Neurocognitive  Disorders  (NCD)  
Major  NCD  or  Dementia:  Degenerative  disorders    

•   Aphasia:  Deterioration  of  language  

•   Echolalia  -­‐  Repeating  what  is  heard  
•   Palilalia:  Repeating  sounds  or  words  over  and  over  
•   Apraxia:  Impairment  of  the  ability  to  execute  common  actions  like  waving  
•   Agnosia:  Failure  to  recognize  objects  or  people  
•   Lose  of  executive  functions  
o   Executive  functions:  Brain  functions  that  involve  the  ability  to  plan,  initiate,  
monitor,  and  stop  complex  behaviors  
 

•   Mild  NCD:  Modest  cognitive  decline  from  a  previous  level  of  performance,  but  do  not  
yet  result  in  significant  impairment  in  functioning  
•   Delirium  
Alzheimer’s  Disease  

•   Mild  memory  loss  that  quickly  progresses  to  profound  memory  loss  and  disorientation    
•   Neurofibrillary  tangles:  Made  of  protein  called  tau  that  impede  nutrients  and  other  
essential  supplies  from  moving  through  cells  causing  them  to  die  
•   Plaques:  Deposits  of  beta-­‐amyloid,  a  class  of  protein    
•   Beta-­‐amyloid:  Neurotoxic  and  accumulate  in  the  spaces  between  the  cells  of  the  
cerebral  cortex,  hippocampus,  and  amygdala  
•   Extensive  cell  death  in  the  cortex  that  shrinks  the  cortex  and  enlarges  the  ventricles  of  
the  brain  
•   Cells  lose  many  of  their  dendrites,  the  branches  that  link  one  cell  to  other  cells  
Vascular  Neurocognitive  Disorder  

•   Significant  decline  in  processing  speed,  ability  to  pay  attention,  and  executive  functions  
•   Severity  of  cognitive  symptoms  and  functional  decline  make  it  a  major  or  mild  NCD  
•   Cerebrovascular  disease:  Blood  supply  to  areas  of  the  brain  is  blocked,  causing  brain  
tissue  damage  
•   Stroke:  Sudden  damage  to  an  area  of  the  brain  due  to  the  blockage  of  blood  flow  or  to  
hemorrhaging  
Neurocognitive  Disorders  Associated  
with  Other  Medical  Condition  

•   Parkinson’s  disease  -­‐  Degenerative  brain  disorder  

 •   Neurocognitive  disorder  due  to  Lewy  body  disease  
•   HIV  -­‐  Can  cause  a  mild  or  major  NCD  
•   Huntington’s  disease  -­‐  Rare  genetic  disorder  that  afflicts  people  early  in  life  
•   Traumatic  brain  injury:  Penetrating  injuries  caused  by  impact  to  the  head  and/or  
concussive  forces  
•   Gender,  culture,  and  education  have  an  effect  on  neurocognitive  disorder  
Delirium  

•   Disorientation,  recent  memory  loss,  and  a  clouding  of  attention  

•   Causes  
•   Neurocognitive  disorder  -­‐  Strongest  predictor  
•   Intoxication  of  illicit  drugs  and  withdrawal  
•   Fluid  and  electrolyte  imbalances,  medication  side  effects,  and  toxic  substances  
•   Abnormalities  in  a  number  of  neurotransmitters